Sunday, January 6, 2013

NICE Ignores The Obvious

This brief article (authored by Andrew D. Furber-Director of Public Health NHS Wakefield)  from the BMJ on tobacco harm reduction just arrived in my inbox:

Re: Tobacco harm reduction: the devil is in the deployment | BMJ

Hastings et al. summarise well the dilemmas associated with tobacco harm reduction, and rightly conclude that the devil is in the deployment.

The use of Nicotine Replacement Therapy (NRT) by smokers for harm reduction outside of established guidelines may already be widespread (1). Certainly locally we have seen a significant increase in NRT use without a corresponding increase in measured quits.

This shouldn't be too surprising, as it has become common knowledge that NRT products have a 97% + failure rate when it comes to smoking cessation. However, it is nice to finally see this acknowledgement coming from a published article in the BMJ. If this doesn't provide the empirical evidence to support a shift towards tobacco harm reduction, away from the old ways of the quit or die orthodoxy, then I don't know what possibly could.

Mr. Furber then goes on to say:

Therefore better management of harm reduction through NICE guidelines (2) is welcome. But the implementation will be difficult and will need to be monitored carefully. In particular the NHS reforms in England potentially create the additional complication of tobacco control being funded by local authorities but much of the financial saving falling to NHS Clinical Commissioning Groups (through reduced NHS activity). Health and Wellbeing Boards will need to quickly develop the maturity to manage this, and ensure they deliver better outcomes for tobacco control.

When addressing this issue of harm reduction  via NICE guidelines, I wonder what Mr. Furber means when he stresses for the need for maturity in dealing with such a complex, but necessary subject.

For anyone who has the time to read it in its entirety, the guideline can be seen here.

In the meantime, here are a few excerpts. One of the first things to gnaw at my craw can be seen on the very first page of this 100 page report:

The use of products containing tobacco as a means of ‘harm reduction’ is outside the scope of this guidance. This means that ‘reduced exposure cigarettes’ and ‘smokeless tobacco’ are excluded..

..Outside of the scope of this guidance? I think that I am beginning to understand what Mr. Furber means when he calls for better management in the world of tobacco control...err, I mean tobacco harm reduction.

What's interesting is that also on the very first page of the NICE guideline is the recognition that smoking less can be a means of harm reduction:

This guidance aims to reduce the illnesses and deaths caused by smoking tobacco among people who smoke and those around them. People who smoke can do this by:

• stopping smoking
cutting down prior to quitting smoking
smoking less
abstaining from smoking temporarily.

This is certainly a welcome admission, but what doesn't make sense is the total and utter disregard for reduced exposure tobacco products! 92+% of tobacco users smoke combustible cigarettes. Hence, I repeat, it simply does not make sense to ignore the obvious.

From one side of the mouth they are saying that less smoke is better than more smoke while giving the finger to what will prove to be THE missing piece of the equation (in terms of harm reduction) that has been missing from the conversation for far too long.



  1. The sledgehammer approach that tries to force smokers to quit relies a lot on instilling guilt and fear among light smokers and, more cynically, fear and hatred among non smokers. This has been deliberately designed to further the second and third hand agenda, which they fraudulently claim is a very serious health threat. They can hardly promote the danger of passive smoking by claiming that very light smoking is far less harmful than a 40+/day habit.

    1. "They can hardly promote the danger of passive smoking by claiming that very light smoking is far less harmful than a 40+/day habit."

      True...That's why (in part at least) the idea of a safe(er) cigarette is so threatening to the prohibitionists. "There can be no safe cigarette", sayeth the Neo-Do Gooders of (Counter) Do-Gooderism , because if one existed it would blow a hole in the ETS is dangerous theory.

    2. The funny thing is that they have just admitted to the obvious.

  2. JRed.

    I have been looking for an explanation for TC's intransigence for a long time. Here it is:

    Cambridge Dictionary:



    • (informal: psycho) someone who is very mentally ill and dangerous

    • (specialized in psychology) a person who has no feeling for other people, does not think about the future and does not feel bad about anything they have done in the past.

    What the definition leaves out is "a determination to get one's own way whatever the cost"

    An interesting thought about the idea that Tobacco Control is, literally, psychopathic is that individuals in TC need not themselves be fully psychopathic. As a group, however, they manifestly are. They exaggerate, lie, fix studies, manipulate, are driven, live only for the present, care nothing about the harm they do, refuse to accept that their actions have bad consequences, have no guilt for what has happened in the past.

    The biggest regret is that Governments cannot see this.

    1. Junican,

      You've reminded me of a quote:

      "Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience."-C. S. Lewis