A PROMINENT cancer expert is encouraging Filipino doctors to rethink their strategies to address the smoking problem in the country, pointing out that the current policies have failed to convince smokers to quit, leaving millions of them exposed to diseases.
Dr. David Khayat, a renowned French oncologist who was a resource speaker in a virtual scientific meeting of the Philippine Medical Association (PMA), said health professionals should look at science and innovation in reducing the exposure of smokers to harm caused by tobacco smoke, noting that nicotine does not cause cancer as misperceived by the public.
“In a perfect world, the dream is to eliminate smoking and therefore all smoking-related diseases. If not possible, I think we have to make decisions based on science, and not on emotion or opinion,” Khayat said in a virtual presentation on the topic “Smoking, Cancer and Tobacco Harm Reduction” during the 115th PMA Annual Convention and Scientific Meetings held on May 19 to 22 this year.
The scientific meeting was chaired by Dr. Ricardo A. Batac, with Dr. Annielyn Beryl Ong-Cornel, Dr. Bu Castro, Dr. Guia Tan, Dr. Maria Encarnita Limpin, and Dr. Rizalina Raquel also as speakers.
A professor of Oncology at Pierre et Marie Curie University and head of Medical Oncology at La Pitié-Salpétrií¨re Hospital in Paris, Khayat said the fight against cancer should involve reducing exposure to known carcinogens, noting that current anti-smoking policies, which revolve around bans and increases in taxes, have failed to address the problem of smoking cigarette, which contains more than 6,000 chemicals and ultrafine particles, including 80 carcinogens or potential carcinogens.
“The greater amount of carcinogens you are exposed to, the higher the risk of cancer,” he said. “Although 80 percent of all lung cancers occur in smokers, only 8 percent of all smokers will develop lung cancer.”
He said it is the responsibility of medical professionals to provide alternatives that reduce harm from smoking, and these should include the use of innovative products such as e-cigarettes, heated tobacco products and snus.
“People make poor lifestyle choices despite suffering negative health effects,” he said, adding that harm reduction is not a new concept, but a term that arose in the context of drug addiction. He said it was the late Prime Minister Margaret Thatcher who pioneered the focus on harm reduction during the AIDS epidemic in the UK, which resulted in the lowest rates of HIV among drug users in the word.
Dr. Khayat encouraged Filipino medical professionals to look at smoke-free alternatives as harm reduction tools that will help address smoking-related diseases in the Philippines. He said this is where tobacco harm reduction comes in. “Accepting that some levels of bad behaviors are inevitable, therefore, we should target to minimize the harm people suffer as a consequence,” he said.
“All of these alternatives such as snus, electronic cigarettes (vapes) and heated tobacco products (HTPs) are showing very significant efficacy in helping people switch from real cigarettes that are very bad to health,” he said.
He also asked the medical community to look at nicotine as part of the solution as he pointed out that nicotine, while addictive, is not a source of cancer, and health experts even prescribe nicotine replacement therapy (NRT) to help smokers quit.
“Smokers commonly misperceive that nicotine is a major carcinogen,” he said, adding that it is contrary to the conclusion of the Cancer Research UK, which found that nicotine is not responsible for the harmful effects of smoking. “Nicotine does not cause cancer, and people have used nicotine replacement therapy safely for many years. NRT is safe enough to be prescribed by doctors,” the Cancer Research UK said.
In Japan, a study found reduced formation of harmful and potentially harmful constituents in HTPS compared to cigarettes. A study on the effects of switching to HTP concluded in 2021 that consistent improvements in respiratory symptoms, exercise tolerance, quality of life and rate of disease and exacerbations were observed in patients with COPD who abstained from smoking or substantially reduced their cigarette consumption by switching to HTP use. On a country level, Japan experienced a 34-percent decline in cigarettes sales
in four years following the introduction of heated tobacco products.
In July 2020, the US FDA determined that the exposure modification order for IQOS would be appropriate to promote the public health and is expected to benefit the health of the population as a whole.
A 2021 study suggested that the use of e-cigs could be a third as harmful to health as smoking especially in high-income country settings. The estimate is based on number of biomarker studies.
