Key points

• Many smokers try to reduce the harm from smoking by cutting down or switching to “low tar” products

• No evidence exists that cutting down or switching to low tar products substantially reduces health risks

• Cutting down on cigarettes with concomitant use of NRT could be a more promising strategy

• Switching to smokeless tobacco should substantially reduce adverse effects from tobacco use, but in many countries its use is illegal

• Switching to pharmaceutical nicotine would substantially reduce harm, but NRT products are licensed as cessation aids, not as substitutes, and smokers tend to find them less satisfying than cigarettes

• The regulatory framework in many countries, including Britain, discourages the development of nicotine products that are less harmful than cigarettes