Estimates of mortality from tobacco are mind boggling even at the local level—telling a politician that a hundred of his or her potential voters will go to an early grave this year just because they smoked can be a very effective way of making them take the issue seriously. But at national level, even modest estimates are so large it is not surprising that politicians and the public find it difficult to comprehend the true scale of avoidable disease and early deaths caused by tobacco use. Move on to the global scale and the World Health Organization estimates by Peto and Lopez (two to three million per annum now, reaching 10 million sometime in the 2020s) are so vast as to be like the cause—breathtaking.

Now Professor Sir Richard Peto of Oxford University, UK, has gone still higher. Reviewing global mortality in the past century, which saw the establishment and rapid spread of cigarette smoking and the massive burden of disease that follows it, and looking forward over the next century on the assumption that current trends in consumption are maintained, his calculations have reached a near unthinkable level. For the two centuries combined, the addictive, lethal products of an industry that lied and cheated to avoid regulation, which now exposed, assures us it has changed while continuing to push them ever more outrageously, and to obfuscate about disease, will kill in total one billion human beings. As Peto modestly points out, when you have one billion deaths to deal with, you can do quite a lot by even moderate changes.