In an opinion piece, Dr. Tom Price — a physician, former member of Congress, and former Secretary of Health and Human Services who spoke at ATNF 2025 — argues that roughly 25 million American adults who still smoke have been left out of the public health conversation, even as Washington increasingly treats smoking as a solved problem. Writing from a clinical perspective and citing the loss of his father to smoking-related disease, Price frames continued smoking as one of the nation’s most persistent health challenges. His central reference point is “The Forgotten Smoker,” a new white paper from Philip Morris International U.S. that urges policymakers to confront stalled progress among those still at greatest risk.
Price builds his case on the principle that the greatest harm from tobacco comes from combustion, noting that the FDA itself recognizes a continuum of risk with cigarettes at the most dangerous end and smoke-free alternatives generally posing lower risk than continued smoking. He argues that for adults who do not quit nicotine entirely, moving away from cigarettes can be a meaningful health intervention, but that this message is not reaching the people who need it, in part because clinicians often feel unprepared to discuss it accurately.
To illustrate the communication gap, the article cites a PMI U.S.-commissioned survey of 1,565 U.S. healthcare practitioners, fielded by Povaddo, in which 47 percent mistakenly believed nicotine is a carcinogen and another 19 percent were unsure. The same survey found that 69 percent wanted the FDA to share clinical evidence on the harm-reduction role of smoke-free products, 68 percent wanted guidance on counseling patients, and 95 percent said they would share FDA-provided information with patients. The white paper research also found widespread public misperception, with 52 percent of Americans incorrectly believing nicotine causes cancer and 73 percent believing all tobacco and nicotine products are equally harmful.
Price’s recommended path is straightforward: the FDA should equip clinicians with plain-language guidance developed with input from practicing physicians, explaining what the agency has authorized and how to have evidence-based conversations with adult smokers. He urges the agency to state plainly that smoke, not nicotine, drives the greatest risk, to make authorization decisions understandable to non-experts, and to communicate directly with populations overrepresented among continuing smokers, including older Americans and veterans.
