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But in suggesting that there is a neurophysiological basis for the observation that nicotine use can increase the reinforcing properties of alcohol, it may also underscore that tobaccos harms may extend well beyond cancer and heart disease, and that the toll it has taken may go well beyond the 100 million people it is estimated to have killed in the 20th century alone.

While acknowledging the well-known health risks, Roberts pointed out that smokers face both higher medical expenses and life insurance premiums