Tobacco Asia

12 tobaccoasia Issue 3, 2026 May / June Q&A THE TA Q A By Thomas Schmid Dr. Charles A. Gardner earned his PhD in developmental neurobiology from the University of Michigan and has held senior positions at the US Department of Health and Human Services, the World Health Organization, and several global health foundations. With over 30 years of experi- ence in public health, Gardner has recently become a strong voice in rethinking how we approach nicotine; and he advocates for "de-demonizing" the substance. De-Demonizing Nicotine Dr. Charles A. Gardner. Tobacco Asia (TA): Charles, let's start with the big picture. Why has nicotine been so thoroughly demonized in the United States and many other countries? Dr. Charles A. Gardner (CG): The short answer to your question is that cigarettes deliver nicotine; and cigarettes are responsible for probably 99% or 98% of all tobacco related deaths. And so, for decades now, the fields of tobacco control and public health have been using the words "nico- tine" and "tobacco" and "smoking" as if they are synonyms -- which they are not. They're three different words. In fact, if you go back to old tobacco control scientific studies, it's often difficult to tell what they're talking about, because they use those words interchangeably. So nicotine gets demonized because cigarettes kill people; and killing people is bad. TA: There are sources claiming that 80% of US physicians still believe that nicotine actually causes cancer… CG: That misunderstanding continues to shape policy and practice. And this is true in other countries as well, for example India. So, 4 out of 5 doctors are profoundly misinformed if they believe that nicotine itself -- the molecule -- causes cancer or heart disease or lung disease. It just doesn't. And that's where equating nicotine and tobacco as if they were the same has really caused a lot of confusion. And that has led to the demonization; and that leads then to prohibitions. TA: How did this narrative that nicotine is bad, bad, bad take hold? CG: It's because nicotine is associated with cigarettes or tobacco. We need to distinguish nicotine from the product that's delivering the nicotine. One of the products that delivers nicotine is a nicotine vape, sometimes also called an "e-cigarette." A survey just came out showing that in the United States the percentage of the adult population who thinks that nicotine vaping is more harmful than cigarettes has been increas- ing steadily over the past 10 years. The same is true, by the way, but not quite as bad, in the UK. And that's an interesting observation. People are getting more and more misinformed, I would say. The real question is who's misinforming them, because that does not happen by accident. And I hate to say it, but it's certainly not the [tobacco] industry that's doing the misinforma- tion there. It's public health itself that's doing that. And I guess there are also many anti-nico- tine lobbies around -- or prohibitionists if you like -- that are exaggerating harms, invoking the "think of the children" rhetoric.

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