Health officials have begun to predict the end of cigarette smoking in the United States.
They have long wished for a cigarette-free nation, but shied away from calling for smoking rates to fall to zero or near zero by any particular year. The power of tobacco companies and the popularity of their products made such a goal seem a pipe dream.
But changes have prompted public health leaders to start throwing around phrases like "end-game" and "tobacco-free generation". Now, they talk about the slowly declining adult-smoking rate dropping to 10 per cent in the next decade and to 5 per cent or lower by 2050.
Acting United States Surgeon-General Boris Lushniak last month released a 980-page report on smoking that pushed for stronger tobacco-control measures. His news conference was an unusually animated showing of anti-smoking bravado, with Lushniak nearly yelling repeatedly: "Enough is enough!"
"I can't accept that we're just allowing these numbers to trickle down," he said, in a recent interview. "We believe we have the public health tools to get us to the zero level."
This is not the first time a US health official has spoken so boldly. In 1984, then-surgeon-general Everett Koop called for a "smoke-free society" by 2000. However, Koop - a bold talker on many issues - did not offer specifics on how to achieve such a goal.
"What's different today is that we have policies and programmes that have been proven to drive down tobacco use," said Matthew Myers, president of the Campaign for Tobacco-Free Kids. "We couldn't say that in 1984."
Among the things that have changed:
- Cigarette taxes have increased, making smokes more expensive.
- Laws banning smoking in restaurants, bars and workplaces have popped up all over America.
- Polls show that cigarette smoking is no longer considered normal behaviour.
- Federal officials are increasingly aggressive about anti-smoking advertising.
- Tobacco companies, once considered impervious to legal attack, have suffered some huge defeats in court.
- Retailing of cigarettes is changing. CVS Caremark, the second-largest US pharmacy chain, announced last week it would stop selling tobacco products at its more than 7,600 stores.
"I do think, in another few years, pharmacies selling cigarettes will look as anachronistic" as ads featuring physician endorsements look today, said CDC director Dr Tom Frieden.
These developments have made many in public health dream bigger. Their goal is to reduce US smoking-related deaths to fewer than 10,000, from the current level of 480,000. But even if smoking rates dropped to zero immediately, it would take decades to see that benefit, since smoking-triggered cancers can take decades to develop.
But Lushniak said zero. Will that ever happen? Many doubt it. As long as cigarettes are legal, it's likely some people will smoke.