When Evidence Matters Most

This chapter examines the imperative for public health communications to remain anchored in scientific rigour when evaluating smokeless products and THR initiatives, employing evidence and precision while avoiding both understatement and exaggeration of risk. Such discipline is essential to ensure that information guiding public health decision‑making remains balanced, transparent, and robust. Yet the current landscape reveals diverging approaches, with institutions applying markedly different evidentiary standards to similar questions. In some settings, risk assessments continue to follow established principles of the science of toxicology and methodological transparency; in others, precautionary interpretations are amplified despite narrow, insufficiently appraised, or inconsistently reported evidence bases.

These asymmetries extend to the treatment of scientific sources. Peer‑reviewed studies originating from scientific researchers employed or funded by tobacco product manufacturers are routinely discounted a priori, whereas publications from other sectors, despite evident methodological limitations or bias, may often circulate uncritically and exert disproportionate influence on public and regulatory discourse. Such uneven scrutiny affects how evidence is weighed, shaping narratives that may misinform or mislead regulators, policymakers and, ultimately, consumers. The state of the evidence as a whole will, of course, benefit from the review and consideration of all credible scientific sources.

An evaluation of the Münzel et al. 2025 manuscript^[11] illustrates this problem. In a formal published critique of the manuscript, Miguel and Steffensen^[12], express various concerns with the manuscript, including that “[it] advances cross-product conclusions by treating nicotine as a transferable causal driver across cigarettes, e-cigarettes, heated tobacco, waterpipes, and oral nicotine products.” Münzel et al. have responded to a number of the concerns raised^[13] and the manuscript usefully identifies areas for further research and consensus-reaching, including in respect of cardiovascular risk. This back and forth is part and parcel of a proper scientific process and dialogue.

A concern, however, arises when such studies are mischaracterised by third parties, or otherwise prematurely leveraged to support policy and regulation, if the same rigour is not applied by the relevant journal or scientific community, especially at a sufficiently early stage. For example, public statements made by Commissioner Olivér Várhelyi, most notably in his December 2025 Euractiv interview^[14] and subsequently reiterated in Parliamentary responses in January 2026^[15] appear to have been shaped by the Münzel article. The Commissioner’s assertion that non‑combustible nicotine products are “as harmful as traditional cigarettes” reflects a potential extension of the article’s identification of nicotine as a major common driver of tobacco-related harm and health risks, despite the growing consensus – one that is itself reflected in a close reading of Münzel et al. 2025 and their response to Miguel and Steffensen – that [not] all nicotine products are equivalent, and…combustible cigarettes [are] the most harmful category”.

In clear contrast to the Commissioner’s statements, a letter^[16] authored by 23 world‑leading scientists to the European Commission provides a rigorous synthesis of international evidence demonstrating that non‑combustible nicotine products, including vaping, oral pouches, and heated tobacco, expose users to dramatically fewer and substantially lower levels of toxicants than cigarettes. Independent assessments from leading national and international scientific bodies consistently conclude that these products present only a fraction of smoking‑related risk, a conclusion reinforced by biomarker data showing near‑background toxicant levels in exclusive users. The letter also details how scientifically inaccurate assertions equating risks of Smokeless Products with smoking undermine policy development, particularly within the forthcoming revision of the Tobacco Products Directive and the Tobacco Excise Directive. Misrepresenting the available evidence on relative risk encourages disproportionate regulations and taxation that inadvertently protect combustible cigarettes, promote illicit markets, and restrict access to lower‑risk profile alternatives to continued smoking, outcomes directly counterproductive to public health goals.

Strengthening the integrity of public health communication requires both rigorous evidence generation and disciplined, transparent evidence interpretation. A framework that consistently applies methodological precision, maintains proportionality in risk characterisation, and clearly articulates uncertainty will be essential to supporting informed decision‑making and preserving public trust in stakeholders from scientific, academic and regulatory spheres.

These dynamics contribute to the broader evidentiary challenges, where the exclusion of tobacco company data increasingly coincides with policy proposals informed by research that has not yet been fully verified or demonstrates methodological limitations. The practice of rejecting studies by researchers employed or funded by tobacco product manufacturers has become deeply embedded, with major scientific publishers routinely declining work supported in whole or in part by the tobacco sector. Yet many contemporary companies operating in tightly regulated scientific environments invest substantial resources to ensure their research meets established ethical, methodological, and regulatory standards. Such organisations consistently devote significant funding to compliance with Good Laboratory Practice (GLP) and Good Clinical Practice (GCP), upholding rigorous protocols for analytical validation, data integrity, transparent study design, and quality assurance. Recognising this sustained commitment to high‑quality research is essential when considering the full body of evidence available for scientific evaluation.

Yet despite the often-automatic exclusion of evidence generated by researchers employed or funded by tobacco product manufacturers, based on the false assumption that doing so inherently improves scientific reliability, the peer‑reviewed literature continues to admit manuscripts whose methodological deficiencies undermine the robustness of their conclusions. This asymmetry, in which rigorously generated data may be dismissed while flawed analyses proceed to publication, underscores the need for consistent quality‑assurance standards across all sources of evidence.

Collectively, these weaknesses highlight the importance of enforcing consistent, objective methodological standards across all research contributions, irrespective of provenance, to ensure that the scientific record remains robust, transparent, and fit to inform regulatory and policy decisions. Taken together, these analyses reaffirm that effective tobacco harm‑reduction public health communication and policy cannot rest on selective interpretation, methodological inconsistency, or assumptions unsupported by toxicological and epidemiological evidence. Ensuring that public health communication sustains its scientific integrity will require continued commitment to transparent methods, rigorous exposure‑based assessment, and balanced appraisal of all credible data.

As the evidence base evolves, maintaining a clear distinction between combustion‑driven risks and those of Smokeless Products will be essential to avoiding conflated narratives that mislead the public and impede informed regulatory decision‑making. A more disciplined, proportionate, and evidence‑aligned framework that applies uniform standards of scientific scrutiny, will be crucial for improving public understanding, strengthening policy coherence, and supporting meaningful reductions in projected smoking prevalence rates, and therefore tobacco‑related disease across the European Union and around the globe.