Majority of Surveyed Doctors Misattribute Tobacco Harms to Nicotine

    Government fearmongering and crackdowns on nicotine vaping products have likely contributed to widespread ignorance about the difference between the harms of tobacco and nicotine. A large proportion of US physicians surveyed by Rutgers University researchers appear to be among those left unclear on the science, according to a study published on September 1.

    About 80 percent of the 1,020 surveyed doctors incorrectly identified nicotine as a substance that directly contributes to heart disease, chronic obstructive pulmonary disease (COPD) and cancer—three harms that are linked to combusted tobacco.

    When it came to birth defects, which the study described as having “The strongest evidence for direct causality for nicotine,” about one-third simply failed to answer the question, indicating that they simply didn’t know. Another third answered correctly, per the study, that it does directly contribute to them. (It should be noted that vaping nicotine while pregnant can still be considered a form of harm reduction compared with smoking, however. The UK National Health Service’s pregnancy advice, for example, states: “If using an e-cigarette helps you to stop smoking, it is much safer for you and your baby than continuing to smoke.”)

    The proportion of ill-informed responses varied by doctor specialty—including cardiology, family medicine, internal medicine, obsetrics and gynecology, oncology and pulmonology. Some were more aware of the true effects of nicotine pertaining to their specialty. Pulmonologists, for example, were the least likely (68 percent, compared to family doctors’ 87 percent) to believe that nicotine directly causes COPD. Yet others proved the opposite. Obstetrician-gynecologists were the least likely (21 percent) to correctly report nicotine’s potential cause of birth defects.

    Doctors’ lack of basic knowledge about the effects of nicotine could negatively impact their ability to provide care to smokers, suggests one of the researchers.

    “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,” said Dr. Michael Steinberg, a Rutgers internal medicine professor and director of the Rutgers Tobacco Dependence Program. “Doctors should be able to accurately communicate these risks, which may include low-nicotine cigarettes, which are not safer than traditional cigarettes.”

    Misperceptions go beyond doctors. Other medical professionals have been shown to misunderstand nicotine. A 2007 study found that 60 percent of surveyed nurses falsely believed it to be a carcinogen. And in the general population, marginalized groups, including people of color, are more likely to miss the critical piece of harm reduction information that nicotine is not a cause of cancer, according to a 2017 study.


    Photo of a patient with her doctor by Zackary Drucker via The Gender Spectrum Collection/Creative Commons

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