Cabinet office ‘nudge unit’ encourages use of product banned in many countries, in bid to reduce smoking-related deaths The government’s “nudge unit” wants to encourage the use of smokeless nicotine cigarettes, banned in many countries around the world, in an attempt to reduce the numbers killed in the UK by smoking diseases each year. The Cabinet Office’s behavioural insight team – better known as the nudge unit – wants to adopt the new technology because policy officials believe the rigid “quit or die” approach to smoking advice no longer works. Rather, they want nicotine addiction to be managed to help smokers who otherwise won’t quit – an approach the unit believes could prevent millions of smoking deaths. Ten million people in the UK smoke, and smoking claims 80,000 lives a year. The nudge unit’s first annual report, published today, says the unit – the first of its kind around the world – has, in the face of criticism, implemented a series of measures they believe could save thousands of lives a year, as well as £100m over the course of the next parliament. Ideas already being rolled out include “nudging” people to donate organs by asking someone to opt out rather than opt in when filling out an online driving licence application. The report also says the government is to change tax forms to tell people how many people in their area have paid their taxes ahead of them. Now the unit wants to explore and encourage new products that deliver nicotine to people’s lungs but without the harmful toxins and carcinogens in tobacco smoke that kill. The annual report reads: “It will be important to get the regulatory framework for these products right, to encourage new products. A canon of behaviour change is that it is much easier to substitute a similar behaviour than to extinguish an entrenched habit (an example was the rapid switch from leaded to unleaded fuel). If alternative and safe nicotine products can be developed which are attractive enough to substitute people away from traditional cigarettes, they could have the potential to save 10,000s of lives a year.” Current alternatives to smoking range from smokeless tobacco to the Swedish snuff-like product Snus, which is illegal in the UK. Versions of smoke-free cigarettes are illegal in Australia, and banned in Canada, Brazil, Singapore and Thailand because side-effects haven’t been tested. But experts have advised the UK government that the nicotine contained in some new, smoke-free cigarettes is no more harmful than caffeine in coffee. A cabinet office source said: “A lot of countries are moving to ban this stuff; we think that’s a mistake.” John Britton, professor of epidemiology at the University of Nottingham, told the Guardian that on top of the current smokeless range – which includes electronic or “e-cigarettes” that simulate smoking by producing an inhaled mist – there are three or four devices in different stages of development. But he said some companies have been reluctant to develop this technology because they had expected it to be as tightly controlled as pharmaceutical drugs. Britton said: “If a manufacturer makes a health claim for anything then it becomes a drug, and drugs have to be regulated with tight controls. The current nicotine replacements are sold as drugs; however, e-cigarettes contain nicotine but get around this by making no health claim and so can be sold freely, but with little or no information on safety or standards. What we’re asking for is a regulation change to bring all nicotine products into a light-touch regime that will guarantee reasonable purity and safety standards but make them as available as cigarettes in a shop.” The Medicine and Healthcare Products Regulatory Agency (MHRA) is looking into approving these devices for use. If it finds in their favour, the government is likely to push for them to be placed prominently in shops alongside tobacco cigarettes, where they would be sold at a cheaper rate. The unit is keen to engage with those critics who believe its analysis and intervention in people’s behaviour is “nanny statism”. David Halpern, the unit’s head, told the Guardian: “As with seatbelts and the smoking ban, these ideas were unpopular at first but after a while when you explain them to people, they understand and say, ‘Yeah, alright then.’ “A year in,” Halpern added, “we’re much more confident about how well this can work, and the early trials have also made us much more confident about public acceptability. There’s no doubt it can save many lives and hundreds of millions of pounds. In fact, our problem has become that we have so many inquiries from across Whitehall, we have to turn down many of the requests for help.” Smoking Health Cancer Health policy Allegra Stratton guardian.co.uk