Dubious study promotes nicotine as protection against CoVid-19

28.04.2020 Unfortunately, the reaction of the media to a study on the correlation between nicotine consumption and CoVid-19 risk can only be described as “business as usual”. After all, whenever research findings relating to tobacco or nicotine are made public, they always generate the greatest possible press coverage. This is also the case here. And smokers can once again say to themselves: “Smoking can even be healthy. So just don’t quit!” However, the media hype can cost many more lives.

However, such preliminary conclusions are based on a solid foundation – anyone who scrutinises them will come across serious methodological gaps and inconsistencies. These, in turn, are not addressed in the press. Because that would ruin the nice nicotine headlines.

Back to the coronavirus infection. Isolated studies in several countries claim a connection between nicotine intake and protection against CoVid-19. Even if this connection exists, it does not necessarily have to be causal. For example, there is a correlation between first screenings of German feature films and the amount of endive harvested in the field[i]. But who would consider one to be the cause of the other?

Some of the studies mentioned above seem to contain gross methodological blunders, e.g. not differentiating patients by gender and age, but using the high overall smoking prevalence as a benchmark for comparison. Or simply categorising patients who consumed less than 30 packets of cigarettes per year as non-smokers. Or not even asking the patients with the most severe cases, those in intensive care, about their smoking habits[ii].

These and other inconsistencies should be ironed out in a French study.

It was initiated by neurobiologist Jean-Pierre Changeux, whose studies were previously co-financed by the tobacco industry[iii]. Here, too, 482 patients at the La Pitié-Salpétrière hospital in Paris showed a proportion of smokers that was significantly lower than in the population as a whole. The study analysed patients with mild and severe cases of CoVid-19 who were treated as outpatients or inpatients. But now comes the aha effect: patients in intensive care units, i.e. the most severe cases, were not included in the study. Whether this was due to a lack of will or a lack of options is not stated. However, this glaring weakness of the study must be clearly stated from the outset, as it severely restricts the proudly trumpeted conclusions, possibly even refuting them completely.

The pre-publication[iv] only addresses this important, perhaps decisive factor in two short sentences at the very end. A possible conclusion could also look like this: Among hospitalised patients with mild courses of a particular hospital, (daily) smokers are underrepresented, while they are strongly overrepresented among patients undergoing intensive care treatment.

However, such details are rarely found in press articles, and almost never in the German media. At most, pulmonary physicians are allowed to express their doubts about the claimed protection provided by nicotine or smoking, since in their experience the damage to the airways and lungs caused by smoking significantly increases the risk of CoVid-19. So far, we have only found information on the shortcomings of the studies in the Pharmazeutische Zeitung. Addendum from 29.04. A critical article has now also been published online in the Deutsche Apotheker-Zeitung, including links to studies that recognise smoking as an increased CoVid-19 risk.

But the critical voices were also drowned out in France: The French government even had to ration the distribution of nicotine patches to prevent a shortage due to hoarding[v]. Similarly, the urgent recommendation to stop smoking is probably being counteracted by the hype surrounding preliminary and error-prone results. During the coronavirus crisis, people are insecure and tense and have fears about the future. Under such conditions, smokers tend to smoke even more, pay even less attention to non-smoker protection regulations and generally take precautions concerning themselves and their surroundings. Cigarette fires inside and outside buildings seem to be on the rise again (as can be seen from press reports). Hygienic self-protection when smoking outside (hand-mouth contact) or even environmental protection through the correct disposal of butts seem to be (still) rather neglected.

Against this background, the uncritical adoption of unsubstantiated findings from initial studies on the role of nicotine in CoVid-19 is irresponsible, also because it leads to “nicotine” and “smoking” being prematurely equated. This is because it is the most convenient way for smokers to convince themselves that smoking does not cost them their lives, but protects them. Before the media stir up hopes that are unlikely to be realised (analogous to the supposed benefits of hydroxychloroquine against CoVid-19), sensationalism should be dispensed with and we should wait for reliable scientific findings.

Smoking kills 20 times as many people prematurely in Germany every year as have died from coronavirus so far.

More on CoVid-19 and smoking: Pro Rauchfrei is now calling for anti-tobacco measures

Addendum 21.06.2021: The following article on the integrity of research explains how the tobacco industry is also promoting false statements about the supposed benefits of nicotine during the coronavirus pandemic. Professor Changeux and his supposedly groundbreaking findings also feature in it: https://www.bmj.com/content/bmj/373/bmj.n1303.full.pdf