My father died from a smoking-related disease. As a physician, I have seen versions of his story repeated too many times: patients who knew cigarettes were harming them, wanted to stop, tried to stop — and still could not fully break free. That experience shaped my view of public health long before I served as Secretary of Health and Human Services. It taught me a lesson Washington too often forgets: If we want to reduce the death and disease caused by smoking, we have to meet adult smokers where they are, not where we wish they were.
That is why the Food and Drug Administration’s recent decision authorizing modified-risk claims for certain ZYN nicotine pouch products matters. The agency concluded that these specific products may be marketed with the statement that using ZYN instead of cigarettes puts adults at lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis. This was not a slogan or a political compromise — it was the result of a federal scientific review under a demanding statutory standard.
For policymakers, public health organizations, and medical professionals, the significance should be clear. According to the Centers for Disease Control and Prevention, cigarettes remain the leading cause of preventable death in the United States. The best outcome for anyone who smokes is to quit nicotine and tobacco entirely. But for the millions of adults who do not quit, accurate information about lower-risk, smoke-free alternatives can help move them away from the most dangerous form of nicotine use: inhaling cigarette smoke.
One central public health fact about nicotine, which is addictive and not risk-free, remains widely misunderstood: Nicotine is not what causes lung cancer, emphysema, and most smoking-related diseases. The overwhelming danger of cigarettes comes from combustion — from burning tobacco and inhaling the toxic smoke that follows. When adults who smoke are led to believe all nicotine products carry the same risk as cigarettes, they may reject options that could substantially reduce their exposure to harmful chemicals.
That confusion is not theoretical. Many patients hear the word “nicotine” and think “cancer.” Many clinicians, too, are understandably cautious in a landscape crowded with conflicting messages, youth-use concerns, and political fights over tobacco policy. Caution is appropriate. Confusion is not. Adult smokers deserve clear, science-based guidance from the people they trust most with their health.
This is where the FDA’s decision should become more than a regulatory milestone. The FDA has done the hard scientific work of evaluating these products and authorizing a specific reduced-risk claim. Now, FDA, medical societies, continuing medical education providers, and public health organizations should help physicians, nurses, pharmacists, and other health professionals understand what the decision means — and what it does not mean.
It does not mean nicotine pouches are risk-free. It does not mean nonsmokers or young people should use them. It does not mean cessation should be pushed aside. It means that, for adults who smoke cigarettes and do not quit, there are FDA-authorized products that fall lower on the continuum of risk than combustible cigarettes.
Doctors practice harm reduction every day. We prescribe medications to lower risk, counsel patients on safer behaviors, and recognize progress even when perfection is not immediately possible. Smoking should be no different. If a patient cannot or will not stop using nicotine, helping that patient move completely away from cigarettes should be viewed as meaningful progress.
Washington has spent decades telling people not to smoke. That message remains essential. But for the adults still smoking today — including those in rural communities, veterans, older Americans, and lower-income populations who are often hardest to reach — the public health system must also be honest about relative risk. “Quit or else” is not enough for patients who have tried and failed. A better message is: Quit, but if you do not quit, stop smoking and move to a scientifically reviewed, smoke-free alternative intended for adults.
The FDA’s authorization should also encourage a more serious conversation among elected officials. Too often, debates over nicotine collapse into slogans. Some advocates treat any discussion of lower-risk products as a threat to tobacco control. But the public is capable of understanding more than one idea at a time: Nicotine is addictive; cigarettes are deadly; smoke-free products are not risk-free; and some smoke-free products, after FDA review, can present less risk than continuing to smoke.
AMERICA’S DEADLIEST PRODUCTS ARE LEGAL. THE SAFER ONES ARE IN COURT
My father did not have the benefit of today’s science, today’s products, or today’s regulatory tools. Many families have lived through the same loss. We cannot change that history, but we can decide whether to use the evidence now in front of us to help prevent more of it.
The FDA has taken an important step. The next one belongs to the broader medical and public health community. If doctors are expected to guide patients through complex health decisions, they need clear, current, and credible information about the full range of options available to adults who smoke. Silence, ambiguity, and misinformation will only leave more smokers with the most dangerous product on the market: the cigarette.
Dr. Tom Price was the 23rd secretary of the U.S. Department of Health and Human Services, is a former member of Congress representing Georgia’s 6th District, and is an adviser to Philip Morris International U.S. Corporate Services Inc.