Confusion among U.S. doctors about nicotine may be costing lives, with nearly half mistakenly believing it causes cancer, a new study has found.
According to a survey of 1,565 medical professionals conducted by Povaddo Research, 47 per cent of doctors, nurses, and other frontline providers believe nicotine itself is carcinogenic. Among those who treat a large number of smokers, this figure jumps to 59 per cent.
The finding comes as smoking remains the leading cause of preventable death in the U.S., responsible for 480,000 deaths each year and more than $240 billion (around £190 billion) in annual healthcare costs, according to the Centres for Disease Control and Prevention (CDC).
Confusion holding back harm reduction
The report, funded by Philip Morris International, warns: “If medical professionals mistakenly believe nicotine is what makes smoking so harmful, they may be hesitant to suggest that patients who don’t wish to quit at least switch to a nicotine-containing alternative that, although addictive and not risk-free, has been shown to be a far better choice for adults than continued cigarette use.”
Just 21 per cent of respondents said they “always” talk to smoking patients about smoke-free alternatives such as vapes, pouches or heated tobacco, while 45 per cent said they only have those conversations “sometimes.”
Public health advocates argue this missed opportunity is keeping smokers smoking.
“The confusion – read ‘ignorance’ – among health care professionals about the role of nicotine in health is shocking and dangerous,” said Dr. Henry I. Miller, a former FDA official. “There is a widespread misperception among them that the nicotine in cigarettes and smoke-free products is a carcinogen, but it is not. This is invaluable information that health care professionals, from doctors on down the medical food chain, need to learn in order to provide patients with accurate, risk-reducing guidance about smoke-free alternatives to cigarettes.”
His point is echoed in Europe by leading French oncologist Dr David Khayat. “Nicotine itself does not cause cancer, as carcinogens come from the burning of tobacco,” he explained. “The combustion that occurs in conventional cigarettes produces thousands of substances, and a percentage of these are carcinogenic.”
A message from Washington
The science is clear: nicotine is addictive, but it is the burning of tobacco that causes cancer. U.S. officials have signalled that safer products have a role to play in ending smoking.
“Nicotine pouches are probably the safest way to consume nicotine, with vapes being second,” said Health and Human Services Secretary Robert F. Kennedy Jr. “But the thing we really want to get away from are cigarettes.”
Pushback from prohibitionists
However, not all groups agree. The Campaign for Tobacco-Free Kids denounced the FDA’s decision earlier this year to authorise marketing of Zyn nicotine pouches, arguing the PMI-funded research lacks credibility.
But Dr. Michael Siegel, professor of public health and community medicine at Tufts University, said that misses the point. He called it “tragically ironic” that PMI – and not mainstream health organisations – is leading the push for harm reduction.
“Sadly, there is currently no place for this harm-reduction attitude within the mainstream of tobacco control or public health,” Siegel said. “The unfortunate consequence is that the ‘all nicotine is equally bad’ message is resonating with doctors and these organisations are misleading doctors into thinking that e-cigarettes are equally as harmful as real tobacco cigarettes.”
FDA urged to lead
The survey suggests the Food and Drug Administration (FDA) could play a pivotal role in correcting misinformation. Eighty-six per cent of respondents said they trust the FDA as a source of information on nicotine and tobacco products, and 93 per cent said the agency needs reform to regulate alternatives appropriately. Sixty-eight per cent want clear guidance on how to advise patients.
“The public health mainstream is more concerned about youth ripping cherry vapes than about smokers dying from lung cancer,” Siegel said.
Advocates argue that unless the FDA provides consistent messaging, confusion will persist and smokers will continue to miss out on life-saving alternatives.
