Intended for healthcare professionals

Rapid response to:

Medical Milestones

Risks of smoking: all done and dusted

BMJ 2007; 334 doi: (Published 04 January 2007) Cite this as: BMJ 2007;334:s16

Rapid Response:

Recent recommendations endanger progress of tobacco control

It is dangerous to make readers believe that the war against smoking
is won already [1] and disregard that the tobacco cartel might strike back
with new weapons, even in countries where tobacco control is most
advanced. If researchers in California think that they need new forms of
harm reduction for their leftover of hardcore smokers, they
unintentionally help the tobacco industry worldwide by promoting another
"light” cigarette.[2] Of course pure nicotine is to be preferred before
smokeless tobacco as a cessation aid, however, one of the problematic
recommendations given recently [3] was that smoking may be continued while
using nicotine replacement therapy (NRT), thus promoting dependence to
cigarettes plus NRT. Also advertising for other nicotine products such as
Ruyan, Nicstic or Aeros (R) switched from helping cessation to continuous
use where smoking is forbidden: "use nicotine everywhere and anytime".
Clearly the aim is not cessation anymore but the contrary: Help the smoker
to stay addicted, prevent quitting for reasons of smokefree workplace,

There is a simple rule in tobacco control: distrust any idea which is
supported by ‘Big Tobacco’. As we all observe that tobacco industries are
not fighting seriously the competition of other nicotine products, we have
to assume that diversification of these products and their placement on
the free market is in fact in their interests. The
simultaneous use of cigarettes and NRT (as recommended for "reduced
smoking") prevents the cessation of smoking as well as the cessation of
NRT use after some months and will help to make the smoker a lifelong
consumer of both products. The advertising of "harmless" nicotine will
promote oral nicotine as a gateway drug to smoking for young people.

Products like Ruyan which look like cigarettes will undermine the control
of smoking bans and make it impossible to denormalize smoking in public.
Doubtless the influence of ‘Big Pharma’ on doctors, pharmacists, other
health professionals and medical journals is much higher than the
influence of ‘Big Tobacco’ which would have the highest profit from a
cooperation aiming to normalize nicotine addiction in the general

Rejoicing in World Health Organization's Framework Convention on
Tobacco Control must not make us forget that there are no sanctions for
violation in this treaty such as for violating a treaty of the World Trade
Organization. In fact smoking is on the rise, especially in developing
countries, women and young people. Following the logic of free market
strategies we have to assume that the spread of nicotine addiction will be
accelerated by so called "harm reduction" nicotine products.


[1] Chapman S. Risks of smoking: all done and dusted. BMJ 2007;334:s16,

[2] Benowitz NL, Jacob P III, Herreraa B. Nicotine intake and dose
response when smoking reduced–nicotine content cigarettes. Clinical
Pharmacology & Therapeutics 2006;80:703-714.

[3] Action on Smoking and Health (U.K.). Guidance for health professionals
on changes in the licensing arrangements for nicotine replacement therapy.
Dez. 2005.

Competing interests:
None declared

Competing interests: No competing interests

10 January 2007
Manfred Neuberger
professor of preventive medicine at the Medical University of Vienna
Center of Public Health, Institute of Environmental Health, Kinderspitalgasse 15, A-1095 Wien