Docs Still Don’t Know Nic

Posted 11th August 2021 by Dave Cross
New research from the Rutgers School of Public Health finds that American doctors are still shockingly ignorant when it comes to nicotine. Despite the incredible gap in knowledge being exposed before, it has not been addressed and the paper details how three quarters of US physicians are still labouring under the misapprehension that nicotine causes cardiovascular disease and cancer.

The study was conducted by lead author Bover Manderski, and supported by Steinberg, Wackowski, Singh, Young, and Delnevo. It was published in the International Journal of Environmental Research and Public Health.

The team amassed data from 926 clinicians, looking at their comprehension of nicotine and nicotine use. In particular, it asked them how much nicotine use results in cardiovascular disease, low birth weight, birth defect, cancers, chronic obstructive pulmonary disease, and depression.

One might expect this misperception to be limited to the general population, but research studies have also documented such misperception among healthcare professionals. For example, a 2007 study found that 60% of nurses incorrectly perceived nicotine as carcinogenic,” they wrote.

Fourteen years and zero progress.

In fact, the same team conducted research in 2018 and found “that a majority of doctors ‘strongly agreed’ that “nicotine directly contributes” to the development of CVD, COPD, and cancer”.


This time around, they discovered findings of perceptions about nicotine “vary by physician gender and specialty”. The team believes it may be subject to selection bias - physicians who chose to participate in the survey differ from those who did not with respect to their perceptions about nicotine.

Regardless of split, the headline figure that 75% of doctors failed to understand the basic truth about nicotine, and are responsible for issuing advice to the general public, is shocking and a clear danger to the health of the nation, especially when it comes to safer alternatives to smoking such as vaping.

The team wrote: “The proportion of surveyed physicians who believe that nicotine directly contributes to these health outcomes is alarmingly high.”

The lead author told journalists at Filter Magazine: “It is very important for physicians to understand the relative harm between nicotine and the other 7,000 toxins in tobacco smoke. This is especially important as physicians play a key role in recommending and prescribing FDA-approved nicotine replacement medications.”

Adding, “respondents may have made judgements and overestimations about the probability that nicotine causes harm based on the ease with which they associate nicotine and cigarettes more generally”.


One omission to the survey was whether doctors felt the nicotine in patches, gums, and sprays offers this misperceived level of harm too.

They concluded: “Our findings demonstrate that question wording is important when measuring physician beliefs about nicotine. However, even after accounting for question version, misperceptions about the direct health effects of nicotine were common, and perceptions about nicotine varied by sex and specialty. Provider education about tobacco and nicotine should be prioritised in order to optimise patient–provider communications about tobacco use and cessation.”


  1. Persistent Misperceptions about Nicotine among US Physicians: Results from a Randomized Survey Experiment -

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