Tob Control 21:287-288 doi:10.1136/tc.2010.040865
  • Endgame visions

The need for new strategies to combat the epidemic of smoking-related harm

  1. Ron Borland
  1. Correspondence to Ron Borland, Nigel Gray Distinguished Fellow in Cancer Prevention, The Cancer Council Victoria, 1 Rathdowne Street, Carlton VIC 3053, Australia; ron.borland{at}
  • Received 16 March 2011
  • Accepted 2 August 2011

In 2003, I published a paper in this journal1 arguing for the consideration of a regulated market model (RMM) for tobacco, a mechanism by which the mass marketing, but not manufacture, of tobacco products would be taken out of the hands of for-profit companies and given to an agency with a harm reduction charter. This agency would determine what was sold and under what conditions, and retailers would effectively become its agents.

In that time, nobody has identified any conceptual flaw in the model. The arguments against it are that it would not happen (true if no-one argues for it), that regulation is anathema to governments, that it would put government in the embarrassing position of selling harmful products (the paper suggested government control of the agency but that is not essential), that the proposal lacks advocacy appeal as it is a mechanism rather than a solution, and that to pursue it would divert limited energy from more conventional solutions.2 This critique assumes that we will be able to achieve everything we want with the continuation and expansion of current strategies, something I doubt.3 4

The paper had some effects. It was a stimulus to Callard and colleagues5 6 to develop a model which would operate outside of government control and was among the first of what is now a steady stream of thinking about endgame solutions.7–12 The big questions are whether radical solutions are required for the tobacco problem and whether …

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