Nicotine misconception may discourage smokers from quitting, says Cardiologist Dr. Prof. Syed Ishtiaq Rasool

Dr. Rasool says treating all nicotine products as equally harmful ignores important scientific distinctions and may hinder efforts to move smokers away from cigarettes.
There is a common assumption that if a product contains nicotine, it is equally harmful. Dr. Prof. Syed Ishtiaq Rasool, an interventional cardiologist, says that assumption oversimplifies the science in ways that matter.
“Not all nicotine products carry the same level of risk. Treating them as identical is tantamount to ignoring science and may discourage smokers from moving away from cigarettes, which remain the most harmful form of nicotine consumption,” said Dr. Rasool.
The confusion largely comes down to nicotine’s reputation. Because it is the most recognised substance in tobacco, it tends to absorb most of the blame for smoking-related harm. But nicotine is only one part of what a smoker is exposed to. The method of delivery determines what else enters the body alongside it.
Dr. Rasool argues that treating all nicotine products as equally risky overlooks important scientific differences. It ignores how different products expose users to different levels of harm, which makes the idea of them being the same difficult to defend.
With cigarettes, the delivery method is combustion. A lit cigarette burns tobacco at extremely high temperatures, and that burning process generates smoke containing thousands of chemical compounds. A significant number of those compounds are toxic, and many of them — including carbon monoxide, formaldehyde and various carcinogens — are not present in the tobacco leaf itself. They are produced by the act of burning.
When a smoker inhales, that mixture of gases and particles travels into the lungs, crosses into the bloodstream and circulates through the body. Nicotine is part of what is absorbed, but so is everything else that combustion creates.
The cardiovascular effects of that exposure are significant. Cigarette smoke damages the lining of blood vessels, promotes arterial plaque buildup and accelerates inflammation — all of which raise the long-term risk of heart attack and stroke. It is that toxic output, he says, that sits at the centre of smoking-related disease.
Nicotine dependence remains a serious issue in its own right and is one of the primary reasons many smokers find quitting difficult. But dependence and disease are not the same thing, and treating them as inseparable leads to an incomplete picture of where the harm originates.
Risk is influenced not only by nicotine itself, but also by what accompanies it. Cigarettes, for example, involve the burning of tobacco, which generates a range of toxic chemicals that are inhaled alongside nicotine. Because different products create different exposures, they can also present different levels of risk.
Health professionals are consistent that quitting tobacco and nicotine entirely remains the best available option for smokers. Dr. Rasool does not dispute that. His argument is about accuracy — that public health discussions are better served when they reflect what the evidence actually shows about where the risk is concentrated.
For Dr. Rasool, the issue is not whether nicotine products should be viewed as harmless. It is whether they should be understood accurately. Recognising that different products carry different levels of risk, he argues, is essential to ensuring that public health discussions remain focused on the product that continues to cause the greatest harm: the cigarette.