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 harm 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 nicotine contributes to cancer, heart disease and chronic obstructive pulmonary disease (COPD). The results are shocking. When you combine the results of all doctors, 83 percent believe nicotine directly contributes to heart disease, and 81 percent believe nicotine contributes to COPD.
A Rutgers research team surveyed more than 1,000 physicians between September 2018 and February 2019. The physicians were all specialists in family medicine, internal medicine, obstetrics and gynecology, cardiology, pulmonary or critical care medicine, and hematology and oncology.
Many of the physicians interviewed come from specialties that are routinely expected to treat advanced cases of smoking-related diseases such as cancer, COPD, and heart disease.
Incredibly, 77.2 percent of cancer specialists (oncologists) believe nicotine directly contributes to cancer, and more than two-thirds of lung specialists (pulmonologists) believe nicotine contributes to COPD. A whopping 86.8 percent of cardiologists incorrectly blame nicotine for cardiovascular disease.
But it is the ingredients in smoke that cause all these 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 use does not cause higher rates of these diseases than among non-nicotine users.
Many of the doctors interviewed come from specialties that are routinely expected to treat advanced cases of smoking-related diseases such as cancer, COPD and heart disease. If they are not aware that prescribing nicotine to help these patients avoid cigarettes is safe - and something to be encouraged - it probably means that the people in their care are being badly advised.
"Physicians need to understand the true risk of nicotine use, as they are critical in prescribing and recommending 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 chief of internal medicine at Rutgers Robert Wood Johnson Medical School.
Their lack of understanding of nicotine probably explains much of the antagonism doctors have towards vaping.
One would expect medical education to include training on the specific harms of smoking, especially for cardiology, pulmonology and oncology specialists. But the level of nicotine ignorance among the physicians surveyed exceeds that of the general public.
According to a 2018 study by PinneyAssociates, 52.9 percent believe nicotine causes most smoking-related cancers, and another 21.2 percent are not sure. This means that more non-physicians than physicians have a largely accurate understanding of the risk of cancer from nicotine.
Their lack of understanding of nicotine probably explains much of doctors' aversion to vaping. Anyone who mistakenly believes that nicotine causes cancer and heart disease perceives the risks of vaping to be similar to the risks of smoking. To make matters worse, many doctors likely 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, this kind of ignorance does real harm to people who smoke and vape.