The Citizens Council provides NICE with a public perspective on overarching moral and ethical issues that NICE should take into account when producing guidance. Made up of members of the public, broadly representative of the adult UK population, the Council operates through a “citizens’ jury” style meeting, to explore and respond to a question set by NICE.

At its May 2009 meeting, the Citizens Council gave its views regarding the pros and cons of supporting smokers to quit and promoting the switch to ‘safer’ products such as medicinal nicotine. Specifically, the Council was asked: “Is ‘harm reduction’ a valid strategy? What are the pros and cons of ‘harm reduction’ and encouraging quitting?”

On the central, broad question of harm reduction as a valid strategy we voted 27 for and one against. However, our discussions revealed that we held two overlapping views of its rationale and its goals. It could be seen as predominantly a means to an end (the end being for the smoker ultimately to quit); or more as an end in itself that would allow smokers to cut down and perhaps stop, but at the price of continuing to rely (perhaps indefinitely) on their chosen nicotine replacement. We therefore held two further votes, with the following results:

A) Harm reduction as a way to quit smoking and break addiction. (26 votes in favour) B) Harm reduction as a way to provide a less harmful alternative to smoking while accepting that nicotine addiction continues. (9 votes in favour)

Because positions A and B are not wholly incompatible, a minority of us voted for both; hence voting figures.

We compiled a list of the pros and cons of harm reduction strategies, for each of positions A and B, and then voted on them. We also compiled (and prioritised) a list of considerations that NICE should bear in mind if and when it is called upon to produce guidance on tobacco harm reduction strategies.

We felt strongly that the tobacco industry should not become involved in harm reduction strategies. We also wish to emphasise the importance of disseminating more information on existing anti-smoking services, and making people aware of what they have to offer (many of us were unaware that these are free). It is also vital to correct widespread misconceptions about the ingredients in cigarettes that are most harmful, as opposed to what makes them addictive.