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Initiated by doctors, Iceland's plan would take cigarettes out of the usual kiosks and supermarkets and make them available only in pharmacies.Lisa Maree Williams

In the global war against smoking, Europe remains a difficult battlefront.

Despite ad campaigns featuring grisly images of rotting lungs and crumbling teeth, "the beautiful continent" continues to have the highest smoking rate in the world.

So forgive Iceland for considering something truly radical -- prescription-only cigarettes. Under proposed legislation, only those with valid medical certificates would be permitted to buy cigarettes from pharmacies.

"I think Iceland can be a test tube to try out progressive things because we are a small country and we don't have a massive lobby for tobacco," said Thorarinn Gudnason, a cardiologist at Landspitali University Hospital in Rejkyavik. "We are taking care of people who are dying of this disease in their 40s and we're fed up with it."

Iceland's smoking rate is already one of the lowest in Europe. Just 15 per cent of the population lights up compared to an average of 31 per cent across the continent. However, the story among young Icelanders is more worrisome: 20 per cent of children and teenagers smoke. Dr. Gudnason hopes the new plan will dramatically reduce that figure and cut overall smoking rates to less than 10 per cent.

Initiated by doctors and backed by the country's former health minister Siv Fridleifsdottir, the plan would take cigarettes out of the usual kiosks and supermarkets and make them available only in pharmacies. The cost of cigarettes (currently about 1000 Icelandic kronur or $8.30 Canadian) would increase by about 10 per cent annually, a strategy that has been proven to reduce smoking rates elsewhere.

Tobacco and nicotine would be classified as addictive drugs and second-hand smoke would be treated and controlled like other carcinogenic substances. Lighting up in public places such as parks and in cars with children would be outlawed.

Eventually, smokers who are unable to kick the habit through treatment and various addiction programs -- or those smokers who simply refuse to quit -- may get a prescription for tobacco from their doctors. Once cigarettes become available only through physicians, the price will go down again -- as it would be unfair to tax those unable to quit supporters of the plan say.

"Tobacco is very addictive and we would recognize them as addicts," said Ms. Fridleifsdottir.

Some of these ideas have had proven success elsewhere. Indeed, the World Health Organization found that every price increase of 10 per cent reduces tobacco consumption by between 4 and 6 per cent.

But the prescription idea is totally new.

"I have not heard of another country that's tried that," said Dr. Armand Peruga, program manager at the WHO's Tobacco Free Initiative.

Though restricting cigarette sales to pharmacies would fit in with the general concept of reducing access to tobacco, Dr. Peruga was less convinced by the idea of doctors prescribing cigarettes.

"To what extent are you making a physician an accomplice to a health hazard decision?" he asked.

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