BUILDING ON FAILURE
The ASSIST Debacle of Deception

Not only did the NCI's (National Cancer Institute's) Community Intervention Trial for Smoking Cessation (COMMIT), implemented in 1989 turn out to be a dismal failure, but even before any meaningful results could have been assessed, by December, 1989, NCI had developed a full scale planning document for the much larger and more expensive American Stop Smoking Intervention Study (ASSIST).

Department of Health and Human Services (DHHS) public documents state that NCI was building on and expanding the strategies of COMMIT and "proven technologies" (DHHS, Prevention '91 '92, p. 91; Office of Cancer Communications, Question and Answers ASSIST, ASSIST Training Manual, 11/91, pp. V-6, 7).

In fact, they rushed to implement the $135 million taxpayer funded ASSIST program well before the failure of the earlier program (COMMIT) was exposed to the public in a published report in early 1995. It seems that in their desire to spend our money, truth was left behind, and failure was "spun" into a strange definition of success.

COMMIT involved 11 pairs of communties to test whether implementation of a variety of community-based strategies could increase the quit rate among smokers. Its planning phase lasted from 1986 to 1988. Implementation did not actually begin until 1989, and lasted till 1992. Then came a three year data analysis, until 1995. COMMIT had spent $45 million of taxpayer money.

When they finally published their results, in early 1995, we learned that they had failed. There was no difference at all in the quit rates of people who smoked 25 or more cigarettes per day between intervention and control communities.

Among those who smoked fewer than 25 cigarettes a day, they report that 30.6 percent in the intervention communities quit, compared to 27.5 percent in the control communities. This group was considered "light-to-moderate smokers." "Quit" was defined as "having not smoked for at least six months and maintained not smoking when the intervention ended." (NCI, Cancer facts, Q & A about COMMIT, 6/1/95, p. 1).

Combining light smokers and moderate smokers into one category in their summary could be misleading, in that the preponderance of "quits" may have occured among the "light" smokers -- possibly better described as "occasional" smokers. If so, then "quitting" becomes virtually meaningless in any practical sense. Further, many people "quit" temporarily, and may do so several times, for a variety of transient reasons. COMMIT's definition of "quit" therefore is disingenuous.

ASSIST was "estimated" to cost $135 million of taxpayers' money over 7 years. Contracts to participating states were awarded so that a two year planning period was begun in 1991. Implementation started in 1993. This was to allow "emerging information from COMMIT to be fully integrated into ASSIST activities," according to the ASSIST 1991 Training Manual. Does this mean that they integrated techniques that failed?

By 1993, DHHS had managed to expand these community based interventions to an additional 32 states, with several million dollars more of taxpayers money. They created a similar program, emanating from the Centers for Disease Control and Prevention (CDC), called the Initiative to Mobilize for the Prevention and Control of Tobacco Use (IMPACT) -- building further on their earlier (but not yet publicly announced) failure.

ASSIST and IMPACT would likely not have been funded, were it not for the unethical presentation by DHHS of desired results as reality, and guestimates as facts to busy members of Congress and a trusting public. Such misrepresentation, for the purpose of obtaining taxpayer money, requires redress. Their funding should be immediately withdrawn, and the perpetrators sanctioned.