Media hype can seriously improve your health

So Zyban is killing patients? Funny that, I thought it was smoking that killed people - about 120,000 a year in this country on current form. None the less, no one wants to die of ignorance. We know smoking kills. We don't know - or didn't - that Zyban does.

So Zyban is killing patients? Funny that, I thought it was smoking that killed people - about 120,000 a year in this country on current form. None the less, no one wants to die of ignorance. We know smoking kills. We don't know - or didn't - that Zyban does.

The figures revealed this week show 18 deaths linked with the new anti-smoking drug which has been taken by about 270,000 people since it was licensed in Britain eight months ago.

Zyban comes with an excellent pedigree, having doubled smoking cessation rates in the US, compared with nicotine patches and gum, and raised no concerns about safety despite having been taken by five million people worldwide.

The best thing about Zyban, though, may turn out not to be the drug itself but the hype surrounding it - of which more later. You will understand why, as a reporter, this is a story that gladdens my heart. Media hype, as we shall see, really can save lives.

So what do these 18 deaths amount to? They are 18 deaths whose link with Zyban needs investigating. If they turn out to have been caused by Zyban then that would be a very serious matter indeed. So far all we know is that there is an association.

That is what the yellow card reporting scheme is for. Yellow cards must be filled in by GPs - it is a legal requirement - whenever they spot any sign or symptom in a patient taking a new drug. It does not matter how unlikely the connection appears to be - a sore toe in someone taking eye drops - every reaction is recorded in order that any statistical trend may be revealed.

What we are dealing with in the case of Zyban, then, as with any other drug subject to yellow card reporting, is an association, not a cause.

Among the 18 who died, four had heart attacks, two committed suicide, four succumbed to brain disorders and one suffered an asthma attack. It would be an unusual drug which could cause death in such variety.

When people say to me they read somewhere that a treatment has some nasty consequence - MMR vaccine causing autism, for example - I invite them to fund my HADDIT research project - Hotels are Dangerous Dodgy Infarct Traps.

The research involves me staying in the best hotels I can get someone else to pay for in order to test my hypothesis which is based on a simple psycho-biological fact. People staying in hotels are invariably tempted to do all sorts of things they would never do elsewhere - including indulging in the cooked breakfast that is always on offer. That means they load up with eggs, bacon, sausages and fried bread, are hit with a ton of cholesterol and - sooner rather than later - drop dead from a heart attack.

Now, even if I persuade some gullible philanthropist to part with his or her cash and keep me in the plushest establishments in the land to test my theory, it will not, alas, prove that hotels cause heart attacks. At most it will prove that by an unhappy coincidence - an accident of menu planning - hotels are the places which provide the conditions for a heart attack.

This is relevant to Zyban because just as there is uncertainty about the significance of the 18 deaths with which it has been linked, there is also uncertainty about its efficacy. Here too we should be wary of interpreting an association - the arrival of the drug with the rise in the number of people quitting smoking - as a cause.

Researchers from Hull University have nailed this one in the current Health Service Journal. Hull and East Yorkshire was one of the first Government-designated Health Action Zones given extra cash to set up stop-smoking clinics which they did in November 1999.

For the first few months things rumbled along quietly until the launch of Zyban in June 2000, accompanied by widespread media reporting of the new wonder cure for smoking. Calls to the service leapt and the numbers trying to quit jumped four-fold from under 200 in the April-June quarter to 800 in the July-September quarter. Interestingly, however, the proportion who succeeded (still not smoking at four weeks) was no higher after the launch of Zyban than before - about 50 per cent in each case. In Hull, in other words, the drug appears to have had no effect.

The hype surrounding its launch certainly did have an effect by quadrupling the number who tried to give up. The promise held out by the drug, even though it was not realised, encouraged more people to make the attempt to give up and, despite the high attrition rate, that translated into more people who succeeded.

Media hype, as I said, can save lives.