Jan 31 2015

A £400 bribe to stop smoking during pregnancy. Whatever next?

Earlier on this week I was involved in a number of good-natured twitter exchanges about the efficacy of financial incentives for smoking cessation in pregnancy (*), or as the Daily Mail rather more sensationally put it, the payment of £400 bribes to help pregnant women stop smoking.

Most of these exchanges centred on the argument that if anyone needed any extra incentive to give up smoking while pregnant, then the woman concerned wasn’t fit to have a child in the first place.

Well quite. But the evidence suggests that pregnancy alone doesn’t appear to be enough motivation to quit in and of itself for a significant minority, with 12% of women in the UK smoking during pregnancy according to a different study undertaken in 2010(+). Leaving aside the health of the mother for the moment, the authors of this study reiterate prior research demonstrating that in the UK:

  • 5,000 miscarriages every year are due to smoking during pregnancy
  • 180 stillbirths are due to smoking due to smoking during pregnancy
  • 113 infant deaths are due to smoking during pregnancy
  • 1/3rd of excess stillbirths in deprived areas are due to smoking during pregnancy

That all adds up to an incredibly depressing amount of additional human suffering and misery, due to a dangerous habit taken up because of personal stupidity / peer pressure / the billions spent by cigarette manufacturers to persuade us to smoke (delete according to your own political biases).

So because the unborn child has no say over the choices their mother makes, I think that it’s a good idea – no – it’s an excellent idea – for research to be carried out into how to further reduce smoking during pregnancy, above and beyond what decades of public health education, taxation and the gradual de-normalisation of smoking has so far managed to achieve.

And that’s precisely what the lurid ‘bribe’ headlines miss – this was a well run, randomised controlled trial (the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment) across a representative sample of 612 volunteers – with 306 of those receiving the incentive. It wasn’t a cash incentive (it was provided as shopping vouchers, presumably by a retailer eager to market their wares with the aim of securing longer-term business) and neither was it given to the participants up-front (so, whatever the payment is, it is definitely not a bribe). The vouchers were earned through the participants demonstrating (though a number of scientific, objective tests) that they had actually managed to stop smoking.

The result of this trial was that 69 (22.5%) of the smokers offered incentives managed to stop smoking, whereas only 26 (8.6%) of those not offered the incentive managed to do so. My own (admittedly crude) extrapolation of that data onto the miscarriage, stillbirth and infant death statistics suggests to me that an additional 13.9% of these could therefore be prevented if it was turned into a national programme – allowing a further 735 unique, precious human beings to experience what it is to live.

And I haven’t even taken account of the positive impact on the mother here too. Nor on the NHS and the taxpayer in general. The study notes that the additional costs of treatment (for mother and child) that the NHS has to fund every year due to smoking during pregnancy is between £20m – £88m, depending on how you count it.

Now, of course there are ethical considerations. The study points these out. We should never be in the business of rewarding bad behaviour that is solely the choice of the individual concerned. However, the behaviour being rewarded is demonstrably a good one – giving up smoking. And in addition to that, I genuinely don’t believe that the ‘choice’ to start smoking is solely down to our own personal agency. Societal conditions (remember peer pressure and the £billions spent by tobacco companies on ensuring cigarettes are available) also play a part in the decision to start.

But if you’re still wavering, consider these facts:

  • No harms were reported, and the incentives offered were acceptable to the participants and healthcare professionals.
  • The longer term cost of the programme per life year gained was £482. The NHS (in general) operates on the basis that a treatment costing £20,000 per life year gained is a cost-effective intervention.
  • Existing interventions aimed at encouraging pregnant women to stop smoking during pregnancy are not highly effective.

So if we believe in basing public policy on evidence based research (and I do), then for me the conclusions of this study and its call for further research to be undertaken must be acted upon, regardless of what the yellow press believes.

 

(*) The report mentioned is published by the British Medical Journal and is free to read. It’s just twelve pages long and well-written.

(+) Health and Social Care Information Centre, Infant feeding survey 2010. Encouragingly, the numbers of UK women smoking during pregnancy have dropped from 17% in 2005 to 12% in 2010, without “the bribe”.

 

Jan 25 2015

Star Trek game – a Python port from Tiny BASIC

A while back I mentioned that I was in the process of porting an old Computing Today Star Trek game from Tiny BASIC to Python on my Raspberry Pi. This was before I’d taken the edX Python course and learned to code properly in the language.

Frankly, although my code works, it is truly horrible stuff. And I didn’t even have the excuse of being limited to a couple of kilobytes of memory that the original was designed to fit into. I’ve just never had the time since to go back and do it better.

However, a couple of people have asked for the code, so here it is, in all of its – ahem – glory.

The original Tiny BASIC version (pdf format) – you’ll need this to make sense of how to play the game.

My Python port (pdf format) – you’ll need to copy and paste this into a .py file to make it work with a Python 2.7 interpreter (obviously).

Have fun!

 

Jan 22 2015

The US government “gets” lifelong learning – so why don’t our politicians?

After I wrote about the fall in OU student numbers for a fourth consecutive year last Saturday, I decided to see if I could get a reaction from the five largest (by membership) UK-wide political parties by asking them about their policies for promoting lifelong learning.

My first attempt was on Sunday. I sent this tweet to @LibDems, @Conservatives, @UKLabour, and @TheGreenParty. I even held my nose and sent it to @UKIP – after all, who knows what May will bring.

 

 

I didn’t get a response (or even a click on the link to my article) from this. But it was Sunday. Maybe those who run political party twitter accounts take the day off. I can understand that. So undeterred, I tried a similar tweet on Monday: 

 


… and it got exactly the same result. Nothing. Yesterday, I tried to introduce an element of competition:

 


… and no-one has responded to that tweet.

Which is a shame. Because the lack of investment in lifelong learning, at all levels of study, directly impacts our ability to compete as a nation. It means we continue to fail to make the best possible use of our greatest resource – the people who live and work here.

By contrast, the Obama administration seems to genuinely “get” lifelong learning. Their latest proposal is to provide free access to two years of higher education through their network of community colleges for eligible students. This is in addition to what seems to be a well thought out and employer supported workforce training programme.

I’m going to keep on pestering our politicians about this. I’m particularly disappointed, but not wholly surprised,  by the lack of any kind of response so far from the political party I belong to.

 

Jan 20 2015

Memory stuff

Going through my parent’s house over the last few months has taken ages. They’d lived there since 1963 until my father died at the end of 2007. Mum had subsequently lived there alone until she needed to go into a nursing home in 2013. Now that they’re both gone, the task of sorting through the house and the memories that are attached to it has been left to me and my brother.

Before we started, we’d made a plan. We both like plans – we’re good at those. First pass – sort through the house and throw out the obvious rubbish, such as tins of food that were long past their use by date and the like. Second pass – work out what we wanted to keep for ourselves, give away to relatives and friends or sell. Final pass – everything that didn’t find a new home would be thrown away. We estimated that it was going to take us until last Christmas. As I write, we’re still not quite at the end of the first pass.

I had no idea how much stuff was in the house and quite how much I’d be affected by sorting through it. It’s not the items of furniture, ornaments or even the mountains of clothes that we’ve considered that has been the biggest surprise. It isn’t even dad’s photographs and cine film or mum’s paintings (I’d prepared myself for dealing with those). Little packets of old birthday, Christmas and get well cards, letters, school reports (theirs, not mine!) have been harder to cope with.

But hardest of all, at least for me, has been finding piles of old ticket stubs and travel receipts for holidays and other events long past. Some of them probably hadn’t been looked at in 50 years before I stumbled across them.

I suppose that they were there at all shouldn’t have surprised me. After all, I do the same thing. I know that hidden away in my sock drawer, the cupboard above the bed and the attic there are little piles of my old tickets and receipts waiting to be found once I’m no longer around to care. Sometimes, when I’m looking for something else, I’ll come across a pile of tickets from (say) a holiday I took ten or twenty years ago and I’ll spend a few minutes reflecting happily on the event. And crying of course, naturally.

This weekend I found the folders of ticket stubs, hotel brochures and letters to the Swiss National Bank about Italian petrol coupons from the holiday to Italy that my father and his best friend took in 1961. It was wonderful to look at them alongside the photographs he took (here’s a few of the first photographs he took on that holiday). Doing that also made me cry, of course.

I also found a collection of receipts and notes from a holiday we took together as a family in Scotland when I was 15. I haven’t looked at these yet, because I’m finding it too difficult. I obviously wasn’t even alive at the time of the Italy trip – but I remember the Scottish holiday vividly.

One day soon, with the photographs that we both took on that holiday, I’ll sit down with a glass of whisky and look at all those receipts and notes. I think I know what the result will be.

 

Jan 17 2015

OU student numbers decline by a further 10.3% in 2013/14

The latest statistical first release from the Higher Education Statistics Agency (HESA) was made on 15th January. New part-time enrolments (often, but not always, mature students) have fallen by 8% across the whole sector, adding to a 15% decline from the previous year. New full-time enrolments have increased by 1%.

Table 10 of the release provides a detailed analysis of OU student numbers (who are all considered to be part-time, regardless of the intensity of study undertaken). This has allowed me to update the chart I created last year.

OU Student Numbers 2008-09 to 2013-14The chart shows a year on year decline of 10.3% in overall student numbers, with an 11.7% decline in undergraduates. However, the number of postgraduate students has increased by 8.8%, albeit still below the number being taught by the OU in 2011/12.

The OU has, of course, taken steps to ensure that it is able to survive in the current climate, not least by the nearly four-fold increase in module fees charged to students domiciled in England who are not on transitional fee arrangements. However, you can’t help but worry when you see figures like these for (a) the health of the institution and (b) the impact that changes in HE funding arrangements must be having on those who want or need to re-skill themselves later on in life. Lifelong learning continues to be undervalued by this government in much the same way that the previous Labour government undervalued it when they removed ELQ (equivalent or lower qualification) funding in 2008.

Perhaps there’s a glimmer of hope on the horizon. At the end of last year, UCAS released figures demonstrating that the number of students placed at UK HE institutions in 2014 reached an all-time high (these acceptances will of course be reflected in next year’s release from HESA). However, it would be misleading to extrapolate this data to the Open University as UCAS do not administer their admissions.

I wish Peter Horrocks, the new vice-chancellor of the OU, every success in the role which he is due to start on the 5th May, a mere two days before the general election. Let’s hope that whatever colour(s) the next government consists of they will be rather more sympathetic to the needs of lifelong learners than the last two have been.

 

Jan 08 2015

On leadership and followership

 

 

I read somewhere that the boatman who rowed King William back across the river after the Battle of the Boyne is supposed to have asked the King which side won … To which the King replied: “What’s it to you? You’ll still be a boatman.”

J.G. Farrell, The Singapore Grip

 

Jan 05 2015

3 tickets I’d like for things that never happened

I’ve been amused by the news today that Accrington Stanley are selling 250 tickets for a third round FA Cup tie with Manchester United that never was, as they’d been already knocked out in the second round by Yeovil Town. It led me to think about the tickets I’d like for events that never happened. In reverse chronological order:

1. The State Opening of Parliament for the Liberal-SDP Alliance government in 1983.

 

Ahh, the heady days of the Alliance and David Steel’s 1981 Liberal Assembly speech – go back to your constituencies and prepare for government. There’s a passage in it about race relations that sadly still seems relevant now when applied to the debate about immigration:

 

You cannot dehumanise a whole section of society by taking away their rights, dividing their families, subjecting them to police and bureaucratic interference and harassment, and then pretend … that this is all done in the interests of good race relations.

2. The FA Cup Final between Derby County and Southampton in 1976.

Derby (the favourites – sigh) were beaten 2-0 by Manchester United in their semi-final, who then went on to lose to Southampton 1-0 in the final. There’s no question in my mind that the Derby side of 1976 would’ve easily beaten Southampton in the final. I still can’t watch the semi-final “highlights” all the way through …

3. The launch of Apollo 18 in 1973

NASA cancelled the scheduled Apollo 18 mission to the Copernicus crater along with the planned Apollo 19 mission (Apollo 20 had already been cancelled to make way for Skylab) during 1971. The cancellation saved around $42m (small in comparison to the whole cost of the programme), but came about due to the political pressure the Nixon Whitehouse was under in the early 1970s to divert spending towards more ‘useful’ endeavours.

 

These are my top three events that never happened that I’d like tickets for – what would yours be?

 

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