In defense of nicotine

Its reputation has been battered. But its benefits might outweigh its harms.

This is from the California Department of Public Health. Tell it to Albert Einstein

People have been smoking tobacco for thousands of years — long before the invention of the cigarette, the growth of the global tobacco industry, the pushback from the anti-smoking movement and, most recently, the arrival of safer nicotine alternatives like JUUL and ZYN. George Washington and Thomas Jefferson farmed tobacco. FDR and Churchill, Mark Twain and Virginia Woolf, and Sigmund Freud all smoked. So did Albert Einstein, a lifelong member of the Montreal Pipe Smokers Club, who once said: "I believe that pipe smoking contributes to a somewhat calm and objective judgment in all human affairs."¹

There’s a narrative out there that contends that the 1.1 billion people who smoke in the world are hapless victims of Big Tobacco, an evil and heartless industry that has lied to the public and governments, marketed to young people and designed the cigarette to addict as many customers as possible. This is mostly true, or at least it was until some of the companies decided to take a different path.

What’s also true is that people like nicotine. It has demonstrable benefits.

“Nicotine improves alertness, concentration, mood and memory,” says David Abrams, a professor of social and behaviorial scientist at NYU whose CV includes stints at the NIH, Johns Hopkins and the Truth Initiative.²

Nicotine is addictive but not lethal. British psychiatrist Michael Russell, an early advocate of tobacco harm reduction, famously said: "People smoke for nicotine but they die from the tar."

This raises a question: Now that nicotine has been decoupled from the cigarette, so that it can be obtained without burning tobacco, which releases toxic smoke and carcinogenic chemicals, how should we as a society think about using, taxing, regulating or, perish the thought, banning nicotine?

What we should not do is demonize nicotine, as anti-tobacco groups do.

Witness the graphic above, from the California Department of Public Health. Trusted sources like the American Lung Association and the Cleveland Clinic exaggerate the harms of nicotine, to the point where surveys show that people mistakenly believe that e-cigarettes are just as harmful as or more harmful than conventional cigarettes. Shockingly, most doctors wrongly believe that nicotine causes cancer and heart disease. No wonder people are confused about the relative harm of nicotine products.

Thankfully, scientists who study nicotine offer a more nuanced view. Nicotine, they tell me, touches nearly every organ in the body; it increases heart rate and blood pressure, triggers a variety of brain chemicals, including dopamine, which is associated with pleasure, and has anti-inflammatory properties. People who smoke have a significantly lower risk of developing Parkinson’s disease, although the causality is unclear so it’s not known whether nicotine is protective. Some researchers had high hopes for an NIH-funded study that tried to determine whether nicotine could prevent or delay progression to dementia among people with mild memory loss; the results have been disappointing. Nicotine is quite complicated, and there’s a lot still to learn.

But there’s little doubt that for many people, nicotine relieves stress. People who smoke cigarettes tend to be poor and less educated; people of color, especially Native Americans; gay or lesbian; homeless or incarcerated; and those with mental-health or other substance-abuse issues.

Nicotine’s cognitive benefits also are well understood. The effects differ, depending on the user, as Marina Picciotto, a professor of psychiatry at Yale, tells me by email:

Human and animal studies show that nicotine is best at improving cognition in people who are already impaired, rather than in normal subjects. If someone has an injury or disorder that impairs cognition, they may benefit more from vaped nicotine than someone who is already doing pretty well.

Neal Benowitz, professor emeritus of medicine at UCSF, agrees, saying:

If you look at people with attention deficit problems, like ADHD, or some forms of depression or mild forms of dementia, nicotine enhances cognitive function.

Nicotine also delivers pleasure. That’s no small thing.

Says Picciotto:

That’s why people smoke after a meal. It makes the meal feel better. They smoke when they’re drinking, it makes the alcohol feel better. They smoke when they’re with friends, and it makes that social interaction feel better.³

But obtaining nicotine through e-cigarettes is not risk-free. Picciotto and Benowitz have concerns about the chemicals in vape liquids; the vaping market is effectively unregulated, with most people using illicit vapes imported from China.

Picciotto says: “We just don’t know what these chemicals will do to the lungs and body after prolonged vaping, and particularly, what heat does to make new chemicals that are not characterized.” Benowitz agrees: “I’d like to see e-cigarettes regulated.” Oral nicotine, like ZYN or the snus that are popular in Sweden, is probably a better option.

It’s also unwise for young people or pregnant women to use nicotine. “There are some unresolved questions about adolescent brain development, which is well documented in animals, not so much in humans,” Benowitz says. Nicotine also constricts blood vessels in the skin so it should be avoided “if you need a surgical procedure that involves a lot of healing, like skin healing,” he says.

Importantly, none of that should discourage people who smoke cigarettes from switching to safer nicotine products.

That, tragically, is what the lung association, American Cancer Society, Campaign for Tobacco-Free Kids and Truth Initiative all do, to varying extents. They were once anti-smoking groups but as teen and adult smoking have fallen to record lows, they have revised their messaging to target nicotine as well as cigarettes. The cancer society warns against “the negative impact of nicotine on oral and dental health, cardiovascular disease risk, and cancer risk.” Tobacco-Free Kids says nicotine “has a negative impact on heart health and the cardiovascular system [and] impacts immune function [and] interferes with normal insulin function and blood sugar control [and] has negative impacts on oral health.” The Truth Initiative says it is “committed to a future free from nicotine addiction.”

All the groups have campaigned to ban flavored nicotine products.

Give that flavored alcohol products, like citrusy vodka and chocolate liqueurs, are widely available, this makes little sense, given the relative harms.

Benowitz tells me:

Alcohol and cannabis, in my perspective, are much more harmful than nicotine. Alcohol causes a lot of death, not just from driving issues but also by increasing the risk of cancer. I'm not saying people shouldn't drink. I have occasional drinks, too. But if you look at total impact on society, I think alcohol is much more harmful than nicotine. The same goes for cannabis.

I’ll conclude with a few words from Matthew Myers, the longtime president of Tobacco-Free Kids. Twenty years ago—before the arrival of nicotine vapes or pouches—Myers said this:

The challenge to me is not to eliminate smoking, but the death and disease from smoking. That should be the end goal. If you had a product that addicted 45 million people and killed none of them, I would take that deal. Then you'd have coffee!⁴

I’m writing from a cafe where I’m enjoying my second cup of the day. I don’t smoke or vape but those who do should be able to enjoy their nicotine if they wish.

1. This quote has been widely cited but I could not find a primary source to confirm it. I’ve learned over the years that some people never said things we’re told they said.

2. The quote is from the documentary film You Don’t Know Nicotine.

3. The quote is from an interview with Brainfacts.

4. The quote is from a story by my former FORTUNE colleague Joe Nocera in the New York Times.