Quitting smoking or reducing it as much as possible is one of the global priorities, but to face this problem, it is always best to listen to expert voices. David Khayat, former president of France’s National Cancer Institute and former advisor to President Jacques Chirac, has criticized the policies being carried out by the World Health Organization (WHO) to end smoking. This oncologist thinks that the strategy based on raising taxes is not achieving the expected results after 30 years of application.
“We must recognize that, after thirty years of taxes, public warnings and regulatory bans, smoking remains a major challenge to public health,” he says.
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Khayat was an advisor to the WHO itself and his message comes at a time when it affects Spain, as the Ministry of Health continues with the new Anti-Tobacco Law, whose draft seeks to equate electronic cigarettes and nicotine sachets with combustible tobacco, thus extending the prohibitions of use to terraces and exteriors of public buildings.
This policy of treating all products equally clashes with the French doctor’s practical vision. He calls for new solutions to achieve two objectives. On the one hand, what everyone wants is to help people quit smoking and, at the same time, offer less harmful alternatives to those who cannot quit. Both with the same common purpose.
Combustion, the real enemy
Khayat explains that you have to know and understand what nicotine is. Scientifically, nicotine is addictive, but it is not the cause of cancer; It is the combustion of tobacco that kills. “Nicotine does not cause cancer; burning tobacco does,” he says. According to him, cigarette smoke is carcinogenic because the combustion of tobacco leaves produces more than 6,000 chemicals, including about 80 ultrafine particles and known carcinogens.
Knowing this is key, since it is the basis of harm reduction policies that countries such as the United Kingdom or Sweden already apply, and which seek to offer adult smokers alternatives that eliminate the burning process, such as vapes or heated tobacco. This doctor remembers that reference health organizations, such as the WHO itself and the United States Food and Drug Administration (FDA), have declared that nicotine itself is not a carcinogen.
However, smoking remains the main cause of preventable death in the world and the largest contributor to non-communicable diseases, responsible for nearly 75% of annual global deaths.
The failure of pure prohibition
Clinical experience and public management support Khayat’s skepticism about the effectiveness of insisting solely on prohibition. The oncologist cites the example of a national campaign he directed in France, in which 1.8 million smokers managed to quit the habit, but almost all of them relapsed within three years. Even more alarming if we look at the clinical data it provides, since 64% of patients diagnosed with serious cancers, including lung cancer, continue smoking after diagnosis.
Thus, and with the data on the table, the doctor warns that policies such as the one that the Ministry of Health wants to include, which are purely prohibitionist, can generate the opposite effect to that sought. That is, those people who cannot leave it because of this prohibition and see that they cannot afford alternatives, decide to go to other markets such as the mafias or the black market, which does not have any type of control. Let’s remember what happened with “Prohibition” in the 1920s in the US.
For the French specialist, harm reduction should not be interpreted as an obstacle to quitting smoking, but as “a vital step towards it”, a necessary tool for that segment of the population that, despite tax increases and restrictions, cannot give up the habit.