Leading Article: Save smokers from themselves

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Given the harm that smoking is known to do to people's health, why are smokers not offered something safer than tobacco? Something that would satisfy their craving for nicotine and in the process save some, even most, of the one billion lives that smoking is expected to cost globally this century?

That, in essence, is the message of today's report from the Royal College of Physicians. Tobacco kills, not nicotine, and though nicotine is highly addictive, it is relatively harmless. Efforts to reduce smoking have been helped by the recent ban on smoking in public, but they are still progressing painfully slowly: rates are falling at 0.4 per cent a year. On present trends, millions of British smokers are destined to die for want of a decent cigarette substitute.

Yet the market is weighted against the development of such a product. While the manufacturers of medicinal nicotine – the safe kind that is presented in gums, patches and inhalers designed to wean people off smoking – are hidebound by regulation and forced to jump through all manner of bureaucratic hoops to get their products on the market, the makers of the unsafe kind of nicotine, the cigarette manufacturers, suffer fewer restrictions and have a freer rein to do as they like.

This unbalanced market has stifled innovation in the area of nicotine substitutes. Tobacco companies have toyed for decades with the idea of a safer cigarette, but no usable product has emerged in the past 50 years. The makers of medicinal products have an opportunity here, and a more benign regulatory regime should certainly help.

Is it possible to devise a workable substitute for a cigarette? Nicotine inhalers produced in the past decade, designed to look chic like the cigarette holders of 70 years ago, were reputed to be so hard to draw on that they induced hernias in their hapless users.

With a little application of modern technology and expertise these may be improved. But it is by no means certain that any device can be developed that delivers nicotine as effectively as burning tobacco. Unless it delivers the hit that smokers crave, it will fail.

If a usable substitute can be developed, this will raise questions of its own. While anything that reduces the harm of smoking is to be welcomed, there is a risk that such a product could actually increase harm. Smokers, for instance, might choose to use it where they are not permitted to smoke tobacco – in public places, for example – thus remaining hooked and continuing to buy cigarettes.

The college's proposal is a bold one. But it will need clever science and careful monitoring if it is to deliver the promised benefits.