This is an exciting time to be involved in tobacco control efforts. We have scientifically based tools and strategies that can reduce disease and prolong the productive lives of current tobacco users. We better understand the pressures on young people to take up tobacco use and how to prevent dependence from developing. Thanks to the investigation of the Food and Drug Administration (FDA) in its tobacco rule making effort, and litigation against the industry,1 2 we have fresh insights into how the tobacco industry maximises its deadly effectiveness as a vector to spread the disease of tobacco dependence. These understandings are no less profound or important in efforts to control tobacco caused diseases than is scientifically based knowledge about how to control other global maladies such as malaria, in which understanding the pathogenesis of the disorder led to breakthroughs in how to prevent its spread and treat those afflicted.3 As with malaria, we also are learning that prevention and treatment go best when hand in hand. It is also clear that, as difficult as it is to control the proliferating mosquitoes that spread malaria, controlling the tobacco industry, which spreads tobacco dependence, is even more difficult in many respects because it enjoys many legal protections and enormous political power. But here is the opportunity for managed care to make a difference.

Managed care has the potential to help break the cycle of tobacco dependence, and thereby address the needs of its individual members, while also helping to control the epidemic. But treatment benefits that are not utilised do not improve public health. In this article, I will highlight aspects of the tobacco addiction process that have implications for developing treatment benefits which could make a difference to the health of managed care members and to the health of …