{"id":31602,"date":"2014-05-20T11:40:57","date_gmt":"2014-05-20T10:40:57","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=31602"},"modified":"2014-05-20T14:10:09","modified_gmt":"2014-05-20T13:10:09","slug":"the-bmj-today-smoking-nicotine-e-cigarettes-and-corruption","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2014\/05\/20\/the-bmj-today-smoking-nicotine-e-cigarettes-and-corruption\/","title":{"rendered":"The BMJ Today: Smoking, nicotine, e-cigarettes, and corruption"},"content":{"rendered":"

\"rich_hurley\"<\/a>Should smokers be advised to cut down as well as to quit? This is the debate captured in our latest Head to Head article<\/a>, just published on bmj.com. The cost effectiveness body for England and Wales, the National Institute for Health and Care Excellence (NICE), last year changed its guidance to recommend that smokers are advised to cut down rather than simply to quit smoking, as Gareth Iacobucci reported<\/a>. However, to achieve this NICE also started to recommend licensed nicotine products for long term use as maintenance treatment rather than simply for smoking cessation.<\/p>\n

In the debate, the behavioural medicine researchers Paul Aveyard and Nicola Lindson-Hawley at the University of Oxford, say that \u201cpeople who are cutting down are more likely to make a future quit attempt than people who are not.\u201d\u00a0They cite physiological evidence that supports their view: \u201cNicotine addiction leads to neuroadaptation, and cutting down on smoking might reverse some of this, leading to less craving and withdrawal after stopping\u2014the primary drivers of relapse.\u201d\u00a0They also note that unlicensed nicotine products are making huge gains in popularity: e-cigarettes are \u201cthe most commonly used cessation aid in England,\u201d they say.<\/p>\n

However, Gerard Hastings and Marisa de Andrade have a different take on the issue. They dispute e-cigarettes\u2019 effectiveness in smoking cessation, urge caution, and suggest that NICE\u2019s revised guidance may give these untested products implicit approval. They present long term use of nicotine products marketed by big tobacco as commercial exploitation of smokers attempting to quit.<\/p>\n

Calling for a broader view of smoking than nicotine dependency, they say, \u201cWhen the only obstacle to progress on preventing the harms of smoking is the user\u2019s dependence, e-cigarettes offer the beguiling prospect of addicted smokers migrating painlessly to safer mechanisms of nicotine delivery.\u201d\u00a0But without evidence that e-cigarettes work, they conclude, \u201cThe tobacco multinationals have leapt enthusiastically into this market; all now have major e-cigarette interests. This is not a consumer movement but the full onslaught of corporate capital in hot pursuit of a profitable opportunity.\u201d<\/p>\n

Let us know what you think by voting in our poll<\/a> and by posting a rapid response<\/a> to the debate. We republish the most interesting and useful responses as formal letters to the editor.<\/p>\n

In other news: a recent Personal View<\/a> by an Australian district medical officer, David Berger, on his experiences of corruption in Indian medicine and healthcare is also stimulating debate. In a rapid response<\/a> published today, the head of a non-profit hospital in Delhi sympathises with Berger: \u201cDeviance has been normalized to a huge extent,\u201d Abhishek Bhartia says, calling for a systems approach to \u201caddress myriad interrelated factors.\u201d He also cites doctors\u2019 low pay among other factors that need to be looked at.<\/p>\n

Richard Hurley <\/strong>is\u00a0deputy magazine editor for<\/em>\u00a0The BMJ.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Should smokers be advised to cut down as well as to quit? This is the debate captured in our latest Head to Head article, just published on bmj.com. The cost […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[447,5750],"tags":[],"class_list":["post-31602","post","type-post","status-publish","format-standard","hentry","category-india","category-the-bmj-today"],"yoast_head":"\nThe BMJ Today: Smoking, nicotine, e-cigarettes, and corruption - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/05\/20\/the-bmj-today-smoking-nicotine-e-cigarettes-and-corruption\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The BMJ Today: Smoking, nicotine, e-cigarettes, and corruption - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Should smokers be advised to cut down as well as to quit? 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