Bribing Pregnant Women to Stop Smoking
In a story attributed to George Bernard Shaw, he asked a lady at dinner one night if she would go to bed with him for £1,000. The lady agreed. Then Shaw asked her if she would go to bed with him for £1. The lady became indignant and asked, ‘What do you think I am?’ Shaw replied, ‘We have already established what you are. Now we only need to settle the price.’
In similar vein, as described in a paper coyly titled ‘Financial incentives for smoking abstinence in pregnancy’ published in The British Medical Journal (22 October 2022), a group of researchers offered 471 pregnant smokers up to £400 in shopping vouchers not to smoke. Only 27 per cent of this number accepted and for eight weeks in late pregnancy ceased poisoning themselves with tobacco fumes. In addition to this disappointing result, we are told that ‘most people who quit…relapsed soon after their baby was born.’
But I wonder by how much the bribe – for such it was – would have had to be increased to entice all these good ladies to stop smoking (assuming no cheating). Would £1,000 have been enough? £5,000? £10,000? Would any amount of money have been sufficient for all of them to resist the urge to smoke?
This paper – a splendid collaborative effort of nineteen people affiliated with eleven British universities – is, alas, yet another demonstration of the current bankrupt state of the orthodox approach to the smoking problem. It shows no hint of understanding what is needed for smokers, pregnant or otherwise, to return to the happy state (assuming other things are equal) of being non-smokers.
The title of the paper implies that smokers need stronger incentives to quit, otherwise they won’t. But the reason that smokers fail to quit is not for lack of incentives. It’s well known that smoking can damage your health and may even kill you, yet smokers keep on lighting up repeatedly every day for years on end.
The study started in 2018 when cigarettes cost around £10 per pack in the UK. Therefore, if a woman smoked ten cancer sticks a day, in eight weeks she would have wasted £280. Pro rata for smoking fifteen or twenty per day, the figures are £487.5 and £560, respectively. These women could have bribed themselves not to smoke because of the money they would have saved. So why didn’t they?
Our intrepid investigators at least appeared to recognise the fact that, although the urge to smoke may be hard to resist, smoking is a voluntary activity. Therefore, it’s possible in theory that bribery might work, but as the result of this trial shows, such an approach is disappointing. This leads to the question of whether any ‘intervention’ including trying to bribe smokers to quit is amenable to scientific assessment in the first place. It’s not as if one is investigating a treatment of a physical illness over which the sufferer has no control; with smoking the decision to light another cigarette is entirely in the hands of the smoker.
The fundamental reason why the results were so poor is that what we are dealing with is drug addiction, the drug, of course, being nicotine. Would bribery work in, say, alcoholism or heroin addiction? I think not. Is there, then, any intervention (other than voluntary abstention) that is highly effective in substance addictions? It seems not.
Therefore, rather than pursuing an endless search for the elusive cure for smoking, what is needed is to tackle the problem at its source. Tobacco products serve no useful purpose in normal human life: they must be phased out within a short time-span and banned.
Text © Gabriel Symonds
Picture credit: John McArthur on Unsplash