Intended for healthcare professionals

Head To Head

Should doctors advocate snus and other nicotine replacements? Yes

BMJ 2008; 336 doi: (Published 14 February 2008) Cite this as: BMJ 2008;336:358
  1. John Britton, professor of epidemiology
  1. 1Clinical Sciences Building, City Hospital, Nottingham NG5 1PB
  1. j.britton{at}

    Use of snus is less harmful than smoking and John Britton thinks that doctors should suggest it to people who are unable to give up cigarettes. But Alexander Macara argues that it could result in increased use of tobacco

    Smoking is the biggest avoidable cause of death and disability,1 and of social inequalities in health,2 in the United Kingdom. Smoking currently kills over 100 000 UK citizens each year,3 predominantly from lung cancer, heart disease, and chronic obstructive pulmonary disease. Half of all lifelong smokers die from smoking, typically losing 10 years of life.4 Non-smokers are victims too. Although smoking is prohibited in public and workplaces throughout the UK, smoking in the home remains an important cause of morbidity and mortality through passive exposure, especially in young children.5 Stopping smoking reverses or prevents progression of these problems.

    Currently, 77% of UK smokers want to give up smoking, and 78% have tried and failed.6 Of the many reasons why they have not succeeded in quitting, the most important is addiction to nicotine. Cigarettes deliver nicotine to the brain rapidly, and …

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