Tobacco smoking is responsible for more adverse health effects than any other psychoactive drug. The scale of tobacco-related ill health is massive. Strangely, it was not until the 1950s that clear and persuasive evidence of the adverse effects of tobacco was produced. This related to the association between tobacco smoking and lung cancer, heart disease, emphysema and chronic bronchitis (Doll and Hill 1952, 1964; World Health Organization 1960; Anderson and Ferris 1962; Wynder and Hoffman 1967; Doll and Peto 1986).