As smoking continues to claim more than eight million lives every year, a growing number of public health experts argue that current tobacco control efforts are failing where it matters most—reducing smoking-related disease. One of the most outspoken voices is Dr. Konstantinos Farsalinos, a Greek cardiologist and internationally recognized expert and researcher in tobacco harm reduction (THR). His message is clear and urgent: it’s not nicotine that kills—it’s the smoke.
Sadly, this fundamental distinction, has been neglected by policymakers worldwide, leading to misguided strategies that hinder rather than help smokers seeking to quit. Safer nicotine alternatives—including vaping devices, nicotine pouches, and heated tobacco products—have shown tremendous promise in reducing the global health burden of smoking. These tools give smokers a practical and significantly less harmful route away from combustible tobacco. When regulated effectively and made widely available, they can yield dramatic improvements in public health. And Sweden stands as living proof of this.
From Sweden to San Francisco – the data are undeniable
Since 2012, smoking in Sweden has declined by 54%, underscoring the effectiveness of embracing harm reduction over prohibition. Sweden didn’t shame smokers—they gave them options. Sadly, many governments continue to reject this strategy. Driven by fear, stigma, and misinformation—especially around flavoured vapes—policymakers are pushing bans that could roll back years of progress. Meanwhile, Dr. Farsalinos has consistently highlighted that flavours play a vital role in helping adults quit smoking. They improve satisfaction and ease withdrawal, dramatically increasing quit rates.
Contrary to common belief, these flavours are not designed to attract children—they’re crafted to offer adult smokers appealing alternatives to cigarettes. In fact, blanket bans, like those enacted in San Francisco and recently upheld by the U.S. Supreme Court, do more harm than good. In San Francisco, smoking rates among adults reportedly increased after flavoured vape products were banned. The U.S. Supreme Court’s unanimous decision to support the FDA’s authority to restrict flavours was hailed by some health groups, however THR experts see it as a serious setback for public health innovation.
Trying to save lives while fighting the wrong battle
The FDA argues that vape companies haven’t adequately proven that flavoured products benefit adults more than they risk enticing youth. Yet critics point out a glaring inconsistency: sweet and brightly colored alcoholic beverages—cotton candy vodka, birthday cake rum, and the like—remain freely sold and heavily marketed with far less regulatory concern. Meanwhile, flavoured vapes, which pose significantly less risk than alcohol, are subject to escalating restrictions.
According to CDC data, nearly 6% of middle and high school students use vapes, with most preferring flavoured options. However, alcohol remains the most commonly used substance among youth and is responsible for thousands of underage deaths each year. This disparity in regulation raises questions about whether youth protection is being used selectively to justify politically expedient crackdowns on vaping.
The case for safer nicotine alternatives
Along with his peers in THR, Dr. Farsalinos advocates for a more rational, evidence-based approach. Rather than banning flavours outright, he proposes targeted safeguards: strict age-verification systems, adult-focused marketing rules, and transparent regulatory pathways. In fact, a number of countries offer further evidence that this model actually works.
New Zealand has seen a sharp increase in daily vaping alongside a halving of smoking rates since 2018. Japan has experienced a 43% drop in cigarette sales, credited to the rise of heated tobacco products. While in the United Kingdom, nearly three million former smokers have quit with the help of vapes.
Despite these successes, the U.S. continues to prioritize restrictive tactics over pragmatic solutions. Current policies are pushing many adult consumers back toward combustible tobacco while wiping out independent vape shops and small manufacturers. The market is increasingly dominated by high-priced, limited-flavour devices—often owned by large tobacco firms.
A global wake-up call for smarter regulation
The environmental critique of vaping—centered on the waste created by disposable products—is also valid but solvable. Instead of blanket bans, governments should invest in recycling infrastructure and product stewardship regulations, much like they do with other battery-operated electronics.
Dr. Farsalinos believes World Vape Day, should have marked a turning point—a moment when health policy catches up with science. In the end, this isn’t just a debate about flavours or devices. It’s a question of whether public health policy will be guided by emotion or evidence. Smokers deserve better than political soundbites and regulatory contradictions. They deserve access to safer alternatives, different options and the right to choose them.
