Intended for healthcare professionals

Rapid response to:


New appointment to drug advisory body sparks controversy

BMJ 2011; 342 doi: (Published 31 January 2011) Cite this as: BMJ 2011;342:d624

Rapid Response:

Harm reduction, evidence and philosophy

The approach of 'harm reduction' is clearly popular among
professionals and this itself has generated a certain amount of evidence
for its effectiveness. Indeed prior to more recent studies it was
demonstrated by perhaps the greatest social experiment in this area, the
prohibition of sale of alcohol in the United States that legal
restrictions can cause as many problems as they solve.

However it is equally apparent both from the critics and the
defenders of Dr Raabe that political and philosophical views are also at
work here. Whether or not 'harm reduction' can be effective is not the
only factor. People are also, reasonably concerned about rewarding certain
pattens of behaviour or about being complicit in behaviour. If the state
supplies a drug which does harm it has a direct responsibility in the way
that is not true where people take drugs despite advice - just as
manufacturers have responsibility for the harm done by their products, but
only incidentally for the harm done because of products produces by

Friends of mine in Scotland sometimes complain to me that people with
a Southern English accent do not realise that they have an accent. They
claim to speak plain unaccented English! Similarly there are some people
who seem to believe that while other people operate from philosophical or
political motives they themselves are concerned purely by the 'evidence'.
This may be a useful rhetorical stategy, as it may be rhetorically useful
to mention one's opponent's religion, but it is naive to think that the
arbiters of evidence (on whichever side of the argument) are not subject
to their own philosophical and political motives.

In the meantime I look forward to the application of these principles
to tabacco and for a campaign for addicted smokers to receive free low tar
cigarettes and special rooms to smoke them in.

Competing interests: No competing interests

08 February 2011
David A. Jones
Anscombe Bieothics Centre, Oxford