Tobacco dependence should be recognised as a lethal non-communicable diseaseBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2204 (Published 21 May 2019) Cite this as: BMJ 2019;365:l2204
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To characterise tobacco dependence as a chronic non-communicable disease makes the matter unnecessarily complicated and is thus unhelpful.
Tobacco dependence (smoking) manifestly is not a disease in the normal sense of the word; it is a voluntary activity, though the urge to smoke may be hard to resist .
The idea that ‘Nicotine physically alters the smoker’s brain, making quitting difficult’ seems to be based on animal studies of dubious relevance to humans. In any case, the main obstacle, as will be evident if one asks open-ended questions to real people who smoke , is not that smokers have difficulty in quitting because their brains have altered, but because they believe themselves unable to quit. Smoking, therefore, is largely a psychological problem  rather than being primarily a physical disorder.
To approach tobacco dependence by ‘encourag[ing] the development of specific disease management programmes…with objective monitoring and continuous assessment…[to] develop and evaluate new treatments,’ as Professors Wan and Xiao propose, is ivory-tower thinking of little practical relevance.
The obvious—indeed, the only—way to solve the smoking problem is to make cigarettes gradually less available and eventually ban them altogether .
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Competing interests: No competing interests