Paying more attention to the 'elephant in the room'.

This commentary argues that a nicotine reduction strategy for tobacco control is a secondary strategy to the wider availability of low toxin forms of nicotine to give smokers a viable alternative to cigarettes. Failure to confront the likely reality of continued nicotine use and to make it as low in harm as possible may prolong the tobacco epidemic. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.