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Smoking, No, Nicotine, Maybe

The diminishing returns of the anti-tobacco ­campaign.

Feb 27, 2012, Vol. 17, No. 23 • By ELI LEHRER
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Unless the United States seriously wants to legislate an all-out tobacco prohibition, the easy public health victories achieved by reducing smoking (prevalence has fallen by almost half since the surgeon general issued the first stern warnings about it in the early 1960s) may have mostly been won, as the “hard core” smokers find themselves unable to quit and thus go to their graves sucking on cancer sticks.

Thus, for at least some people, some of the time, less harmful ways to get nicotine deserve attention from public health authorities. Anecdotal evidence shows that it might work. The country with the lowest smoking-related cancer and cigarette smoking rates for men in the Western world, Sweden, also has the highest rates of smokeless tobacco use. People who use snus, nicotine gum, or lozenges as a replacement for cigarettes, likewise, see many of the same short-term positive health benefits as those who quit tobacco use altogether. (Longer-term trends look promising, too, but, as with any public health issue, the data are incomplete.)

Public health strategies that continue to discourage smoking while accepting and, in certain cases, even promoting the use of other tobacco or nicotine products deserve a try. In fact, Rodu and some others are trying just this in Owensboro, Kentucky. (Results won’t be available for a few years.) Absent significant evidence to the contrary, efforts that ban the use of all tobacco/nicotine products—particularly those that appear less harmful than cigarettes—may well do more harm than good. 

Public health should never promote tobacco use for those who don’t already use it, but it should be welcoming to the idea that some forms of tobacco are less harmful than others. Americans will never stop smoking altogether, and truly safe tobacco use is impossible. But strategies that try to direct smokers towards less harmful alternatives could save lives.

Eli Lehrer is vice president of the Heartland Institute.

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