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Royal College of Physicians: Ending tobacco smoking by 2025

A new report issued today by the Royal College of Physicians says that if the Government was prepared to take far more radical measures to combat smoking, we could practically eradicate smoking in Britain by 2025.

The report "Ending tobacco smoking in Britain: Radical strategies for prevention and harm reduction in nicotine addiction" forms part of the RCP's response to the Department of Health's consultation on the future of tobacco control which closes tomorrow, Monday September 8.

It says that the conventional approaches to preventing smoking that have been implemented in the UK - increasing the cost of cigarettes, advertising bans, smokefree public places and workplaces, health promotion campaigns, cessation programmes - will only deliver a drop in smoking prevalence of between 0.5 and 1.0 percentage points per year.
That means it will take between 11 and 22 years for the smoking rates in England to drop even by half from 22% to 11% - from 10 million to 5 million people.

The report argues that much more could and should be done to make smoking as unappealing and unacceptable as possible, and importantly, to make alternative, less hazardous nicotine products as affordable and attractive as possible. The report therefore calls for the introduction of a wide range of newer and more radical measures on smoked tobacco, existing and new medicinal nicotine products, and non-medicinal smoke-free nicotine products:

  • Smoked tobacco: Make smoking and smoked tobacco products as unappealing, unattractive, unaffordable and unavailable as possible, as quickly as possible. Proposed measures include:
  • Increase the tax on tobacco by 10% every year
  • License tobacco retailers and prohibit the sale of smoked tobacco in premises where children are admitted
  • Crack down on tobacco smuggling, and apply Class A drug penalties for tobacco smuggling and under-age sale
  • Protect children from exposure to smoking role models in the media
  • Existing medicinal nicotine products: To make this product group as available and attractive to smokers as possible, and to encourage smokers to switch as completely as possible to use of medicinal nicotine instead of smoking:
  • Encourage sale of low cost single day nicotine packs, available
  • Encourage and promote commercial competition to make medicinal nicotine attractive and affordable
  • Permanently exempt medicinal nicotine from VAT
  • Provide free medicinal nicotine for all smokers on the NHS, not just those on a smoking cessation programme
  • New medicinal nicotine products: Encourage development and marketing of new medicinal nicotine products that are more acceptable and satisfying alternatives to smoking than current products:
  • Encourage development of products that deliver doses of nicotine as quickly as cigarettes
  • Remove unnecessary restrictions and regulations that currently inhibit development of new, more effective cigarette substitutes
  • Make these products widely available to smokers at competitive prices
  • Non-medicinal smoke-free nicotine products: Realise any benefit that smokeless tobacco and other potential nicotine sources might offer as reduced hazard alternatives to smoking, while minimising the hazard to users by:
  • Allowing restricted marketing of products for which there is evidence of efficacy as a smoking substitute from randomised clinical trials, and for which potential hazard has been
  • Prohibiting the sale of all other non-medicinal nicotine products currently on the market

The report also calls for the establishment of a new Nicotine Regulatory Authority, independent from the tobacco and pharmaceutical industries, to implement these changes, monitor their impact on smoking behaviour, and tasked to reduce the prevalence of smoking as quickly as possible.

Professor John Britton, Chair of the RCP Tobacco Advisory Group, said:
"Smoking is still the biggest public health problem in the UK, and a problem of this magnitude and importance demands radical and effective action to prevent any further avoidable loss of life. Our governments have shown themselves more than willing to react decisively to other public health problems, but despite the progress of the past 10 years, still do not seem willing to take all the actions in their power to prevent children from starting to smoke, or encourage existing smokers to quit. The UK has led the world in many areas of public health in the past; here is our opportunity show the world that tobacco smoking can be driven out of our society."

Professor Ian Gilmore, President of the Royal College of Physicians,
"As a country, we have a real opportunity to build on previous steps, and I believe the public are ready for strong action. They would support bold government in resolute steps to attack what remains the number one threat to the nation's health, smoking."

Notes to Editors

The report is available to download free from the College website
Background information:
The most recent figures suggest that about 22% of adults, or about 10 million people in the UK, are smokers (continues.)

Half of all smokers die as a result of a disease caused by their smoking, typically losing 10 years of life

Smoking currently kills about 87,000 people every year in England, and 104,000 in the UK

Smoking causes more death and disability in the UK, contributes more to social inequalities in health, and places more of a burden on the NHS than any other known avoidable factor

Most smokers start smoking in childhood or young adulthood; once addicted, most will want to quit smoking but succeeding is extremely difficult

Quitting smoking generates health benefits immediately and does more to improve individual health than any other lifestyle measure

Preventing children and young people from starting to smoke is especially difficult while smoking appears to be a normal adult behaviour; international evidence shows that the best way to reduce the uptake of smoking by children is to reduce the prevalence of smoking among adults

Although smokers are addicted to the nicotine in tobacco smoke, nicotine itself is not particularly harmful. It is the other chemicals and particles in tobacco smoke that are responsible for the great majority of the lung cancer and other diseases caused by smoking

While quitting smoking and all nicotine use is the healthiest option for any smoker, switching to an alternative source of nicotine that does not involve inhaling smoke is the next best option.

Using smoke-free nicotine products not only greatly reduces the risk to smokers themselves, it would also prevent exposure of their families, particularly children, to second hand smoke and to smoking role models.

The safest form of nicotine is medicinal or 'pure' nicotine, like that in nicotine replacement therapy products (NRT) such as skin patches and chewing gum. However, few smokers find NRT to be satisfying, as it delivers lower doses of nicotine more slowly than cigarettes. It is also expensive compared to cigarettes.

New products, that mimic the nicotine delivery of cigarettes but do not involve exposure to other toxic chemicals are therefore urgently needed, to give smokers a viable alternative to smoking.

Achieving this, and making existing and new safer nicotine products attractive to smokers will require a radical overhaul to the regulations that currently apply to nicotine products

The report recommends that new, more effective, affordable and acceptable forms of NRT are needed to help smokers quit and provide an alternative to smoking for those not able to give up altogether. It should be made cheaper and more widely available, not just in pharmacies, and more heavily promoted and advertised, not just as an aid to giving up, but as a long-term replacement.

Linda Cuthbertson
PR Manager
Royal College of Physicians
11 St Andrews Place
Regent's Park
London NW1 4LE
Tel: 020 7935 1174 ext.254, 0794 105 7494

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