Wondering about the various aspects of nicotine is a fascinating pastime, but don't make the mistake of thinking that anyone knows much about it. Even the 'experts' are clearly way off the mark and it's easy to see why: the taboo surrounding nicotine, the huge amount of propaganda, and the myths.
When a situation exists where 44% of doctors in a highly-developed country are not only completely wrong about a subject they should know something about, and in fact believe the opposite of the truth, you know you're in a medical topic area that is abnormal. (In a recent survey 44% of British doctors thought nicotine was associated with cancer.)
Currently the biggest issue is that a foundation of current medical practice in this area is that nicotine is deemed to cause dependence and is responsible for dependence. It is very hard for senior figures to go against the convention, and to date only a handful have done so.
It's difficult to say exactly why this situation arose, but it is convenient for all and it has great commercial advantages, principally for the pharmaceutical industry. In practice they control how people think about this and similar issues, and you can see their power in the way that propaganda caused 44% of doctors to give a wrong answer that, in certain circumstances, will contribute to actions that could easily be deemed medical malpractice. A doctor assuming wrongly that nicotine is addictive (by itself, for never-smokers) and is associated with cancer can very easily make a wrong decision and give advice that could possibly lead to serious disease and death. I have seen this described as medical malpractice and can't really argue against it. The circumstances where this might occur are in helping the climate against THR solutions, and in prescribing pharmacotherapies for smoking cessation instead of a THR solution: a guaranteed 9 out of 10 failure rate for the first option versus an excellent success rate proven in the real world in ideal circumstance to be in excess of 50% (Sweden) and zero clinically-significant health implications for the average person, for the other option.
Some doctors think nicotine is associated with cancer; doctors in general don't know that THR is proven to work far better than pharmaceutical interventions when mentoring is available; doctors in general probably don't know that consumption of low-risk THR products is proven to have no clinical significance; and doctors in general probably don't know that there is no evidence whatsoever - not a single clinical trial, anywhere, ever - that reports nicotine can create dependence in a never-smoker; and that no person ever anywhere is reported as having become dependent on nicotine outside of delivery within tobacco; and that hundreds of never-smokers have been exposed to large quantities of nicotine for months at a time and not a single subject, ever, has been reported as showing any sign of reinforcement or dependence.
I think it is probably correct to refer to this as medical malpractice by the profession in general, and their senior figures, rather than to accuse individual doctors of this when they are clearly very badly advised by their seniors and specialists, and when the propaganda is universal. NICE and the FDA are very slowly moving to address this, but that movement is far too slow and will certainly result in many lives lost before it reaches the position of being accepted as incontrovertible. NICE have advised that nicotine is not associated with any disease; the FDA are beginning to make it clear that nicotine consumption has no known harms and does not create dependence; and several medical authorities have pointed out that long-term consumption has no clinical significance. But, in general, this information is not just being hidden from the public, but since many doctors are also clearly unaware of it, the information can probably be accurately described as being deliberately hidden.
When senior medical figures prevaricate on the issue of pure nicotine's potential for dependence in never-smokers, when not only is there zero evidence for it, but plenty of evidence opposing it, and the lack of such evidence raises important questions such as that it is probably impossible to provide it if none exists in the current climate, and finally that if such specific evidence existed then of course it would be trumpeted from the highest mountain, we can clearly see that there is a problem. That problem, put simply, is a general cowardice and/or prevarication by those in the profession who do know the facts.
It is impossible to provide evidence that pure nicotine can create clinically-significant measurements of dependence in never-smokers or those never exposed to tobacco. Senior medical figures who know this, but are not prepared to say so in public, are cowards and implicated in the resulting loss of life.
If they really wanted to preserve life then they would establish clinical trials to measure the dependence potential of pure nicotine in never-smokers. There are many such trials already, for other purposes, and without exception all report that there has not been a single example of nicotine dependence resulting from the administration of large quantities of nicotine to hundreds of never-smokers for many months.
We can also see that ethics panels have no problem with such trials, so protestations of problematic trial applications are a red herring (or, possibly, just another lie). There are many published trials where large amounts of nicotine were administered to never-smokers and this was the entire point of the trial. Let's see that proposed with an addictive and harmful drug - I'm sure you can think of one or two - and then look at the ethics committee's response... It is clear they have no problem with administering large amounts of nicotine to unexposed individuals as that was the whole point of these trials, and they were passed by ethics panels without issue.
The whole subject is obscured by a climate of outright lies, and the cowardice of senior medical figures doesn't help either.
