Should be recognised as the central problem of smoking

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Last week the Royal College of Physicians of London published its latest report on smoking,1 the sixth since 1962. It reminds us that almost 40 years after the first report smoking cigarettes remains the single largest cause of premature disability and death in the United Kingdom. Moreover, smoking prevalence has stabilised at one in four of the adult population, with much higher levels in deprived sections of society. This greatest of all health problems refuses to go away. What is new is the report's emphasis on nicotine as an addictive substance and the actions that should flow from that recognition.

The central theme of the report, refined across 200 pages of lucid, carefully researched text, is that cigarette smoking should be understood first and foremost as a manifestation of nicotine addiction. Nicotine is as addictive as “hard” drugs such as heroin. Smokers usually start the habit as children, are addicted to nicotine by the time they are adults, and thereafter the choice to stop becomes an illusion. Thus, although two thirds of smokers want to quit, and about a third try each year, only 2% succeed.

The modern cigarette, developed and …