Thirty years ago, as a young public health researcher and professor, I would begin my lectures by telling students that 480,000 Americans die from cigarette smoking every year, making it the leading cause of preventable death. Sadly, thirty years later, I still begin my talks with the same fact. In those 30 years, 15 million Americans have died unnecessarily from cigarette smoking. The majority tend to be persons of color, and those from lower socioeconomic status, those with dual addictions, and those with co-occurring mental health disorders. Those without a voice. To change this trajectory, it is time for the FDA to embrace bold, new thinking, including offering smoker’s safer nicotine containing alternatives. The historical Tobacco Control Act, passed in 2009, was supposed to be a tipping point and set the stage to save millions of lives. Many initiatives, like graphic warning labels, are stalled in courts. The menthol ban has yet to occur, even though it was first considered in 2011. And while FDA has finally proposed a ban on menthol this year, that too will likely be delayed in the courts (though I think that will be a losing battle for the industry). Another recent proposal by the FDA to establish a maximum nicotine level in cigarettes may not produce the results FDA wants, and likely would be held up in courts. If the FDA plans to impose a cap on nicotine levels in cigarettes, it is critical that the FDA concurrently authorize lower risk nicotine products, such as e-cigarettes and nicotine pouches with PMTAs, alongside a portfolio of approved smoking cessation medications. Just as public health has embraced harm reduction concepts for opioids, alcohol and many other public health areas, we must embrace it for tobacco products too. Alternative nicotine products may be the game changer we have needed to save lives. Isn’t that the story we want to tell the next generation 30 years from now?