Medical professionals are badly misinformed about nicotine, with severe and tragic consequences for patients’ health. There are people working hard to change this—though not all are able to do so publicly.
Research has shown that majorities of doctors around the world, including in the United States, falsely believe that nicotine, in and of itself, causes cancer, chronic obstructive pulmonary disease (COPD) or other smoking-related illnesses.
When medical providers conflate nicotine with combustible tobacco, patients who smoke are discouraged from pursuing tobacco harm reduction (THR). They might be wrongly advised, for instance, that vaping is as bad for you as smoking, and told not to switch. They’re denied the most successful smoking-cessation options we have: safer nicotine alternatives like vapes, heated tobacco products, pouches or snus.
For many, this missed opportunity will be deadly.
Australia is prominent among countries where nicotine vapes have been demonized by politicians and health authorities. Its highly restrictive prescription-only model meant those who wished to switch to vapes could only access them through a doctor, if at all. When most of those doctors don’t know that vapes are exponentially safer than cigarettes, this model effectively amounted to prohibition. Australia’s bid to cut smoking rates duly stalled.
In October 2024, Australia slightly loosened its policy. Adults can now buy a limited selection of vapes from participating pharmacies, after a consultation with a pharmacist. But those who wish or need to vape at a concentration higher than 20 mg/ml still need a prescription. It remains a hostile landscape.
“There are many people in the health industry who do not want to get involved in THR. Some have expressed that the subject is too controversial.”
One Australian medical professional was deeply unhappy with how many of her colleagues remain ignorant about nicotine, including those meant to act as its gatekeepers. She knew—from personal experience—about the benefits of THR. So she took action, by discreetly organizing education sessions inside a hospital.
Due to how Australian health authorities might view this, and the potential consequences for her, she spoke with Filter on condition of anonymity. Our interview has been edited for length and clarity.
Kiran Sidhu: How was this project conceived?
Australian Medical Professional: The idea was born after hearing a young doctor give incorrect information to a patient about the dangers of nicotine—not tobacco. I then witnessed a senior doctor correct the young doctor that the dangers are the chemicals in cigarettes, not the nicotine.
I was annoyed and disappointed with the young doctor, but nurses never correct a doctor in front of a patient. I spoke to the senior doctor the following day, and he, too, was frustrated with skilled medical professionals ignoring scientific evidence and instead “repeating unsubstantiated information from the internet.”
I brought up the idea of education sessions to him; we then spoke to one of the oncologists, and with the help of another person, the sessions started to be designed a week later. At that time, we did not know if the hospital would allow the sessions, but we pushed ahead with correlating the most reliable peer-reviewed data whilst waiting for the hospital’s decision.
“The advice was that we should aim to help the attendees feel comfortable, and not feel they were being judged.”
KS: Can you give us a breakdown of what a session looks like? What are the key messages you’re trying to get across?
AMP: The sessions are being conducted in conference rooms in a hospital. They run for 90 minutes. Attendees are mainly doctors, nurse practitioners and medical students. The average number of attendees per session is 40 to 60. The sessions have been designed to be informal and non-biased. We want to educate, not alienate.
Our aim is to separate the researched and well-known impact of tobacco use on the body, and re-focus the attention on how nicotine affects the body.
I consulted with two friends, one a psychologist and another who does university lectures, on how to go about the sessions. This topic is controversial; the advice we received was that we should aim to help the attendees feel comfortable, and not feel they were being judged. We were also encouraged that a few jokes thrown in would assist in making the sessions enjoyable and the attendees more receptive.
One example was: “It seems no one needs to listen to highly trained doctors like yourselves anymore. They can now rely on the accuracy of Dr. Google and social media influencers.” That works to bolster their self-esteem and to highlight the dangers of where a considerable amount of misinformation is coming from.
Although I am present, I do not host the session—we have an ex-university medical lecturer conduct them. We have a Q&A afterwards. We have had a guest pharmacologist attend two sessions to explain the pharmacokinetics and pharmacodynamics of nicotine. That data has been used in other sessions and is incredibly important, as it supports the peer-reviewed studies we use. To date, we have had five sessions. It is unlikely that we will have another session this year due to time restrictions.
KS: Have the people attending the sessions generally been receptive? Have there been any hurdles?
AMP: Overall, we have received more positive feedback than negative. Several attendees have attended more than one session. Some have thanked us afterwards for the information.
There are many people in the health industry who do not want to get involved in THR or even conversations about NRT or nicotine. I don’t know all their reasons, but some have expressed that the subject is too controversial. Some want people to quit smoking using therapy, Champix, hypnotherapy, etc.
“Some attendees did state that nicotine causes cancer.”
KS: What’s to blame for this absolute stance against THR?
AMP: As the sessions were on nicotine itself, rather than THR or vapes, that is impossible to answer based on the sessions themselves. It could be the “EVALI” outbreak, the “popcorn lung” lie, the government’s hard stance, and the lack of studies on nicotine usage not associated with tobacco smoking.
We assume that it’s a combination of all the above, and doctors are fearful of suggesting any product that could lead to a malpractice case.
I can only state from the doctors who spoke to us after the sessions that a few years ago, they had included nicotine vapes as a smoking cessation tool, especially if the patient had already tried other traditional, medically accepted treatments.
KS: What have you found are the most commonly held misconceptions about nicotine among the medical professionals at the sessions?
AMP: The misconceptions that we have encountered are that there is a link between nicotine and cardiac and lung disease. Some did state that nicotine causes cancer.
We countered the misconceptions with multiple studies. Highlights from the studies and links were part of the PowerPoint presentation. We had hard copies of the literature and studies for them to take with them.
I can’t answer whether there was surprise about the truth of nicotine. Doctors tend to be quite guarded about what they believe to be true or false.
KS: What difficulties do health providers encounter when recommending or prescribing vapes?
AMP: Presently the biggest issue we have heard is that doctors do not recommend them, as they do not have enough information from evidence-based studies.
We would like more universities and researchers to conduct unbiased nicotine studies. We need more studies comparing the health of smokers who have smoked for a similar length of time who quit using nicotine harm reduction and have the same health tests done at routine intervals.
Personally, I experience the gamut of emotions over nicotine falsehoods and vaping lies that I’m sure most who are fighting this battle feel. At times, I want to yell at people who are so closed-minded and refuse to look at the facts. It is exhausting, and at times I feel very low and defeated, to the point where it affects my mental health. That is when I take a step back and re-immerse myself back into everyday life. I regain my strength and come back fighting harder each time.
It is so frustrating that I, and so many others, are living healthier lives that we never thought possible because, when we were smokers, most of us knew the risks associated with the habit. We owe our futures to vaping, THR and NRT. But it’s impossible to get some people to understand.
“We are already helping other people around the country who want to do something similar. Doctors are in a unique position, and they need to learn the truth.”
KS: How, if at all, are medical providers changing their practices having learned about nicotine in your sessions?
AMP: It’s too early to determine what the long-term benefits of the sessions will be. However, due to the sessions, two general practitioners who did not include e-cigarettes as a method for smoking cessation now include them as an option for patients.
KS: What are your future plans for the project?
We are hoping to take the sessions out of the hospitals altogether and use private conference rooms. At present we believe the number of people attending is a good number. We are already helping other people around the country who want to do something similar. There are more of us working on this now.
Our goal is the same: We want doctors to unite in a common cause of defeating smoking-related illnesses and deaths, by accepting that not every person can quit smoking using traditional methods.
Doctors are in a unique position; they know that people think, behave and react differently. What works for one person doesn’t work for another. The onus is on medical professionals to change the dialogue about nicotine and THR, and they need to learn the truth and keep repeating it. Governments should not be controlling and removing a product that can save, and is saving, lives. In short, we want to keep teaching the science of nicotine to as many medical professionals as possible.
