Advertisement
The PLoS Medicine Debate

The PLoS Medicine Debate The PLOS Medicine Debate discusses important but controversial issues in clinical practice, public health policy, or health in general. Debates will be commissioned from two or more authors with differing points of view.

See all article types »

The Case against a Smoker's License

  • Jeff Collin mail

    jeff.collin@ed.ac.uk

    Affiliation: Global Public Health Unit, School of Social & Political Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom

    X
  • Published: November 13, 2012
  • DOI: 10.1371/journal.pmed.1001343

Reader Comments (1)

Post a new comment on this article

Number one goal should be saving health and lives

Posted by EKeller on 15 Jan 2013 at 14:22 GMT

Driving the opium and coca plant growers out of business hasn't worked. What makes public health think their anti-tobacco industry efforts will work any better?

Pretending that all forms of nicotine consumption are equally hazardous works to perpetuate smoking. Even scientists and medical providers are fooled by the cleverly worded message, "X is not a safe alternative to smoking." They interpret this, as intended, to be saying, "X is not one bit less hazardous than continuing to smoke." It probably is not the intended result, but most smokers go on to reason, "If switching to X won't lower my risks, I might as well keep smoking."

The main reason that smokers can't or won't quit is because they are unwilling or unable to give up the beneficial effects of nicotine such as enhanced concentration, attention and memory, and relief from mood impairments. Scientific research has demonstrated that these are absolute effects, not just relief from withdrawal.

The Royal College of Physicians stated in their 2007 report, "We demonstrate that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved."

"Acceptable and effective as a cigarette substitute" is key. Very few smokers switch to pharmaceutical nicotine products as a substitute. This is partly due to warning on the products to stop using them after 12 weeks. It is also partly due to the false idea that nicotine is the cause of smoking-related diseases. The public health community refuses to do anything to counteract this misinformation. But another major reason this doesn't occur is that the pharmaceutical products don't deliver nicotine effectively. There are low-risk products that do so.

The low rates of smoking, of lung cancer mortality, and of all types of cancer in Sweden demonstrate that switching to Snus has saved many more lives of smokers than all forms of treatment combined. Likewise, two clinical trials on using e-cigarettes as a substitute for smoking have shown high rates of smoking reduction, as well as a 20% cessation rate in cohorts that were unwilling to quit smoking. Surveys of e-cigarette consumers show that 77% of daily users no longer smoke. There is no approved treatment with a success rate anywhere near that high.

After 45 years of smoking and countless failed attempts to quit, in March of 2009 I switched to an electronic cigarette and have remained smoke-free ever since. I have no urges whatsoever to relapse to smoking.

Competing interests declared: I am retired and currently serve in a volunteer capacity as president of The Consumer Advocates for Smoke-free Alternatives Association (CASAA). CASAA works to ensure the availability of effective, affordable, low-risk alternatives to smoking by increasing public awareness of and knowledge about tobacco harm reduction.