Former HHS secretary says 25 million smokers are being left behind

As a physician, former member of Congress, and former secretary of the U.S. Department of Health and Human Services, I have spent much of my career focusing on policies that improve health outcomes. I also saw the cost of smoking up close. I lost my father to what I often call “Lucky Strike lungs”. This experience has stayed with me and underscores a simple truth: smoking remains one of the nation’s most serious and persistent public health problems.

But there is a growing habit in Washington of talking about smoking as if it were yesterday’s problem. Not. Nearly 25 million American adults still smoke, and too many have been left out of public health discussions. this is the main message “The Forgotten Smoker” A new white paper from Philip Morris International US (PMI US) urges policymakers to confront a truth they often overlook: progress has stalled for the millions of Americans still at greatest risk.

From a physician’s perspective, these Americans are not abstractions. They are patients, parents, workers, veterans and neighbors. Many have tried quitting more than once. Many know the risks very well. But understanding the danger and overcoming addiction are not the same thing. If we are serious about reducing smoking-related diseases, our policies must reflect the lived realities of adults who continue to smoke, rather than assuming the problem will resolve itself.

A more effective approach starts with a simple public health principle: The greatest harm comes from burning. The FDA has recognized that tobacco and nicotine products pose a persistent risk, that cigarettes are at the most dangerous end, and that smoke-free alternatives generally pose lower health risks than continuing to smoke. This is important. For adults who have not completely quit nicotine, quitting smoking may still be a meaningful health intervention.

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Unfortunately, this message is still not reaching the people who need it most. The FDA may make real progress by allowing smoke-free products through a rigorous scientific review process, but that progress means little if patients never hear about it or their clinicians don’t feel prepared to discuss it properly. As a doctor, I find this particularly disturbing. Regulatory action is important, but communication is what turns regulatory action into public health impact.

We can see the results in the data. A national survey of 1,565 U.S. healthcare practitioners commissioned by PMI US and fielded by Povaddo LLC found that 47% mistakenly believed nicotine was carcinogenic, while 19% were unsure. The truth is that nicotine itself does not directly cause cancer.

The same survey found that 69% want the FDA to share clinical evidence on the role smoke-free products can play in harm reduction, 68% want clear guidance on counseling patients who want to transition away from cigarettes, and 95% say they would share information provided by the FDA with patients. This is not a marginal finding. This is a clear sign that clinicians want reliable, practical tools and the FDA is uniquely positioned to provide them.

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This confusion doesn’t end at the clinic door. ““The Forgotten Smoker” The survey found that misinformation about nicotine and relative risk is widespread: 52% of Americans mistakenly believe that nicotine itself causes cancer, and 73% mistakenly believe that all tobacco and nicotine products are equally harmful.

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But the public is also aware that there is unfinished business. When presented with the smoking continuation scale, 79% say more needs to be done to reduce smoking-related harm. In Washington, this should be seen as both a warning and an opportunity for action.

What should happen next is pretty simple. FDA should provide practical, plain-language guidance to clinicians that they can use now; Materials developed with input from GPs explaining what the agency mandates, what that mandate does and does not mean, and how to have evidence-based conversations with adult smokers trying to quit smoking.

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It must be said clearly and repeatedly what poses the greatest health risk: cigarettes, not nicotine. It must make authorization decisions understandable to non-specialists and bring this science into the exam room where patient decisions are often shaped. And it must speak directly to adult smokers, particularly populations that are overrepresented among those who continue to smoke, including older Americans and veterans, in a way that meets them where they are.

Good public health policy meets people where they are, uses the best available evidence, and provides both patients and clinicians with the tools to take action. The forgotten smoker was overlooked for too long. Washington must stop looking the other way.

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