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The future outlined by Clive Bates is one in which public health joins with the pharmaceutical industry to design nicotine delivery devices that deliver the same addictive hit as cigarettes with lower toxicity. Rather than going into business with the pharmaceutical industry to compete with the tobacco industry to deliver nicotine, we should be competing with big tobacco to increase the market share of non-smokers.
While there is nothing wrong with continued legal and regulatory pressure to force the tobacco industry to market less dangerous products, the experience in California shows that it is possible to reduce tobacco consumption rapidly with an aggressive campaign that denormalises the tobacco industry, and promotes the dangers of passive smoking so as to undercut the social acceptability of smoking. The key innovation in the California programme was to speak to thenon-smokers as much or more as the smokers. In the early years, before the programme was cut and toned down, we were on a path towards a 60% reduction in tobacco use in just 10 years.1-4
The fact that the Europeans have chosen to concentrate on trying to regulate the tobacco industry and run traditional quit smoking programmes rather than enlist the non-smokers in the battle for clean indoor air may explain why progress there has been so slow, despite stronger public support for non-smokers' rights in Europe than in the USA 10 years ago.5 6
An aggressive, broad based tobacco control programme that includes everyone—including the non-smokers—could go a long way towards eliminating the problem in 10 years. All that we need is the political will to make it happen.