INHALATION of smoke, not nicotine, is the culprit that causes smoking-related deaths and diseases, according to a Canadian health expert.

Professor David T. Sweanor, chair of the advisory board of the Centre for Health Law, Policy & Ethics at the University of Ottawa, said for anyone wishing to tackle the global toll of 20,000 lives a day lost due to cigarette smoking, one needs to remember four words: "it’s the smoke, stupid."

He stressed that contrary to popular belief, nicotine is not the substance that causes these deaths, adding that the primary cause of the cancers, heart and lung disease is the repeated inhalation of smoke.

The professor made the distinction to differentiate the risk profile of non-combustible alternatives (NCAs) like vapes, heated tobacco products (HTPs) and oral products like Sweden’s snus, which deliver nicotine without burning tobacco. He said by eliminating combustion or the burning process, these innovative products provide smokers with less harmful alternatives to smoking.

Sweanor said the human body is simply not designed to inhale smoke. It is the tar from combustion and not nicotine that contains carcinogens and toxicants.

He likened nicotine to caffeine, saying it is a psychoactive substance that is addictive and gives assorted benefits to many users.

He, however, noted that by themselves, neither have significant health risks when used at normal dosage levels. If obtained through a toxic delivery system such as smoking, great injury can be caused.

Sweanor said making NCAs available to countries such as the Philippines will help millions of smokers reduce their exposure to smoke and illnesses.

Mounting evidence from scientific studies around the world confirms that NCAs are significantly less harmful than traditional cigarettes. According to Public Health England and the Royal College of Physicians, e-cigarettes are at least 95 percent less harmful to humans than combustible tobacco.

A February 2019 clinical trial by UK’s National Institute for Health Research found that e-cigarette was twice as effective as nicotine replacement treatments such as patches and gum at helping smokers quit.

NCAs offer a similar ritual and pleasure as cigarettes with less exposure to the dangerous toxins and carcinogens found in tobacco smoke.

Citing Japan’s experience, Sweanor said it reduced cigarette sales by more than 30 percent in just over three years following the introduction of HTPs.

He noted, however, that many governments cannot keep up with the advances in science and technology.