Hunter College epidemiologist Philip Alcabes has an op-ed in the Washington Post arguing against an "abstinence only" approach to nicotine. "Like other abstinence campaigns (alcohol prohibition, sexual abstinence before marriage, just saying 'no' to drugs), this one is both moralistic and ineffective," he argues. Instead Alcabes suggests public health advocates should be willing to promote alternative, less-harmful means for people to get their nicotine fix.

Obviously, nicotine use is a popular and tenacious habit. Equally obviously, tobacco policy is a failure. Surveys show that a majority of current smokers would like good alternatives to smoking as ways of getting nicotine. But we will not tell nicotine users that there are safe ways to continue to use the legal drug they crave. Apparently, our policymakers would rather see those people get sick and die.

Smokeless tobacco is hardly a "safe" alternative to cigarettes, but it is "safer," in that it poses a lesser risk of cancer and other health problems. (Nicotine patches and gum work for some, but not for all.)

If the aim is to reduce tobacco-related deaths, why not inform smokers of this fact? One possible argument is that this knowledge could encourage some people to use smokeless tobacco who otherwise would have given up tobacco use altogether. Perhaps, but given the enormous death toll from cigarettes, I find this argument unconvincing. To the contrary, if smokeless tobacco companies had the guts to promote the comparative health "benefits" of their products over cigarettes, I am inclined to think the net public health benefit would be quite substantial.

Perhaps even more provocatively, Alcbes suggests public health professionals should take a second look at so-called "social smoking":

And then there's what many smokers nowadays really do: Mix periods of abstinence (encouraged by smoke-free workplaces and restaurants) with periods of light smoking. Mixing light or occasional smoking with other nicotine-delivery products might be even safer -- but it can't be studied as a possible alternative because current funding goes only to research on how to quit smoking, not on finding a safe level of smoking.

If the aim is to improve public health, this mindset should change.