The role of medical community in policy making on tobacco control

September 25, 2020

Professor David Khayat in his keynote lecture today, sought to answer the question “Could the scientific and medical community play a role in making policy makers to reconsider the tobacco control strategies?.”

Not only in the past but even in the present, Professor Khayat said, all policy makers receive guidance most often by epidemiologists and not clinicians, by people who have never seen a real patient, who have never really taken care of these human beings affected by cancer or cardiovascular disease due to tobacco. If we want to improve the situation in the future, he stressed, we have to empower doctors, since they are the only population that know the science and care for the patients.

Speaking about the current situation in the field of tobacco control, Professor Khayat pointed out that everything is based on the international convention that has been signed in 2005 by more than 181 countries, with the goal to eradicate smoking. According to this convention, tobacco control means for smokers that they “quit or die”, and that if they die, it is their fault. Of course, doctors cannot accept something like this as the only existing option for their patients. Fortunately, this policy is not generally accepted anymore, he added, since there are many countries that have changed their position for tobacco control and recognize that today, due to innovation we have also other options, like snus, e-cigarettes and heated tobacco products.

“Countries with the lowest number of cigarettes smoked have something in common, they have embraced tobacco harm reduction strategies,” he said. Sweden, Norway and Iceland have accepted snus and UK e-cigarettes.

The real issue when we talk about smoking is cancer, Professor Khayat said, since this disease is a major public health issue. Smoking was the number one risk factor globally for developing cancer since 1990 to 2017, which means that whatever the tobacco control policies were all these years, they have failed. Cancer development is a matter of dose response, Professor Khayat added, since the greater the amount of carcinogens you are exposed to, the higher the risk of cancer.

“People make poor lifestyle choices despite suffering negative health effects,” he commented, and added that,

Harm reduction strategy is based in accepting that at some level our bad behaviors are inevitable; therefore, this strategy targets to minimize the harms people suffer as a consequence.

“The question if innovation in harm reduction can save lives is very important, since at the end of the day doctors want to save lives, the lives of their patients,” Prof. Khayat said. Examples from various countries show that innovation can do that, he added. In Sweden, where smokers have been given the possibility to switch from cigarette smoking to snus, they had a huge decrease in the number of cigarette smokers; therefore they had also a significant decrease in the tobacco-related mortality (lowest in the EU).

As doctors, how can we accept that these innovations are not available everywhere and to all citizens? Prof. Khayat wondered.

Quitting tobacco smoking is by far the better option, he noted, but unfortunately 64% of smokers diagnosed with cancer continue to smoke. Lifestyle change may be the best care in theory, he added, but it has a high failure rate. Harm reduction acknowledges the patient’s values as strength not a weakness, accepts people’s freedom to choose unhealthy behaviors, but reduces their harm through innovation.

Patients deserve the best available care, and doctors must focus on providing their patients and/or future patients with the best care.

As doctors, we owe this to our patients, it is our duty, as well as the honor of our profession, Professor Khayat concluded.