Doctors lack basic knowledge about nicotine and smoking cessation, with serious consequences for smokers. This is according to a new report from the UK.
"A common theme is that doctors around the world believe nicotine causes cancer, and few have a clue how to use nicotine to help smokers quit," says British/Indian doctor Sud Patwardhan.
Reports "Confidence in nicotine for tobacco harm reduction-Bridging the policy-practice gap". is a compilation of a large number of studies in which doctors from around the world were asked questions about nicotine and smoking cessation.
"We started surveying doctors on their knowledge of nicotine and tobacco back in 2010. The first one was a comparison between Swedish and British doctors and their knowledge of nicotine. It found that 40% believed that nicotine causes cancer, which it really doesn't." says author Sud Patwardhan to GFN TV channel.
A global pattern
Over the years, similar studies from other parts of the world have shown the same pattern, mainly in India, South-East Asia and the Middle East, but also in the United States. Further studies among health professionals, family doctors and other specialists in the field showed the same knowledge gap. Sud Patwardhan, himself a doctor practicing in the UK, began to wonder about the causes. He found it in education.
"The only thing medical students are taught is that tobacco in various forms causes a variety of diseases and that they should advise patients to quit. At best, they are taught that there are nicotine medications that they can prescribe to the patient. And that's a good thing." says Sud Patwardhan.
Lack of sustainable tools
According to Sud Patwardhan, the knowledge gaps have major consequences, not least for individuals who smoke or use other dangerous forms of tobacco. In India, where tobacco use is very high with nearly 300 million users and 1.2 deaths annually, doctors are without sustainable tools to reverse the trend. Pricing and access are key factors. Unlike nicotine medicines, e-cigarettes and other harm reduction products such as snus and nicotine pouches banned in India. And the only options for smoking cessation are too expensive, notes Sud Patwardhan.
"A pack of nicotine gum costs ten times more than a pack of gutkha, an oral tobacco product that causes oral cancer and leads to 300 000 deaths a year. It is not enough to simply ask patients to quit. Sustainable alternatives need to be combined with smoking cessation education. But it must start with a sober discussion about nicotine and harm reduction" says Sud Patwardhan
E-cigs or chewing gum matter less
Since harm reduction for smokers was introduced, first in the form of nicotine gum in the 1970s, various tools have slowly gained acceptance to reduce the harms of smoking. E-cigarettes, but also snus, have come more recently and have not yet gained the same acceptance among doctors and lawmakers. But according to Sud Patwardhan, it matters less which method doctors advocate. As long as it works.
"We need to put the individual at the center here. The smoker should have a variety of tools at their disposal, be it gum, spray, patch or nicotine pouches and regulated e-cigarettes. The studies may show that e-cigarettes are more effective than nicotine medicines in clinical trials. But let's not forget that the common factor in these trials is actually behavioral therapy. Regardless of the tool, it is the support that the smoker receives that is crucial. That's why doctors need to understand the different products on the market and then teach the patient how to use them properly, whether it's e-cigarettes or nicotine gum." says Sud Patwardhan.
Various recommendations
In Sweden, the Public Health Agency of Sweden and several medical groups only recommend various forms of nicotine replacement therapy for smoking cessation. I United Kingdom and New Zealand the corresponding authorities also recommend e-cigarettes as a tool to quit smoking.
