“Alarmingly High” Number of US Doctors Think Nicotine Causes Cancer

    More than 75 percent of US physicians wrongly believe that nicotine directly contributes to the development of cancer and cardiovascular disease (CVD), a new study shows.

    Published in the International Journal of Environmental Research and Public Health, the paper assessed the impact of question wording on physician perceptions about nicotine use.

    Researchers led by Dr. Michelle Bover Manderski used the data from 926 physicians who received one of two versions of a questionnaire. They were asked about the “extent to which they agree or disagree that ‘nicotine’ (Version 1) or ‘nicotine, on its own,’ (Version 2) directly contributes to birth defects, CVD, cancer, depression and chronic obstructive pulmonary disease (COPD).” Apart from that difference, the surveys were virtually the same.

    For Version 2, with the “nicotine, on its own” wording, 69.6 percent and 67.3 percent of physicians “strongly agreed” that nicotine directly contributed to cancer and COPD, respectively. For Version 1, 85 percent and 85.2 percent of physicians strongly agreed with those incorrect statements.

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

    Wording matters, given the lower percentages of physicians who answered incorrectly about nicotine “on its own.” There were also differences between medical specializations—with pulmonologists generally the least likely to hold misperceptions about nicotine and family medicine physicians the most likely.

    Nonetheless, the misperceptions were common across the board. “Even after accounting for question version, the proportion of surveyed physicians who believe that nicotine directly contributes to these health outcomes is alarmingly high. It is possible that participants are conflating the addictive effect of nicotine with the comparatively more harmful effects of tobacco use” the authors wrote.

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

    It is crucial, as Dr. Manderski further emphasized, so that physicians can provide patients who smoke or use nicotine in other ways with accurate information and help. This research unfortunately indicates that many patients are likely being failed.

    The public-awareness implications apply not only to nicotine patches and gums, but to nicotine vapes, which research has found to be the more effective quit-smoking tools. The FDA may well approve some vaping products as “appropriate for the protection of public health” as soon as September, under its Premarket Tobacco Product Applications process.

    The researchers suggest something that’s clearly needed in a country with around half a million deaths each year caused by smoking tobacco, not by nicotine itself: the prioritization of health provider education in this area.



    Photo by National Cancer Institute on Unsplash

    • Kevin is a tobacco harm reduction fellow for Filter. He began working in harm reduction as a health educator, providing street-based syringe access services for people who inject drugs. He was later a bilingual medical case manager, providing case management for people living with HIV/AIDS. He has also been a chapter leader and member of the board of directors at Students for Sensible Drug Policy.

      Kevin’s fellowship is supported by an independently administered tobacco harm reduction scholarship from Knowledge-Action-Change—an organization that has separately provided restricted grants and donations to support Filter.

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