Smoking remains one of the leading causes of preventable disease and death in Pakistan. An estimated 160,000 to 170,000 people die each year from illnesses linked to tobacco use, including lung cancer, heart disease, stroke, and chronic respiratory conditions. Millions more live with long-term disability caused by smoking, placing a sustained burden on households and an already overstretched healthcare system. Hospitals across the country continue to treat tobacco-related cancers and cardiac illnesses that could have been avoided.
Public health messaging has long emphasised one clear truth: quitting smoking is the best option. Stopping entirely reduces health risks significantly, regardless of age or how long someone has smoked. Yet despite widespread awareness of smoking’s dangers, many smokers find it extremely difficult to quit. Relapse rates remain high, even among those who attempt to stop repeatedly. Understanding why this happens is central to addressing Pakistan’s smoking crisis.
For decades, much of the blame for smoking-related disease has been placed on nicotine. Many people believe nicotine is the chemical that causes cancer, heart disease, and lung damage. This belief is widespread and deeply ingrained. However, scientific evidence tells a more precise story.
The real driver of smoking-related disease is combustion, the burning of tobacco. When a cigarette burns, it produces smoke containing hundreds of toxic and carcinogenic chemicals. These include tobacco-specific nitrosamines, benzene, arsenic, carbon monoxide, and polycyclic aromatic hydrocarbons. Together, these substances damage blood vessels, scar lung tissue, and trigger cancers across multiple organs. It is this toxic mixture, created by burning tobacco, that makes smoking so deadly.
Nicotine plays a different role. It is the substance that makes cigarettes addictive, which explains why many smokers struggle to quit even when they understand the risks. But nicotine itself is not the primary cause of cancer, cardiovascular disease, or chronic lung disease. This distinction has been recognised by major health authorities, including the US Food and Drug Administration, which states that while nicotine drives addiction, the illnesses that kill smokers are caused by other chemicals in tobacco smoke.
Large clinical studies reinforce this point. One of the most prominent, the US Lung Health Study, followed thousands of participants over more than a decade and examined long-term use of nicotine replacement therapies such as gum and patches. Researchers found no increased risk of lung cancer, gastrointestinal cancer, or overall cancer among users of nicotine replacement, while continued cigarette smoking remained strongly associated with disease and death.
Despite this evidence, confusion persists. Research from Pakistan suggests that a significant proportion of healthcare professionals continue to associate nicotine itself with cancer and chronic disease. This misunderstanding matters. When nicotine addiction and smoking-related harm are treated as the same thing, it can distort public debate, policy decisions, and even clinical advice.
None of this diminishes the importance of quitting. Nicotine is addictive and not risk-free, and no one should start using it. But understanding why smoking harms health and why quitting is so difficult requires separating addiction from disease. Nicotine explains why people keep smoking. Combustion explains why smoking kills. Recognising this difference is an essential first step toward reducing the heavy toll that smoking continues to take on lives in Pakistan.
