The Great American Smokescreen

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This Thursday, November 19th, marks the 33rd "Great American Smokeout," in which smokers are encouraged to quit, even if only for one day. The goal is to make that Day One in the life of a smoker as a successful ex-smoker.

So how are we doing so far? Not so great. The latest statistics compiled by the CDC show that in 2008 there were still over 45 million addicted smokers in our nation--and worse, the fraction of the adult population who smoked rose slightly to 20.6% from 2007's 19.8%. This slightly reverses the declining trend in smoking rates we have gotten used to, since it was 24.1% in 1998.

The accepted mythology to counter this trend is to praise the "success" of cessation aids approved by the FDA and marketed by various pharmaceutical companies. While this is a big business, it has accomplished little in the way of achieving the ostensible goal--helping addicted smokers quit. Cessation rates, from utilizing any or all of the standard therapies with medical counseling and follow-up, vary from 5% to 25% at one year.

Telling people "quit or die" doesn't seem to be inspiring much quitting. The "harm reduction" alternatives are the unacknowledged stepchildren of the anti-tobacco movement. These include (a) smokeless tobacco, inspired by the impressive quit rates in Sweden, and (b) the potential delivery of "clean nicotine" via the e-cigarette. But any possible remedy that uses tobacco to help smokers quit--and consequently adds to a tobacco company's bottom line--is anathema to anti-tobacco zealots. They ignore the plight of smokers who have tried over and over again to quit and keep relapsing.

The recently enacted "Family Smoking Prevention" law, giving the FDA "authority" over tobacco, has accomplished the following two public health pseudo-breakthroughs:

•banning flavored cigarettes, which are smoked by...almost no one
•formalizing the ban on even discussing harm reduction products (such as snus, moist smokeless tobacco)

It is likely to never accomplish anything significant in terms of reducing the deadly toll of cigarettes, though, and will lend the cigarette industry valuable credibility in the marketplace, and in the courtroom, as an apparently FDA-approved industry. ACSH was opposed to the law from the get-go, and we see no silver lining--no surprise, since the bill was co-written by Philip Morris.

I fear stabilization (or, heaven forbid, an increase) in smoking rates -- until wiser heads prevail and harm reduction eases the path to cessation for smokers.

Gilbert Ross, M.D., is Medical Director of the American Council on Science and Health (