Dr. David Khayat, a leading oncologist
A leading French cancer specialist and former adviser to the World Health Organization (WHO) has underscored the importance of harm reduction as a vital approach to lowering the incidence of smoking-related illnesses.
Dr. David Khayat, a professor at Pierre et Marie Curie University and former adviser to French President Jacques Chirac, said that WHO-led tobacco control measures have not achieved their intended impact. He advocated for alternative solutions tailored to smokers who are not ready or willing to quit.
“We must acknowledge that after 30 years of taxation, public warnings and regulatory bans, smoking remains a major public health challenge,” Dr. Khayat said.
“It’s time to adopt new, pragmatic solutions that both support cessation and reduce harm for those unable to quit,” he said.
Smoking is the leading preventable cause of death worldwide, contributing to a growing public health crisis.
Dr. Khayat noted that noncommunicable diseases (NCDs), including cancer, are responsible for about 75 percent of global deaths each year.
He underscored a vital distinction in tobacco harm reduction: Nicotine is not the cause of cancer. He noted that while smokers seek nicotine, it is the combustion of tobacco — a process that releases toxic chemicals and ultrafine particles — that leads to deadly health outcomes.
“Nicotine doesn’t cause cancer — burning tobacco does,” he said.
Dr. Khayat reaffirmed that quitting smoking is the optimal choice for health, but noted its difficulty. He referenced a national campaign he led in France as a presidential adviser, which saw 1.8 million smokers quit but nearly all resumed smoking within three years.
According to Dr. Khayat, decades of tobacco control efforts — including increased taxation, graphic health warnings, standardized packaging and public smoking restrictions — have not prevented smoking from remaining the primary contributor to NCDs worldwide.
He said that prohibitionist approaches to smoking can lead to harmful side effects, including the rise of illicit markets and criminal networks. He likened the situation to the prohibition era in the U.S., where efforts to ban alcohol gave way to widespread underground activity.
Dr. Khayat highlighted a troubling reality, as 64 percent of lung cancer patients continue to smoke after diagnosis. As a cancer specialist, he stressed the urgent need for harm reduction, noting that contrary to widespread misconceptions, 95 percent of cancers stem from carcinogen exposure, not heredity.
He said cigarette smoke is carcinogenic due to the combustion of tobacco leaves, which produces more than 6,000 chemicals, including around 80 known carcinogens and ultrafine particles. He emphasized that these toxic compounds are the true drivers of smoking-related diseases.
Dr. Khayat also highlighted the dangers of cigarette smoke, noting that burning tobacco generates over 6,000 chemicals, including roughly 80 carcinogens and ultrafine particles. He stressed that these toxic byproducts — not nicotine — are responsible for the vast majority of smoking-related diseases.
He underscored the dose-response relationship — higher exposure to carcinogens leads to greater cancer risk — as the core rationale behind harm reduction. He noted that this principle applies to smoking behavior and drew a parallel to the reduced likelihood of injury when driving at lower speeds.
Leading health organizations such as the WHO and the US Food and Drug Administration have declared nicotine itself is not a cancer-causing substance. Khayat pointed out that until smoke-free alternatives emerged, smokers had no choice but to rely on combustible cigarettes for nicotine.
Dr. Khayat’s clinical experience has deepened his conviction in harm reduction strategies. He cited data showing that 64 percent of patients diagnosed with serious cancers, including smoking-induced lung cancer, continue to smoke — underscoring the difficulty of cessation and the need for pragmatic solutions.
“Harm reduction should be seen not as an obstacle to cessation, but as a vital step toward it,” Dr. Khayat said.
