Banning retail tobacco sales: time to start the discussion.

Smoking is being increasingly banned where there is power and the will to enact bans—cars transporting children, hospital grounds, public buildings, public transport, parks and private apartment blocks [1–4]. Internationally, smokers are being excluded from opportunities, such as employment with the World Health Organization and free health insurance in Jakarta [5,6]. Here in Australia we only enact these partial or settings-based tobacco bans but have not yet progressed to discussion of a total ban on the sale of tobacco.To date, only one country, Bhutan, has actually legislated a total ban of retail tobacco sales [7]. The rationales for partial bans in Australia are that they limit non-smokers’ exposure to second-hand smoke and assist smokers to quit smoking by creating obstacles to smoking. There is no doubt, the bans— intended to be cruel to be kind on smokers—achieve these objectives.We justify the bans through the benefit to society in health-care dollars saved and the gift of health to ex-smokers. However, while there is a kindness, there is also an undertone of cruelty behind these policies. Eighty-one per cent of regular smokers have made an attempt to quit [8]. Until they overcome their addiction or die, they are subject to society’s tobacco bans.The flip side of making smoking a non-normative behaviour is to make smokers themselves non-normative. As the bans become more and more intrusive, smokers have become a stigmatised underclass subject to discrimination and exclusion [9,10]. In addition to the suffering of actual ill health, smokers may suffer anxiety about developing tobacco-related illness, a negative self-image as an ‘addicted person’, the frustration of multiple cycles of quit attempts and failure, and the ever increasing financial burden of tobacco taxation. The time has come to discuss how we transition to a more lasting kindness to smokers—a total ban on retail tobacco sales. I believe this will have a lower ‘cruelty to kindness ratio’ than the current partial bans. Yes there will be suffering, but it will be a compression of the suffering of withdrawal into a matter of months instead of continuing the cycle of smoking, quitting, and smoking. It will end the stigmatisation and financial stress; smoking-related cancers could end in the 21st rather than the 22nd century. In the past, calling for a total retail sales ban was considered ‘radical’ or ‘extremist’ and at risk of undermining the credibility of tobacco control advocates occupying the reasonable ‘middle ground’. But is it credible not to discuss a ban when smokers are banned from smoking in so many public and private places, denied employment and health care, and the World Health Organization is proposing ‘third hand smoke’— the contamination of housing contaminated with old tobacco pollutants—as an important public health issue [11]? We cannot assume that a black market will flourish with a retail ban and we must not let fear mongering about black markets obstruct the considered examination of black market risk and control measures. Even at the current high tobacco tax levels only tobacco funded studies are able to identify a significant black market. Independent studies suggest that less than 5% of current smokers have ever used illegal or ‘chop chop’ tobacco regularly [12]. Diversion of commercially grown tobacco was an important source of black market sales when Australia had a legal tobacco growing industry and there has been smuggling of illegal tobacco into Australia [13]. It is an open question as to whether a ban on retail sales would encourage