I’ve just commented on LBC’s Iain Dale show about the report in today’s Guardian on Big Tobacco pushing for e-cigarettes to be prescribed on the NHS. The immorality of their position is staggering: the very companies who woo us to part with hard earned cash for their addictive highs are now after our tax money to maintain our addiction, via the NHS medicines budget! Have they no shame?
Nicotine replacement therapy (NRT) is already available on the NHS, though research shows that simply prescribing NRT (such as the gum or patches) without any formalised withdrawal programme or psychological support has a measly 5% success rate. There is no indication that Big Tobacco wants anything to do with helping people kick the habit. This is only about exploitation and profits, no altruistic concern with harm reduction.
Should e-cigarettes get approval, the article indicates that it will be down to local commissioners to decide whether they are available in your area. We can be certain that Big Tobacco will be doing what they can to persuade doctors to prescribe. Yet the bigger questions remain. Harm reduction is a controversial approach for any risky behaviour. Critics say that it implies that you can carry on with certain activities in a safer way, when the reality is people take more risks because they think perceive what they are doing to be less harmful. Of course, with e-cigarettes you cut out the health risks of inhaling smoke, but nicotine remains a highly addictive, mood altering drug that can cause blood clots, raised blood pressure, increased heart rate, muscular tremor and breathing difficulties. The push is to make smoking acceptable, even glamorous again, with it’s new ‘safe’ form. Harm reduction however doesn’t address the underlying issues: why you need a high in the first place?
And secondly, we cannot go on talking about paying for new NHS services without a fundamental review of what the NHS is for, on which I have written previously. Decisions about funding e-cigarettes should not be being taken in isolation: we desperately need a review of what the NHS can and should provide. I have no problem with people moving to e-cigarettes from the traditional tobacco variety, they will save themselves a lot of money, but it should not be at our cost and without a wider debate.