It is now more than 60 years since the British scientist Richard Doll first proved, beyond doubt, that tobacco kills. Since then, governments and agencies all over the world have attempted to regulate, control, tax and, in a few cases, ban a product that killed more people in the 20th century than all that era s wars combined, and which the World Health Organization predicts will claim the lives of a billion more in the 21st.

Now, regulatory authorities are wrestling with what is, in many ways, more a philosophical than a medical dilemma How do you deal with a new product that is as addictive as cigarettes, and which may do some harm, yet could also free millions of smokers from a far more lethal habit?

Smoking rate edges down to 18% in U.S., but still hovers at 20% for younger adults

Fewer American adults are smoking, a new U.S. government report says.

Last year, about 18% of adults participating in a U.S. national health survey described themselves as current smokers.

The U.S. smoking rate generally has been falling for decades, but had seemed to stall at around 20% to 21% for about seven years. In 2011, the rate fell to 19%, but that might have been a statistical blip.

Health officials are analyzing the 2012 findings and have not yet concluded why the rate dropped, a spokesman for the U.S. Centers for Disease Control and Prevention said. The CDC released its study Tuesday.

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The impasse comes due to a range of products that are flooding the market, all designed to reduce the harm done by nicotine addiction. Some are well established, such as the chewing gums and patches that are sold as quitting aids. But some are new notably electronic cigarettes, which deliver a puff of vaporized nicotine. It is these e cigarettes, used by an estimated 1.3 million Britons, who spend $160 million a year on them, that have sent lawmakers scurrying to catch up with changing technology.

Perhaps inevitably, the bureaucrats appear to be moving in Europe at least in the direction of greater regulation.

A review of the EU Tobacco Products Directive currently under way looks set to reclassify e cigarettes as a “medicinal” product. This would mean that, when it comes into effect in 2016, e cigarettes will effectively be banned across the Continent, since in most countries they will have to jump through the same hoops as any new drug including expensive three stage clinical trials.

European Union rules, however, mean that interpretation and implementation of the policy will be devolved to the governments of the nation states. While countries including France and Germany are set to effectively ban e cigarettes, in the U.K. the Medicines and Healthcare Products Regulatory Agency (MHRA) looks set to impose a more lenient series of controls, which will mean that while some basic safety guidelines for e cigarettes will have to be met after 2016 along the lines of those already in place for other tobacco substitutes such as nicotine patches there will be no ban, and no requirement for full clinical trials.

According to Dr. Chris Proctor, the chief scientific officer of British American Tobacco which, like other tobacco giants, is developing its own cigarette replacement products any move effectively to ban e cigarettes would be madness.

“It is clear that smoking is extraordinarily dangerous it causes heart disease, lung cancer and it needs to be extraordinarily well regulated,” he says. But, he adds, “these replacements are being more strongly regulated than tobacco.”

Proctor points out that in the U.K., about 18% 20% of the population continues to smoke. Public policy should therefore be encouraging them to move to less harmful nicotine products, rather than deterring them.

The scientific evidence is that, compared with normal cigarettes, e cigarettes are pretty benign

So can e cigarettes cause harm? The scientific evidence is that, compared with normal cigarettes, they are pretty benign. Burning dried tobacco leaves releases a toxic combination of more than 100 compounds, including vaporized tars, carbon monoxide and nicotine. These substances can raise blood pressure and, in the case of the tars, may cause genetic changes in the cells lining the lungs and respiratory tract that in turn trigger cancer.

An e cigarette looks like a real cigarette, but instead of tobacco smoke, the user inhales a puff of pure nicotine delivered by heating a capsule. Nicotine the alkaloid “active ingredient” in tobacco acts as a stimulant and is certainly highly addictive. But it is not known to be carcinogenic.

The real fear with e cigarettes is they may also act as a gateway drug to tobacco

Aside from its addictive properties, nicotine can raise blood pressure. There are also some question marks over the long term safety of the chemicals used as solvents, typically propylene glycol although, again, there is no evidence at all of any danger at present.

The real fear with e cigarettes is not to do with their medical properties. It is that because they resemble the “real thing” far more than, say, patches or gum, and are far cheaper than cigarettes, they may also act as a gateway drug to tobacco, encouraging children to take up smoking and adults to continue with a dangerous habit merely switching to e cigarettes in bars and planes, where they are otherwise not allowed to smoke.

However, research carried out by Action on Smoking and Health (ASH), the anti smoking charity, found no evidence that e cigarettes are being used by children. According to the MHRA, the general attitude in Britain is that e cigarettes should be cautiously welcomed.

“We d like them to be better made and to deliver more reliable nicotine doses,” a spokesman says, adding that a requirement for full clinical trials is “not appropriate clearly they are effective”.

Anti smoking campaigners are supportive of any product that may reduce harm even if these products have the backing of the cigarette companies themselves. But according to Martin Dockrell, head of policy at Ash, we need to keep an eye on companies that have a history of “distortions and denial about their products.”

“We are pretty sure that the tobacco industry is not getting into this because they want people to give up smoking,” he says, although he accepts that anything that “reduces harm” will be welcome.

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• Smokers face life long nicotine addictions if they carry dependency gene study

Black market for cigarettes expands, costing e.u. billions – nytimes.com

Is it legal to buy cigarettes online from europe, then have them mailed to the usa?

The containers were actually crammed with more than 20 million illicit cigarettes smuggled by an unlikely ring that included a recruitment consultant, a scaffolding company owner and a millionaire Dubai businessman in plastics recycling who had fallen on hard times during Europe s economic downturn.

“He borrowed money and took the wrong route,” a lawyer said in open court earlier this year, apologizing for the gang s ringleader, Paul O Meara, 48, of Suffolk, England, adding that he “lived the good life,” but lost it all, and then risked his reputation “as a result, really, of the financial collapse.”

For years, law enforcement officers and smugglers have played cat and mouse in Europe, where contraband cigarettes are stashed in everything from furniture shipments to loads of Christmas trees. But Europe s four year old economic crisis is expanding the black market for cigarettes, robbing European Union nations of valuable revenue and drawing in a new class of smugglers.

In May, a judge in England scolded Terry Nolan, a blind man from Yorkshire, who was convicted after investigators found him stashing more than 200,000 contraband cigarettes, some behind a false wall in his garden shed. Mr. Nolan refused to reveal the source, claiming he was afraid of reprisals, and was given a five month suspended sentence after pleading guilty to evading more than $150,000 in excise taxes.

“You are 61 years old, and apart from a sentence in your youth for cannabis possession, you have remained law abiding for the last 40 years,” Judge David Tremberg lectured him in court, issuing a curfew and a fine of about $1,000. “At a time when the public purse is at breaking point, this business robs the country of much needed finances.”

Indeed, the impact of lost tax revenues is enormous, especially since the European Union is partly financed by customs duties, 75 percent of which are passed to the bloc by its member nations.

“The damage 1 billion euros missing in the E.U. budget and up to 9 billion euros missing in the member states,” according to Jens Geier, a German member of the European Parliament, who worries that the volume of smuggled cigarettes hints at serious structures of organized crime behind these illicit, everyman retailers.

Hard facts about this smuggling trade are found in the lowliest places the garbage. In annual surveys, financed by cigarette companies, researchers fan out to major cities in 27 European nations and collect crumpled cigarette packs. In turn those packs are analyzed by laboratories to determine how many are bought across the counter and how many are counterfeit. Some boxes are so meticulously produced in China, Dubai or Eastern Europe that they contain bogus tax stamps for different nations.

The latest results of the garbage scavenging showed the black market competition had increased to record levels. In Spain, illicit sales last year soared 300 percent to more than 4.6 billion cigarettes. In the struggling region of Andalusia, they showed, contraband cigarettes commanded 20 percent of the market.

In Ireland, smugglers are robust competitors with legal cigarette companies, reaching more than 17 percent. Over all, black market cigarettes continued a steady climb for the fifth straight year, topping 10 percent of consumption or 65 billion cigarettes, according to the annual report issued in June by KPMG for Philip Morris International.

Smuggling has flourished in particular in nations where the price of a pack of cigarettes has edged past $10, the result of rising taxes and tighter wallets.

“In times of economic crisis, especially a long economic crisis like the one Europe is experiencing now, people have less disposable income, and they are particularly interested in cheaper products,” said Simeon Djankov, deputy prime minister and finance minister of Bulgaria. There, he said, the market share of smuggled cigarettes more than doubled between 2008 and 2010.

In Dublin, Benny Gilsenan did his own personal research. When Ireland s economy started to founder in 2008 after the nation s real estate crash, Mr. Gilsenan noticed the regulars were dwindling from his store, Benny s, a 40 year fixture in the neighborhood.

Then he confronted a former customer, whom he could see smoking just a few hundred yards away. The man explained the math to him.

“I sell a pack for 9.20 euros, while they can get one for 3.20,” about $7.30 less, Mr. Gilsenan said, noting that his sales declined 40 percent in the last four years and resulted in layoffs of two employees. Since then, he and other shopkeepers have formed a group called Retailers Against Smuggling that is pressing for higher penalties for smugglers.

The turtle toy smuggling case was masterminded by Mr. O Meara, the businessman who embarked on what prosecutors called a “massive international smuggling operation.”

Among the seven men, sentenced earlier this year, none had previous records for smuggling, according to Paul Barton, assistant director of criminal investigations at Britain s HM Revenue & Customs.

According to investigators and court records, the turtle plot began sometime in 2009 when Mr. O Meara was struggling with debts and began work on setting up a haulage business called Vincent Logistics, which prosecutors described as a front company.

He received financial help from another member of the smuggling ring, Robert Doran, 47, a Dubai millionaire. The potential tax loss from the operation was more than $5 million for the British government, according to Mr. Barton, who said the plot had taken around four to five months to prepare and was so well organized that plotters marketed the cigarettes with glossy brochures. In the end it cost them prison sentences, ranging from two years to four and a half years.

Despite the emergence of middle class smugglers, investigators believe that criminal organizations are behind them.

Contraband tobacco is less lucrative than narcotics, but it is attractive because those caught receive much shorter prison terms.

While governments fret about lost revenue, law enforcement officers are concerned about how smuggling profits are reinvested in other criminal activities.

“A lot of people perceive this as a Robin Hood type of fraud and that the ordinary person in the street, who has a lot less money these days, is gaining the benefit,” said Austin Rowan, head of the unit responsible for cigarette smuggling at OLAF, the European Union s Anti Fraud Office. “But this trade is financing organizations that are involved in other activities including drugs smuggling.”