EVEN though quitting tobacco is by far the most effective means of tobacco harm reduction, it is difficult to achieve due to a myriad of factors chief among them being the addictive nature of Nicotine, hence the need to introduce innovative and less harmful alternative ways of reducing smoking related cancer deaths and illnesses, a top harm reduction expert has said.
By Michael Gwarisa
According to the World Health Organisation (WHO), tobacco kills more than 8 million people each year and more than 7 million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke.
Speaking during a virtual meeting with Journalists from across Africa, Philip Morris International (PMI) Harm reduction Consultant, Professor David Khayat said offering smokers less harmful tobacco options was easier than forcing them to quit smoking completely.
The question is, can we change the bad behaviors and what is it we can do to make these bad behaviors less harmful? For example we know that alcohol is amongst the cancer risk factors and between 1920 and 1930, the United States issued a prohibition on alcohol but it didn’t work. In tobacco, we have almost the same thing, the Framework Convention on Tobacco Control (FCTC), the global convention that was signed through the WHO by more than 190 countries in order to set policies against tobacco.
“Did it work better than the prohibition of alcohol? My answer is no. You see that the leading cause of death by cancer 20 years ago was tobacco smoking, we have to see that 30 years later, in 2019, the leading cause of death by cancer was still tobacco. What does this mean? This means that all our policies for 30 years have totally failed. We are still facing the reality that smoking was and continues to be the leading cause of death cancer in the world,” said Prof Khayat.
He added that there is need to scale up Tobacco Harm Reduction efforts in Africa as evidence points to a growing population of smokers over the years.
“Africa is going to be the place in the world where we have to work very deeply on harm reduction. I am the former president the National Cancer Institute of France and the advisor for the National Cancer Plan from 2002 to 2005. I have to say that one of the main objective of this national cancer plan was to try to improve the situation on tobacco smoking in my country.
“We signed a law which would ban smoking and we raised the price for a packet of cigarettes and thanks to all these measures we had about 1.5 million less smokers in France. Unfortunately we had to face the reality which is that about three to four years later, all these 1.5 million who had quit, went back to smoking. We have to accept that some levels of our bad behaviors are inevitable.”
He also said that 64% of the people that are diagnosed with lung cancer and are put on chemotherapy still continue to smoke until death because of the addiction.
“If we want to apply the concept of harm reduction for those who can’t quit, let them continue to get something that is less harmful. We know that cancer is always due to the exposure to a Carcinogen. The longer time you have been smoking, the higher your risk of lung cancer. So how does cigarettes cause cancer? It is well known that when you burn tobacco leaves at temperatures higher than 400°C, this burning of tobacco will reduce the onset of a lot of different Carcinogens but if you heat the tobacco leaves at temperatures between 250°C and 350°C, there is no burning, there is no smoke, tobacco is just heated and at that temperature, you will not have the occurrence of most of the usual Carcinogens.”
Tobacco harm reduction experts have also noted that burning tobacco generates smoke which in turn contains more than 6000 chemicals and ultrafine particles. 93 of these are listed by the United States Food and Drug Administration as harmful and potentially harmful Constituents (HPHCs). Majority of them, almost 80 are carcinogens or potential carcinogens.
Meanwhile, Dr Kgosi Letlape an ophthalmologist from South Africa and Harm Reduction advocate said there was a lot misinformation around tobacco reduction and there was need to correct the perception at a global scale.
“The issue of harm reduction in Africa is very difficult because of the circumstances that we find ourselves in. There are three things that I would like to touch on. The first one is that knowledge is power and one of the biggest problems in Africa is that there is no access to information and sometimes lack of information leads abundance of misinformation.
“The major problem in tobacco is by combusting the tobacco. The greatest harm comes from accessing what you want from the tobacco through combusting it. It has been known that smoking is a major contributor to death through the carcinogens that are produced during combustion and the damage that it causes to the lungs. When we are talking of harm reduction, we are not talking about harmlessness but we are talking of reducing the harm from smoking,” said Dr Letlape.
Mr Joseph Magero, the Chairman for Campaign for Safer Alternatives (CSA) said, “Reducing tobacco use in Africa has proved to be the hardest to deliver. Reducing tobacco use plays a major role towards achieving the global efforts to achieve the Sustainable Development Goals (SDGs) to reduce mature deaths from Non Communicable Diseases (NCDs) by one third by the year 2013.
“Governments here in Africa may not be aware that tobacco harm reduction has great benefits both economically and for health and this lack of information at times hinders reduction in smoking prevalence in the region. As smoking has reduced in other countries, smoking in our continent has increased by 50 percent over a period of 35 years.”
