A prominent French cancer specialist and former advisor to the World Health Organization (WHO) has strongly advocated for harm reduction as an essential strategy to reduce 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 the WHO-led tobacco control measures have not been as effective as intended, necessitating alternative solutions for smokers unwilling or unable to quit.
“We must acknowledge that after thirty years of taxation, public warnings, and regulatory bans, smoking remains a major public health challenge,” said Khayat.
“It’s time to adopt new, pragmatic solutions that both support cessation and reduce harm for those unable to quit,” he said.
Khayat cited a critical distinction in tobacco harm reduction: nicotine does not cause cancer; burning tobacco does.
He noted that while smokers seek nicotine, it is the combustion process—which releases toxic chemicals and ultrafine particles—that leads to deadly health outcomes.
Leading health organizations, including the WHO and the US Food and Drug Administration (FDA), have also stated that nicotine itself is not a carcinogen.
Smoking remains the leading preventable cause of death worldwide and the primary contributor to non-communicable diseases (NCDs), which account for about 75 percent of global deaths each year.
Khayat said decades of traditional tobacco control efforts—including increased taxation, graphic health warnings, standardized packaging, and public smoking restrictions—have not prevented smoking from remaining the main driver of NCDs globally.
The cancer specialist noted the difficulty of quitting, citing a national campaign he led in France where 1.8 million smokers quit, but nearly all resumed smoking within three years. He stressed the urgency for harm reduction by stating a troubling reality from his clinical experience: 64 percent of patients diagnosed with serious cancers, including lung cancer, continue to smoke after diagnosis.
Khayat said cigarette smoke is carcinogenic because the combustion of tobacco leaves produces more than 6,000 chemicals, including around 80 known carcinogens and ultrafine particles. He stressed that these toxic compounds are the true drivers of smoking-related diseases, and that the dose-response relationship—higher exposure leads to greater risk—is the core rationale for harm reduction.
He also cautioned that purely prohibitionist approaches to smoking can have harmful side effects, such as the rise of illicit markets and criminal networks, drawing a parallel to the alcohol prohibition era in the US.
“Harm reduction should be seen not as an obstacle to cessation, but as a vital step toward it,” Khayat said.
