Tobacco should be made illegal and the possession of cigarettes a crime in order to curb the menace of smoking, a leading medical journal will say today.
In an attempt to drive the lethal habit to extinction, The Lancet calls on the Government to ban tobacco to save the lives of hundreds of thousands of people.
It is the most radical demand yet made by the medical profession on tobacco, and comes only a week after the 13 royal medical colleges called for a ban on smoking in public places.
The British Medical Association yesterday published a draft bill to ban smoking in public and appealed to MPs successful in the ballot for private members bills to back it.
However, The Lancet's proposal for tobacco to be outlawed was greeted with scepticism by campaigners yesterday and ridiculed by the tobacco lobby which said it revealed the "true voice of the rabid anti-smoking zealot."
In an editorial headlined "How do you sleep at night, Mr Blair?", The Lancet says a ban on smoking in public would be a start but that it is "missing the point." The availability and acceptability of smoking is far more significant.
"If tobacco were an illegal substance, possession of cigarettes would become a crime, and the number of smokers would drastically fall.
"Cigarette smoking is a dangerous addiction. We should be doing a great deal more to prevent this disease and to help its victims. We call on Tony Blair's government to ban tobacco," it says.
Simon Clark, director of Freedom Organisation for the Right to Enjoy Smoking Tobacco (Forest) said the editorial was laughable and The Lancet had scored "a stunning own goal ."
He added: "Smokers are not victims nor should they be treated as criminals. Like it or not people choose to smoke just as they choose to drink alcohol and eat certain foods or take part in extreme sports. Do we ban everything that is potentially dangerous and turn the practitioners into social outcasts?"
The pressure group Action on Smoking and Health (Ash) said there were 13 million smokers in Britain, 26 per cent of the population, who would be criminalised by the proposed law.
Amanda Sandford of Ash said: "Tobacco has been legally acceptable for more than 100 years and unfortunately it became widely used before it was understood what damage it caused. We can't turn the clock back. If tobacco were banned we would have 13 million people desperately craving a drug that they would not be able to get. It is ludicrous."
Astrid James, deputy editor of The Lancet, defended the editorial on the grounds that smoking was a major cause of disease and its role could not be ignored by doctors. "A huge number of papers we see here are about smoking-related disease so as a medical journal we felt we had to take it further."
Smoking had fallen steadily from the end of the second world war until the mid-1990s.
Every effort to reduce it further had failed. Measures such as increasing the price of cigarettes and imposing restrictions on smoking at work and in public had not worked, Dr James said.
"I disagree that [banning tobacco] is hopelessly impractical. Any government can push through changes where there is a clear public health argument - such as on seat belts. It is taking the nanny state further but the public health gains are clear." The Royal College of Physicians, which led the coalition of royal medical colleges in its call for a ban on smoking in public last week, rejected The Lancet's demands but praised its motives.
Professor John Britton, chairman of the college's tobacco advisory group, said: "A ban on tobacco would be a nightmare."
But he added: "What I applaud is that they have recognised that a health problem as big as that caused by tobacco needs a radical solution and we need a government that is prepared to face up to that."
A ban on smoking in public, including restaurants and bars, was the first step and a Nicotine and Tobacco Regulatory Authority to introduce new ways of delivering nicotine was the next he explained.
Bans on smoking in public have been, or are being introduced in countries round the world. Ireland is to go smoke-free from 16 February 2004, following the lead of New York and California. Norway is to introduce a ban in the Spring with New Zealand to follow suit next year.
Nicotine inhalers and other devices should, under new regulations, be sold alongside cigarettes, instead of in pharmacies as medicines.
Professor Britton said: "There is a hard core of about four million smokers who say they do not want to give up. They need a safer way of taking nicotine.
"But you can't go into a pub, put coins in a vending machine and get a nicotine inhaler out. It is a ridiculous restriction."
THE HABIT THAT KILLS 120,000 PEOPLE A YEAR
Smoking causes 120,000 deaths a year in the UK and 364,000 hospital admissions in England. Smoking-related illness accounts for 8 million consultations and 7 million prescriptions. Half of all smokers die from the habit if they continue to smoke.
The Government earned £9.6bn in tax revenue on tobacco in 2000. The cost to the NHS of smoking-related disease was £1.5bn and the amount spent on helping smokers to quit was £138m. There were 5,043 people employed in tobacco manufacturing in 2000.
Three million workers are forced to breathe other people's smoke when they go to work. Fewer than 20 pubs in England are smoke-free, but 73 per cent of people are non-smokers and 50 per cent think smoking in pubs should be restricted. A review of 100 studies showed no negative impact of smoke-free policies on the hospitality industry.
It is illegal to sell tobacco or cigarettes to children under 16. Cigarette advertising has been banned on TV since 1965, and all tobacco advertising was banned this year. Cigarette packs must carry health warnings and there is an upper limit for the tar, nicotine and carbon monoxide content.
New York and California have banned smoking in public places. Ireland, Norway and New Zealand are introducing similar bans in 2004. Smoking restrictions in the workplace have been established in Australia, Canada and Hong Kong.