Why the nicotine myth might be the most lethal public health lie

An alarming new survey reveals a dangerous blind spot in the medical community: Countless doctors still believe nicotine directly causes cancer. That myth has been repeated for decades, but science says otherwise.

The survey by Povaddo LLC included 1,565 U.S. medical professionals. Nearly half of health care practitioners (47%) and 59% of those treating heavy smokers incorrectly identified nicotine as a carcinogen. Another 19% weren’t sure. The result: Many physicians discourage patients from trying “tobacco harm reduction” products — like e-cigarettes or smokeless tobacco — that contain nicotine but eliminate the thousands of toxins in combustible cigarettes.

It’s time for the FDA to cut through decades of propaganda and tell the truth: Nicotine is addictive, but it isn’t the cause of cancer.

This misunderstanding costs lives. By misidentifying nicotine as the killer, doctors steer smokers away from safer alternatives that could dramatically reduce cancer, heart disease, and lung disease.

Education matters. Health care providers need to know nicotine is addictive, but the real harm comes from the smoke. Until that distinction is clear, patients will remain trapped in the deadliest habit of all — traditional smoking.

Science has already proven the case. A conventional cigarette contains more than 600 ingredients and, when burned, produces over 7,000 chemicals, including arsenic, formaldehyde, tar, and lead. Smoking kills more than 480,000 Americans each year, according to the CDC, making it the nation’s leading cause of preventable death. By contrast, studies show vaping or smokeless products cut exposure to those toxic substances by orders of magnitude.

Even the FDA admits this. In 2017, then-Commissioner Scott Gottlieb said, “Nicotine, though not benign, is not directly responsible for the tobacco-caused cancer, lung diseases, and heart disease that kills hundreds of thousands of Americans each year.” Yet years later, the agency continues to regulate vaping into oblivion while dragging its feet on promoting THR.

The public is ahead of the bureaucrats. A 2024 poll of U.S. voters found overwhelming support for FDA reform and a strong desire to reduce smoking. Congress has noticed too. Former Rep. Larry Bucshon (R-Ind.), a physician, called risk reduction for combustible smoking not “a partisan issue.” Rep. Don Davis (D-N.C.), co-chairman of the Congressional Tobacco Harm Reduction Caucus, added: “As we move from smoke-based to smokeless products … that’s going to reduce the harm [caused by] tobacco across this country.”

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Americans want safer alternatives. Lawmakers in both parties support tobacco harm reduction. The medical community, however, remains misinformed — and the FDA’s mixed messaging hasn’t helped. Every day doctors cling to the nicotine myth, more smokers stay chained to cigarettes.

It’s time for the FDA to cut through decades of propaganda and tell the truth: Nicotine is addictive, but it isn’t the cause of cancer. Doctors need to know it, patients need to hear it, and policies need to reflect it. Mislabeling nicotine has killed enough people already.

If regulators and medical professionals are serious about saving lives, they must stop demonizing nicotine itself and start promoting harm reduction. Millions of lives depend on it.