We had the opportunity to speak with Dr. David Khayat, a renowned Professor of Medicine, and Medical Oncologist at Clinic Bizet in Paris. During the 11th International Multi Thematic Scientific Biomedical Congress, organized by the European University Cyprus on 9-11 November, Dr. Khayat shared insights on tobacco harm reduction highlighting the significance of this approach in evaluating cancer risk reduction potential of novel tobacco and nicotine containing products. 

The concept of harm reduction, first used in relation to illicit drugs, refers to policies and programs which aim to reduce the harm from addictive behaviors for individuals, and the community and society in which they live. Harm reduction concept recognizes that, while the preferred goal is abstinence, this is not always achievable. Helping people change to less harmful alternatives may be a more effective approach. It, therefore, primarily aims to reduce the harms associated with certain behaviors. 

Contrary to the common misconception that the danger of smoking stems from added chemicals in tobacco, most cigarette companies use pure tobacco. When burnt, this tobacco releases around 6,000 chemicals, of which about 100 have been identified as causes or potential causes of smoking-related diseases. These harmful chemicals are predominantly released at temperatures above 350 degrees Celsius. Heated tobacco product (HTP) technology capitalizes on this by heating tobacco to just below this threshold, thus allegedly reducing the release of carcinogens. 

According to Dr. Khayat, this method results in a potentially less harmful experience for consumers, with less exposure to carcinogens compared to traditional cigarettes. This reduction is even more pronounced in electronic cigarettes and vapes, which do not contain any tobacco. It's worth mentioning that the combustion of substances, like cannabis, poses similar cancer risks as tobacco combustion.

Although conclusive research regarding the overall safety of alternative smoking will take years, Dr. Khayat believes that the in-between period is crucial in reducing cancer risk, as these products can potentially offer reduced risk compared to traditional cigarettes. It is important to note, however, that the World Health Organization’s (WHO) official position is that there is no evidence to demonstrate that HTPs are less harmful than conventional tobacco products.

Government efforts to deter smoking, including the graphic packaging warnings, and increased cigarette prices, have largely failed to curb smoking habits of existing smokers. Research indicates that addicted individuals, especially those with low income, often prioritize purchasing cigarettes over essential goods. Dr. Khayat draws an analogy between smoking and driving: both are inherently risky, yet driving remains an essential part of modern life. Consequently, safety measures such as seatbelts and speed limits are implemented to mitigate risks. Similarly, Dr. Khayat believes that outright prohibition of smoking is not the solution, given the addictive nature of smoking. This is evident as 64% of smokers diagnosed with cancer continue to smoke, underlining the strength of addiction.

Nicotine, while highly addictive, is not a carcinogen and is sometimes prescribed to assist in quitting smoking. The lethal aspect of smoking is tobacco combustion, not nicotine. Therefore, offering alternatives that mimic the smoking experience/ritual and provide nicotine without tobacco’s harmful byproducts of combustion are crucial in lowering the risk for cancer. Vapes and HTPs, which offer a similar nicotine rush and social experience to smoking, are potentially effective in reducing the smoking habit in those people who don’t quit.

Cancer encompasses a variety of diseases characterized by the uncontrolled growth and spread of abnormal cells. Factors, like the duration and intensity of exposure to a carcinogen, play a significant role in cancer risk. For example, the risk associated with sun exposure increases with duration. Likewise, the extent and frequency of smoking are directly linked to cancer risk. While a healthy lifestyle and genetics are beneficial, they cannot fully offset the cancer risk posed by cigarette smoking, which is the leading cause of about 25% of cancer-related deaths globally.

Regarding his association with Philip Morris International, Dr. Khayat clarified that his role is as a consultant on harm reduction, not as a tobacco industry employee. He expressed optimism about the industry's potential transformation towards a smoke-free future by 2030, emphasizing the importance of science in this endeavor.

David Khayat is Professor of Medicine, Medical Oncologist at the Clinic Bizet in Paris. He was Head of Medical Oncology at the Hospital Pitié-Salpêtrière for 28 years, Paris, France. Professor Khayat gained a Master of Science in tumour immunology from the University of Paris and went on to complete his PhD in tumour immunology at the University Pierre and Marie Curie, Paris. In addition to his current position, he is also Adjunct Professor of Medicine in the Department of Breast Diseases at the MD Anderson Cancer Center, University of Texas, Houston, United States. He was the President of the French National Cancer Institute from 2004 to 2006. He was member of the ASCO Board Directors (2014-2018).

In 1998, he organised the French Federation of Medical Oncologists (FFOM) and was elected its first President, a post he held until 2001. He set up the Master of Excellence of Medicine in Oncology programme. Professor Khayat was one of the organisers of the World Summit Against Cancer, 2000 and 2001, and the Charter of Paris Against Cancer, 2000, both at UNESCO.

He is Professor Emeritus of several institutions, including the Suzhou Institute for Onco-haematology in China, the Matsumoto University in Japan and the Heraklion University in Greece was elected in 2011 as Full Member of Russian Academy of Sciences. Professor Khayat received the American Association for Cancer Research public service award in 2000. He received the ASCO distinguished Achievement Award in 2011. He is also Commander of British Empire (CBE) and Officier de la Légion d’Honneur in France.