The development and promotion of safe, effective and affordable smoking substitutes should be pushed up the agenda of public health policy, many now argue. Smoking substitutes have the ability to deliver nicotine to the smoker in a relatively safe way. It would be mad and irresponsible to ignore the huge benefits that smoking substitutes give at the expense of pursuing an evangelical crusade against nicotine addiction.

Millions have been spent over the years by governments and anti smoking lobbies on stop-smoking campaigns in order to reduce the number of people smoking. Although these efforts have not been wholly ineffective, today the rate of decline has slowed to only 0.4% per year.

The harmful effect of smoking is beyond debate: the premature death rate for smokers is 50%. In the 20th century around 100 million smokers died prematurely and in the current one nearly 1 billion are expected to share that fate. Successive administrations have persevered with the same approach to tackle the problem: persuade the young not to start smoking, and those who already smoke, to give it up.
Now some people are advocating a radically different approach: the aim is to save smokers' lives from the damaging effects of inhaling the tobacco smoke that delivers the nicotine. If smokers could be persuaded to switch to safer nicotine delivery devices, or "smoking substitutes", then that would surely be a worth-while outcome.

Why do smokers smoke? Smokers smoke because they cannot do without the nicotine. Yet it is not the nicotine in the cigarette smoke that kills, but rather the myriad of other poisonous chemicals that are also inhaled when smoking. Many smokers are simply unable to quit and it is these people who require smoking substitutes that, while satisfying their cravings, do not at the same time kill them.
There are of course a number of smoking substitutes on the market today, such as NiQuitin nicotine patches and Nicorette nicotine gum. Their effectiveness is debatable as they supply a steady, low dosage of nicotine over a long period, where what the smoker really desires is an instant hit of nicotine. These products were conceived with the morally loftier aim of making people stop smoking altogether over time. The smoking substitutes approach admits that nicotine addiction is in fact endemic in many people and simply searches for a safer means of satisfying that addiction.

Many now argue that in order to seriously dent the tobacco-related mortality rate in populations decent smoking substitutes have to be invented and marketed. So what, they say, if the result were that millions of people ended up addicted to alternative nicotine delivery devices. Arguably more people are already addicted to caffeine and it is not like that is in the least bit controversial.

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