A conference staged recently online from Bulgaria gathered a panel of four scientists and medical professionals who discussed the latest evidence behind smoke-free products and addressed key issues related to tobacco harm reduction.
As an opening statement, it was first agreed among these independent experts that despite the attempts of many countries to raise awareness around the fatal consequences of smoking, it continues to be one of the main factors for many diseases the world over.
Therefore, “we, as doctors, have to do something to tackle this problem not only to the individual smokers but also to the whole population and passive smokers,” stated Professor David Khayat who was the first to intervene in the webinar.
Khayat, who is Head of the Medical Oncology Department at Hospital in Paris since 1990, and also Founder and Honorary president of the National Cancer Institute in Paris, started by acknowledging the many responsibilities that fall on his back. “As the person responsible for the national cancer plan, I had to do everything that we could in France to try to reduce the number of smokers in the country and the diseases related with tobacco. In order to do so, we had to implement several measures to protect the 1.8 million smokers in France,” he said. Results in 2 years: 80 billions cigarettes sales down to 55.
Being an anti tobacco person himself, he advises many organizations and companies to prevent this problem. Nonetheless, he reckons that the anti-smoking policies put in place are all failing.
He goes on elaborating on the danger of smoking due mainly the burning tobacco, which contains more than 6,000 chemicals & ultrafine particles. The majority (almost 80) are carcinogens or potential carcinogens. And they have scientific proof: The more time you are exposed to chemicals and carcinogens the higher you risk developing cancer.
Therefore, Khayat believes it is part of his responsibility too to acknowledge that there are smoking alternatives that reduces the harm smoking causes in general although he asserts that quitting tobacco smoking is by far the best option.
And here, Khayat concedes that vaping poses only a small faction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits over continued smoking.
In April 2019, the FDA authorized the sale of PMI’s IQOS, as tobacco heating system that contains fewer toxic chemicals than cigarette smoke and many of the toxins identified are present at lower levels than in cigarette smoke.
Hence, Khayat acknowledges that innovation such as heating tobacco and e-cigarettes can lead to a path of new and safer alternatives for the smokers than can’t or don’t want to stop smoking.
Following Prof. Khayat’s intervention, Dr. Efrain Cambronero Moraga, a renowned specialist in medical oncology at the Costa Rica Cancer Center, took the lead to discuss further “Tobacco Harm Reduction in the 21st century: How can we save lives and the effects of Tobacco Harm Reduction on Cancer diseases.”
Dr. Moraga reminded the virtual audience that eight million people are killed by tobacco-related diseases worldwide. And smoking is the leading cause of cancer. “If nothing changes, more than 8 billion people will die and this is a monumental public health problem to any country,” he notes.
So, what can be done to decrease morbidity and mortality induced by tobacco use? This is how the concept of Tobacco Harm Reduction (THR) was born. And the goal is to lower the health risks to individuals and wider society associated with using tobacco products.
Despite the many criticisms against THR, mainly the continued promotion of an addictive substance (nicotine) and its unproven long term safety, unclear efficacy for smoking cessation and reduction and being a gateway to attract the youth, Dr. Moraga admits that all these arguments are valid as we need to remember all forms of tobacco are hazardous and there is no safe level of exposure. He adds: “There is no magic wand to make people quit smoking but we should use everything at our disposal to prevent smoking initiation to help smokers quit.”
Dr. Moraga is convinced that tobacco products must be regulated.
Historically, he explains, tobacco companies have deceived the public and in 1950-1960. Advertising strategies in the past seemed to say that some cigarettes were better than others. Even today, these strategies are still in place and generate much confusion among the population and smokers. This is why he says, “there is a need to promulgate clear information on existing science-based alternatives,” especially that many high school students consume this type of product.
He also insists on the fact that modifiable tobacco products as a solely harm reduction strategy is unlikely to succeed at significantly benefiting population public health.
He concludes saying, “our long term goal is to protect non-smokers to not becoming all time smokers.”
To support Dr. Moraga’s take on Tobacco Harm Reduction, Prof. Georgi Momekov, chairman of the Bulgarian Scientific Society of Pharmacy, pharmacologist and lecturer in the Department of Pharmacology, Pharmacotherapy and Toxicology at the Faculty of Pharmacy of the Medical University of Sofia, introduces some scientific facts.
The author of over 150 tobacco-related publications in scientific journals, insists mainly on the addictive power of nicotine and the chemical compounds of the toxic smoke that is carcinogenic and can damage our cells. Another major point he develops is the Harm Reduction process: “toxicants associated with burning are the primary cause of smoking-related disease. The high temperatures in the lit end of a burning cigarette, above 600C, cause a large number of chemical reactions to take place, breaking down the tobacco into the thousands of chemicals that appear in cigarette smoke. Many are considered harmful, and together they are recognized as the main cause of smoking-related diseases”.
Therefore, the FDA’s authorization of IQOS Tobacco Heating System comes as no surprise as the IQOS system heats tobacco but does not burn it. This significantly reduces the production of harmful and potentially harmful chemicals.
Prof. Georgi Momekov asserts that scientific studies have shown that switching completely from conventional cigarettes to the IQOS system significantly reduces one’s body exposure to harmful or potentially harmful chemicals. He opposes Cigarettes vs IQOS to show the pros of the latter concluding that IQOS is a reference example for the smoking cessation strategy.
Finally cardiologist, Dr. Rada Prokopova who is the Head of the Cardiology Department at Sofia’s Internal Medicine Clinic since 2014, offered Real life data from his cardiology practice.
Dr. Prokopova says that few people realize that toxic irritants are associated with cardiovascular and respiratory diseases. He reiterates the fact tobacco smoke is made up of thousands of chemicals, including at least 70 known to cause cancer. Tobacco dependence occurs when you need nicotine and can't stop using it.
There is not a single doctor who has not tried to persuade their patients to stop smoking. But it is a very difficult problem to solve.
This is why, for Dr. Prokopova, the current alternatives for smoking cessation as heating tobacco products are leading the way to meet the needs of people who cannot quit smoking by reducing their exposure to toxic substances in a high proportion.
In a world where tobacco consumption is still prevalent and growing in certain areas, what we can conclude out of these expert perspectives is that the best strategy doctors can come up with for now is THR, which can diminish the negative effects for health. The sounding proof was the latest scientific evidence shared throughout this conference backing smoke-free products, like IQOS or other similar products, as better choices for smokers who would otherwise continue to smoke. Last but not least, it is science and not dogma that should direct public health policy in tobacco and nicotine.
