NHS stop smoking counsellor jailed for fraud

A London primary care trust has admitted that its systems were "seriously flawed" in allowing a smoking cessation counsellor, who was paid by the number of people he helped to quit, to falsify his number of successes 

Harry Singer, a former community adviser for the NHS’s smoking cessation service, was found guilty on 20 August of stealing £90 000 (113 000; $165 000) from the NHS. He was convicted of 18 specimen charges of false accounting and sentenced to 18 months in prison by Blackfriars Crown Court.

Mr Singer was employed by Kensington and Chelsea Primary Care Trust between April 2006 and January 2007. The trust paid him for every person he helped to stop smoking, up to a total of £45 for six contact sessions with each client.

The trust says it realised early on that there were anomalies in the numbers of people Mr Singer claimed to have helped to quit smoking. It commissioned an internal audit as soon as the anomalies came to light and referred the matter to the NHS’s counter-fraud service in November 2006.

Under the Department of Health funded smoking cessation scheme, individual primary care trusts arrange for counsellors to help smokers in their area to quit. There is "nothing unusual"’ about this system of repayment, said Pat Goodall, press spokeswoman for the NHS Alliance, which represents most primary care trusts in England.

The health department, which allocated £56m this year for smoking cessation services, has introduced a series of measures to reduce the risk of fraud.

A spokesman said, "Regional performance managers have recently been introduced to monitor services, and next year a national smoking cessation training centre will be established to ensure services are professional and effective."

The Kensington and Chelsea trust’s chief executive, Diana Middleditch, said, "We acknowledge that the process in place at the time was seriously flawed and that this was unacceptable."

Since then the system has been reviewed, she said, and she described the new data collection process as "robust." She added: "The actions of one individual should not detract from the excellent work of the majority of our community advisers, who have a genuine interest in working alongside the NHS to improve the health of our communities."

The trust said that it fully complied with the Department of Health’s Stop Smoking Service guidelines.

The NHS counter-fraud service established that Mr Singer had falsely claimed to have seen more than 2000 clients in eight months and to have achieved a success rate of 100%. It also emerged that he targeted people who he believed would have been unable to give evidence against him.

Department of Health statistics on its smoking cessation service, which take in the period after the smoking ban was introduced in England, show that around half (52%) of the 680 289 people who had set a quit date were not smoking four weeks later.

Source: BMJ 27 August 2008
Link: http://www.bmj.com/cgi/content/full/337/aug27_1/a1441

Champix is boosting smoking quit rates in England

Varenicline, launched in England in December 2006, is boosting the success of smokers kicking the habit, NHS figures suggest. 

One in seven people trying to quit are using Champix, according to the first figures published since the stop smoking drug was licensed in 2006. NHS Information Centre data showed 63% of people were successful last year at the four-week mark compared to half using nicotine replacement therapy.

Champix has come under scrutiny over reports it causes suicidal feelings.
The Medicines and Healthcare Products Regulatory Agency says it is "closely" monitoring the drug after almost 3,000 reports of adverse reactions. So far there have been more than 200 reports of suicidal thoughts in patients taking Champix as well as
more than 350 reports of depression, although these have mainly involved patients who had an underlying psychiatric illness.

The drug is unusual as it both stimulates and blocks specific nicotinic receptors in the brain. By stimulating the receptor it is thought to mimic the effects of nicotine to reduce cravings. At the same time, it partially blocks the receptor preventing nicotine from binding to it, resulting in a weaker response in people who give in to temptation and have a cigarette.

Trials suggested around 44% of smokers give up after taking the drug twice a day for 12 weeks, compared with 18% of those given a placebo and 30% of those taking another major anti-smoking drug, bupropion.

The latest figures show that in 2007-8 - the first year since the smoking ban was introduced - there was a 13% increase to 680,000 in the number of people setting a quit date. There was also a 10% rise to 350,800 in the number of people who had stuck to their attempts to quit after four weeks.

NHS Stop Smoking Services spent almost £61 million in the past year on helping people to quit - nearly £10 million higher than the year before. 

Source: BBC News, 22 August 2008 

BAT’s CSR activity in Malaysia

In the wake of the WHO’s Framework Convention on Tobacco Control, corporate social responsibility (CSR) is among the few remaining mechanisms for tobacco companies publicly to promote their interests. A case study of BAT’s CSR activities was undertaken in Malaysia to construct a typology of tobacco industry CSR. 

The investigation found that BAT’s CSR activities included assistance to tobacco growers, charitable donations, scholarships, involvement in anti-smuggling measures, ‘youth smoking prevention’ programmes and annual Social Reports. BATM has stated that its model is predominantly motivated by social and stakeholder obligations. Its CSR activities, however, have had the additional benefits of contributing to a favourable image, deflecting criticism and establishing a modus vivendi with regulators that assists BATM’s continued operations and profitability.

The authors of the study conclude that it is imperative that health advocates highlight the potential conflicts inherent in such arrangements and develop strategies to address the concerns raised.

Source: Barraclough S and Morrow M. A grim contradiction: the practice and consequences of corporate social responsibility by British American Tobacco in Malaysia. Soc Sci & Med 2008; doi:10.1016/jsocscimed.2008.01.001

NZ anti-littering group takes tobacco cash

A New Zealand anti-litter group is being bankrolled by a $300,000 donation from British American Tobacco. Not-for-profit environmental organisation Keep New Zealand Beautiful has signed a three-year deal with the cigarette company and has received smaller payments since 2005. 

A company official also sits on Keep New Zealand Beautiful's board as an industry representative, though the board chairman insists there are no strings attached.

In its latest social report, the multinational company says the money will help minimise the impact of pollution by cigarette butts, in line with its environmentally-focused business activities.

But anti-smoking groups have labelled the deal an attempt to legitimise the actions of a corporate monster whose products help kill 5000 New Zealanders each year.

"People who market cigarettes are not good community citizens," Cancer Society chief executive Dalton Kelly said. "But here they are trying to be a good citizen through the back door."

The society had written to Keep New Zealand Beautiful asking it to reconsider accepting big tobacco money.

The Life Education Trust, which offers health and education programmes to schools, ended a $150,000-a-year deal with British American Tobacco in 2006 after public pressure and criticism from then- education minister Trevor Mallard.

"We felt . . . that it was in the best interests not to take it anymore," trust chief executive Peter Cox said.

Keep New Zealand Beautiful's former chief executive Barry Lucinsky, who brokered the $300,000 deal, said the company was acting responsibly.

Mr Lucinsky said he sought clearance from then-environment minister Marian Hobbs and her officials.

Keep New Zealand Beautiful's chairman, former children's commissioner Roger McClay, said his group depended on money from unpopular sources.

British American Tobacco spokeswoman Susan Jones said the company gave about $500,000 to community groups each year.

"We're not doing this for publicity. We feel that it's a sensible thing for us to be supporting."

Source: Stuff, August 25, 2008
 

California tobacco control programme saved $86 billion

California's large-scale tobacco control campaign has saved $86 billion in health care costs in its first 15 years, researchers from the University of California have reported. 

The $86 billion reduction in health costs, based on 2004 dollars, represents about a 50-fold return on the $1.8 billion California spent on the program, they said.

"The benefits of the program accrued very quickly and are very large," Stanton Glantz, director of the University of California San Francisco Center for Tobacco Control Research and Education, said in a statement.

Unlike many programs which center on teens, the California program focuses its tobacco-control efforts on adults through an aggressive media campaign and changes in public policy, such as promoting smoke-free environments.

"When adults stop smoking, you see immediate benefits in heart disease, with impacts on cancer and lung diseases starting to appear a year or two later," said Glantz, whose findings appear in the Public Library of Science journal PLoS Medicine.

According to the study, the program prevented the sale of 3.6 billion packs of cigarettes -- worth $9.2 billion to the tobacco industry -- between 1989 and 2004.

The report may help persuade states to step up funding for such large-scale efforts to counteract the tobacco industry's $13 billion annual spending on smoking-related advertising and promotions.

Tobacco accounts for one in 10 adult deaths worldwide and is the leading preventable cause of death in the world, according to the World Health Organization. In the United States, smoking kills more than 400,000 people prematurely each year.

To study the effects of California's program, Glantz and colleagues used statistical models that looked at the relationships between per capita spending on cigarettes and health costs between 1980 and 2004.

They compared these with information gathered from 38 states that had no comprehensive tobacco control efforts and that had only increased cigarette taxes by 50 cents per pack within the study period.

The researchers saw a steady rise in cost savings from the start of the program in 1996 until the study ended in 2004, despite major cuts in the program's funding.

If the state had maintained original funding levels at about $80 million per year, total health cost savings would have exceeded $150 billion over the 15-year period, they said.

Glantz said the study shows tobacco control programs not only reduce smoking and prevent disease, but also quickly and significantly reduce health care costs.

Source: The New York Times, August 27, 2008   Lightwood J, Dinno A and Glantz S. Effect of the California Tobacco Control Program on Personal Health Care Expenditures. PLoS Med 5(8): e178 doi:10.1371/journal.pmed.0050178
Link: http://medicine.plosjournals.org/
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050178&ct=1
 

New media and the potential for tobacco (& health)promotion

Many nations have banned or curtailed advertising of potentially harmful products to protect public health, particularly in the area of chronic disease control. The growth in Internet-based marketing techniques is subverting these advertising regulations. Explosive rises in use of social networking and user-generated content websites is further fuelling product promotion through electronic media. 

In contrast, there is a very limited body of public health research on these "new media" advertising methods. A study published in the journal Tobacco Control provides an overview of these advertising methods and details examples relevant to chronic disease control. The authors conclude that there is a vast untapped potential for health practitioners and researchers to exploit these same media for health promotion.

Source: Freeman B, Chapman S. Gone viral? Heard the buzz? A guide for public health practitioners and researchers on how Web 2.0 can subvert advertising restrictions and spread health information. Journal of Epidemiology and Community Health 2008;62:778-782
 

Cigarettes in movies seen to cause teen smoking

Tobacco promotions and depictions of smoking in movies cause teenagers to start smoking, according to a major review of tobacco in the media by the US National Cancer Institute. The report found the tobacco industry spent more than $13 billion on smoking-related advertising and promotion in 2005. These efforts boosted overall tobacco use, contradicting industry claims that they are intended to build brand loyalty. 

"This is the first government report to present definitive conclusions that, number one, tobacco advertising and promotion are causally related to increased tobacco use in the population," said Dr. Ronald Davis, senior scientific editor of the report and past president of the American Medical Association.

"And, number two, (it shows) that depictions of smoking in movies is causally related to youth smoking initiation," Davis told a news conference.

The report, which examined more than 1,000 scientific studies on how the media influences tobacco use, comes at a time when efforts to keep young Americans from picking up cigarettes have stalled.

Tobacco use remains the single-largest cause of preventable death in the United States, accounting for more than 400,000 premature deaths each year.

Smoking is down from 42 percent of U.S. adults in 1965 to 21 percent in 2006. Still, more than 4,000 young people smoke their first cigarette each day, and another 1,000 become regular smokers. Nearly 90 percent of adult smokers began smoking while in their teens.

The report found that even brief exposure to advertising influences adolescent attitudes. Three-quarters or more of hit movies depict cigarette smoking, and specific brands can be identified in about one third.

Last month, six major movie studios -- Viacom Inc's Paramount Pictures, Sony Pictures, News Corp's Twentieth Century Fox, General Electric Co's Universal Pictures, Walt Disney Co and Time Warner Inc's Warner Bros -- said they would place anti-smoking public service announcements on DVDs of all movies with youth ratings that depict smoking.

The campaign, brokered by the Entertainment Industry Foundation, a non-profit industry group, does not include youth-rated movies (PG-13 or below) in theaters.

But the report found mass media campaigns aimed at reducing smoking do work, especially when combined with other tobacco-control strategies. Health experts at the news conference called for much more money for such media efforts.

They said 1969 legislation banning smoking advertising in broadcast media and other curbs have led tobacco companies to shift marketing tactics. Price discount promotions, which accounted for 75 percent of total tobacco marketing expenditures in 2005, have proved to be highly effective.

"Any promotional technique that lowers the price the kids see when they go to buy a pack of cigarettes is extremely important," Davis said. "Partial advertising bans don't work."

Dr. Janet Collins, who directs chronic disease prevention and health promotion at the U.S. Centers for Disease Control and Prevention, endorsed the report's findings.

"The report speaks clearly to what amounts to an assault on the nation's health," Collins said.

[Ed Note: Whilst focusing largely on experience in the US, the NCI report has relevance to other countries and reviews not only the impact of tobacco advertising but also the effectiveness of the media in delivering anti-smoking health campaigns.]

Source: Reuters, 22 August 2008   Monograph 19: The Role of the Media in Promoting and Reducing Tobacco Use
Link: http://www.cancercontrol.cancer.gov/tcrb/monographs/19/index.html