It is undoubtedly true that if an alien from another planet was to sit down with a blank sheet of paper and a pile of evidence-based research on the harmfulness of a range of substances, from heroin to alcohol, and crack cocaine to tobacco, it is very unlikely that they would designate substances as either legal or illegal in the same way as we currently do, if that judgement turned only on the harm the substance causes to its users. In 2006, the United Kingdom's Science and Technology Select Committee published a report on the system of drug classification in the United Kingdom, which they found was not ‘fit for purpose’ (House of Commons Science and Technology Committee, 2006). Since 1971, illegal substances have been ranked as ‘A’ (e.g. heroin, cocaine and ecstasy), ‘B’ (e.g. amphetamines, codeine and barbiturates) or ‘C’ (e.g. cannabis, valium and ketamine). The Select Committee concluded that the question of the ‘harm’ caused by a drug is complicated, and not reducible simply to the physical impact the drug has upon its user's body. One of the most serious risks associated with heroin use, for example, is HIV transmission, but this is caused by sharing needles, rather than by the drug itself. Illegality too creates specific health risks. In order to increase their profitability, drugs sold on the black market are adulterated with bulking agents, some of which are highly toxic (Cole et al., Reference Cole, Jones, McVeigh, Kicman, Qutub Syed and Bellis2010). The social harms caused by the criminal behaviour engaged in by crack cocaine and heroin addicts are the result of their need to fund their habit, rather than the drugs’ biological action.

The Select Committee report also considered how tobacco and alcohol, both legal substances, compared with illegal drugs, in terms of harmfulness. On the basis of a comparative assessment of harm, evidence from Professor Nutt and his colleagues suggested that tobacco and alcohol would be ranked as more harmful than LSD and ecstasy (both Class A drugs).Footnote 1 The Committee also referred to the report of the Independent Inquiry into the Misuse of Drugs Act 1971, chaired by Viscountess Runciman (known as the Runciman report), which stated that, on the basis of harm, ‘alcohol would be classed as B bordering on A, whereas cigarettes would probably be in the borderline between B and C’ (Police Foundation, 2000). In their evidence to the Select Committee, the Transform Drug Policy Foundation estimated that together tobacco and alcohol cause ‘approximately 40 times the total number of deaths from all illegal drugs combined’.Footnote 2

It is clearly right, therefore, to point out that there is some inconsistency in our classification of substances as lawful or unlawful, and that our alien from another planet might make other choices about which substances should be freely available in corner shops and supermarkets, and which should be criminalised. We are not, however, starting from scratch, and when designing legislation intended to minimise harm, it is impossible to ignore the social and cultural history of alcohol and tobacco use.

While the Runciman report found that alcohol was significantly more harmful than tobacco, it has been suggested that, in small doses, alcohol is not harmful and may even be beneficial in some circumstances. Many people enjoy alcohol occasionally and harmlessly, and it is the misuse of alcohol, rather than its moderate consumption, which causes substantial physical and social harms. In relation to tobacco, however, there is no ‘safe’ or ‘beneficial’ dosage. From a public health perspective, it is therefore important to work out what measures might be likely to be most successful in progressively reducing and ultimately, ideally, eliminating consumption of tobacco.

The authors of ‘Tobacco: A product like any other’ argue in favour of the criminalisation of tobacco sales. Importantly, they do not want to criminalise users of tobacco, who – if addicted – would still be able to smoke. But tobacco manufacturers should, in their view, be penalised for supplying what is essentially an unsafe and dangerous product.

Recent history of prohibition – most obviously of the supply of alcohol in the United States in the 1920s and 1930s – does not indicate that it is overwhelmingly successful in reducing consumption. Indeed, in relation to illegal drugs, there are grounds for thinking that the real harms caused by drugs like heroin result more from their illegality than from the chemical substance itself, and many people have argued that the legalisation of class A drugs might be a sensible public health strategy (Boseley, Reference Boseley2010; Rolles, Reference Rolles2010).

And while the authors are right that tobacco is harmful to its users, so are many other freely available substances, including alcohol, trans-fats and the huge quantities of sugar and salt in processed and fast-foods. People who smoke are at increased risk of a range of illnesses, but so are people who live on junk food. If we are going to prohibit the supply of one harmful substance, why not these others?

The authors also suggest that consumers of tobacco are addicted and therefore unable to make decisions about smoking for themselves, yet is it really that simple? There are people who claim to enjoy smoking, and we know that for people with certain mental health problems, smoking does provide some sort of relief or perceived benefit.

Nonetheless, the authors are clearly right that it has proved exceptionally difficult to curb the promotional activities of the tobacco industry. Their capacity to find ways around restrictions, or to find new ways to promote their products, is astonishing. It might, for example, be thought that counterfeit cigarettes pose a risk to their dominance in the marketplace, but in reality, tobacco companies benefit enormously from the supply of, for example, fake ‘Marlboro’ cigarettes, since these packets help to introduce the ‘brand’ to new markets.

The WHO's framework convention on tobacco use advocates a number of measures – such as accessible nicotine cessation services and bans on advertising – intended to address the public health dangers of tobacco use.Footnote 3 The best long-term solution would clearly be to eliminate the desire to smoke, and to make smoking socially unacceptable, as has happened fairly effectively with drink driving. If demand continues to exist, people will find ways to access cigarettes, even if that has to be done on the black market, rather than in their local corner shop. Illegality could even give smoking additional kudos with the young and the impressionable. In short, it is demand for cigarettes that needs to be tackled, rather than supply. The widespread prohibition on smoking in public spaces has the long-term health goal of making smoking so socially awkward and inconvenient that people will be deterred from starting in the first place. Criminalising the suppliers of tobacco is a thought-provoking and interesting idea, but unless it is implemented simultaneously throughout the world, people will find ways to import cigarettes from countries where supply continues to be lawful. And the danger of criminalising is the development of a black market in supply. Past experience with illegal drugs suggests that criminalisation does not stop consumption; it simply makes it more dangerous, both to the users themselves and to society as a whole.