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The US Public Health Service “treating tobacco use and dependence clinical practice guidelines” as a legal standard of care
  1. Randy M Torrijos,
  2. Stanton A Glantz
  1. Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
  1. Correspondence to:
 S A Glantz
 Center for Tobacco Control Research and Education, University of California, 530 Parnassus Avenue, Suite 366, Box 1390, Library, San Francisco, CA 94143-1390, USA; glantz{at}


Background: The important factors in evaluating the role of clinical practice guidelines (CPGs) in medical malpractice litigation have been discussed for several years, but have focused on broad policy implications rather than on a concrete example of how an actual guideline might be evaluated. There are four items that need to be considered in negligence torts: legal duty, a breach of that duty, causal relationship between breach and injury, and damages.

Objective: To identify the arguments related to legal duty.

Results: The Treating Tobacco Use and Dependence (revised 2000) CPG, sponsored by the US Public Health Service, recommends effective and inexpensive treatments for nicotine addiction, the largest preventable cause of death in the US, and can be used as an example to focus on important considerations about the appropriateness of CPGs in the judicial system. Furthermore, the failure of many doctors and hospitals to deal with tobacco use and dependence raises the question of whether this failure could be considered malpractice, given the Public Health Service guideline’s straightforward recommendations, their efficacy in preventing serious disease and cost-effectiveness.

Conclusion: Although each case of medical malpractice depends on a multitude of factors unique to individual cases, a court could have sufficient basis to find that the failure to adequately treat the main cause of preventable disease and death in the US qualifies as a violation of the legal duty that doctors and hospitals owe to patients habituated to tobacco use and dependence.

  • CPG, clinical practice guidelines
  • PHS, Public Health Services

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  • Funding: This work was supported by National Cancer Institute Grant CA-61021. The funder had no role in the conduct of the research or in the preparation or revision of the manuscript.

  • Competing interests: None declared.