Six Urban Myths About Smoke-Free Nicotine

A scientific look at the myths surrounding nicotine

As a general internist, I am obsessed with smoking cessation. I can’t imagine how many times I have said to a patient, “The best thing I can do for your health is to get you to stop smoking.” The decrease in smoking has been an enormous public health success. This is not to say our efforts have been flawless. We have already featured a two-part series by Sally Satel on the topic. Today, I am happy to give space to Brad Rodu, a Professor of Medicine and an endowed chair in Tobacco Harm Reduction Research addressing our misunderstanding of the health effects of nicotine and cigarette substitutes.

Adam Cifu

There is a well-documented misunderstanding among American doctors about nicotine and cigarette substitutes. Recently, Dr. Bruce Scott, president of the American Medical Association, and Dr. Nicole Saphier, a breast cancer imaging specialist at the Memorial Sloan Kettering Cancer Center, each published high-profile articles containing serious errors. Their mistakes, disseminated on the AMA website and in the New York Post, are the result of repetition of falsehoods about nicotine. This article takes a scientific look at the urban myths surrounding nicotine.

Myth #1: Tobacco/Nicotine is equivalent to smoking.

Conflation of all tobacco/nicotine use with smoking is common, but misleading. The CDC publishes the precise number of deaths attributable to smoking, but does not break out the number of deaths due to use of traditional oral smokeless tobacco. A large study authored by federally funded researchers found that dip/chew products are only minimally associated with head and neck cancer.¹ Our retrospective follow-up study using federal surveys found that American men, who do not smoke, but use dip/chew have no excess mortality from any smoking-related diseases. Estimating deaths due to nicotine vaping is difficult, because most vapers are current and former smokers. The number is unknown but likely to be low.

Swedish snus is vastly safer than cigarettes and the FDA recently authorized the sale of heat-not-burn tobacco (HNB), e-cigarettes/vapor, and nicotine pouches as “appropriate for the protection of the public health.”

Myth #2: Nicotine directly contributes to cardiovascular disease, cancer and chronic obstructive pulmonary disease.

Two national surveys document that over 80% of physicians believe that incorrect statement, and my research shows that this misperception is both profound and chronic. There is no evidence that nicotine itself is a factor that kills 480,317 smokers every year.

Myth #3: “Is Nicotine bad for long-term health? Scientists aren’t sure yet.”

That was the title of a Nature article last year. If Myth #2 is challenged, apologists retreat with “we don’t know, we need more research,” even though Ovid Medline cites over 28,000 studies on nicotine. There is no lack of knowledge, just a lack of courage to acknowledge that nicotine is no more dangerous than another widely consumed drug, caffeine.

Myth #4: “Nicotine can harm brain development, which continues until about age 25.”

This one is a CDC quote, but that harm has only been seen in experimental animal studies. No neurodevelopment deficits have ever been measured in the 29 million current and 56 million former U.S. smokers, virtually all of whom started smoking as teens. That goes for Swedish snus users as well.

Myth #5: Teens vaping nicotine will end up smoking.

This gateway theory has been used to demonize many drugs, like alcohol and marijuana but research shows that, with vaping, gateway is just an inclination to use either e-cigarettes or cigarettes. A recent published study by my research group shows that teen and young adult smoking declined even faster as vaping was on the upswing.

Myth #6: “The use of tobacco products during adolescence increases the risk for adverse health effects and lifelong nicotine addiction.”

This is a direct quote from Dr. Brian King, director of FDA Center for Tobacco Products. Federal officials use “lifelong” when they’re trying to scare us about kids, but that’s deceiving. The claim is obviously false for the nation’s 56 million former smokers. Lifelong is relevant for the 29 million current smokers who want to avoid a killer disease, but Dr. King only offers them “products scientifically shown to be safe and effective, including FDA-approved medications and devices.” How effective are those at the population level? About 7%, according to a meta-analysis published over 20 years ago. That’s why access to satisfying and safer nicotine cigarette substitutes that don’t require abstinence is vital for smokers.

The Trump Administration is installing new CDC and FDA leadership and priorities, and speculation about tobacco regulation is rampant, but killing urban myths doesn’t require government action. If anything, it needs government inaction, allowing tobacco users and health professionals to educate themselves about the facts surrounding smoke-free nicotine.

Brad Rodu is a Professor of Medicine and an endowed chair in Tobacco Harm Reduction Research at the University of Louisville. He blogs at Tobacco Truth.

1. I do not think there is any association, a statement that might surprise you. In an upcoming article on Sensible Medicine I will make my case.

Photo Credit: Thomas Stephan

In response to comments, I am adding this comment from Dr. Rodu:

I have conducted and published research on tobacco harm reduction since 1994 (https://louisville.app.box.com/file/1793592529260?s=ztqsq1ue1bdisllarvhpmi2ogrrvvjzj), and my funding has been a matter of public record for the entire period. From 1999 to 2018 my research was supported by unrestricted grants to the University of Alabama at Birmingham (1999-2005) and to the University of Louisville (2005-2018), which were publicly acknowledged. I now report no conflict of interest (COI), as six years without industry funding is a longer period than specified by the COI policies of professional journals and other relevant organizations. I have no personal or other professional conflict of interest.