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Nicotine Propaganda

The amount of propaganda surrounding nicotine is considerable. Below, the most-often quoted myths created by the propaganda are examined.
 

1. "Nicotine is addictive."

This is an opinion with no evidence to support it, and in this situation any opinion is valid. However, such a statement is probably incorrect on multiple levels:

  • Use of the term 'addictive' is deliberately emotive and used for the purpose of inflaming the debate when applied to a material for which harm is impossible to measure reliably; it is incorrect because modern custom is to use the word 'dependence' and 'dependence forming' for a material causing no reliably measurable harm (e.g. coffee, for which there is some evidence for dependence creation).
  • 'Addictive' is used when the custom or consumption is likely to cause reliably-identifiable harm of some kind (e.g. gambling addiction, crack addiction).
  • There is no evidence that nicotine is dependence-forming except in tobacco smoke along with a mix of 9,600 other compounds including multiple synergens and boosters. Describing one item from a list of 9,600 as responsible for the whole is a gross logic error. Ketchup could be made to create dependence with such an ingredient profile.

There is no evidence whatsoever that nicotine has any significant potential for dependence outside of tobacco smoking, and anyone who tells you that it can create dependence is offering an unsupported personal opinion, or is badly misinformed. In the case of a well-informed expert who would know that there is no evidence that nicotine (by itself) is dependence-creating and that in contrast there is a body of anecdotal evidence that it isn't, then it may be hard to avoid the interpretation that the statement is a deliberate lie, especially where they appear financially conflicted (for example if their employment or funding depends on some aspect of public health or pharmaceutical industry grants).
 

2. "There is plenty of evidence that nicotine is 'addictive' / dependence-forming."

No - there is no such evidence. There is plenty of evidence that smoking creates dependence, but since tobacco smoke contains thousands of compounds [2], a statement that one of those compounds causes the dependence (as against dependence on that compound being caused by smoking) has no scientific validity until tested.

But there are no tests: since there is no published clinical trial of nicotine (not tobacco smoke) and, obviously, in never-smokers (since we know that smoking causes dependence, therefore testing it is not needed - this is already established), then it is obvious that no evidence exists. Indeed, what evidence there is contradicts this: nicotine is anecdotally shown to have no potential for dependence.

There is not a single published clinical trial of nicotine administration to never-smokers for the purpose of determining its potential for dependence. Anyone claiming expertise in the area who tells you there is such a published trial is badly misinformed (or a liar) [2] - and therefore can hardly claim to be an expert, since they don't know the basics and their knowledge appears based on propaganda.

Ask for a reference to a clinical trial that examines the potential of nicotine to cause dependence in never-smokers (the only valid method); there is no such trial. All citations lead to trials of smoking dependence or where the subjects are smokers (or ex-smokers). A person who is already dependent due to smoking cannot be used as a subject in a trial to determine the potential of one compound in tobacco smoke to create dependence - this is a basic principle of logic and cannot be avoided.

Note that in medical terminology, a non-smoker = an ex-smoker = an ever-smoker; a never-smoker, in contrast, is one who has never smoked, and the class that of course must be used to test for any dependence potential of (pure) nicotine.


3. "There are dozens of clinical trials of nicotine, all showing its dependence-forming capability."

No - there are none. There are many trials with smokers or ex-smokers but we already explained why this is irrelevant [3]. A trial, to qualify as 'a trial of nicotine', must be of the administration of unadulterated nicotine to never-smokers. Otherwise, clearly, it has no relevance.

However, there are around six clinical trials identified so far, of this type, where nicotine was administered to never-smokers, for other purposes. (Administration to ever-smokers is irrelevant.) These trials took place in order to evaluate nicotine's beneficial effects on medical conditions such as cognitive dysfunction and auto-immune diseases. Despite high doses administered for several months, no subject experienced withdrawal effects, or symptoms of dependence, or continued to use nicotine afterward. In these trials, nicotine was demonstrated to have no potential for dependence. It must be stressed that this is pure nicotine, not tobacco with nicotine or tobacco smoke with nicotine, and the subjects had never smoked: we are only interested in the effects of nicotine, not the effect of a cocktail of synergens or the effect on those already dependent due to previous smoking.

These results are considered anecdotal evidence only, because the purpose of the trials was not to investigate this issue. Be that as it may, we now know:

  • There are several trials involving pure nicotine given to never-smokers
  • No subject exhibited any sign of dependence
  • There are no trials of pure nicotine with never-smokers where dependence was reported
  • There is clearly no issue with ethics committees regarding the administration of high doses of nicotine for many months to never-smokers, as all these trials did exactly that

You may consider this to be anecdotal evidence, which is the accepted definition of evidence acquired from studies of other issues; or you may consider it quite useful information since there is no other source of any evidence.

Separately, you may want to consider why no one has ever published a clinical trial that:
- Administered pure nicotine to never-smokers to examine any dependence potential
- Showed that, having done so, nicotine has potential for dependence

...when we know beyond doubt that:
 (a) such trials are regularly carried out
 (b) there is no problem with ethics panels
 (c) such a trial, if it reported dependence, would be fabulously useful to many very well funded pressure groups.

It is difficult to avoid the conclusion that such trials have indeed taken place but the results were not beneficial to the commercial / political agenda of the funders. After all, nothing would be easier to demonstrate, according to the mythology - and we know such trials are regularly carried out, so there is clearly no problem with ethics panels. This single fact alone is almost enough to demonstrate that nicotine probably has no demonstrable potential for dependence. When this is combined with the fact we know that trials have taken place for other purposes in which an equivalent dose to 18 cigarettes per day was administered to never-smokers for 6 months, with zero effect, then we might conclude, with some justification, that nicotine has no potential for dependence when consumed outside of tobacco smoke.
 

4. "Nicotine is highly toxic."

No, it is probably not much more toxic than some other normal dietary elements. In addition, consultant toxicologists have advised that retail e-liquid is in the same official toxicity class as washing-up liquid (the detergent used for washing plates).

In October 2013, Prof Mayer of Graz showed that nicotine's toxicity has been greatly overstated; that there is zero evidence for the current LD50; that no one has ever died as a result of consuming a dose equivalent to the current LD50; and that people routinely survive consumption of doses many times the current LD50 with no ill effects to speak of.

This was the first-ever comprehensive review of the evidence supporting the current LD50; and as a result (as Mayer reports that there is none whatsoever), the LD50 will need to be adjusted upward by as much as a factor of 20 (in line with his research into what does constitute a proven fatal dose). Even so, it still only applies to certain delivery methods such as injection, because it has been demonstrated that people can ingest a very large amount of nicotine and suffer no lasting effects [4]; although apparently the abdominal pain at the time takes some beating - nicotine ingestion (swallowing it) triggers a vomit reflex in adults and the material is almost entirely expelled.

"Nicotine is a toxic material because if you swallow a lot, the prolonged vomiting to expel it, and the abdominal pain, are severe." This statement is true.
 

5. "Nicotine is an addictive, highly toxic, dangerous, alien chemical that should be avoided."

Hard to know where to start with this one...

Is it 'addictive'? No: there is no evidence for this and some that it is not dependence forming. Also, it would currently be incorrect to describe it as 'addictive' as no harm can be demonstrated for the average person.

Is it 'highly toxic'? No. Nicotine is certainly toxic, just like many normal dietary ingredients and medicines. In fact the only difference between a nutrient or a medicine and a poison is the dose. "The dose makes the poison", as doctors have known for more than 2,000 years - so it's not exactly news. Also, we now know from Prof Mayer's work (which is the only analysis of nicotine toxicity in humans) that it is far less toxic than current medical literature suggests. The current LD50 is around 20 times too low, and an LD50 for ingested nicotine will be difficult to establish as it appears difficult or impossible for a non-anaesthetised adult to ingest a fatal dose (because it is expelled by reflex). Children are a different matter though, since the vomit reflex may be absent.

Is it 'dangerous'? It is dangerous in large amounts, just like many other normal dietary ingredients such as vitamin A, vitamin D or iron. The dose makes the poison: you can kill yourself with an overdose of any one of several normal dietary components. In fact a scientist would be even more strict with this definition: everything is toxic; you can die from an overdose of anything/everything.

Is it 'alien'? Hardly - nicotine is a normal ingredient in the diet, and you should probably suspect the motives of someone who tries to tell you otherwise. Every large-scale clinical test of people to determine nicotine presence in the body has always - without exception - reported that all subjects test positive for nicotine. The last such test was of 800 people by the CDC in the USA [5].

Should it 'be avoided'? This would be difficult, completely pointless, and possibly harmful: nicotine is a normal and natural part of the diet, everyone tests positive for it, it is harmless in the diet, and it is closely associated with the B vitamin group. One form of nicotine is vitamin B3 (nicotinic acid). Nicotine and nicotinic acid share several effects in the human organism (such as improving cognitive function in some circumstances), although a deficiency of nicotinic acid can lead to pellagra (a severe deformity of the skin) and psychiatric symptoms. Nicotine is present in many vegetables such as tomatoes and potatoes (members of the Solanaceae family), where it is co-located with vitamin B3, plus other foodstuffs such as tea - this usually contains five pharmacologically active alkaloids, which is of course why it works. Aubergines (eggplants) and ketchup contain most nicotine, though the quantities are dietary - that is to say, quite small in absolute terms, and normally insufficient to raise the plasma nicotine level to more than 2ng/gm (the highest background plasma nicotine level measured in a non-smoker whose diet is perfect). Because nicotine is detectable in anyone with a good diet, medical smoking tests that use nicotine or its metabolytes such as cotinine as the marker to test for, need to have a starter level that is well above zero, since otherwise everyone would test as a smoker.

As regards 'avoiding' nicotine, even if it could be accomplished - perhaps by avoiding any vegetables and instead taking supplements - it does not seem a good idea. Active dietary components are eventually found to have a beneficial effect. Since nicotine is demonstrated to assist with cognitive function and certain medical conditions such as auto-immune diseases, in some circumstances, then perhaps this question is being looked at the wrong way round - perhaps instead it should be, "What are the effects of removing a normal, active component from the diet? Can this lead to cognitive function issues or other medical conditions?". This is a hypothetical question, but it has as least as much validity as suggestions that such a component should be avoided.

So the statement at the start of this section #5 is propaganda, probably with some sort of financial or ideological motive - it has no basis in reality and above all is irrelevant (or harmful) in a health context.


You feed your baby nicotine
This seems an important point to make - no one has ever been stupid or deranged enough to suggest that feeding your baby mashed-up vegetables is a bad idea. Vegetables contain nicotine. Not only is there nothing wrong with this, it is highly desirable, because:

(a) Nicotine is closely associated with the B vitamin group, and trying to remove it would probably create nutritional deficiencies;
(b) Active dietary ingredients are eventually found to have a benefit or they would not be part of the diet. Discovery of the function of an active dietary ingredient is related to the progress of research, not the state of our knowledge at any given point in time;
(c) Normal dietary ingredients are not usually described as undesirable [6].


6. "Nicotine causes cancer."
"Nicotine promotes cancer."
"Nicotine is associated with cancer."
"Nicotine causes heart disease."
"Nicotine causes vascular disease," etc.

This is a group of lies that can all be addressed at the same time. Nicotine is not associated with cancer or heart disease. Anyone who tells you otherwise is badly misinformed [7] (or a liar).

The UK's NICE (the official clinical guidance org for doctors), in PH45, state this clearly. The US FDA no longer considers nicotine harmful or 'addictive' and are to remove warnings from medicines that previously cautioned about this.

Snus consumers in Sweden have provided us with a data mountain on this topic [8]. Smokers who switch to Snus have the same health outcomes as smokers who totally quit: clinically speaking, Snus consumption is considered equivalent to quitting. Because of the huge size of the data resource, and because no clinical significance can be attributed to Snus consumption, it is considered that long-term nicotine consumption has no clinical significance. There is also a (far smaller) data resource from NRT consumption, which gives the same result. Note that consumption of such products cannot be 'absolutely safe' or 'harmless', just as coffee consumption cannot be, either; simply that any harm is below clinically-significant levels and indeed cannot be reliably identified.
 

Everything you thought you knew about nicotine is probably not only wrong, it is most likely the opposite of the truth.


Welcome to the world of propaganda: you just had your first lesson in how easy it is to convince the general population to believe the opposite of the truth.


 

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Notes

[1] Rodgman, Perfetti 2013 identifies 9,600 compounds in tobacco / smoke.

[2] All citations lead to clinical trials of smoking - irrelevant as there are 9,600 other compounds in tobacco, as measured at Q1 2014; or to trials with smokers or ex-smokers - irrelevant because we know that smoking causes dependence and, commonly, dependence on nicotine, due to supposedly irreversible or difficult to reverse changes in brain chemistry.

[3] Dependence on nicotine caused by smoking is believed to be due to additional compounds in tobacco such as the MAOIs, and these are believed to both act as synergens and to cause permanent or semi-permanent changes in brain chemistry. Several professors have stated that nicotine by itself is not dependence-forming (which is an opinion, due to the lack of hard evidence either way).

[4] We still don't know what the LD50 for *ingested* nicotine is likely to be, because ingestion of nicotine without suppression of the vomit reflex is not well-demonstrated to be fatal in adults. In contrast, ingestion of 1,000mg is well-demonstrated to have no significant effects, and ingestion of 1,500mg is known to be survivable. Thus, the median fatal dose for ingested nicotine in adults, without anaesthetics or other drugs to suppress the vomit reflex, may be several grammes.

[5] The CDC have done their best to hide this clinical trial as it does not agree with their political agenda. There is no online link available although the study has been referenced in several places, and therefore its existence cannot be denied even though it has been removed from public view.

[6] Part of the propaganda war on nicotine depends on it being described as a "highly toxic, addictive, dangerous, alien chemical". It is of course none of those things. In the main, it is the opposite of those things. Propaganda is the art of making people believe lies, and nowhere has it been as successful as with nicotine.

[7] A recent survey of British and Swedish doctors showed that 44% of British doctors thought nicotine is associated with cancer. Most thought nicotine is one of the more toxic ingredients in tobacco smoke. You may want to consider what use a doctor's advice may be in this area when their knowledge appears based on propaganda and myths rather than science; it demonstrates how utterly misinformed someone may be whom you consider to be an expert.

NICE have tried to correct this, but are themselves seriously conflicted due to the close relationship of the health service with the pharmaceutical industry (and in fact they are frequently one and the same), when pharma has been the principal funder of the propaganda. The US and UK authorities (NICE, FDA) no longer believe nicotine to be either harmful or dependence-forming, and both have published advice to this extent (see NICE PH45; FDA re-labelling consultation to remove references to harm or addiction from nicotine-containing medicines). NRTs have no potential for dependence, or harm, and therefore cautions are unnecessary (they are among the safest of medicines).

[8] Snus is a local oral tobacco product that is not chewed, is specially processed to remove most of the carcinogens, and delivers significant quantities of nicotine. The data resource is only applicable to Swedish Snus consumed in Sweden, because the national health statistics, epidemiology and hundreds of clinical studies over three decades there give us all the information we need on this topic; other products in other areas are not so easily assessed.


 


This article was previously published on ECF
created here: 2014-03-27