Cigarettes are harmful. There is no disputing that. But one of the most widely misunderstood concepts is the actual impact of cigarettes on smokers and the reason behind it. It was identified by a British tobacco researcher, Michael Russell, back in 1976 and yet remains one of the most important yet most ignored insights in public health.
“People smoke for nicotine but die from the tar.”
It is a deceptively simple observation that should have changed the approach to policymaking around tobacco consumption. According to Russell, nicotine is the reason people cannot stop smoking. Why? Because nicotine releases dopamine, a hormone that regulates pleasure, memory, and focus in a person. When a person continues to smoke, the brain is restructured to continue to expect the dopamine that nicotine induces.
This is why sudden cessation makes a person irritable, restless, lose focus, and experience anxiety, among other symptoms. This is why so many smokers pick up smoking again. This is not a personality flaw; it’s biology.
However, nicotine is not what causes fatal diseases. It is the smoke that unleashes thousands of chemicals, including tar, the moment a flame meets tobacco. When a cigarette is lit, the act of burning fundamentally changes what is being inhaled. Tobacco does not simply burn in a clean way. It breaks down under heat and produces a complex mixture of chemicals that were not present in the original form.
Many of these substances are known to be harmful, and some are directly linked to serious diseases, including cancer. What matters here is not just the presence of tobacco, but what combustion turns it into
Hundreds of these chemicals are toxic. At least 70 are carcinogens that are known to cause cancer. These include formaldehyde, a chemical used to preserve dead bodies. Benzene, which is found in crude oil and linked to leukaemia. Others include arsenic, cadmium and Hydrogen cyanide. None of these chemicals is a result of nicotine. They are all released due to combustion.
This is a distinction that Russell understood in 1976, and one that public health has struggled to communicate clearly. The three leading causes of death among smokers, lung cancer, chronic obstructive pulmonary disease (COPD), and cardiovascular disease, are not primarily caused by nicotine. They are the result of the toxic byproducts of burning tobacco.
However, despite multiple studies confirming Russell’s insights, confusion persists. Even when there are attempts to start a public discourse on the matter, the word ‘smoking’ does a lot of quiet damage. It bundles together nicotine and smoke, which are two very different things. So even when smokers, who want to move away from cigarettes, reach out for alternatives that enable them to consume nicotine without setting anything on fire, the reaction is often discouragement.
This distinction matters when it comes to the conversation about harm reduction. Because if combustion is fatal, switching to non-combustible products is incredibly meaningful for a smoker who is unable to quit. The risk, while still present, is significantly lower if they switch to products that heat tobacco without burning it, or enable nicotine consumption through vapour or oral absorption. It is important to reiterate that none of these methods is free of harm, but they pose less risk when compared to smoking cigarettes.
The best outcome, indisputably, is complete cessation. But for millions of people who smoke today and will most probably continue to smoke tomorrow despite knowing the risks, making the distinction between nicotine and combustion can encourage them to effectively adopt less harmful methods to take in nicotine.
By Dr. Fawad Farooq
Author Bio: Dr. Fawad Farooq is Professor of Interventional Cardiology at the National Institute of Cardiovascular Diseases (NICVD), Karachi, with over 25 years of experience in cardiology.
