Thursday, 28 April 2011

Tobacco harm reduction: NICE makes a silk purse of a sow's ear

The National Institute for Clinical Excellence has reinvented tobacco harm reduction.

It's a poorly guarded secret that smoking cessation treatments don't work. The tobacco control professionals know this very well. Their strategy is therefore changing.

NICE has a section dedicated to harm reduction in tobacco. It even has its own email address, and a list of registered stakeholders. In seeking to promote harm reduction, they have published a draft  consultation paper, aimed at professionals in smoking cessation and public health managers, with a view to publishing guidance about harm reduction.

The consultation begins with a preamble making emphasising: 1) the health toll from smoking; 2) health inequalities reflected in smoking rates; 3) the dangers and recorded damage caused by passive smoking in the home; 4) people's wish to quit and low rates of success. (They still insist that NHS help is more effective than cold turkey.) It also explains the methods that it includes and those it specifically excludes (including hypnotherapy and all other alternative therapies).

Excluding therapies with a known track record from an approach that calls itself harm reduction seems odd, but not unexpected in the field of smoking cessation.  In fact the consultation paper includes e-cigarettes in its methods. But the overall point seems to be that although smoking cessation meds don't work they still have their place for people who want to cut down smoking, whether for their own health or other people's. Is this the answer to Tim Coleman's prayer – a passport to keep people on smoking cessation meds for longer periods, especially people on low incomes?

Were it not for the fact that they are playing another guilt trip on smokers for damaging their loved ones and putting themselves at risk, this could almost be taken for benevolence. It appears that the pharmaceutical apron strings are still pulling tight.

The authors of the questionnaire seem a little confused about the ethics of promoting smoking harm reduction rather than complete withdrawal:
Question 8: Are there any unintended consequences from adopting a harm-reduction approach, for example, does it deter people from trying to stop smoking?
Question 9: How can practitioners deliver the complex messages about harm reduction without weakening advice about the benefits of stopping smoking?
But they do ask:
Question 10: Does long-term use of pharmacotherapies or ‘nicotine-containing products’ to reduce smoking have any ill-effects on health?
... surely another opportunity to complain about Champix at the highest level!

Organisations can become stakeholders by registering (details here). The list of stakeholders is dominated by 'public health interests', but both the Vapers' Network and have also joined up. Organisations that represent patients are eligible to register: that means any smokers or users of any kinds of tobacco, since they seem so keen to treat smokers as patients. (It doesn't appear to cover Scotland, however.)


Unknown said...

Have not checked out the links yet but could, or should, F2C become a stakeholder I wonder.

handymanphil said...

My thoughts exactly John!