At the Global Tobacco & Nicotine Forum (GTNF) in Brussels, experts from science, medicine, and industry agreed that misinformation about nicotine remains one of the greatest obstacles to tobacco harm reduction, and that changing those perceptions will require more than data alone. Moderator Dr. Mohamadi Sarkar, Fellow in Scientific Strategy and Analysis at Altria Client Services, opened the discussion by urging a focus on solutions rather than problems. He pointed to persistent misconceptions that distort both public and professional understanding. “According to analyses from the National Institutes of Health’s PATH study, 94% of smokers think e-vapor products are as harmful or more harmful than cigarettes,” he said. “And 63% believe nicotine causes cancer, despite evidence showing otherwise.” Sarkar noted that even among doctors, misinformation is widespread, with 80% of U.S. physicians believing nicotine is directly responsible for smoke-related diseases. His team’s modeling suggests that as many as 800,000 premature deaths could be prevented over the next 50 years if these misperceptions were corrected. “If doctors don’t have accurate information, how can they educate their patients?” he asked. For Sarkar, the path forward depends on credible voices, evidence-based messaging, and a “groundswell” of informed advocates within healthcare and beyond. “To change intentions, you first have to change attitudes and beliefs,” he said.
Dr. Jasjit Ahluwalia, Professor of Behavioral and Social Sciences and Medicine at Brown University, lamented that scientific research rarely informs public policy in a meaningful way. “You’d think research would inform policy, but it doesn’t,” he said. “People don’t listen to scientists or regulators; they listen to their own physicians. It doesn’t matter how good or bad they are.” Ahluwalia believes that changing physician behavior could be the key to improving patient understanding. He suggested borrowing tactics from behavioral economics and academic detailing to equip doctors with accurate, accessible information about lower-risk products. He also stressed the importance of engaging the media, which he described as “unbelievably powerful” but largely absent from the current dialogue. “The media could change public understanding overnight,” he said. “We’re not taking advantage of that.”
From the perspective of Dr. Pritika Kumar, Director of Scientific Engagement at Philip Morris International, the problem begins within the healthcare community itself. PMI surveys found that two-thirds of healthcare professionals were unsure what nicotine is or believed it to be carcinogenic, and only one in five felt confident discussing alternative products. “They operate in a system that has not kept up with the science,” she said. “Physicians don’t know what products are authorized, and they’re competing with time constraints and mixed messages that put all nicotine in one bucket.” Kumar called for a shift in tone from blame to collaboration. “If we don’t talk to them, we lose a powerful opportunity,” she said. “They told us that if the FDA provided clear guidelines, they would be happy to share that information with patients, but they’re not going to read a policy paper. They need practical guidance at the point of care.” She also warned that the proliferation of illicit and unauthorized products complicates physicians’ willingness to recommend alternatives. “Illicit trade is not just an enforcement issue,” she said. “It’s a public health issue.”
Italian researcher Dr. Riccardo Polosa, founder of the Center of Excellence for the Acceleration of Harm Reduction, reflected on a decade spent countering myths about vapor products. “In 2012, we were debunking claims about antifreeze and heavy metals,” he recalled. “I’m afraid we haven’t made much progress.” To improve communication, Polosa proposed what he calls the “3M framework”—message, messenger, and moment. “We need evidence-based messages, credible messengers, and the right moment to reach people,” he said. He outlined three target groups: healthcare professionals, who must be empowered to discuss harm reduction; researchers, who need better tools for peer review and interpretation; and the public, who must be reached directly through social media and community influencers. His team has even trained an AI-based system to assist in scientific peer review. “Researchers keep repeating the same mistakes,” he said. “Better peer review will mean better science and fewer misperceptions.”
For Dr. Christopher Russell, Director of Russell Burnett Research and Consultancy, the issue is one of legitimacy and communication. “It’s an awkward position for a doctor to talk about a product that hasn’t been approved,” he said. “A lot of people would feel better about getting their nicotine from a doctor rather than a gas station.” Russell argued that regulatory authorization can give both doctors and consumers greater confidence in alternative products. He also believes that packaging and labeling should be used to communicate accurate information about reduced risk. “The best time to reach an adult smoker with information is at the point of purchase,” he said. “Consumers deserve access to facts that help them make safer choices.” Russell cautioned against directly engaging with misinformation online, noting that “when we reply to false information, algorithms actually push it in front of more people.” Instead, he urged amplifying credible voices and increasing exposure to accurate messages.
Dr. Carrie Wade, Global Regulatory Science Liaison at BAT, emphasized that the concept of the continuum of risk remains poorly understood, even among professionals. “How can we expect the public to understand it when the message hasn’t even reached all our colleagues?” she asked. Wade argued that the industry spends too much time reacting to misinformation and not enough time being proactive. BAT’s internal research reflects the same challenge: while most employees recognize that non-combustible products are less harmful, a significant minority still do not. For Wade, this underscores how deeply misconceptions about nicotine are embedded and how urgently the message must be reframed.
Across the panel, there was broad agreement that correcting nicotine misperceptions will take coordinated action across science, medicine, regulation, and media. The facts about nicotine, they said, are clear, but unless they are delivered by trusted voices, at the right moments, and in the right way, those facts will continue to be lost amid noise and misunderstanding. “Science alone doesn’t change behavior,” Sarkar concluded. “People do. And that means every one of us has to be an ambassador for harm reduction.”
