What do medical schools teach about nicotine? Not much, if the results of a recent Rutgers University study are to be believed. Like the general public, physicians have a poor understanding of nicotine, and many mistakenly believe that nicotine is responsible for harms caused by inhaling cigarette smoke.
The study, published in the Journal of General Internal Medicine, shows that most specialists from fields that treat lifelong smokers believe that nicotine contributes to cancer, heart disease and chronic obstructive pulmonary disease (COPD). The results are shocking. Combining the results from all of the doctors, 83 percent believe that nicotine directly contributes to heart disease, and 81 percent think nicotine contributes to COPD.
A research team from Rutgers surveyed more than 1,000 doctors between September 2018 and February 2019. The doctors were all specialists practicing either family medicine, internal medicine, obstetrics and gynecology, cardiology, pulmonary or critical care, and hematology and oncology.
Incredibly, 77.2 percent of cancer specialists (oncologists) believe nicotine directly contributes to cancer, and more than two-thirds of lung specialists (pulmonologists) think nicotine contributes to COPD. A whopping 86.8 percent of cardiologists mistakenly blame nicotine for contributing to cardiovascular disease.
But it is the constituents in smoke that cause all of those diseases—not nicotine, which is a mostly harmless drug that makes smoking attractive and addictive. Epidemiological studies of Swedish snus and nicotine replacement therapy (NRT) product users show that regular nicotine intake doesn’t cause higher rates of those diseases than the rates seen in non-nicotine users.
Many of the surveyed doctors are from specialty fields routinely expected to treat advanced cases of smoking-related diseases like cancer, COPD and heart disease. If they are unaware that prescribing nicotine to help these patients avoid cigarettes is safe—and something to be encouraged—it probably means people in their care are getting poor advice.
“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 study co-author Michael B. Steinberg, medical director of the Rutgers Center for Tobacco Studies and internal medicine chief at the Rutgers Robert Wood Johnson Medical School.
One would expect medical education to include training on the specific harms of smoking, particularly for specialists in cardiology, pulmonology and oncology. But the level of nicotine ignorance by the surveyed doctors exceeds that of the general public.
According to a 2018 PinneyAssociates study, 52.9 percent believe nicotine causes most of the cancer from smoking, and another 21.2 percent aren’t sure. That means more non-doctors than doctors have a mostly correct understanding of nicotine’s cancer risk.
Their poor understanding of nicotine probably explains much of doctors’ antagonism toward vaping. Anyone who mistakenly believes that nicotine causes cancer and heart disease is liable to perceive the risks of vaping as being similar to the risks of smoking. To make matters worse, many doctors probably believe that the positions on vaping held by their medical societies reflect scientific understanding, rather than political alliances with anti-smoking (and anti-vaping) groups.
Unlike nicotine, that kind of ignorance causes real harm to people who smoke and vape.