Is nicotine all bad?

Since he ditched Marlboro Lights five years ago, Daniel’s fix is fruit-flavoured nicotine gum that comes in neat, pop-out strips. He gets through 12 to 15 pieces a day and says he has “packets of the stuff” stashed all over. But he doesn’t see himself as a nicotine addict.

Like many people, Daniel believes nicotine gum is far less harmful for him than smoking. Doctors worldwide agree. By giving up cigarettes, they say, Daniel has removed at least 90 per cent of the health risks of his habit.

Even so, the possibility that people can be addicted to nicotine, but not die from it, is at the heart of a growing debate in the scientific community. Scientists don’t doubt nicotine is addictive, but some wonder if a daily dose could be as benign as the caffeine many of us get from a morning coffee.

It’s a debate that has been aggravated by the rising popularity of electronic cigarettes — tobacco-free gadgets people use to inhale nicotine-laced vapour, which have helped some people quit smoking. The idea of nicotine as relatively benign goes against the negative image of the drug that built up over the decades when smoking rose to become an undisputed health threat.

Psychologists and tobacco-addiction specialists, including some in world-leading laboratories in Britain, think it’s now time to distinguish clearly between nicotine and smoking. The evidence shows smoking is the killer, not nicotine, they say.

“We need to de-demonise nicotine,” said Ann McNeill, a professor of tobacco addiction and the Institute of Psychiatry, Psychology & Neuroscience at King’s College London, who has spent her career researching ways to help people quit smoking.

She wants people to understand the risks are nuanced — that potential harms lie on a curve with smoking at one end, and nicotine at the other. People who don’t see that may hesitate to seek help stopping smoking, or try to restrain their intake of nicotine replacement therapy (NRT). That can make it harder to quit.

Some studies show nicotine, like caffeine, can even have positive effects. It’s a stimulant, which raises the heart rate and increases the speed of sensory information processing, easing tension and sharpening the mind.

All this raises other questions: Could nicotine prime the brains of young people to seek harder stuff? Or, in an ageing society, could its stimulant properties benefit people whose brains are slowing, warding off cognitive decline into Alzheimer’s and delaying the progression of Parkinson’s disease?

So far the answers aren’t clear. And the divide is as political and emotional as it is scientific.

McNeill says her work is, in part, to honour the legacy of her former mentor at King’s, British psychiatrist Mike Russell. About 40 years ago, Russell was one of the first scientists to suggest that people “smoke for the nicotine, but die from the tar” — an idea that helped lay the ground for the NRT business of gums, patches, vaporizers and now e-cigarettes.

Some scientists note Russell’s insight has been misused by the tobacco industry. For decades, companies’ false promises of ‘light’ cigarettes helped lure more smokers, says Mike Daube, professor of health policy at Curtin University in Australia. “We have seen more than six decades of tobacco industry distraction products, promotions and deceptions,” he says. “They revelled in advertising that implied both reduced risks and even health benefits.” Smoking kills half of all those who do it — plus 600,000 people a year who don’t, via second-hand smoke — making it the world’s biggest preventable killer, with a predicted death toll of a billion by the end of the century, according to the World Health Organisation.

Studies have looked at nicotine’s potential to prevent Alzheimer’s disease, and to delay the onset of Parkinson’s.

A study in the journal Brain and Cognition in 2000 found that “nicotinic stimulation may have promise for improving both cognitive and motor aspects of Parkinson’s disease.” Another, in Behavioural Brain Research, suggested “there is considerable potential for therapeutic applications in the near future.” In Sweden, many people get their nicotine from sucking smoke-free tobacco called ‘snus.’ Research there has put rates of lung cancer, heart disease and other smoking-related illness among the lowest in Europe.  Even so, the idea of ‘safe nicotine; has not caught on.

Marcus Munafo, a biological psychologist at Britain’s Bristol University, says public health campaigns of the 1970s and 1980s bound nicotine, addiction and cigarettes tightly together to hammer home smoking’s harms. Those associations may blur the potential for cleaner nicotine.

Munafo is questioning the notion that a nicotine addiction is, in itself, bad. “Should we really be that bothered about addiction in and of itself, if it doesn’t come with any other substantial harms?” said Munafo.