What was the Today programme up to yesterday morning letting the man, described by Melanie Reid, as "jobs worth personified, complacent and patronising", get away with his ingenuous  'nothing to do with me gov'  distancing of himself and the NTA from the latest residential rehab beds crisis? As 'Furious of Suffolk' wrote to me: "talk about shifting the blame! The NTA are now criticising drug agencies for not sending people to rehab after forcing maintenance on agencies for the past 9 years..."

Nothing has changed with our great national drug treatment hegemony since Mark Easton first exposed its chronic waste two years ago and since last year's effort by Paul Hayes on the Today programme to justify the unjustifiable and to deny the undeniable - why only 3.6% of the 200,000 going through his treatment system were cured each year. 

That is, except a reinvigorated and sustained NTA public relations exercise - thanks to taxpayer's treatment money. Dawn Primarolo's advice at the NTA's 2008 Annual Conference has been taken to heart. No problems with the treatment, only with the message, she publicly rebuked the executives and board.

So to the untutored ear Paul Hayes's boast on yesterday's Today programme, that an article in the Lancet showed that 'drug treatment' of the NTA brand was really working sounded convincing. It was however little more than a clever exercise in media management - one that most of the media uncritically picked up; and to which BBC Online gave the helpful endorsement "Drug therapy record 'encouraging'".

Addiction Today described it as another "dodgy dossier of addiction non treatment" as its editor, Deirdre Boyd, revealed the Lancet paper to be nothing less than a well disguised vanity publishing exercise:

"The Goliath of Labour's National Treatment Agency for Substance Misuse", she wrote, "to guard its large well-fed body, has (also) funded a document - Effectiveness of community treatments for heroin and crack cocaine addiction in England: a prospective, in-treatment cohort study - proclaiming its own effectiveness...

 "Seven of the nine authors ....... are employed by or received funding from the NTA, whose employees also designed the study, gathered data and interpreted it from study 'treatment' settings that depend entirely on the NTA for funding. Due to the Lancet's prior reputation,  Neither flaws in the contents...... nor the intertwined interests were spotted by the medical journal Lancet, which published the NTA document in what appears to be a leap of faith." 

 Independent experts from the field went on line with her to set out their reservations.

"If one were to substitute the NTA initials for the name of a drug company ...... it is questionable if such a paper would have been accepted by such a prestigious journal as the Lancet," Professor McKeganey wrote, 'The fact that seven of the nine authors on this paper are either employed by or have received funding from the NTA should have sounded a note of caution. ...We should regard the results set out in Effectiveness of community treatments... paper with considerable caution.  The paper reports that six months after starting addiction treatment, 37% of heroin users and 52% of crack cocaine users were abstinent from those specific drugs in the 28-days before their first review. Recovery from dependent drug use is about sustained not temporary abstinence. And it is striking that the authors refer to individuals being abstinent from these drugs "in" the 28 days before review but we are not told how many days these individuals were free of all drugs over the 28-day period."

Dr Duncan Raistrick from the Leeds Addiction Unit shared the view that self evaluation is a risky business, adding: "There is also a problem with the data collection. The NTA has imposed a burdensome system which was created for political not clinical purposes. Fair minded people would support some form of national outcome measurement but this needs to be of universal application, simple, and preferably using international conventions such as EQ5D and ICD10. To impose something that is not seen to be useful, indeed is seen to be for another purpose, will not be embraced by clinicians. Furthermore, these same data are used to performance manage service providers - contracts depend on achieving good outcomes. In short, data quality will be uncertain.

"In summary this looks like good analysis of bad data. A crucial finding, not discussed, appears to be that both heroin and crack users do as well or better in the psychosocial intervention as compared to the more costly pharmacotherapy (presumably substitute prescribing). If these findings are valid is it not logical that the NTA should be rapidly dismantling methadone programmes?".

No one on the BBC - or in any of the other media - has yet come round to putting Raistrick's important question to the NTA, although yesterday's annual treatment statistics release - a case for inspection by Michael Scholar if ever there was one - showed no real improvement in drug free outcomes.  For the £800 million spent annually on treatment the percentage emerging drug free from the system - if the NDMTS's constantly changing categorizations and data are to be trusted at all -  is 4%, barely more than would become drug free of their own volition, without any intervention.

"There are many myths about detox", one rehab doctor wrote to me last week. "It is usually an extremely simple process. We recently had a woman come to us who had been on methadone for the best part of 28 years. She had continually been told that she was not ready to come off. We detoxed her in three weeks and she is now about 6 months clean and sober, looking for employment and reunited with her family."

The trouble is hardly any of the thousands the NTA has 'engaged in treatment' have had the benefit of this simple approach.