The Citizens Council of the National Institute for Health and Clinical Excellence (NICE), which provides public input into the Institute’s work, has published a report on its meeting to discuss smoking and harm reduction.  The public is now invited to comment on the Council members’ views on the theoretical strategy of harm reduction with regard to smoking – an approach not currently used in the UK. This includes the pros and cons of promoting the switch to alternative products such as medicinal nicotine, alongside supporting smokers to quit. NICE has not been asked to produce guidance on harm reduction in smoking. However, should guidance be requested on this topic, the views of the Citizens Council on issues which should be taken into account will be helpful to inform NICE’s independent committees.

Whereas smoking cessation strategies are familiar – helping smokers to quit both smoking and their reliance on nicotine completely – the concept of harm reduction in smoking has a different focus.  Instead, it aims to reduce the harm associated with smoking cigarettes for people who cannot quit. This may include replacing cigarettes with a clean form of nicotine, or with cigarettes which intend to deliver lower levels of toxins.  In this scenario, nicotine continues to be provided through a less harmful method than by standard smoking.  

The Citizens Council voted overwhelmingly in favour of the position that harm reduction in smoking is a valid strategy.  In particular, using harm reduction as a way to quit smoking and break addiction was supported. However the notion of considering harm reduction as a way to provide a less harmful alternative to smoking – while accepting that nicotine addiction continues – proved relatively unpopular.

Sir Michael Rawlins, Chair of NICE, said: “The Citizens Council makes an important contribution to the work of NICE by enabling it to take the views of the general public into account when undertaking its work.  The Citizens Council’s comments on harm reduction in smoking – a difficult social values issue that may be seen as contentious in some fields – is therefore particularly helpful. 

 “The concept of harm reduction conflicts with traditional smoking cessation as it does not necessarily seek to help people stop smoking altogether, nor does it treat nicotine addiction.  What would this approach mean for the goal of having a smoke free society? The Citizens Council’s view will help guide our independent advisory committees, should they be required in the future to make recommendations about harm reduction in smoking.   But first, we are very keen to hear what the general public thinks about the conclusions the Citizen’s Council reached, before the report is presented to the NICE Board.

“Importantly, the Citizens Council discussion also revealed that there seems to be general public misunderstanding about nicotine, namely that many people may think that it is the nicotine in a cigarette that kills you.  Many members of the public are also unaware of the smoking cessation services already available.  The Citizens Council’s view was that there was a need for better public information about these services. I’d like, once again, to thank the Council for its consideration of this issue.”

The report on the Council’s views is available for public comment, at www.nice.org.uk .  Comments must be sent in by 5pm on Wednesday, 31 March 2010.