When will everything change?

If tobacco control has an iconic characterisation of cigarette smoking, it is surely Michael Russell’s 1976 statement that ‘People smoke for nicotine but they die from the tar’.1 The statement suggests either providing smokers with satisfying levels of nicotine but with greatly reduced tar (Russell’s proposal) or, somewhat ironically (but no less logically), the opposite: ignoring the tar but reducing nicotine to non-addicting levels.

Four decades later, entrepreneurs are offering smokers a high-tech version of the first approach in the form of electronic cigarettes and heat-not-burn (HnB) tobacco ‘sticks’. These novel products deliver satisfying levels of nicotine (at least satisfying for some smokers), while yielding many fewer chemicals than does combusted tobacco.2 The devices’ ultimate health effects are unknown and possibly unknowable, reflecting the decades required to accumulate sufficient evidence, constant product evolution and multiple patterns of use. But the new products’ dramatically reduced yields of toxins…

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