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A November 8, 2026, MedPage Today opinion article argues that clinicians and public health agencies should explain how risks vary across nicotine and tobacco products. Its authors say cigarettes remain especially harmful, while stressing that noncombustible products are not harmless and that the best way to communicate relative risk is not yet known.
Three researchers in tobacco communication and regulatory science are urging clinicians and public health agencies to explain how health risks differ across nicotine and tobacco products, arguing that conflicting messages leave people without clear guidance. In an opinion article published by MedPage Today on November 8, 2026, they say communication should distinguish cigarettes from noncombustible products without portraying any nicotine product as safe or encouraging nonusers to start.
Authors Ying Zhang, Andy Tan and Meghan Moran describe a market spanning cigarettes, e-cigarettes, nicotine pouches, smokeless tobacco, snus and heated tobacco products. They say consumers encounter warnings about tobacco use alongside advertising that presents some products as cleaner or smoke-free, as well as news and research discussing youth vaping and e-cigarettes as a possible quitting aid for adults. The authors argue that this mix can make the relative risks hard to interpret.
The article says the U.S. Food and Drug Administration recognizes combustible products such as cigarettes as carrying the greatest health risks, while noncombustible products generally fall lower on the risk spectrum. The authors also note that the agency has allowed certain products to be marketed with claims that switching from cigarettes reduces the risk of several serious diseases. Such authorizations apply to specified products and claims; they do not mean tobacco products are safe.
For people who do not use nicotine or tobacco, the authors’ advice is not to start. For people who smoke, they identify quitting altogether as the best option and say approved nicotine-replacement products and prescription medicines should generally be considered first-line treatments. They argue that, for people who cannot or will not quit, fully moving away from cigarettes may reduce harm compared with continuing to smoke. Using cigarettes alongside another product is not equivalent to switching completely, they stress.
Clearer Guidance for Smokers
The authors’ argument concerns decisions people may make while trying to quit or weighing alternatives to cigarettes. If guidance treats every product as identical, smokers may not understand the potential difference between continuing to smoke and switching completely to a noncombustible product. But describing some products as lower risk without clear limits could also be misunderstood as an endorsement or an invitation to use nicotine.
That tension gives trusted, independent communication a public-health role, the researchers say. Health professionals and agencies need to explain both relative risk and the continued dangers of nicotine use. The authors warn that silence or oversimplified messages could leave advertising, social media and informal advice to shape public understanding instead.
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A Market With Mixed Messages
The opinion article situates its call for clearer guidance in a rapidly changing product market and an information environment that can appear contradictory. Public health campaigns warn against tobacco use, while the FDA has authorized modified-risk claims for certain products. The authors say readers also encounter coverage of youth vaping and research on e-cigarettes as a potential cessation aid for adult smokers.
The researchers point to a separate op-ed about a nicotine and tobacco risk continuum as an example of why readers should check disclosures. Although that piece carried a byline attributed to former Health and Human Services Secretary Tom Price, the disclosure, as described by the authors, said it was produced in partnership with and paid for by Philip Morris International. The researchers use the example to argue that risk information should come from sources without a financial stake in product sales.
The authors do not present the article as a new clinical guideline or a study testing a particular product. It is a commentary and call for research into how clinicians and public health bodies can explain relative risk while avoiding unintended encouragement of nicotine use.
““Cigarettes are extraordinarily dangerous, and nicotine is what makes them so hard to quit.””
— Ying Zhang, Andy Tan and Meghan Moran, authors of the MedPage Today opinion article
How Risk Messages Should Work
The article does not establish which communication method works best. The authors say it could involve clinician-patient conversations, public education campaigns, an accessible trusted information source, or a combination; each has trade-offs in reach, cost and potential unintended effects. They call for evidence on how to help smokers understand relative risk without encouraging people who do not use nicotine to begin.
The opinion piece also does not provide a product-by-product ranking or new clinical trial results. Its broad description of noncombustible products as generally lower on the risk spectrum should not be taken to mean that every product carries the same risk, or that any is harmless. The article’s discussion of FDA-authorized claims concerns certain products; it does not specify those products or provide a full account of each authorization.
Evidence for Better Risk Communication
The researchers call for studies comparing ways to communicate nicotine-product risks and for guidance to come from credible, independent sources with no commercial stake in sales. The article does not announce a research program, government policy change or implementation timetable.
For now, the authors urge clinicians and public health agencies to give people accurate information about the differences among products while making clear that not using nicotine is the safest choice for nonusers and quitting smoking entirely is the best option for smokers. Whether a particular approach can improve understanding without increasing uptake remains a question for future evidence.
Key Questions
What are the researchers asking health professionals to do?
They want clinicians and public health agencies to explain how risks differ among cigarettes and other nicotine products, while making clear that nicotine products are not harmless and nonusers should not start.
Do the authors say nicotine products are safe?
No. The authors say no tobacco products are completely safe. They describe cigarettes as especially dangerous and say noncombustible products generally carry lower risks, not zero risk.
They say quitting entirely is the best option. They also say approved nicotine-replacement treatments and prescription medicines should generally be considered first-line approaches.
Does using another product while continuing to smoke provide the same risk reduction as switching?
No. The authors say switching completely matters and that continuing to use cigarettes alongside another product does not deliver the same risk reduction.
What remains unknown?
The authors say it is not yet known which format—clinical conversations, public campaigns, an independent information source or a mix—best communicates relative risk without encouraging nicotine use among nonusers.
Source: medpagetoday.com
