Docs Confused Over Nicotine

Posted 15th September 2020 by Dave Cross
“Nicotine,” says the research paper, “is responsible for the highly addictive nature of tobacco products, but most tobacco-caused disease is not directly caused by nicotine, but rather by other chemicals”. Worryingly, researchers at Rutgers University and the University of Pennsylvania found that far too many American doctors do not understand this simple fact.

The paper has been published in the Journal of General Internal Medicine and details a frighting set of findings, with male doctors revealing themselves to be the most ignorant.

Steinberg, Bover Manderski, Wackowski, Singh, Strasser, and Delnevo surveyed 1020 doctors specialising in family medicine, internal medicine, obstetrics (pregnancy) and gynecology, oncology, and pulmonary disciplines. The medical specialists were asked about asked about their understanding of tobacco treatment practices, harm reduction beliefs and tobacco and e-cigarette use.

The authors state that only birth defects carry linked to nicotine use carries any reasonable amount of evidence. They say there is “limited evidence” linking nicotine to the development of cancer and cardiovascular disease (CVD), and next to no evidence to support the hypothesis that nicotine causes chronic obstructive pulmonary disease (COPD).

Despite this,” they state, “many misperceive nicotine as responsible for smoking -related health risks, like cancer. These misperceptions are not unique to the general population; in one study, 60% of nurses incorrectly perceived nicotine as carcinogenic.”


  • Nicotine causes cardiovascular disease – 83.3% strongly agreed
  • Nicotine causes cancer – 80.5% strongly agreed
  • Nicotine causes COPD – 80.9% strongly agreed

While oncologists performed better than other disciplines, the fact that 77.2% of them still believe that nicotine causes cancer should give many cause for concern – not least the organisations they obtained their certificates to practise medicine from.

World Vapers Alliance

The most ignorant set of doctors worked in family medicine (general practice); 88.6% think nicotine causes CVD, 87.1% think it causes cancer, and 87.6% think it causes COPD.

To our knowledge, this is the first study to document wide-spread nicotine misperceptions among physicians in the USA. While it is possible that some physicians may have misunderstood the question (e.g., considered harm caused by tobacco, rather than nicotine), results are consistent with other studies finding notable nicotine misperceptions.”

Lead author Michael Steinberg, director of the Rutgers Tobacco Dependence Program, said: "Physicians must understand the actual risk of nicotine use as they are critical in the prescription and recommendation of FDA-approved nicotine replacement therapy products to help patients who use other dangerous forms of tobacco. Doctors should be able to accurately communicate these risks, which may include low-nicotine cigarettes, which are not safer than traditional cigarettes."

Cristine Delnevo, director of the Rutgers Center for Tobacco Studies, added: “Correcting misperceptions in medicine should be a priority given the FDA's proposed nicotine-centred framework that includes reducing nicotine content in cigarettes to non-addictive levels while encouraging safer forms of nicotine, like NRT, to help with smoking cessation or non-combustible tobacco, like smokeless tobacco for harm reduction.”


  • Nicotine Risk Misperception Among US Physicians” by Steinberg, Bover Manderski, Wackowski et al. – [link]

 Dave Cross
Article by Dave Cross
Freelance writer, physicist, karateka, dog walker