Now we have immune-therapy and many other different ways to treat people. Everything that was considered easy has been tried. It’s the same as trying to tell an obese teenager with a body mass index of 35 or 33 to stop eating pizza and nachos every day. We had 1.8 million less smokers. They don’t want to understand that everything that is less toxic is for the better. The concept of harm reduction refers to programs and practices aimed at minimizing the health and social impacts that are associated with the use of harmful products, such as cigarettes. Quitting is what you should do, but if you can’t, it’s my responsibility, as someone concerned about the public health situation, to find a way to help you have less consequences based on your bad behavior. Try at that moment to tell someone to quit cigarettes. Prohibition has been tried; threatening people who smoke was already tried; making smoking too expensive has been tried. I am a doctor who, for 45 years, has seen my patients, like your stepfather, die from cancer. That’s without any known genetic connection. You cannot consider it just as some sort of pleasure or a habit or as a behavior. David Khayat, former president of France’s National Cancer Institute and head of medical oncology at the Clinique Bizet in Paris
The world has understood the risks of smoking for several decades and that quitting the habit is essential to maintaining one’s good health, but not everyone can break free from the habit. I had a (cancer) patient who was smoking from here (through the hole from a tracheotomy) It’s an addiction. So why? This addiction, in the 2020s, is like the case of depression 20 years ago: “Please, stop being sad. If you look at the WHO data, in 1999, the first cause of death in the world was smoking. Meanwhile, every government in the world has been trying to do something against smoking. It’s that all of those policies have failed. There’s always a carcinogen, an exposure to a carcinogen, and a dose response to the exposure and the risk. Can you imagine how many thousands I’ve seen die because we didn’t have a treatment in those days? Traditional cigarettes contain over 6,000 chemicals and ultrafine particles, 93 of which are on the US Food and Drug Administration (FDA) list as potentially harmful. The problem that we have with bringing these harm reducing remedies to a wider public is that we’re dealing with very dogmatic people who refuse to look at the science. I did my job to fight tobacco smoking, but after two years, it failed. If look back to just 1982 in the US, not so much in Europe, there were advertisements saying that menthol cigarettes were safe. DK: That’s interesting. Remember the dose/response relationship – the more carcinogen you get, the higher your risk of cancer. They continue to smoke. As a doctor, though, I don’t care about eradicating cigarettes. There’s a different risk. SNUS does that and E-cigarettes do that, heated tobacco does that – each without any (significant measurable levels) of carcinogen. The radiation exposue that you receive from getting a CT scan once or twice a year in comparison to the dose that you would receive if you visit Chernobyl is, quite obviously, not the same. The government, and this is (a) very political (motive), wants to say they’ve been very efficient and what we did was effective and good. “As a doctor, I cannot accept ‘stop or die’ as the only choice offered to a patient who smokes,” Dr. It’s a disease. He’s been gone for quite some time, but the scientific research and medical information (about the health risks of smoking) were available to him for his review. You can’t imagine how many of my patients I’ve lost in that time because they continued to smoke; maybe 30-40% of them. You know, when I was an oncologist and the advisor for Chirac, I would never, ever talk to them (tobacco industry companies). 95% of all cases, however, are what we call “sporadic cancer”. He was originally diagnosed in 1990 but continued to smoke for some time, regardless of the diagnosis and the multiple treatments that he received for cancer. If we can give them the nicotine without the combustion, that’s obviously better. He was a heavy smoker; an army officer and a veteran of World War II. If you haven’t any combustion, which comes from the black smoke that contains all of the carcinogenic chemicals, and you replace it with white vapor, you have 95% less carcinogen. No, it’s an addiction; a disease. This is important, 80% of lung cancer occurs in people who smoke, but only 8% of smokers will actually develop lung cancer; 92% won’t. Dr. So, I did real work. DK: Yes, of course, but we don’t know yet how to treat that. Because they are between 90-95% less toxic. And in this case (regarding nicotine), it’s an addiction and needs to be treated. You’re crazy. Now, if we talk about the rise in the cost of tobacco cigarettes, when I became the advisor for (former French President) Jacques Chirac, I was the first one to raise the cost of cigarettes. We help bad eaters with Metformin for diabetes. DK: Yes. The people buying counterfeit cigarettes on the street are not going to say, “Yes, I smoke fake cigarettes bought on the black market.”
The point is that the information the population is given, or fed with, is fake. In fact, I understand his position and his philosophy for his life. From the perspective of a doctor and a scientist, the concept of a third way is the best method. What’s the conclusion, based on those figures? Two weeks later, however, there was a report in the French media from the customs organization saying that the result of the huge increase in the price of cigarettes to more than €10, the illicit trade of cigarettes has reached a level that has never been seen before. They’ll pay €10, and cut the money they would have used for the cost of their food. But the scientific community is afraid of being stigmatized for supporting electronic cigarettes and heated tobacco. Now there’s one thing that has to be understood, and this is where a lot of these people are a bit embarrassed, it’s that the so-called ‘third way’ for tobacco smokers is being led by the tobacco industry. One of the best solutions for smokers is Snus (an oral smokeless tobacco product which is usually placed behind the upper lip,) sold in Scandinavia, where they have reduced the number of smokers to 5% It works best to help you stop smoking and it’s finally been approved in Europe and the United States. When I was interviewed earlier this year, I commented that French government, in their annual report earlier this year, mentioned that because of the rise in the cost of cigarettes to above €10, they had about 1% less smokers. style=”font-size:40px; line-height: 1.3em; font-weight: 800; padding:7px;”>Scientific community focuses on tobacco harm reduction through alternative solutions – such as E-cigarettes and heated tobacco
By Nicholas Waller
Dr. They do continue with their addiction to nicotine. That person will have a huge risk of getting cancer – breast cancer; colon cancer – at some point in their life. Most, roughly 80 of those listed, are or are potentially carcinogenic, with the end result remaining the same – smoking is the most important risk factor for cardiovascular disease and various forms of cancer. But, as a scientist, as well as a doctor, I want to see the data. When 400 people died there in two years ago in one summer, it was because whoever was selling the E-cigarettes put toxic chemicals into the device’s reservoir. The point being is that there’s always a dose response. In the case of hereditary cancer, it’s the gene itself that will give you cancer, it’s that the gene is weak. It is purely a stimulant, just like caffeine. They’re eating even less. And yet, it’s still the first cause of death in the world. We help bad drivers with seatbelts and ABS. But when looking at the long-term results, it simply doesn’t work. I love that because it is effective to quit smoking. Scientific studies and medical practitioners have noted that E-cigarettes and heated tobacco, as modified risk products, can help smokers in the path of detachment from traditional cigarettes. Now we have electronic cigarettes, but there have been a lot of problems in the US because there was no regulation. NE: Do medical statistics show that regular smokers actually quit? There was an automatic feeling that we couldn’t trust them. They quit smoking combustible cigarettes. The concept of harm reduction is fantastic, just like ABS for driving. We help people who like to sit in the sun on the beach with different types of cream and gels. At that time, we had the experience of Australia, where they started to increase the price of cigarettes. DK: No, no. The way is to try and share your logic, which is that I know if you continue your bad habits, you are going to die. What I want is to eradicate smoking-related deaths. Khayat has previously explained, while emphasizing that the scientific community should “play a stronger role in convincing policymakers around the world to reconsider and be more innovative in their tobacco control strategies, including coming to a realization that some levels of our bad behavior by people are inevitable, but that limits on their freedom and dire warnings about the consequences of their actions “is not a viable path” towards reducing health risks. Now we come to a third way. I’ve been publicly attacked in my own country by scientists who are working with the anti-tobacco lobbies. He lived well into his 90s. NE: So if my stepfather was here, and if you could give him some advice, how would you explain to him the “third-way” option in a way that would persuade him to be less skeptical? Staying for half an hour under the sun at 5pm while at the beach against staying for five hours under the sun from 11am-4pm; the risk of skin cancer is not the same. They tested E-cigarettes and heated tobacco against normal cigarettes and they stated that the first two could provide a better health alternative to the (smoking) population. New Europe (NE): I wanted to begin this with somewhat of a personal angle to my question, my stepfather died of throat cancer in 1992. NE: Is there the same hostility in the scientific community? After two years, however, it was less than 10%. You have to understand that with cancer, whether you’re talking about the sun and skin cancer, red meat and colon cancer, almonds and breast cancer; whatever. I want to review the evidence. What this means is that the public policy, which I originally initiated, to control the prevalence of smoking by increasing the cost of cigarettes, has failed. This is why I have committed myself to find any innovation that could help people have an alternative to quit smoking – of course, quitting is the best thing to do – or die. But what I’ve done, and what I want to do, has nothing to do with the economy of cigarettes. We all know people in the countryside who drink a liter of red wine every day, plus some digestive after the meals, smoking several cigarettes without filters, and living until they’re 92
NE: Very true. But the idea of “quit or die”, has been the basis of all of our policies – meaning that you understand that if you don’t quit, you will get a terrible disease that will eventually I want a third way. Go out and have fun; see people and feel better.” No, it’s a disease. When you are an addicted person, you simply don’t fully understand that. But for me, what my goal for the rest of my life is to have young oncologists have less patients die from cancer. The poorest people in the country are already at the highest risk of obesity, diabetes, and cancer. The sets of cigarettes from Philip Morris went from 80 billion sticks per year, down to 55 billion. I am only concerned with the consequences of cigarette smoking. David Khayat (DK): Let me tell you, there has been a recent big study that has shown that 64% of those who are given the diagnosis of cancer, smokers, for example, who are diagnosed with lung cancer, will continue to smoke until the end. So when the government says there are fewer smokers, that’s not backed by real data. And yet, despite the empirical data that reveals the risks of smoking, more than 60% of those who are diagnosed with cancer continue to smoke. What has been shown recently, and what is interesting is after COVID, is that a pack of cigarettes costs more than €10 in France, one of the most expensive in Europe, is that this policy (of high pricing) didn’t work. While attending the Global Forum on Nicotine in Warsaw, Poland, Dr. For tobacco, innovations like SNUS, heated tobacco, and E-cigarettes – all are vastly better than smoking normal cigarettes. I would tell him that I understand that trying to quit an addiction to nicotine once you’ve been given the diagnosis of having potentially terminal cancer, which would mean having to undergo treatments like radiation, surgery, chemo… it’s an immense amount of stress. David Khayat, the former president of France’s National Cancer Institute and head of medical oncology at the Clinique Bizet in Paris, is one of the most respected and forceful voices who opposes what he says are ineffective peremptory slogans like ‘quit smoking or die’. What happened was that I started to trust what I was reading when I saw the data from the FDA, which is not an easy institution to get through. There’s the dose, one cigarette per day, or 10 cigarettes per day; or the duration, smoking for one year in your whole life, or smoking for 40 years. NE: What, exactly, was the initial concept that you had when you thought of the idea to raise the cost of cigarettes? You could buy E-cigarettes anywhere. Those are statistics from organizations like the FDA and their counterparts in Europe and the UK. For me, what is totally unacceptable, is that these smokers are the poorest people in society; a guy who is unemployed and living off state social benefits. We have to understand the disease, the process of the disease, the mechanics of the disease, and find ways to treat the disease. For example, eating one slice of ham every week, as opposed to 200 grams of processed meat every day, the risk of colon cancer will obviously not be the same. Let’s look at the whole picture. You know, in the public health plans of some countries, in the UK, for instance, the NHS can now prescribe E-cigarettes as part of a health plan for smokers. In Europe, when E-cigarettes were commercialized, they were very regulated. If you look at the NRT – the nicotine replacement therapy – which I made available to all French citizens, and which were totally reimbursed without a prescription, the efficacy was 60% after two months. Not at all. DK: I would tell him that, first of all, I am not against him. However, as the technology for heated tobacco and E-cigarettes has improved, a bitter chasm has appeared between those advocating for the use of less harmful products as a pragmatic and realistic approach and those who think prevention and cessation through anti-smoking campaigns and increased taxation are the only methods needed to halt the use of harmful products. We don’t understand why. That means only 5% of people, that we know of, got a gene from one of their parents that was mutated from the time of conception. Ultimately, you ask people to stop smoking and do what you can to get young people to not smoke, but if they don’t want to stop, you have to help them find another way. Kayat spoke with New Europe about these topics and his vision for the path ahead. It doesn’t matter. NE: Sorry for what may seem like an ignorant question, but is there any scientific data which shows that one’s own genetics plays a role in their susceptibility to cancer or the risk of eventually getting cancer? Dr. But an increasing effort from sectors of the scientific community has focused on harm reduction through alternative solutions – such as E-cigarettes and heated tobacco – with the overall goal aimed at minimizing the damage that people suffer from unhealthy lifestyle choices, while at the same time not limiting or impinging upon their rights to make personal choices. Why? DK: Yes, but we don’t understand much about hereditary cancer, which is only 5% of all cancer cases in human beings. NE: Do you think that’s because, after a certain amount of time, the population adapts to the new reality? The results, which we had requested, showed that after one year or a few months it looked like it was a very efficient way of doing things in terms of a public policy. They had a long history of lying. But, what I found out two years later, those 1.8 million went back to smoking. The policy of higher prices for cigarettes has made the poorest people even poorer, and they continue to smoke and smoke even more. It’s the same with red meat and colon cancer – eating it every day or once a week. NE: One’s own genetic make-up does play a part in the suceptability? I did get 1.8 million fewer smokers, and I helped come up with a law to ban smoking in public places. Smoking is an addiction. DK: Exactly, that’s it. DK: Yeah, exactly. I think, as a doctor, we have to consider all addictions as diseases. David Khayat, former president of France’s National Cancer Institute and head of medical oncology at the Clinique Bizet in Paris
Interview with Dr. DK: It’s because there were so many lies from them for a century. My late wife’s close family friend – like an uncle, and who was a Crimean Tatar, his daily morning routine included a diet of rolled Soviet cigarettes, a shot of vodka, and a glass of kefir (fermented sheep’s milk). In 2002, one of my missions was to fight against tobacco smoking. The FDA has a huge research facility on tobacco in Florida. So, if you are exposed to a carcinogen, you will most likely be at a higher risk because of the weak gene that you inherited. Absolutely not. In 2017, almost 20 years later, the first cause of death was smoking. You know, it’s a bit like the statistic that in Europe, there’s a 215% increase in the risk for lung cancer in non-smoking women over the last 15 years. They’ll continue to sit in front of the TV and keep eating pizza and nachos. The decrease in smoking that we’ve had in the last two years, at 1.4%, is only from those with disposable incomes or those who are wealthy. NE: Is that because you and a lot of other policy-making officials and lawmakers automatically assumed that the tobacco industry would be disingenuous in their quest to find a third way? It looks like the cheapest drug in the world, but it is an addiction. If you are depressed, you need to be treated for depression. There’s no room for luck. Scandals like what happened in the US never happened in our countries. So it’s not just people like your stepfather, it’s almost everybody. People smoke because they addicted to nicotine, but they’re dying because they get it from combustible cigarettes. That’s my objective. For the first time in France, in 2003, 2004 and 2005, I raised the cost of tobacco cigarettes from €3 to €4; €4 to €5, in less than two years. But that is not enough. To make them prohibitively expensive, which would make smokers turn away from them? But, and this is not widely known to the general public, the medical community and every doctor knows that nicotine has no toxicity for cancer. And it is not at all true that it promotes smoking amongst teenagers.Studies have shown that the uptake of young people taking up smoking because of E-cigarettes is only 1%. That is hereditary cancer.