Can Siri help you quit smoking?


So you want to quit smoking. But you want to do it right, with expert advice and evidence-based information. Should you ask Siri?

This week my co-author Nick Wilson and I published results of a pilot study reporting how effective personal digital assistants are at providing information or advice to help you quit smoking.

As far as we are aware our study is the first study looking at whether Siri or Google Assistant can help you quit.

The internet is widely used for obtaining health-related information and advice. For example, in the United Kingdom, 41% of internet users report going online to find information for health-related issues, with about half of these (22% of all users) having done so in the previous week.

We compared voice-activated internet searches by smartphone (two digital assistants) with laptop ones for information and advice related to smoking cessation.

We asked Siri and Google Assistant three sets of questions. We entered the same questions into Google as an internet search on laptops.

The first set of questions were adapted from the ‘frequently asked questions’ on the UK National Health Service (NHS) smokefree website.

The next set of questions were related to short videos on smoking-related disease produced by the Centers for Disease Control and Prevention (CDC) in the USA.

The final set of questions we devised to test responses to a range of features such as, finding smoking-related pictures, diagrams, instructional videos; and navigating to the nearest service/retailer for quitting-related products.

We graded the quality of the information and advice using a three tier system (A,B,C) where A represented health agencies which had significant medical expertise, B was for sites with some expertise (e.g. Wikipedia) and C was for news items, or magazine style content.

Google laptop internet searches gave the best quality smoking cessation advice 83% of the time, with Google Assistant on 76% and Siri 28% (equal firsts were possible).

The best search results by any device used expert (grade ‘A’) sources 59% of the time. Using all three methods failed to find relevant information 8% of the time, with Siri failing 53% of the time.

We found that Siri was poor when videos were requested according to the content the might contain, all three tools sometimes returned magazine or blog content instead of professional health advice, and we found that all tools had trouble when gay and lesbian-specific information was requested.

A weakness of our small pilot study was that we only considered the first result returned in each search.

Overall, while expert content was returned over half the time, there is clearly room for improvement in how these software systems deliver smoking cessation advice. We would encourage software firms to work with professional health organisations on ways to enhance the quality of smoking cessation advice returned.

See Adapt Research Ltd’s related blog: ‘To vape or not to vape… is not the right question

Health inequalities in NZ


Everyone knows that socio-economic inequalities in health exist – in recent times. But one thing we do not know is whether they have always been there. Adapt Research Ltd contributed to a just published study that looks at two historical datasets – with one of these suggesting life span differences by occupational class as measured 100 years ago.

The study found strong differences in life expectancy by occupational class among men enlisted to fight in the First World War (but not actually getting to the frontline). Whilst not definitive evidence (it is hard to get perfect evidence from 100 years ago!), it does suggest that socio-economic inequalities in mortality have existed for at least 100 years in NZ.

In this blog we also take the opportunity to discuss what might be done to address the current inequality problem in this country, this is especially relevant given the Tax Review currently underway… Click here to read the full blog (hosted externally).

Reducing Harm from Falls: What have we learned in the last 12 months?


Falls are a major cause of injury and reduced quality of life for older people.

Estimates suggest that more than a quarter of people over 65 years of age fall in any given year. Broken hips and head injuries are among the most serious complications of a fall.

This is why the New Zealand Health Quality and Safety Commission has spent several years encouraging the health sector in New Zealand to implement programmes that reduce harm from falls.

A set of evidence-based guidance, the ‘Ten Topics’ is available on the Commission’s website.

However, every day more than 4 new research papers about falls are published. The Safety Lit database contains over 1500 items for ‘Falls’ in 2017 alone.

Every week there are new systematic reviews, meta-analyses, guidelines or health technology assessments.

So what does all this new evidence tell us?

We know that in New Zealand aged residential care facilities 13% of patients have a fall in the previous 30 days.

We also already know that bisphosphonates are an important medication to fight osteoporosis and prevent fragility fractures in older adults. But did you know that they are cost-effective at a fracture risk of just 1%? And yet in New Zealand there is scope to increase the rate of bisphosphonate prescribing for patients suffering fragility fractures.

Strength and balance exercise programmes can help prevent falls and new evidence suggests that Tai Chi is also effective.

As for medications, data previously appeared to show that antihypertensives increase the risk for falls. But some large new reviews indicate this may mostly be due to falls in the first 24 hours after a dose adjustment, or if the patient is taking diuretics.

Selective beta blockers may not increase the risk of falls, and treating hypertension to guideline levels is likely to be safe.

We are now pretty sure that prescribing vitamin D to otherwise healthy older people does not prevent falls or fractures.

However, sleep disturbances can increase the risk of falls.

Finally, home safety assessment and modification programmes and in-home strength and balance exercise programmes appear cost-effective in the New Zealand context.

The above is just a taste of the new evidence available to help in reducing harm from falls, and the Commission’s website indicates that their ‘Recommended Evidence-based resources’ webpage will be updated annually.

So don’t just take my word for it, examine the new evidence for yourself, and we can all look forward to the next comprehensive update.

For now, the Ten Topics are an excellent resource for anyone who is in the business of reducing harm from falls, and reducing harm from falls is everyone’s business!


AI Update: Have you seen my Putin Impersonation? It’s a blast.


Two recent articles in the media reminded me of a concern about AI.

Firstly, the BBC asks us whether we would care if a feature article was, ‘written by a robot’? The implication is clear, it will soon be the norm for digital content to be created by intelligent systems.

Secondly, and more menacingly, another BBC report suggests that hacked video and voice synthesis tools will soon be producing lifelike quality. The actual report cited by the BBC story can be found here: The Malicious Use of AI Report.

Impersonating humans

It may not be long before digital tools can convincingly (read indistinguishably) produce fake video and speech, thereby impersonating specific human beings. This content could be augmented with mannerisms and linguistic style harvested from previous online posts, speeches, comments or video produced by the target.

What emerges is a simulacrum. Reality recedes and we can no longer tell what is real and what is not.

The problem with all this is that very soon the capacity of someone, or some system with advanced voice, video, and linguistic style tools at their disposal will be able to convincingly impersonate human beings. To all intents and purposes they will be able to hack reality.

Impersonation does not mean that the system doing the impersonating will need to interact with people or pass a Turing test. All that is required is that the content produced is convincing.

It is not completely in the realm of fantasy to picture ‘Vladimir Putin’ giving the order to use nuclear weapons, and this order is either acted upon, or retaliated against. Many other undesirable situations are possible, both mundane and terrifying.

A host of companies are already working very hard, and with much success, to create impersonations, of their own staff, for the purpose of interacting with customers.

Currently many states have laws forbidding the impersonation of a person, by another person, but do our laws adequately forbid the impersonation of a human being by a digital system? And even if it forbidden, how will we enforce this?

Trust: the next big human problem

Humans over time have struggled with some key societal problems, and found solutions. These include:

  • the problem of coordination and cooperation, solved by language and written symbols
  • the problem of exchange, solved by money
  • the problem of information dissemination, solved by the printing press
  • the problem of scale, solved by the industrial revolution

We now must solve The Problem of Trust and Authenticity.

This has been demonstrated by the debacle around Fake News, where Facebook and other digital media companies are scrambling to implement change.

We need to solve the issue of trust, at the levels of moral norms, digital systems, societal systems, and laws.

Technologies like blockchain are small steps in the right direction, but the problem persists and other solutions and constraints are needed.

We need to have a conversation as a society about what kind of future we want to live in, and what limits, laws and norms we want to impose on emerging technologies, particularly artificial intelligence, which by it’s very nature mimics us.

This conversation needs to begin now and it needs to involve the technology sector, a fully informed general public, and the government.

Click here to listen to a talk by Adapt Research Ltd’s Matt Boyd on AI and the media given at the NZ Philosophy Conference in 2017. 

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