Cutting down smoking = harm reduction

Interesting report in today’s Lancet, showing that the risks of dying young are significantly reduced if people give up smoking before 40 and almost eliminated if you quit before age 30.  The research, based on a longitudinal study of over a million women, has been published today to mark the centenary of the birth of Sir Richard Doll the scientist who first proved the link between smoking and lung cancer.

I chaired a seminar this week on the benefits of smoking harm reduction policies.  As chair of the cross party committee on smoking and health I convene many meetings in Parliament to promote good evidence based public health policy.  At this meeting we heard from experts at NICE, the health body that approves products and treatments for prescription by the NHS and the MHRA, the body that licenses health products for use in the UK.

We discussed the benefit of giving smokers the nicotine hit that they crave but separating it from the harmful cocktail of carcinogens and other chemicals that are present in tobacco smoke. Nicotine itself is relatively harmless.  But inhaling it as a by product of burnt tobacco can be lethal.  People will be familiar with nicotine patches and these have been successful in weaning some people off smoking.  Some people find that the patches enable them to quit their habit, others use them as a help to cutting down the number of cigarettes smoked a day.

The best thing for smokers to do to improve their quality of health and lengthen their life expectancy is to give up in one step.  But for many people this is just too hard and can lead to depressing successive failures to kick the habit.  So nicotine replacement therapies (NRT) have a useful role to play in helping people to at least cut down.

Many NRTs are already licensed by the MHRA and can be bought in shops. Some will be used by local GPs and other NHS smoking cessation programmes.  But others are unlicensed, consumer products that cannot claim health benefit. Most prominent among these are electronic cigarettes.  When I first saw an advert for these “e-cigarettes” I was sceptical.  But one of my friends, once a heavy smoker, has now managed to quit tobacco completely by using an e-cigarette.  These e-cigarettes are the same size and shape as the real thing.   But they are plastic and metal, not paper and tobacco.  They deliver a nicotine hit but without the other harmful gases and chemicals in burnt tobacco.  And I guess they help with the habitual side of smoking, something to hold between the fingers or lips.  They even glow on the end…though I think it would be better to have a blue or green colour so people nearby aren’t alarmed into thinking they are real cigarettes!

So we may find that smokers who are finding it hard to quit are given more help by the NHS to break their habit.  I support a range of measures that drive down the rate of smoking. This normally leads to me being caricatured a politician in favour of draconian bans and a nanny state politician who likes telling people what to do.  But I have always known that quitting smoking is really hard for some people.  They are addicted to nicotine and many actually like smoking.  So I hope that once NICE has finished its review, the NHS will be able to give practical help to people who know that smoking is harmful but find it too hard to summon up the will power to quit.

 

You can read the Lancet report here http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61720-6/fulltext

The NICE draft guidance is here http://guidance.nice.org.uk/phg/52/consultation/latest