The tobacco control policy tools developed in a few rich countries in the 1970s, 1980s, and 1990s are currently being implemented widely in many poorer countries, thanks in part to the astonishing success of the Framework Convention on Tobacco Control (FCTC). With smoking rates already high in most of the Third World, however, the projections for the twenty-first century are grim: up to 1 billion tobacco-caused deaths, which raises the issue of what more can be done, particularly to help people who already are addicted to nicotine. Only massive and effective smoking cessation programs could reduce this death toll significantly, at least in the short-term. Tobacco control's existing tools, if widely applied, likely will reduce premature deaths significantly but can be expected to leave unacceptably high levels of tobacco-related mortality. This finding has sparked fierce discussions among anti-tobacco activists about the role of harm reduction in curbing death and disease. This article discusses whether harm reduction is possible with the tobacco industry subject to a largely unregulated environment for tobacco products.