We have become somewhat numb to the fact that 440,000 Americans a year die from a preventable cause – cigarette smoking. That’s 1,200 deaths per day. Use whatever analogy you want -- 48 Amtrak accidents per day where 25 die, 3 fully loaded jumbo jets crashing daily with all lost – you name it. It is a lot of lives tragically lost. The U.S. is not alone in this loss of life. It happens world-wide, every day.

A new report issued by the Royal College of Physicians proposes “radical measures” to eradicate smoking in Britain by 2025. Some of their proposal makes sense, but some of it is weak on science and could be called short-sighted.

Measures that make sense and have been implemented in parts of the U.S. with considerable success include:

Increasing tax on cigarettes
Restricting smoking in premises where children are admitted (indoor smoke-free policy)

Ideas that deserve action, but have received little or no attention due to outdated FDA regulation or lack of initiative by the pharmaceutical industry include:industry include:

Encouraging sale of low cost single day nicotine replacement, like nicotine patches, nicotine gum, and nicotine lozenges. It is utterly silly, even perverse, and just one example of how outdated the U.S. FDA is in their policy, that these safe products are restricted while nicotine in its most deadly form is completely unregulated.
Developing nicotine replacement products that deliver nicotine much more quickly than current products do – as quickly as cigarettes. In their simplest form, cigarettes are a nicotine delivery system, and a highly effective one. The problem is that they deliver thousands of chemicals and carcinogens with the nicotine. If nicotine could be delivered as quickly as it is via a cigarette, but without the chemicals and carcinogens, then smokers might be willing to give them up – willingly.

But some of the recommendations are questionable. One smacks of prohibition (Crack down on tobacco smuggling, and apply Class A drug penalties for tobacco smuggling and under-age sale) or the U.S. war on drugs policy that has done nothing to reduce drug use but has put the U.S. in the unenviable position of having the highest percentage of its population in prison among all developed nations. Don’t get me wrong. Cigarette smuggling and sales to children are real problems, I would question whether this is the right approach.

Another recommendation of “realizing the reduced risk from smokeless tobacco” is also getting a fair amount of attention in the U.S. Some U.S. tobacco control experts are strongly in favor, some are not, and many are on the fence, and with good reason. While use of spit tobacco is not associated with two major causes of illness and death that are associated with smoking, (emphysema and lung cancer), there are many unanswered questions. Among these is what the public health implications would be of wholesale transition of smokers to spit tobacco. We just don’t know, and until we do, it is irresponsible to promote it. Another question is how to message such a policy. Some are convinced this policy would not undermine promotion of tobacco dependence treatment, but many are not convinced. More research is needed.

My hat is off to the Royal Academy of Physicians. They are thinking outside the box, and that is what it will take to put a serious dent in the loss of life due to cigarette smoking.