When a treatment recommendation is promulgated for a particular condition, clinicians must ask whether the recommendation should be applied universally or whether there are patients for whom the treatment should be withheld or modified. Two articles in this issue of JAMA1,2 address this question with regard to tobacco use: should some smokers not be encouraged and helped to quit? This is an important issue, because about half of smokers will die prematurely from a disease that is directly caused by their smoking.3 Thus, withholding smoking cessation treatment may have serious consequences.
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