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A November 8, 2026, MedPage Today opinion article argues that clinicians and public health agencies need clearer ways to explain how risks differ among nicotine and tobacco products. The authors say cigarettes are especially harmful, nicotine products are not risk-free, and people who do not use nicotine should not start; they also stress that the best communication approach is not yet known.
Three researchers in tobacco communication and regulatory science are calling for clinicians and public health agencies to explain differences in health risks across nicotine and tobacco products, as consumers encounter an expanding range of cigarettes, e-cigarettes, pouches and other products. In a November 8 MedPage Today opinion article, they argue that clearer guidance could help people who smoke understand alternatives without suggesting that nicotine products are safe or encouraging nonusers to start.
Authors Ying Zhang, Andy Tan and Meghan Moran describe a marketplace that includes combustible cigarettes, e-cigarettes, nicotine pouches, smokeless tobacco, snus and heated tobacco products. They say consumers also face messages that can seem to conflict: broad warnings about tobacco use, advertising that presents products as cleaner or smoke-free, and research discussing e-cigarettes as a possible aid for adults trying to quit smoking.
The authors say people who do not use nicotine or tobacco should not start, noting that nicotine is addictive and that nicotine-containing products carry health risks, including cardiovascular risks. For people who smoke, they identify quitting entirely as the best option and say approved nicotine replacement products, such as patches, gum and lozenges, and prescription medications should generally be considered first-line treatments.
For people who cannot or are not ready to quit, the authors argue that understanding differences between products may matter. They say combustible cigarettes pose the greatest health risks and that noncombustible products generally fall lower on the risk spectrum, while stressing that no tobacco product is completely safe. They also emphasize that switching completely matters: using another product while continuing to smoke does not provide the same risk reduction as eliminating cigarette smoking.
Guidance for People Who Smoke
The debate has practical consequences for healthcare conversations and public messaging. If people hear only that all products are equally dangerous, they may not understand differences in exposure; if reduced-risk claims are presented without caveats, they may mistake them for proof of safety or an invitation to use nicotine. The authors argue that communication should explain both points at once.
The issue also involves who delivers the information. The authors say messages should come from credible, independent sources without a financial interest in selling nicotine products. They warn that if health professionals and public agencies do not address questions, commercial marketing, social media and word of mouth may shape public understanding instead.
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A Crowded Product Marketplace
The authors situate their argument in a rapidly changing U.S. market where products differ in how they deliver nicotine and whether tobacco is burned. They note that the U.S. Food and Drug Administration has authorized modified-risk claims for certain products, allowing claims that using those products instead of cigarettes reduces the risk of several serious diseases. Such authorization applies to specific products and claims; it does not mean the products are harmless.
The article also refers to a recent opinion piece attributed to former Health and Human Services Secretary Tom Price. The authors say a disclosure at the end stated that it was produced in partnership with and paid for by Philip Morris International. They cite the example as a reason to distinguish independent health guidance from material backed by companies that sell tobacco products.
“For someone who does not use any nicotine or tobacco products, the advice is straightforward: Don’t start.”
— Ying Zhang, Andy Tan and Meghan Moran, authors of the MedPage Today opinion article
Which Messages Will Help Smokers
The article does not identify a proven best format for explaining relative risks. The authors say possible approaches include clinician-patient discussions, public education campaigns, a trusted information source, or a combination, but each may differ in reach, cost and risk of unintended consequences.
They call for research into whether these methods help people who smoke understand product differences without encouraging nicotine use among people who otherwise would not start. The article also does not provide a product-by-product ranking or quantify the health risks of each product. Its broad comparison—that combustible products generally carry greater risks than noncombustible ones—is not a guarantee of safety for any individual product.
Testing Independent Risk Communication
The authors call for evidence on which communication strategies can explain relative risk accurately and reach people who smoke. They do not set out a specific study, agency action or timetable. For now, their proposed direction is for health professionals and public agencies to communicate openly about what is known, what remains uncertain and the importance of quitting cigarettes entirely.
As product marketing and FDA-authorized modified-risk claims continue to reach consumers, the authors say trusted, independent sources will need to address questions without minimizing addiction or implying that noncombustible products are risk-free.
Key Questions
What are the researchers asking health professionals to do?
They want clinicians and public health agencies to explain that nicotine and tobacco products differ in risk, while making clear that no tobacco product is completely safe and that nonusers should not start.
Do the authors say nicotine products are safe?
No. They say nicotine is addictive and nicotine-containing products carry health risks. Their argument is that some noncombustible products generally present lower risks than cigarettes, not that they are harmless.
What do the authors recommend for people who smoke?
They identify quitting entirely as the best option and say approved nicotine replacement therapies and prescription medications should generally be considered first-line treatments. They also argue that people who cannot or are not ready to quit need clear information about relative risks.
Does using a second nicotine product while smoking reduce risk in the same way as switching?
No. The authors say switching completely matters; continuing to smoke while using another product does not provide the same risk reduction as eliminating cigarette smoking.
Is there a proven best way to communicate these risks?
Not yet, according to the authors. They say research is needed to compare clinical discussions, public campaigns and trusted information sources and to assess whether they inform smokers without encouraging nonusers to begin using nicotine.
Source: medpagetoday.com
