According to the the Royal College of Physicians (RCP), heavily-addicted smokers in Britain who find it impossible to quit are being let down.
The RCP says the government must recognise that smoking is an addiction and treat smokers the same as heroin addicts by offering tobacco substitutes that deliver the same hit of nicotine without the harm.
The RCP says the number of people smoking is declining by only 0.4 per cent a year despite graphic and aggressive campaigns aimed at making smokers quit and legislation discouraging smoking.
The RCP says a new approach is needed to protect those who continue to smoke from the lethal effects of their habit.
Professor John Britton, chairman of the RCP Tobacco Advisory Group, and a lung specialist at the University of Nottingham, has called for a new "harm reduction" approach to help the millions of smokers who cannot give up.
Professor Britton says the killer in cigarettes are the hundreds of toxic chemicals rather than the nicotine and nicotine products could satisfy a craving for cigarettes without killing them.
Professor Britton says the medicinal market needs to be liberalised and a decent cigarette substitute introduced.
The report by the RCP, 'Harm Reduction In Nicotine Addiction: Helping People Who Can't Quit', says harm reduction is an established principle in the treatment of drug addiction, where addicts who cannot give up their habit are encouraged to switch to a safer drug.
It gives the example of Sweden where an oral tobacco product called "snus" that is chewed instead of smoked has been available for decades, and the country has the lowest smoking rates in the world.
Britton says the best thing that a smoker can do for his or her health is to quit all smoking and nicotine use completely but for the millions of smokers who can't quit, or who are unlikely to quit, nicotine products can satisfy their addiction.
The RCP believes that the regulatory systems that govern nicotine products in most countries, actively discourage the development, marketing and promotion of significantly safer nicotine products to smokers, but in contrast cigarettes are relatively unregulated.
The RCP is calling for the whole nicotine market to be reformed by a new regulatory framework that favours harm reduction, which would include providing smokers with safer sources of nicotine and effective cigarette substitutes; encourage the development of innovative, more effective and user-friendly medicinal nicotine substitutes for cigarettes; and change nicotine product regulation to make it easier to produce and market medicinal nicotine products.
Many existing products, such as nicotine chewing gum and patches have proven unsatisfactory because they were designed as aids to stopping smoking rather than as substitutes for it; the products deliver a steady, low level of nicotine rather than the hit of nicotine that smokers crave.
The RCP suggests that by making safer nicotine products more widely available health inequalities would be reduced, as people in disadvantaged groups are more likely to smoke, to smoke heavily, and be more addicted to smoking; but they are also less likely to be successful in giving up smoking and have most to gain from harm reduction strategies and safer alternatives.
Experts say half of all smokers will die prematurely if they do not give up, which equates to 150 million worldwide in the next 20 years.
One hundred million died in the last century and one billion are projected to die in the 21st.