By the way...Maybe we SHOULD bribe smokers to quit

PAYING people to quit smoking or lose weight is a controversial idea; after all, why should we pay for people to look after themselves when many of us do it for free? But then if it worked, our irritation would be a small price to pay for the sizeable gains to the NHS budget as well as the health of the ex-smoker. A few weeks ago, a significant research study published the results of a trial of four financial incentive programmes — or bribes — aimed at getting smokers to quit. Two of the research schemes had paid $800 (about £500) to those who stopped smoking, and two demanded a deposit of $150 (about £100) from the smoker at the start as a sign of commitment, and then paid out $800 when the smoker was confirmed as having stopped. The smokers underwent screening tests — a sample to check for cotinine, a residue that is detectable in those who have been using tobacco — after two weeks, one month, and six months to confirm compliance and collect the prize. We as physicians have failed to change the behaviour of our patients — not only have we had little to no success getting people to stop smoking, but we haven’t convinced people to eat less saturated fat in order to lower cholesterol levels and we’re hopeless at enabling our patients to lose weight. Given all this, this is a useful piece of research. So what did it find? The proportion of those who gave up smoking in both schemes ranged from 9.4 per cent to 16 per cent, hardly earth-shattering but higher than the usual quit rate of 6 per cent for other approaches. So financial incentives are partially effective, although I note that, at 12 months, 50 per cent of the successful quitters were smoking again. What, of course, is not mentioned is that governments actually want you to smoke: forensic accounting has established long ago that the State benefits from the extra tax paid by smokers on their cigarettes. At the same time, smokers’ shorter lives means they’re not around to be a burden on the public purse in old age. In other words, despite the costs of the medical care of their smoking-related illnesses, smokers actually make a net profit for the Exchequer. Governments take no interest in ethics. And while medical ethics may not be at the forefront of the minds of most doctors as we make day-to-day decisions, we do all want the best for our patients. And most doctors are desperate for techniques to help their patients stop smoking. Bribery may be one. I leave you with one thought: each cigarette shortens the life of the smoker by 11 minutes. Who wants that?