KUCHING: The key driver of smoking-related diseases is not nicotine itself, but the combustion process of burning cigarettes, which releases thousands of toxic chemicals.
Public Health Specialist, Hospital Management and Health Economics, UKM Medical Centre Professor Dr Sharifa Ezat Wan Puteh said many people continue to wrongly associate nicotine with the dangers of smoking, when the real risk comes from chemical-laden cigarette products and the burning process.
The combustion process, she said, is what releases thousands of toxic substances linked to major diseases.
“So, if it is truly tobacco, when we consume the tobacco leaf itself, the effects are not like what we see from cigarettes.
“Nicotine comes from the plant, but cigarettes have already been mixed with chemicals, and it is the burning process together with these additives that causes harm. That is what makes cigarettes dangerous,” she said.
She said this during the “Sarawak’s Illicit Trade: Drivers, Risks & the Cost of Prohibition” programme, Session 2 Policy & Impact Fireside Chat: Ban vs Regulation – Public Health at a hotel here on Saturday (April 25).
She added that nicotine, on its own, is not the main cause of cancer based on international research, but becomes harmful when delivered through burned tobacco.
Echoing similar concerns Philip Morris Malaysia (PMM) Scientific Engagement manager Dr Vijayndhran Balakrishnan, said public misunderstanding of nicotine has led to confusion about the true source of smoking harm.
He said that cigarette smoking involves combustion, a process requiring oxygen, fuel, and heat, which produces smoke containing more than 6,000 chemicals, including hundreds of toxic and carcinogenic substances.
Vijayndhran stressed that nicotine is often wrongly blamed as a carcinogen, despite international scientific assessments confirming otherwise.
“Nicotine is not classified as a carcinogen. It is addictive, yes, but it is not the substance that causes cancer.
“But smoking causes many health problems, including heart disease, lung disease, breathing issues, hypertension, and stroke, as highlighted by Dr Sharifa,” he said.
He added that nicotine also exists naturally in several plants and that the key issue lies in how it is delivered, particularly through combustion, which exposes users to toxic smoke and carbon particles.
He also highlighted the concept of harm reduction, where smokers who are unable to quit completely may switch to smoke-free alternatives that do not involve combustion.
According to him, second-hand smoke exposure remains a major concern, with non-smokers also at risk due to passive inhalation of toxic compounds.
“This is why combustion is the real issue. It produces carbon particles and toxic chemicals that affect both smokers and those around them,” he said.
The discussion also highlighted harm reduction strategies for adult smokers who are unable or unwilling to quit completely.
These include nicotine replacement therapies (NRT), heated tobacco products, e-cigarettes, and nicotine pouches, all designed to avoid combustion.
“These products do not burn tobacco. Instead, they deliver nicotine without producing smoke, significantly reducing harmful chemical exposure,” he said.
While quitting remains the gold standard, he said harm reduction plays an important role for smokers who have tried multiple cessation methods but remain unable to quit.
Scientific findings cited during the discussion suggest smoke-free alternatives can reduce toxic exposure by around 90 to 95 per cent compared to traditional cigarettes.
However, he cautioned that these products are not risk-free and should not be considered safe, but rather less harmful compared to continued smoking.
“The goal is not to say these are safe products, but that they are lower-risk alternatives for smokers who cannot quit,” he said.
He added that smoke-free alternatives aim to reduce risk at both individual and population levels, similar to public health strategies used in vaccination campaigns.
“The idea is population-level protection, where reducing exposure across smokers can lower overall health risks,” he said.
