A leading French oncologist and former adviser to the World Health Organization (WHO) says harm reduction is essential to curbing smoking-related illnesses.
Dr. David Khayat, a professor at Pierre et Marie Curie University in Paris who also served as advisor to former French President Jacques Chirac, said that the WHO-led tobacco control measures have failed, and new solutions are necessary for smokers who do not want to quit smoking.
‘After thirty years of taxes, warnings, and bans, we must admit: we have failed to stop smoking,’ Khayat said. ‘The reality is that we need new solutions for helping people to quit and reducing, therefore, the harm for those who cannot,’ he added. Smoking is the leading preventable cause of death globally, fueling a massive public health crisis. Non-communicable diseases (NCDs), including cancer, are responsible for almost 75 percent of all annual global deaths, Khayat said.
Khayat stressed a key distinction, stating that nicotine itself does not cause cancer. People smoke for the nicotine, but they die from the toxic chemicals and ultrafine particles released by the smoke in burning the tobacco. ‘Nicotine doesn’t cause cancer, burning tobacco does,’ he said.
While quitting smoking is the best option, Khayat said it is extremely difficult. He recalled a successful French initiative he led as a presidential adviser, where 1.8 million smokers quit, only to see almost all of them relapse within three years.
Decades of interventions – such as raising cigarette taxes, adding health warnings, implementing plain packaging, and banning smoking in public places – have failed to stop smoking from remaining the number one cause of NCDs today, Khayat said.
He said that when people try to prohibit a persistent behavior like smoking, it often leads to negative consequences. ‘When you try to prohibit it, what’s going to happen is mob, mafia, illicit trade and everything,’ he said, comparing it to the failed prohibition era in the United States in the 1920s.
He noted that even a majority of lung cancer patients – 64 percent – continue to smoke after their diagnosis. As a medical oncologist, Khayat said that while many believe cancer is primarily hereditary, 95 percent of cancers are actually caused by exposure to a carcinogen that damages DNA, and only 5 percent are truly hereditary.
Khayat said that cigarette smoke causes cancer because burning tobacco leaves creates over 6,000 chemicals, including about 80 known carcinogens and ultrafine particles. These chemicals from the smoke are the real culprits behind smoking-related diseases, he said.
He cited the dose-response relationship – the greater the amount of exposure to a carcinogen, the higher the risk of developing cancer – as the fundamental basis for the idea of harm reduction. This concept applies to the duration of smoking and is analogous to the reduced risk of injury when driving slowly versus fast.
Official health bodies worldwide, including the WHO and the FDA, have formally stated that nicotine is not a carcinogen. He said that before smoke-free alternatives were developed, combustible cigarettes were the only way to get nicotine.
Khayat’s clinical experience further cemented his belief in harm reduction, noting that 64 percent of patients diagnosed with life-threatening cancers, like lung cancer caused by smoking, still continue to smoke because they cannot stop.
Harm reduction involves the switch to less harmful alternatives such as vapes, heated tobacco, and nicotine pouches for smokers. Scientific studies have shown that these smoke-free products are far less harmful than combustible cigarettes.