Monday 17 June 2013

NICE Don't Care Much About Health Either

You may remember a blaze of publicity earlier this month as the National Institute for Health and Care Excellence (NICE) produced their new guidelines on tobacco harm reduction.

Very proud they were of it too.
Landmark guidance to reduce tobacco-related harm for people who don't feel able to stop smoking in one step is published today by the National Institute for Health and Care Excellence (Wednesday 5 June). 
The NICE public health guidance is the first in the world to recommend that licensed nicotine-containing products can be used to help people to reduce the amount they smoke, especially those who are highly dependent on nicotine. This includes people who may not be able to stop smoking in one go, those who want to stop smoking without necessarily giving up nicotine, and those who might not be ready to stop but want to reduce the amount they smoke.
Wahey! The part emphasised is exactly what e-cigs provide, is it not?

Amongst others, the BBC (link now disappeared) quoted Professor Paul Aveyard, Nice guidance developer, GP and Professor of Behavioural Medicine at the University of Oxford who had this to say about their harm reduction potential.
E-cigarettes are an increasingly popular NRT option but they are controversial because they have not yet been licensed as safe and effective by drug watchdogs. 
But the guidance from the National Institute for Health and Care Excellence  says doctors seeking to help smokers can advise ‘these products are likely to be less harmful than cigarettes’. 
Professor Aveyard said he will tell patients that using e-cigarettes is ‘better than smoking.'
Yep, that's entirely the point of tobacco harm reduction. A key clue is in the the use of 'reduction' alongside the word 'harm'.

E-cig users welcomed this development almost as if it were a new age of common sense emerging from the 21st century fog of denormalising bilge from the public health Mafia.

The problem is that NICE were very careful to say that they would only recommend "licensed" nicotine-containing products, which is just another way of promoting pharmaceutical NRT ... but as a long term thing which will earn more money for those who produce it.

Of course, the MHRA have since stated that they are arranging the deck chairs so that e-cigs can be officially licensed as medicines even though, err, they are not medicines. Yesterday, I raised the possibility that this was merely a way of protecting the profits of pharma companies which most of the MHRA committee are linked to and the body itself is funded by.

Still, this surely opens up the possibility of e-cigs being available on prescription, doesn't it? The Telegraph believes this could happen "within nine months"!
GPs will be able to prescribe e-cigarettes, which let users inhale a mist of nicotine instead of tobacco smoke, once they have been licensed by the Medicines and Healthcare products Regulatory Agency (MHRA). 
However, e-cigarettes will not be prescribed on a widespread basis across the NHS unless the National Institute for Health and Clinical Excellence (Nice), the public health watchdog, backs their use over other means of helping smokers kick the habit.
And here we have a sticking point. You see, NICE don't even see much advantage of e-cigs over traditional tobacco cigarettes according to a freedom of information request submitted by a fellow jewel robber.

From their Health and Safety Manual:
4.5 Smoking (including the use of e-cigarettes) is prohibited in NICE’s offices and in all other areas of NICE buildings. Failure to comply may be considered a disciplinary offence
From a team meeting in May:
1) It was agreed that e-cigarettes should not be used on NICE premises; and the Human Resource team should contact the relevant line manager/s to ask them to inform staff members as appropriate that e-cigarettes should not be used.
And just in case staff weren't aware, it was reiterated in the internal newsletter, just two days after NICE's grand press release.
Staff are reminded that smoking (including the use of electronic cigarettes) is prohibited in NICE offices and in all other areas of NICE buildings. Failure to comply may be considered a disciplinary offence.
So, NICE's approach to harm reduction attempts by its staff using e-cigs is to throw them outside with the smokers? What's the point of that? If you're going outside anyway, why not just spark up a fag?

From that short-sighted knee-jerk idiocy, it's going to be one hell of a stretch for them to "back [e-cig] use over other [pharma] means".

Are e-cigs banned from workplaces by law? No. Is there evidence that they harm others around the user? No. Is there evidence that e-cigs aid harm reduction (you know, the that thing NICE's guidelines were meant to address?). Yes!

But NICE have banned them anyway, at pain of disciplinary action no less.

I'm not sure how this squares with the self-congratulation in their June 5th harm reduction guidance which gained so much publicity.
However, there are other ways of reducing the harm from smoking, even though this may involve continued use of nicotine. This guidance is about helping people, particularly those who are highly dependent on nicotine, who: 
- may not be able (or do not want) to stop smoking in one step
- may want to stop smoking, without necessarily giving up nicotine
- may not be ready to stop smoking, but want to reduce the amount they smoke.
Great stuff. Except that NICE will fire you if you dare to get your harm reduction option from anyone but pharma suppliers.

It's beginning to look like a cleverly-contrived publicity exercise to hide a defence of pharma corporate status quo, isn't it?

As I said yesterday, serious questions need to be asked of these people. Do consider getting involved and asking them.

H/T JR for the FOI


Ivan D said...

The well being of the nation together with its bank balance would be improved if NICE was abolished . The effect would be enhanced if WHO funding was terminated too. It isn't complicated but would require a degree of courage that is sadly lacking in Westminster. Neither of the organizations is of any significant value to anybody, except those who they employ and who make a tidy living from bureaucracy and /or politics.

vereybowring said...

This very evening I have contacted my MP (again) over proposed legislation of e ciggies and after the previous template replies have been far more exacting with my wording and expectations. I talk about my concerns over the validity of any legislation coming from a captured regulator.

Junican said...


I have just written a post over at the Bolton Smokers Club about this subject, but from a different slant. Here is the text:

"Do you know what? I think that the ecig manufacturers are missing a HUGE opportunity. They should make ecigs look like pipes! The method of operation lends itself to to a pipe-like method of enjoying tobacco. Imagine an ecig which looks like a pipe. The battery could be in the bowl of the pipe. The surface of the bowl could glow when operated. There is no need for ‘smoke’ to arise from the bowl. The button to operate the ecig could be on the side of the bowl, thus the action of operating the ecig/pipe would naturally follow from holding the bowl. The heater could be in the stem of the pipe and the eliquid close to the mouthpiece. The whole operation of using an ecig pipe would be as natural as smoking tobacco in a pipe. Puff, puff, puff and then tap and put in pocket.

No wonder that the Zealots are scared stiff of ecigs. Ecig pipes could scupper the whole movement very, very quickly. Imagine an MP pulling an ecig pipe out of his pocket in the chamber of the House of Commons and puffing away contentedly!!! What fun!!!!

So the Zealots will do anything they can to halt the progress of ecigs. It has nothing to do with health and everything to do with money and control.

Ecig pipes might well be on the market for all I know, but I have not seen one.
I am too old to be bothered, but you are a youngish entrepreneur. Get with it DP!!! Make enquiries and start an ecig pipe (e-pipe?) construction company!
I would buy one and 'smoke it proudly' in Manchester airport or any other venue where smoking is banned. Also, it would be very easy to overcome silly Local Authority bans on ecigs with such an e-pipe.

SteveW said...

They already are mate. I stock a basic model and my suppliers have just about finished an improved model.
The e-big I use is more like a pipe than a cig and the bio-absorption pathway is, as you suggest, far more akin to pipe smoking.

Dick_Puddlecote said...

Nice one, MPs need to know the chicanery going on with e-cigs in their name.

Jack Dawson said...

Given the adverse effects of making ecigs more difficult to obtain, and the lack of evidence of significant harm from them, any registered medical practitioner who provides advice which results in bans or controls may be in breach of their professional duties as defined by the General Medical Council - to "Protect and promote the health of patients and the public."

Michelle GERVAIS said...

I am very very concerned at the way smokers are supporting vapors, essentially because we are saying that smoking is so dangerous that no-one should smoke and everyone should vape.

Vapors have NEVER supported the choices of smokers, why should smokers support the choices of vapors?

Frank J said...

Agreed. As I've said before, e-cigs are crap and no comparison. I've no wish to give up smoking as, imo, from what I've seen most 'research' is massively overblown and shot full of holes. The good thing about a potential e-cig and snus ban is that it shows strongly what authoritarian freaks these people are.

Well, it was never about 'health', anyway.

Crossbow said...

A large number of vapers are pro freedom of choice (albeit often in a patronising way that sees smoking as second best) even if some are anti.
It is however often politically useful to use the TCI arguments about smoking against them of course :P

Dick_Puddlecote said...

I'm sure that is something for the future, as I've written about before. See this article.

Dick_Puddlecote said...

All should defend all attacks on freedom of choice, just as drinkers, fatties etc should have defended smokers from the ridiculous bans that have come about. If not, the health zealots are only encouraged. Divide and conquer is a real tactic which only helps the hideous, as those who enjoy alcohol and fast food are learning to their cost.

Or, as I put it a long time ago ...

"You can't pick and choose which liberties you wish to keep, and which are OK to be stamped on. Bending an inch to these people just boosts their power and leads, eventually, to something being attacked which you hold dear."

Gerry Dorrian said...

"Harm reduction" places nicotine alongside heroin and cocaine. Has anybody at NICE noticed that nicotine and tobacco are legal?