UK Consultation on Tobacco Control: Real opportunity or false dawn for Tobacco Harm Reduction?

The UK Department of Health has recently published a consultation on the future of tobacco control. This consultation is seen as the first step in the development of a new UK tobacco control strategy and covers four main areas: Reducing smoking rates and health inequalities caused by smoking, protecting children and young people from smoking, supporting smokers to quit and lastly, helping those who cannot quit. While the first three areas build on orthodox tobacco control initiatives, in public policy terms the last area is potentially groundbreaking. This is because it considers the potential of a harm reduction approach. The consultation document (section 5 part D) points out that harm reduction strategies seek to minimize the adverse health and social consequences of substance use and that to date harm reduction approaches have not received widespread attention for tobacco. As the health impacts of smoking are largely unrelated to nicotine, it may therefore be possible to find new ways to reduce the risk to smokers who are unwilling or unable to break their addiction. For this reason it is argued that future UK government strategy in tobacco control should therefore address the needs of the smoker who cannot quit and give consideration to how the harms caused by smoking can be reduced. The consultation document acknowledges that for critics, the disadvantage of even a harm reduction strategy using only ‘pure’ nicotine products is that it involves an acceptance of addiction. Furthermore there are even greater concerns about a harm reduction approach using non-smoked tobacco products, as it would lead to the implicit abandonment of the goal of a tobacco-free society. The fact that harm reduction is incorporated in a consultation document coming from the country currently rated as having the most effective tobacco control strategies in Europe is a very interesting development. Hopefully it is a sign that the debate on tobacco harm reduction is going from fringe to more mainstream. The question posed in the consultation document is “Do you support a harm reduction approach and if so can you suggest how it should be developed and implemented?” Responses (from any group or member of the public with an interest in tobacco control) can be submitted online to the UK Department of Health by 8th September 2008. A summary of responses will be made available on the Department of Health website at the end of the year. What are your thoughts? Will tobacco products get a look in? Will this have any influence on global tobacco control policy?

14 comments ↓

#1 Copenhagen Charlie on 07.02.08 at 9:37 PM

Very interesting article and I think it will bring to the fore front the issue. Any opportunity like this can only assist the cause of moving sanity to the issue of letting the public know that harm reduction is an option.

#2 virginia blend on 07.07.08 at 9:34 AM

Wow it’s refreshing to see you folks all taking a stand. I find it very interesting that the US could probably learn so much from what has taken place in the UK and also in Canada. The public needs to be given the straightforward facts and not an extremist view.

#3 TAZ on 07.09.08 at 7:04 PM

Adrian,

It would be my hope that the public is given the opportunity to have the truth presented to them. It becomes more and more relevant as each day passes that the folks who want to see tobacco use outlawed period use science to present it’s case but in many of the incidents that science reportedly is saying their is grave danger the conclusions are not what have been arrived at in the results. Too often the anti tobacco movement takes – “cuts it and pastes it” to support their cause! Anyone can do that! We need o get the full story out to people!

#4 Chris Crawley on 07.10.08 at 10:56 AM

Helping smokers who cannot quit potentially shows a bold and innovative move by the UK government – And a pragmatic approach to tobacco control.

I have long advocated that not all cigarette smokers are willing to quit or want to migrate to other tobacco products. Their options are becoming fewer and yet they are the ones most at risk!

The public health community and the major portion of the cigarette industry is ignoring this consumer.
Where’s the sense in that?

#5 Adrian on 07.10.08 at 11:51 AM

Chris- No sense at all! But the politics of tobacco are unfortunately sometimes more complex than the science! Having said that, the major tobacco companies have invested a lot into developing cigarettes that may be endorsed as potentially being less harmful, but it’s a long hard road and needs a bi-partisan approach (industry/public health) to develop and agree an appropriate testing framework. It’s just not possible to drive R&D strategy on ‘safer’ cigarettes if you have to wait 30 years for epidemiological results.

#6 CIG GUY on 07.11.08 at 1:44 AM

I was wondering after reading the comments above. Can’t one measure the levels of carcinogens and TNA’S? If one can do that would not the reduction or elimination led one to believe the product was safer? How does that work?

#7 Adrian on 07.11.08 at 1:50 PM

In response to CigGuy – yes you can measure the level of carcinogens and TSNAs in the smoke, but it’s very hard to find a consensus as to what (or by how much) you would have to reduce them to make the product safer. There is also the issue of reducing exposure rather than simply delivery, while at the same time and developing a product assessment framework that takes into account biomarkers of harm. It’s crucial to have bi-partisan (industry/public health) discussion on developing such a framework. There is also the possibility that simply having smoke passing through your airways (not natural unless you are a dragon!) causes a non-specific inflammatory response that pre-disposes to disease.

#8 CIG GUY on 07.16.08 at 8:47 PM

Thanks Adrian – I for one do think that one day someone will develop a cigarette that will be safe. The issue will be whether it can get pass all the folks that just go berserk when the thought of tobacco being safe is gets verbalized.

#9 TOBACCO KILLS on 07.22.08 at 12:47 AM

THIS BLOG IS VERY INTERESTING BUT IT SEEMS LIKE IT IS ONLY READ BY FOLKS THAT ARE WANTING TO KEEP TOBACCO USE AT A HIGH LEVEL. LET’S FACE IT FOLKS YOU ALL KNOW TOBACCO KILLS PEOPLE JUST LIKE WALKING ACROSS THE STREET IN FRONT OF A 18 WHEEL TRACTOR TRAILER. THE WORLD WILL BE SO MUCH OF A BETTER PLACE WHEN TOBACCO IS NO LONGER USED. I DON’T EVER SEE THE FOLKS THAT KNOW TOBACCO KILLS WORKING OUT A COMPROMISE POSITION WITH THOSE LYING & DECEIVING TOBACCO COMPANIES. WE WILL BE A STEP CLOSER TO GETTING RID OF TOBACCO WITH FDA REGULATION, NEW LEGISLATION OUTLAWING SMOKING IN THE HOME AND THE NEXT PRESIDENTIAL ELECTION. VICTORY WILL BE OURS!

#10 CIG GUY on 08.08.08 at 4:10 PM

WOW – This tobacco kills guy is off his rocker. He is just so brain washed. I mean we know that not all tobacco kills folks. And there are obviously differences between smoking and dipping. Just seems like he has a problem.

#11 kentucky rebel on 09.01.08 at 4:42 PM

I believe if more people become seriously involved and work quickly that we can use opportunities like the UK Consultation to open the debate. If we can get the same activity here in the US with key individuals maybe we will be able to get the Senate to force the issue. But we can’t just sit back. We need to get our voice heard regarding harm reduction. I mean look at the FDA’s ability as we watch a very harmful drug, Chantix stay on the market. I often look at BIG PHARMA and just wonder what is the difference between them and BIG TOBACCO.

#12 adrian on 09.02.08 at 1:39 PM

To Kentucky Rebel

You are absolutely right. I am just finalising my comments to the UK DoH consultation document and hope that others might also be doing so. Only by making our voice heard will there be any challenge to the outmoded and outdated moralistic groupthink that otherwise exists. Having said that, there are a few brave individuals who aren’t afraid to stand up and be counted, we just need more of them!

#13 kentucky rebel on 09.02.08 at 11:05 PM

Adrian,

Will you be putting your thoughts on the blog? I’m sure they would be very insightful. It would help get out the knowledge that is needed for others to be “smart” in what they say!

#14 adrian on 09.04.08 at 12:50 PM

to kentucky rebel

What I think I will do is summarise my thoughts via the blog once the submission deadline has passed. It’s not that I’m being paranoid, but I really don’t want to be accused by anyone of leading the horses. As for being smart in what they say, get your drift, even though I’m somewhat flattered! The great thing about harm reduction is that it’s common sense. I’d recommend anyone who doubts this to read the following two articles: Tobacco harm reduction: an alternative cessation strategy for inveterate smokers. Rodu, B and Godshall, W.T. http://www.harmreductionjournal.com/content/3/1/37 3:37, 2006
Tobacco harm reduction: How rational public policy could transform a pandemic. Sweanor, D., Alcabes, P. and Drucker, E. International Journal of Drug Policy 18: 70-74, 2007

The only problem is that the politics of tobacco are a lot more complex than the science!

Everyone I talk to gets it, even politicians. The problem is that tobacco is seen by many as a hot potato, that they don’t won’t to be caught holding.

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