Treatment Regulation in Promoting Tobacco Control

To the Editor: The Commentary on global regulatory strategies for tobacco control by Mr Gostin¹ included most of the accepted regulatory options to promote tobacco control but failed to include one of the most important: treatment regulation.

Several of the actions suggested in the Commentary have been shown to motivate smokers to attempt to quit, but there is little evidence that these actions help smokers stop once they have tried to quit. If smokers only needed to be motivated, then treatment would not be necessary. However, if smokers are dependent on nicotine, then ignoring treatment does not make sense (imagine a global program to treat alcoholism that did not include a treatment component).

In addition, with more than 150 randomized controlled trials validating smoking cessation treatments,² increasing access to treatment is a much more scientifically based regulatory strategy than most strategies proposed by Gostin (with the exception of taxation).^{3 - 4} Helping adults stop smoking provides countries with health savings in the next decade, whereas preventing young people from starting smoking realizes savings only 30 to 40 years later.⁵ This is an especially important distinction to make in developing countries, which must focus on immediate gains.

Examples of possible treatment regulatory strategies include training clinicians, decreasing the cost of treatments, making treatments easy to access (eg, over-the-counter medications), decreasing restrictions on the use of medication treatments (eg, not requiring attendance at counseling), and making it easier to develop and market medications for smoking cessation so they can compete with tobacco products.