Reinhard Niessner, Technical University of Munich
A toxicological review released by the US National Library of Medicine warns that current public health discourse may be missing an opportunity to save lives by overlooking smoke-free products.
The review, titled “The potential of smoke-free products to reduce harm for smokers: What does the toxicological evidence say?” concludes that e-cigarettes, heated tobacco products and nicotine pouches are significantly less harmful than traditional cigarettes.
Technical University of Munich aerosol chemist Reinhard Niessner authored the report, which was released in August 2025.
Niessner noted that the adoption of smoke-free alternatives is helping smokers transition away from combustible tobacco in various countries. He explained that these products emit only a fraction of the toxins found in cigarettes and provide a path toward lower-risk nicotine use.
The review highlights that the United Kingdom saw adult smoking rates fall from 20.3 percent in 2010 to 11.9 percent in 2023 following the endorsement of smoke-free options. Similar trends were observed in Sweden due to the use of snus and in the US through the uptake of e-cigarettes. Niessner emphasized that the primary cause of smoking-related disease is the toxic chemicals produced by combustion rather than the nicotine itself.
Niessner said that ignited cigarettes release around 6,500 components, with 100 identified as major toxicological concerns. Because smoke-free products eliminate combustion, they avoid the most hazardous chemical reactions. Data show that e-cigarettes reduce harmful constituents by 80 percent to 99.9 percent compared to cigarettes, while heated tobacco products cut key carcinogens by over 90 percent.
Analysis within the review indicates that nicotine pouches have toxicant levels similar to pharmaceutical aids like patches and gum. Niessner said that failing to communicate these reduced risks prevents 20 million smokers from accessing life-saving information. He said that raising concerns alone does not sufficiently inform the public about comparative health risks.
While the review acknowledges that nicotine remains addictive and these products are not entirely harmless, it concludes they play a vital role in reducing societal health risks. The findings urge regulators to protect youth and nonsmokers while ensuring adult smokers have access to accurate data on lower-risk alternatives.
