Majority of Health Care Practitioners In the Dark When It Comes to Nicotine and Cancer

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WASHINGTON — Nearly two-thirds of U.S. health care practitioners who say a majority of their patients smoke mistakenly believe nicotine is a carcinogen, despite scientific consensus that the harm related to smoking is mainly caused by the burning of tobacco, according to a new survey.

The survey, funded by PMI U.S. — a U.S. affiliate of Philip Morris International — found that while half (47%) of U.S. health care practitioners mistakenly believe nicotine causes cancer, the number rose to 59% among practitioners who said half or more of their patients smoke.

Another 19% of those surveyed said they were unsure of whether nicotine is a carcinogen or not.

The survey conducted by Povaddo LLC, an international research firm, gathered the opinions of 1,565 medical professionals, including physicians, nurses and mental health practitioners. It was conducted between March 10 and April 5 of this year.

Matt Holman, former director of the Office of Science at the Food and Drug Administration, who now serves as vice president of U.S. scientific engagement and regulatory strategy at PMI U.S., said in a written statement that he found the prevalence of misinformation about nicotine even among otherwise well-informed health care professionals “striking.”

Even more worrisome, the findings also suggest these beliefs may be obstructing progress on tobacco harm reduction at a time when an estimated 480,000 Americans die each year from smoking-related illnesses.

Holman said the survey’s findings illustrate that “robust, evidence-based communication from authorities,” like his former colleagues at the FDA, is crucial to helping providers guide their patients and support harm reduction.

A number of reputable research organizations running from the National Institutes of Health to the World Health Organization’s International Agency for Research on Cancer, have published research showing that it is not nicotine, but other chemicals in combustible cigarettes, like arsenic and formaldehyde, that cause cancer.

In fact, nicotine replacement therapies — such as gum and patches — have been on the World Health Organization’s list of “essential” medicines since 2009 and nicotine is considered safe and effective in these medicines as way to help people stop smoking.

These therapies are not for everyone, however.

Practitioners surveyed generally agreed that smoke-free products — such as nicotine pouches and other noncombustible alternatives — though not entirely risk free, would greatly reduce the health risks their patients face compared to continued smoking.

Despite the prevalence of this belief, however, a majority of survey respondents said they don’t often discuss smoke-free products with their patients.

Only about one-in-five (21%) said they “always” have these conversations with their patients, while a little over one-third (35%) said these conversations happen “most of the time.”

Instead, the plurality (43%) responded that they only have these conversations “sometimes.”

While there is a slight increase among those medical professionals who indicate that more than half of their patient base smokes cigarettes, the results are still low.

Among this group, only approximately one-third (34%) said they “always” discuss smoke-free products, while a statistically equal number (36%) said these conversations happen “most of the time.”

Oncologists, pulmonologists, licensed social workers and mental health nurses reported the highest frequency of conversations about smoke-free products with their patients who consume these products or smoke cigarettes.

The percentage who said they “always” discuss smoke-free products increased to 30% among oncologists, 49% among pulmonologists, 32% among licensed social workers and 37% among mental health nurses.

Asked what might help change this situation, more than two-thirds (69%) of medical professionals said they want the FDA to share clinical evidence that demonstrates the role of authorized smoke-free products in harm reduction.

A similar percentage, 68%, said they also want the agency to provide clear guidance on counseling patients about transitioning to smoke-free alternatives as part of harm reduction strategies.

If that happened, 95% of the survey participants said that they would definitely share the FDA-provided information on smoke-free products with their patients.

That said, a number of medical professionals (68%) said they are not always sure which products the FDA has deemed “appropriate for the protection of public health” or “appropriate for the promotion of public health.”

They went on to say that this lack of critical information — and the absence of updates when new smoke-free products become available — risks diminishing the guidance they provide their patients.

In light of this, there was near-universal agreement that reform is needed to allow the FDA to regulate new nicotine-containing products.

Ninety-three percent of medical professionals agreed with the statement: “When the FDA began regulating tobacco products in 2009, e-cigarettes and nicotine pouches were not on the market. To better protect public health, reform of the FDA is needed so the agency can regulate these products appropriately.”

“Health care professionals are at the heart of patient care and need reliable, science-based information to help their patients make informed choices,” said Stacey Kennedy, CEO of PMI U.S., in a written statement released with the survey results.

“These findings reinforce the urgent need for transparent, evidence-driven communication from the FDA and other health authorities about the full spectrum of tobacco and nicotine products,” Kennedy continued.

“We encourage the agency to provide timely, scientifically validated guidance to health care practitioners on FDA-authorized smoke-free alternatives. Ensuring clinicians have access to accurate information is essential to help adults 21+ who smoke make better choices and improve public health,” she added.

This article was produced in partnership with and paid for by PMI Corporate Services Inc. part of  PMI U.S. “PMI US”, “we”, “our” and “us” refers to one or more of Philip Morris International’s U.S. affiliates.