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