Why 80% of doctors got this wrong

"Ask most people and they'll tell you it's the thing that gives smokers cancer. Ask some others and they’ll tell you they use it on purpose. So is nicotine good for you or not?" -- Ken

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SPEAKER_00 0:00

Could nicotine actually be good for you? Ask most people and they'll tell you it's the thing that gives smokers cancer. Ask some others and they'll tell you they use it on purpose. Joe Rogan does it. He calls it a neuroprotectant that slows down the decline of his nervous system. RFK Jr. is a regular user of nicotine pouches. And a growing number of prominent health influencers say they are too. Here's a number that got me. In a survey of a thousand American doctors, cardiologists, oncologists, smart people, four out of five of them said nicotine directly contributes to cancer, but it doesn't. Many of the people giving you medical advice don't seem to know the truth. So the elephant in the room is this something we've spent decades treating as pure poison might actually have real, legitimate upsides, and saying that out loud almost feels taboo. I'm Ken LaCourte, and my job here is simple. Did past what everyone assumes and tell you what I learn, even when it's inconvenient. So here's where we're headed. I'll start with looking at the unlikely comeback of nicotine. Then we'll describe how it became the wrong culprit people blamed. Then I'll look at how often it's the exit ramp for smokers, before looking at nicotine as medicine, and finally, I'll tackle the unsettled questions. Alright, nicotine might just be the most demonized drug in modern history. It's blamed for a body count higher than just about any substance on Earth. Doctors, parents, and public health campaigns have spent 60 years warning us away from it. So why is it making an unlikely comeback? As is so often the case, most of this started online with podcasts and biohacking forums. But it's quickly moved into the real world. A lot of smart people concerned about their health are choosing to take it. So why? Stanford neurobiologist and podcaster Andrew Huberman has said that nicotine sharpens the mind and that he occasionally uses small amounts.

SPEAKER_01 1:52

So occasionally, like right now, I do a half a piece, but I'm not Russian. So I'm a little, you know, you know, did you just pop the whole thing in your mouth? Mm-hmm. So I'll do a couple milligrams every now and again, and it definitely sharpens the mind.

SPEAKER_00 2:07

He's told a story in his own show about a colleague of his, a Nobel Prize winner, who choose nicotine gum specifically to boost cognitive focus. Peter Atia, a physician who's built his entire brand around living longer and better, for years has talked about using nicotine gum and lozenges as a focus aid before deep work. Dave Asprey, the guy who basically invented the word biohacking, says he doses one to two milligrams a few times a week, specifically for long work sessions and jet lag. I mean, these aren't burnouts smoking outside of a 7-Eleven. There are people who read science for a living and they've decided that it's worth doing, of course, carefully and in doses. These days, nicotine is now a big business. Gum sales are worth almost $2 billion a year now. There's also a new nicotine energy drink on the market, infused with nicotine and caffeine. Its first production run, about 250,000 cases, nearly sold out. The company's co-founder said it's stuck in a regulatory limbo, waiting on the government to tell them whether they can actually keep selling it. All this hasn't gone unnoticed by big corporations. In 2022, Philip Morris paid $16 billion for the company that makes zin. It shipped almost 800 million cans in the US alone last year. What does it do to the body that people find so appealing? First, it raises dopamine and norpinephrine, the chemicals behind alertness and focus. Researchers confirm that effect. Now, most of them put it roughly in the same range as a strong cup of coffee. It's real and measurable, but not really transformative. The dosing that biohackers talk about? None of them are doing it daily or in big amounts. They're doing it occasionally, in small doses. Closer to a double espresso before a long stretch of grunt work than a pack-a-day cigarette habit. Some in the space also point out to nicotine's appetite suppressing effects, since it mildly raises your metabolism. Now, if that pitch sounds familiar, it's because it's almost word for word the one cigarette companies use for decades to sell smoking to women and teenage girls, especially. They said that nicotine would help them keep slim, and they weren't wrong. A lot of people gain weight after they stop smoking. But even Huberman, who's about as pro-nicotine as any credentialed scientist gets, doesn't pretend it's free of downsides. The most obvious one is addiction itself, and it's very addictive. But it's unclear just how much it takes and how often you have to use it before you find yourself really needing a daily fix. For pouches and gum, we just don't know yet, they're too new. But for cigarettes, we've got decades of science, and that's not reassuring. For years the assumption was that dependence took months of daily use, but studies tracking kids from their very first cigarette have found some showing real symptoms of dependency within days or weeks, from as little as two cigarettes a week. Adults have more of a buffer, but the direction's the same. It's the same molecule hitting the same receptors, whether it's from a cigarette or a pouch, so there's no chemical reason to expect pouches to be any different. But we just don't have that data to prove it either way yet. What we have learned is that we've been blaming the wrong culprit for the dangers of cigarettes for as long as I've been alive, and nobody's really bothered to correct the record. Start with a number that's legitimately scary. Cigarette smoking kills almost a half million Americans every single year. Worldwide, it's something like 7 million. Nobody really disputes that. But the nicotine in a cigarette isn't what's killing people. It's a wrong notion that many people have, as I mentioned, including many in the medical system. That survey up top was from researchers at Rutgers who published it in 2021 and found 80% of doctors say that nicotine contributes to cancer. Some even blamed it for COPD, which is also not true. Among the general public, opinion's kind of all over the map. Another survey, also by Rutgers, but more recently in 2026, it found that depending purely on the phrasing, the share of Americans who got it right swung from 10% to 80%. So all over the map. And here's the thing that makes this wild. The science pointing away from nicotine really isn't new at all. Back in the 1920s and 30s, a physician named Angel Rofo, who ran Argentina's main cancer institute, painted tobacco tar onto the ears of rabbits, and they grew tumors. Then he did the same thing with nicotine alone, and nothing happened. A century ago, the tar, not the nicotine, was the known carcinogen. The distinction between the addictive part and the deadly part has been part of the scientific record since well before World War II. So how did we get to the point where nicotine became the demon? Well, part of it's real. Nicotine is the reason cigarettes are so hard to quit. It's genuinely one of the most addictive substances people regularly put into their bodies. And the industry itself didn't help untangle things. In 1994, seven tobacco company CEOs sat in front of Congress, raised their right hand, and testified, under oath, that they didn't believe nicotine was addictive.

SPEAKER_01 6:59

Just yes or no. Do you believe nicotine is not addictive? I believe nicotine is not addictive, yes. Mr. Johnston. Uh Congressman, cigarettes and nicotine clearly do not meet the classic definitions of addiction. There is no intoxication.

SPEAKER_00 7:15

We'll take that as a no and this is also why people dismissed a lot of the research from back then. Nobody believed them, and the fallout from that testimony also helped cement nicotine specifically as public enemy number one. So for most of the last century, nicotine and cigarette have basically functioned as the same word. In public health messaging and law and how your grandmother talked about it at the dinner table, the two got fused into one thing. Once something that addictive sits at the center of something that deadly, it's an easy, almost automatic leap to assume the addictive part is also the deadly part. But that's just not how the chemistry works. California still playing it into that hype. I was at a movie recently, and before the film, they showed an ad produced by the state, which was part of a $5 million statewide campaign targeting what they call big nicotine, and it was one of those disgusting close-ups of eyes, close-ups of gross gums. And that confusion has real costs in the real world. Nicotine patches and gums that was designed to help people quit smoking still carry a lot of warning labels. And those aren't necessarily untrue, but to the extent they keep people smoking, that's a bad problem. Vapes ran into the same wall when they first showed up. In 2008, the World Health Organization said there wasn't enough scientific evidence to back up the claims that e-cigarettes were safer than regular cigarettes. A year later, the FDA went further and tried to block their import into the United States entirely. That was overturned by the courts. And here's the part that's a little hard to swallow in hindsight. Because while regulators were trying to treat the new vapes like a drug, they went on to outperform the FDA's own approved nicotine replacement therapies, like patches, gums, and lozenges. Hey, look, I tried to get every fact right here, and my sources are down in the notes, but if I slipped up somewhere, let me know and I'll fix it in the comment section below. Alright, so the exit ramp is what alternate nicotine products really became for millions of smokers. For many, it was the main thing that helped them get off cigarettes for good. But to understand it, we should first look at the chemistry because cigarette smoke contains thousands of chemicals, and dozens of them are known to be carcinogens, although not nicotine. The FDA itself has now put that in writing. As of this year, the agency authorized zin to be marketed using a specific claim that using zin instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis. It's worth being exact about what that claim covers, because it's about switching from cigarettes. It's not a blanket declaration that nicotine is safe for everybody, and the FDA has been very careful not to say that. Here's some more data. Researchers have pooled together well over a hundred clinical trials, with more than 60,000 people total, all of them smokers trying to quit. Some of them got nicotine replacement tools, others got placebos. The nicotine groups, they succeeded at quitting long term at rates roughly 50 to 60% higher than the placebo group. Those results hold up regardless of setting or country. Same story with vaping. In a major clinical trial, smokers who used e-cigarettes had better success in stopping smoking altogether. Several countries have done this at a national scale. Sweden. Pouches replaced cigarettes there on a massive scale, despite complaints from the EU, which banned them in 1992. Sweden only sells them because it negotiated an exemption while joining the Union in 1995. Every other country in the EU is still legally barred from selling the product that helped drive Sweden's smoking rate to below 4%. It's the first country in Europe to drop below 5%, the threshold that the WHO says is smoke-free. Swedish men now have lung cancer mortality about 60% below the European average. And the pattern isn't just Sweden. Norway saw its own smoking rates fall to about 7% on the same kind of switch. Japan tested it with an entirely different product, heated tobacco that arrived in 2014, and in the years after, cigarette sales fell twice as fast as before. Different countries, different products, but the same direction. Now let's look beyond nicotine as just an aid to stop people from smoking. Let's talk about nicotine as medicine. I mean, it sounds like a contradiction, but for the last 30 years, serious researchers have tested it out as exactly that. The question now is whether nicotine, on its own, does anything actively good for you beyond that cup of coffee focus I talked about. Nicotine raises your heart rate and blood pressure and constricts your blood vessels. As a stimulant, it also helps delay sleep and it reduces deep sleep. That's nicotine acting on a healthy body. But researchers also spent decades asking a more strange question. Could that same chemical actually treat a diagnosed disease? The answer on this is it's very mixed. It runs from promising to a full-on scientific dead ends, sometimes for the exact same condition. So get this. People with schizophrenia smoke at dramatically higher rates than the general population. One serious hypothesis is that they often have trouble focusing and that they're self-medicating a concentration problem. Smokers have also shown lower rates of Parkinson's disease. Now, these are similar brain receptors, so that got scientists excited. They tested nicotine seriously for Parkinson's, cognitive decline, ADHD, schizophrenia, depression, even Tourette's. Now, some of the early small studies and animal studies were promising, but most didn't hold up later. Scientists now think that other components in smoking, maybe the carbon monoxide, might work together in a way that they just don't yet understand. So it's not a clean sweep of failure, but drug companies are worried because it's nicotine. I mean, it still carries an addiction risk. It still has some potential cardiovascular costs, and they just don't want to be the ones selling the next nicotine tablets next to aspirin. So something's gonna have to come out and show that it really works well for them to cross that Rubicon. Alright, so let's look at some of the many unsettled questions. Because while it might not be the killer we thought, whether it's harmless is a separate question entirely, and that's still open. Again, people like Huberman, ATIA, Aspiry, they're all using small occasional doses. They're what create the addictive craving for more. So a dose that worked last month stops registering as a boost and starts being what normal requires. It's a straightforward tolerance effect, the same kind that shows up with caffeine or cannabis, just faster and stronger. So, what specifically is that effect they're chasing? A 2010 meta-analysis pulled together every reliable study on nicotine's cognitive effects. It found real measurable enhancements in six specific areas: fine motor control, short-term memory, and above all, two particular kinds of attention, alerting attention, which is basically raw vigilance, and orienting attention, the ability to redirect focus onto whatever matters most right now. That's a very narrow kind of boost. There's nothing there about creativity or deep insight, but it's staying locked in and being able to direct focus during long, monotonous stretches. There are also more open questions on the individual health side. The short-term cardiovascular effects, it raises heart rate, raises blood pressure, those are proven. But what's less settled is the long-term cardiovascular risk from nicotine alone, isolated from smoke because that data is just thinner and newer than cancer research. There's also a newer complaint showing up in dental offices. Nicotine is a vasoconstrictor wherever it sits, and a pouch rests directly against gum tissue for extended periods. Dentists are now reporting gum recession and localized tissue damage tied into that. Again, not a large body of research, but an early pattern to be aware of. There's also questions relating to the vaping process itself. Heating any oil to vapor creates byproducts, benzene, formaldehyde, compounds your lungs weren't built to handle. And vape pens most have a metal coil that heats up hundreds of degrees each time you hit it, and that sheds microscopic particles of nickel, chromium, and lead into your body. What does that do to lungs over 20 years? We really don't know because the pens just haven't been around that long. But there may be hardware issues with the delivery. There is one data point that's pretty clear though, and it's around age. Nicotine exposure during pregnancy and adolescence affects brain development directly through the physical rewiring of the prefrontal cortex while it's still under construction. At that age, it alters the circuits responsible for attention and impulse control and raises the odds of lifelong addiction more than the same exposure would as an adult. That's a serious problem. And in fairness to the California ad people, teen and young adult use has been climbing. So a lot of these things don't have an answer, but that one, it actually does. Alright, so how do we wrap all this up? I'd say if you're a smoker and are already addicted to nicotine, shifting to ways that won't kill you as quickly as smoking is an absolute no-brainer. Nicotine isn't the villain we were taught it was, but that just also doesn't make that a health supplement either. It's an addictive stimulant that gives some people a real but modest edge, and anyone who does it really seems like they should do it in small doses and with their eyes open about the trade-off. For me, given the unknowns and the potential for addiction, I'd think long and hard before jumping into something like that was such a minor benefit. Look, I've seen too many smokers huddled out in the cold getting a fix they thought they could once control. Hey, I'm Ken Lecourte. Thank you so much for sticking with me through this. I hope you found it valuable, and until next time.