Study: 78% of Doctors Say Cigarette Smoke, Not Nicotine, Causes Smoking-Related Risks

A global survey of more than 15,000 physicians from 11 countries reveals that 78% of doctors believe cigarette smoke—rather than nicotine—is the main cause of smoking-related health risks. This conclusion aligns with extensive scientific research underscoring the dangers of tobacco combustion, rather than nicotine itself.

The survey was conducted by Sermo, the world’s only dedicated social network for doctors providing healthcare insights. It was funded by the Foundation for a Smoke-Free World and included physicians specializing in internal medicine, cardiology, pulmonology, oncology, and psychiatry. The participating doctors were drawn from countries such as the United States, China, Germany, Greece, India, Japan, and South Africa, among others.

Research has long confirmed that the combustion of tobacco—occurring at temperatures starting from 400°C—releases more than 6,000 chemical compounds, of which around 100 are classified as harmful or potentially harmful to human health. These chemicals are the primary cause of smoking-related diseases, such as cancer, heart disease, and respiratory illnesses.

In contrast, nicotine, though addictive, is not the primary driver of these diseases. French oncologist David Khayat explained that it is the smoke resulting from burning tobacco, not nicotine, that introduces most of the toxic elements.

In response to these findings, some alternative tobacco products aim to minimize harm by heating tobacco instead of burning it, at temperatures below 350°C. These products produce no smoke and significantly reduce the levels of harmful chemicals by up to 95% compared to traditional cigarettes. However, experts caution that this reduction in harmful chemicals does not mean such products are completely risk-free.

Between 71% and 94% of the physicians surveyed agreed that quitting smoking is the best and first option for smokers. The doctors also expressed their desire for more training in smoking cessation programs and harm reduction strategies, to better support patients who are trying to quit.

David Khayat emphasized that while quitting should always be the primary goal, harm reduction is an important approach for individuals who struggle to stop smoking. “Some people will never quit smoking,” Khayat explained. “This is where smoke-free products that reduce harm through heating tobacco, rather than burning it, play an essential role. Ongoing research is needed to develop even safer alternatives.”

Khayat recommended that those unable to quit smoking should turn to smoke-free alternatives to reduce their exposure to toxic chemicals, as these products eliminate the harmful byproducts of combustion.