International health experts have condemned a United Nations speech by Palau’s head of state as “grossly misleading” and a “dangerous misrepresentation of science”.
President Surangel Whipps Jr told the UN General Assembly that “nicotine claims over 7 million lives annually” as he promoted Palau’s campaign for a World Health Organization (WHO) review of nicotine as a psychotropic substance.
But WHO’s own figures say something very different.
WHO states that tobacco kills more than seven million people every year and the global authority draws an explicit distinction between nicotine and cigarette smoke.
While nicotine is addictive, “it is the tobacco smoke, not the nicotine, that causes most of the harm,” the WHO states. Nicotine is “not a substantial cause of cancer” and is not a significant risk factor for cardiovascular events, it adds.
Furthermore, nicotine is listed in the WHO’s Model List of Essential Medicines as nicotine replacement therapy. Annually, millions of people worldwide use nicotine replacement therapy to quit smoking.
Smoke Free Sweden leader Dr Delon Human said: “Seven million people do not die every year because they consume nicotine. The WHO itself attributes those deaths to tobacco.
“To stand before the United Nations and blur that fundamental distinction is profoundly concerning. This is a dangerous misunderstanding of the science that risks misleading governments, public-health officials and, most importantly, people who smoke.
“How can such a basic distortion of one of the world’s most widely quoted public-health statistics be presented from the podium of the UN General Assembly without challenge?”
Professor Marewa Glover, an international tobacco harm-reduction researcher based in New Zealand, said the mistake mattered because millions of people who smoke need accurate information about relative risk.
“Nicotine is addictive, but nicotine and smoking are not synonymous,” she said.
“People overwhelmingly die from smoking because they inhale the toxic products created when tobacco burns. If we tell them that nicotine itself is responsible for the death and disease caused by smoking, why would they believe there is any benefit in switching to a non-combustible alternative?
“That kind of misinformation can have real public-health consequences.”
Sweden provides a striking real-world example of why the distinction matters.
One in four Swedish adults consumes nicotine, yet the country’s incidence of cancer is 41% lower than the European average and it suffers less than half of the tobacco-related deaths experienced by 24 of its 26 EU neighbours.
That is because Sweden has exceptionally high use of smokeless nicotine products, including snus and nicotine pouches, and the lowest smoking prevalence in the EU.
“Sweden exposes the flaw in President Phipps’s argument perfectly. Nicotine consumption has remained widespread in Sweden while cigarette smoking has collapsed,” said Dr Human, a former secretary-general of the World Medical Association.
“If nicotine itself were responsible for the enormous burden of cancer, cardiovascular disease and lung disease caused by cigarettes, Sweden’s health outcomes would look very different.”
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Photo by IISD/ENB – Diego Noguera, CC BY 4.0, via Wikimedia Commons
