In a years’ later memoir, N. A. Semashko, the fi rst Commissar of Health, recalled that Lenin was the one to start the entire thing when he asked, “Why don’t you start a fi ght against that poison tobacco? I will support you.”2 Semashko set forth with great enthusiasm-little realizing that the battle would be, as he later recalled, “one of the comic episodes of [his] life.”3 What ensued from Semashko’s taking up of Lenin’s lightly proffered challenge was more than his own “comic” tale. In the battle over tobacco regulation in 1920 competing visions of health, state power, and national priorities combined in a story of health advocates calling for reform while representatives of the state and industry answered even more strongly for the health of the economy in the short term over the protection of the population’s health in the long term.