The Deadliest Disinformation in Tobacco Control: Nicotine Equals Cancer

Nicotine isn’t the killer—combustion is. Misconceptions fuel harmful policies, deter harm reduction, and keep smokers from safer alternatives that could save lives.

In the United States, cigarette smoking remains the single largest cause of preventable death, claiming nearly half a million lives each year. Yet efforts to reduce this toll continue to be undermined by a stubborn misconception: that nicotine itself is the main culprit behind cancer and smoking-related disease.

Nicotine is addictive and may in some cases influence cardiovascular function, but it is not the chemical that causes the heart disesases, cancers, lung diseases, and countless other illnesses tied to cigarettes. Science has consostently shown that those stem from combustion, via the toxins created when tobacco burns. Unfortunately, surveys reveal that most Americans continue to believe nicotine itself causes cancer. This misunderstanding, once harmless when cigarettes were the only nicotine products available, has become a major barrier in today’s world of safer, smoke-free alternatives.

Misplaced fears, missed opportunities
Modern alternatives such as nicotine pouches, vapes, and replacement therapies like patches and gums expose users to dramatically fewer harmful substances than combustible cigarettes. The FDA has finally authorized certain nicotine pouches after concluding they pose significantly lower risks of cancer and other serious conditions compared to cigarettes or even traditional smokeless tobacco. Yet because many people still equate nicotine with deadly smoke, they hesitate to adopt these tools. Smokers dismiss them as “just trading one addiction for another,” even though switching could reduce their health risks by orders of magnitude.

Research consistently shows that correcting these misperceptions improves quitting outcomes. Smokers who understand that patches, vapes, or pouches are lower-risk, are more likely to use them successfully. Unfortunately, stigma and misinformation persist, not only among the public but even within the medical community. Many doctors continue to view all nicotine products as equally dangerous, reinforcing myths that keep patients locked into smoking.

The politics of tobacco misinformation
The confusion is not only a matter of public misunderstanding—it is being fueled at the highest levels of policy. Earlier this year, EU Health Commissioner Oliver Varhelyi declared that new nicotine products carry health risks “comparable to smoking.” Scientists reacted with outrage: 83 public health experts signed a protest letter, warning that such claims abandon evidence-based policymaking.

Their frustration is justified. All major comparative reviews—including those by the British Government, U.S. FDA, French Government, and German regulators—agree: the risks of smoking far exceed those of combustion-free nicotine products. By blurring these distinctions, the Commission undermines trust in health authorities and risks repeating the tragic cycle of misinformation that already haunts debates over vaccines and public health.

The stakes are not theoretical. The Commission has also suggested increasing taxes on safer alternatives, explicitly stating that the goal is to make them less attractive as substitutes for cigarettes. As Norwegian researcher Dr. Karl Erik Lund put it, “Closing the life-saving escape route that smokers can have in nicotine pouches and e-cigarettes is a bit like closing the door to the fire escape because the steps may be slippery.”

How policy missteps keep smokers trapped in harm
Misguided policies are also playing out in the United States. A growing body of research now shows that banning flavoured vapes—measures intended to protect youth—are backfiring.

A 2025 US study published in Health Economics, found that statewide flavour bans reduced vaping among young people, but simultaneously triggered a rise in cigarette smoking. Among 18- to 24-year-olds, vaping declined by two to three percentage points, yet cigarette smoking increased by nearly the same margin. Other analyses, including those from Mass General Brigham and JAMA Health Forum, reveal the same trend: when young adults lose access to flavoured vapes, many turn back to combustible tobacco.

This substitution effect is deeply troubling. Cigarettes remain by far the deadliest form of nicotine delivery, causing nearly all of smoking-related deaths. By driving people back to smoking, flavour bans may undermine the very public health objectives they aim to achieve.

The case for smoke-free alternatives
At the risk of sounding like a broken record, the challenge is to strike a balance: protecting young people from unnecessary nicotine exposure while giving adults realistic pathways away from smoking. Prohibition has repeatedly proven to produce unintended consequences, from illicit markets to increased cigarette use. Smarter regulation would combine rigorous age-of-sale enforcement and marketing restrictions with continued access to lower-risk alternatives for adults.

This is especially urgent given the latest evidence on who is actually using nicotine pouches – the latest scapegoat among nicotine products after vapes. A major national survey published in JAMA Network Open in 2025 found that daily pouch use in the U.S. is concentrated among former smokers and recent ex-vapers—not people who had never touched tobacco. Far from serving as a gateway to addiction, pouches appear to be functioning primarily as harm reduction tools.

Science over stigma, facts over fear
For decades, nicotine was synonymous with smoking, so it is no surprise the public continues to conflate the two. But in today’s diversified nicotine marketplace, clinging to outdated perceptions has consequences. It can discourage smokers from switching to far less harmful products, prolong cigarette use, and cost lives.

Moreover, one cannot not mention the ongoing studies looking into nicotine’s potential therapeutic applications. In 2023, psychiatrist and physician-scientist Professor Paul Newhouse described a pilot trial from the early 2000s involving 74 non-smoking patients with mild cognitive impairment, where transdermal nicotine improved attention and produced significant, sustained memory gains. Results also showed modest weight reduction, no major cardiovascular effects, and overall safety. Beyond cognition, Newhouse noted nicotine’s potential as an antidepressant in older individuals. These findings challenge conventional perceptions, suggesting that while addictive, nicotine may hold underexplored medical value in treating memory decline and mood disorders.

Meanwhile, the message from harm reduction experts has remained consistent: while nicotine may not be harmless due to its addictve nature, it is not the killer in cigarettes. Combustion is. As psychiatrist and public health scientist Professor Michael Russell said in 1976, “people smoke for the nicotine but die from the tar.” Policies and communications that fail to make this distinction risk perpetuating smoking’s deadly toll.

Healthcare providers, regulators, and advocates have a responsibility to deliver accurate information. Patients deserve to know that while quitting all nicotine is the ideal, switching from cigarettes to smoke-free alternatives can dramatically reduce health risks. That is not “trading one addiction for another.” It is a pathway out of the fire. If public health is serious about saving lives, it must stop treating nicotine as the enemy and start confronting the real culprit: the cigarette.