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The Centers for Disease Control and Prevention report that 440,000 Americans die from smoking-related illnesses every year. However, even this enormous number does not adequately describe the extraordinary burden that cigarette smoking imposes on American society. Our research provides additional perspective: If smoking-related lung cancer did not occur, cancer mortality rates in the United States would have declined continuously since 1950 (Figure 1)(1). Thus, for the past 50 years the American cancer "epidemic " has primarily consisted of one disease, cancer of the lung, and has been due to one dominant lifestyle factor, cigarette smoking. It is compelling evidence that the anti-smoking campaign in the United States, now nearly 40 years old and of ever-increasing intensity, has failed to help adult smokers to quit. Conventional approaches to cessation have failed because they offer smokers only behavioral therapy. An excellent example is a 1993 NCI smoking cessation manual, How to Help Your Patients Stop Smoking, which advises physicians to recommend coping tips such as "Keep your hands busy-- doodle, knit, type a letter; " "Cut a drinking straw into cigarette-sized pieces and inhale air; " "Keep a daydream ready to go."(2) Such advice ha