Book: Tobacco: Science, Policy and Public Health
Authors: Simon Chapman
Journal: BMJ (2005)

In this digital age, when almost anything can be “Googled” and medical abstracts can be downloaded from PubMed to your desk in a nanosecond, why bother producing an 800 page doorstopper with syntheses of 44 topics written by the glitterati of the tobacco research and policy world? As we drown in information, such books can be liferafts of sanity. Aggregators and distillers of information at the peak of their fields do us all a service, as do those who have the patience to compile convenient collections like this one.​one.




Figure 1



Eds Peter Boyle, Nigel Gray, Jack Henningfield, John Seffrin, Witold Zatonski

Oxford University Press, £69.50, pp 830 ISBN 0 19 852687 3

Rating: ★★★⋆




Four decades of reports from US surgeons general have given us encyclopaedic single issue volumes on different aspects of the tobacco problem, with regular omnibus overviews such as the latest volume published last year. This book is often in that class, with US doyens handling most of the reviews of tobacco chemistry, addiction, and product design, while the chapters on diseases caused by tobacco use are dominated by European authors. Most of the book comprises reviews of smoking and disease (12 contributions on different cancers, for example) and addiction and cigarette engineering (six chapters), with useful pieces on the history of tobacco related disease epidemiology and the contribution of smoking restrictions to declining consumption.

In a field that now draws on disciplines as diverse as neuroscience, agricultural economics, and political science, some unevenness is inevitable. There are chapters on tobacco consumption in China, India, the United Kingdom, Poland, and Africa but none on the United States; nor, conspicuously, does the book offer a global overview of consumption or forecasts. It has useful treatments of two of the most beguiling developments in tobacco control: harm reduction through product modification, and the increase in understanding of genetic susceptibility to both smoking behaviour and disease, although the second topic avoids engaging with the tortuous policy implications that will arise.

The tobacco industry has invested billions over 30 years to try to maximise the addictiveness of nicotine while reducing the unfortunate propensity of its products to kill many of its best customers, sometimes decades early. No doubt remains that the industry can greatly reduce the carcinogenic load of cigarettes, but there is much heated debate about how significant this will be in reducing numbers of deaths from smoking related cancer. The contributions here mostly advance a lucid case for harm reduction.

It is disappointing that the book offers no analysis of the implications of the tobacco industry's forced rebirthing after having to publicly swallow truth serum in the form of revelations from publication of its own documents. Nor is there any chapter on the challenge to drag the industry to the regulation table and out of its law-unto-itself status. The historic United Nations frame-work convention on tobacco control gets fleeting mention.