Richard Wagner was a German composer, theatre director and conductor who was instrumental in shaping and developing modern day opera and musical theatre. Unfortunately for Wagner, Hitler and the Nazi regime took a profound appreciation for his works, and often used his music for Nazi propaganda. Wagner’s compositions were shunned in many circles due to this regrettable association. History reminds us that people are notorious for throwing the baby out with the bathwater, the moment the metaphorical ‘bathwater’ has been perceived as harmful or dangerous.
Today we live in an era saturated with information where the threshold for acting on misinformation has significantly lowered. In the context of smoking, the statement that ‘smoking is injurious to health’ is irrefutable to the extent that it has now become medical dogma – an unquestionable truth that few dare to dissect. This absence of discussion has equated smoking to an inevitable decline in quality of life. But a more granular analysis of what constitutes smoking may reveal that this black-and-white narrative has shades of grey, and the blanket vilification of nicotine may be obscuring viable harm reduction strategies.
To have a meaningful conversation about the harmful effect of smoking, we must differentiate between tobacco and nicotine, clarifying their distinct roles in smoking and their respective health impacts. For decades, consumer exposure to nicotine has mostly occurred via cigarette smoking. That is why the effects of smoking and nicotine tend to be conflated in many scientific studies, and in people’s minds. Tobacco is a plant of the Nicotiana genus, having been cultivated and used for centuries, mainly for smoking and chewing. Nicotine, on the other hand, is a naturally occurring compound found in its highest level in tobacco plants, but is not exclusive to them, as it appears in lower levels in other natural sources i.e., potatoes, tomatoes and eggplants. If the same Wagner-boycott mentality was to seep its way into this dialogue, one could argue that family lunches should be devoid of batumoju, for fear of contracting respiratory diseases – an absurd notion, yet a reflection of how misinformation can misguide public perception.
While nicotine is the primary addictive component in tobacco, it is not the culprit behind smoking-related health issues. The real danger lies in the combustion of tobacco, which leads to the tobacco breaking down into thousands of chemicals, many of which are not present in the unburnt material, including tar, carbon monoxide, and carcinogens. Nicotine by contract, as stated by the UK’s National Health Service (NHS) ‘Vaping myths and facts’: “although nicotine is addictive, it is relatively harmless to health.” The NHS acknowledge that it is the many other toxic chemicals contained in tobacco smoke that cause almost all the harm from smoking, and nicotine itself does not cause cancer, lung disease, heart disease or stroke and has been used safely for many years in medicines to help people stop smoking.”
An overwhelming majority of smoking-related illnesses i.e., chronic obstructive pulmonary disease (COPD), heart disease and stroke, which are cardiovascular diseases (CVD), and cancer (specifically lung), are linked to the 150 toxicants in the smoke produced through combustion of the tobacco that cause disease and death, rather than nicotine itself. While nicotine is not risk-free, its primary concern relates to addiction rather than direct harm to vital organs.The World Health Organization (WHO) does not classify nicotine as carcinogenic and many other national health authorities recognise that nicotine, while addictive, does not directly cause cancer.(The Omni™)
The National Academies of Science, Engineering, and Medicine (‘NASEM’) in the United States has concluded that completely replacing cigarettes with e-cigarettes reduces exposure to numerous toxicants and carcinogens. Despite this finding, only 11.4% of Americans perceive e-cigarettes as less harmful than smoking, showing a gap between scientific evidence and public perception.
Although smoking is undeniably harmful, nicotine consumption, when decoupled from tobacco, is not synonymous with the perils of smoking and may offer a more sustainable path for those looking to distance themselves from combustible cigarettes.
By recognizing the distinction between nicotine and tobacco, we can shift the conversation from blanket condemnation to informed harm reduction. Just as Wagner’s music should not be dismissed purely because of its ill-fated association, nicotine should not be vilified simply due to its historical link with smoking. So, let’s answer the question, or at least start the conversation, on what it is about smoking that’s injurious to health.