Scientists and medical doctors cautioned that the widespread misconception about nicotine’s harm is hindering millions of smokers worldwide from adopting effective, less harmful alternatives.
During a panel discussion at the eighth Summit on Tobacco Harm Reduction: Novel Products, Research and Policy in Athens on Sept. 30 and Oct. 1, 2025, organized by SCOHRE, the International Association on Smoking Control and Harm Reduction, 200 experts from 51 countries emphasized a collective message: Science, not ideology, must guide global tobacco control efforts and embrace harm reduction as a vital public health tool for smokers unable or unwilling to quit.
Tobacco harm reduction is a public health strategy aimed at reducing the harm caused by traditional cigarettes by promoting less harmful alternatives such as e-cigarettes, heated tobacco and nicotine pouches. While cessation remains the ‘gold standard,’ experts said these alternatives represent a pragmatic, science-based option.
Dr. Konstantinos Farsalinos, a physician and research associate in Greece, noted the important role of the scientific community in correctly communicating the effects of nicotine to dispel misconceptions about it.
The failure to confront these misconceptions will only allow them to thrive, continuously leading many health care professionals-and the public-to mistakenly consider nicotine itself as highly hazardous.
Research shows nicotine itself is not the main cause of diseases associated with smoking, though it is addictive.
Meanwhile, Dr. Giovanni Li Volti, a full professor of biochemistry at the University of Catania, cited studies suggesting nicotine is ‘perfectly safe’ for cardiovascular health and not associated with conditions such as recurrent stroke.
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He said the very existence of nicotine replacement therapy (NRT) makes no sense if nicotine were inherently risky.
Despite this evidence, Li Volti said the prevailing misperception is widespread.
‘This is the result of our failure as a scientist to communicate. We fail to teach them what is exactly the effect of nicotine and which is the toxic effect of combustion products,’ he said.
He added that high-quality human epidemiological evidence does not support an increase in the risk of cardiovascular disease or cancer from nicotine alone.
The practical consequences of this failure were illustrated by Dr. Rohan Andrade Sequeira, a consultant cardio-endocrine physician in Mumbai, India, where the widespread use of local oral tobacco contributes to exceptionally high rates of oral cancer.
With the global success rate for NRT at only 7 percent, Sequeira said the remaining 93 percent of users ‘have to go back to their old patterns,’ remaining trapped in a cycle without a safer alternative.
For Sequeira, nicotine pouches present an opportunity for India to progress from its traditional patterns of oral tobacco use.
Damian Sweeney, chair of the New Nicotine Alliance Ireland, presented Sweden as a powerful ‘proof of concept.’
While the country’s overall nicotine use is at the European Union average, the majority is through snus, a smoke-free tobacco product.
This has reduced Sweden’s smoking prevalence to just 5 percent-the lowest in the European Union-a clear achievement for tobacco harm reduction supported by robust real-world data.
Sweeney contended that misinformation about nicotine and low-risk alternatives is ‘as deadly as smoking itself.’
The consumer perspective is vital, Sweeney said, urging individuals to share their positive experiences with novel products directly with policymakers.
Farsalinos corroborated the impact of misinformation, noting that a 2017 survey he published found only 5 percent of smokers correctly believed e-cigarettes are substantially less harmful than smoking.
‘When they’re not properly informed, they will not even try to quit using a harm reduction product,’ he said.
Clive Bates, former director of Action on Smoking and Health (ASH) UK, cited evidence that all noncombustible nicotine sources are ‘very much less risky than smoking.’
He said the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) has moved away from its core objective of reducing smoking and is actively blocking tobacco harm reduction.
He said a ‘coalition of the willing’ among FCTC parties should emerge to challenge the secretariat and the WHO to integrate harm reduction and reverse the current ‘fanaticism’ against nicotine. The panel concluded that the scientific community should consistently communicate evidence-based findings across all channels, while media outlets share a responsibility to correct misinformation and provide balanced coverage of harm reduction.