American Univesity of Beirut


Dear friends and colleagues in the AUB community,

As a thoracic/head and neck medical oncologist, I have spent most of my career studying
and treating cancerous tumors of the airways, among the world’s biggest killers, which in
many but not all cases are caused by the use of tobacco. Improving the prevention and
care for those with life-threatening illness quickly became the most compelling part of my
professional existence as a cancer physician. Those intense therapeutic relationships leave
you with a profound and lasting sense of empathy, with no room for judging individuals’
lifestyle choices. Every exchange is underpinned by the knowledge that your worst
imaginable day is almost always better than your patient’s very best day. But while I and
my colleagues have boundless sympathy for the victims of these diseases, we cannot in
good conscience show any detachment towards the very addictive and clearly harmful
activity responsible for so much of this preventable and unnecessary suffering. Tobacco
leads to more deaths on our planet than wars. I hardly need to add that tobacco smoke is
not only the prime cause of lung cancer, but also increased levels of coronary heart
disease, stroke, myriad lung diseases, and many other cancers and adverse effects
throughout a smoker’s body, not to mention for those of us inhaling tobacco smoke

Groundbreaking research and advocacy


While Lebanon is disturbingly among the most persistent countries for tobacco abuse, its
prime educational establishment is a pioneer in the battle to limit the practice and the
harm it causes. Through the outstandingAUB Tobacco Control Research Group (AUBTCRG),
our faculty leads the way in multidisciplinary knowledge production and
dissemination, but also crucially in advocacy for evidence-informed policy changes. The
different perspectives coming together make for an authoritative research combination.
The Faculty of Health Sciences breaks new ground in evaluating tobacco control policies
for the region, including gauging the effectiveness of taxation and health warnings, and
surveying the prevalence of smoking; the Faculty of Engineering and Architecture hosts its
unique aerosol research laboratory; while the Faculties of Medicine, Arts and Sciences,
and Agricultural and Food Sciences, and the School of Nursing, all play their part, from
developing new analytical techniques, to estimating the costs of tobacco on society, to
tailoring chemotherapy, radiation, surgery, targeted and immunotherapies for cancer

On a separate track, the Wellness Program at the Department of Family Medicine has an
outstanding program to help all smokers among the AUB community willing to quit the
habit—or as I prefer to think of it—the addiction. Admission to the program currently
costs much less than the average savings that a smoker would accumulate as a freshly
made non-smoker, and the success rate is substantially higher than the international rate
for similar programs (40% compared to 32% generally). Patients receive individual
sessions with a special physician and group or individual sessions with a certified nurse
from the UK National Centre for smoking Cessation and Training; they have their CO levels
and lung functions monitored throughout. There is a one-year telephone follow-up plan
to help them stick to their path. I know that most people find “giving up” tobacco hard,
and almost impossible, but really there’s nothing to give up, just to gain; think of all the
benefits—a lifetime of better health, more time, money, and freedom from addiction—
that start the moment you stop smoking.

Lebanon’s daring Law 174


As many of you know, the superlative work of AUB-TCRG led to the promulgation of Law
174 in September 2011, which banned smoking in enclosed public places, as well as all
advertising and promotion of tobacco products in Lebanon. The credibility which AUB
faculty brought to the discussion was fundamental in attracting media support and
getting policy makers, parliamentarians, and ministers to sign up and formulate a law
which was state-of-the-art in terms of encompassing the available evidence and the
international conventions which Lebanon has ratified. Unfortunately, owing to a lack of
enforcement brought about by an absence of political will, other national preoccupations,
and—yes—the unconcealed interference of third parties in the hospitality industry and
Big Tobacco, the law is now widely flouted in cafes, restaurants, even government offices.
Beirut’s omnipresent hookah (waterpipe) bars, which all-too-briefly were severely
curtailed by the ban, now congest our streets just as their pungent and toxic products
obstruct the life-sustaining lungs and arteries of those who use it and many of those
around them.

The lesson we draw from this setback is not that controlling tobacco use is impossible in
Lebanon. Quite the contrary. Vested interests have tried to stymie restrictive legislation
on smoking all around the world. Here, they just happen to be more successful thanks to
key government figures undermining their own legislation by declaring, three months
after the ban came into force in restaurants, cafes and night-clubs, that during the 2012
holiday season authorities would turn a blind eye to violations of Law 174. How shameful,
that at New Year’s Eve, a time when many smokers resolve to try giving up tobacco,
Lebanon’s own political leaders were sabotaging their own flagship legislation to control
it! It is tragic indeed given that, conservatively, an estimated 4,010 people die annually
from tobacco-caused disease in this country, and Law 174 provided a path towards
improved public health. The lesson should not be despair, but that AUB can once again
lead the way by bringing its expertise and advocacy to bear, modelling a different, more
socially responsible example for Lebanon and the region.

Tobacco-free future


A little over a year ago, I had the privilege of signing an MOU with the World Health
Organization, making this university the global knowledge hub for waterpipe tobacco
smoking. We were honored by a visit by Dr. Vera Da Costa E Silva, the Head of the
Secretariat of the Framework Convention on Tobacco Control who signed on behalf of
WHO. It was a proud moment when Dr. Da Costa E Silva described AUB as “a symbol of
the determination to place learning and rational thought at the heart of society”. During
that meeting (see photo above), surrounded by members of the AUB-TCRG and other
interested parties, I undertook to make AUB completely tobacco-free within 24 months.
With a packed agenda of programs in the meantime, we have kept this tight timeline in
view and last month I sent out instructions to form a Taskforce for a Tobacco-Free
Campus with Dr. Rima Nakkash, Associate Professor at FHS and AUB-TCRG Coordinator,
chairing a faculty/staff/student advisory team that will guide the AUB community in the
development, implementation, enforcement and evaluation of a tobacco‐free campus
policy by the end of 2017.

Today, AUB campus is largely smoke-free, inasmuch as you cannot smoke here except for
in designated areas, denoted by brown benches, and in private residences. The work of
the taskforce is to bring an end to this accommodating approach to tobacco use, to
expand it to all forms of tobacco, smokeless and the water pipe included, and to
transform the university space into one that supports the choice of not smoking, that
enables smoking cessation, and allows everyone the right not to be exposed to secondhand
smoke. By contrast, the existence of brown-bench areas indicates smoking is an
acceptable norm that we as an institution can condone. As I said in my introduction, we
cannot stand by and allow that to continue. Certainly, we are open to hearing arguments
against a comprehensive approach, so that every possible line of debate is explored and
measures to mitigate any reasonable objections can be deployed. And I want our top-ofthe-range
Smoking Cessation resources to be working at full capacity to help students,
faculty, and staff grasp this opportunity to liberate themselves from the destructive, 
demoralizing and expensive chains of addiction and impaired health that tobacco use
inevitably leads to. Given our strength in research, this taskforce will deliver significant
amounts of survey data that can underpin this important initiative. But if one additional
person can be shielded from the ordeal of requiring my medical expertise as one of our
cherished cancer patients, it will be well worth it.

Best regards,

Fadlo R. Khuri, MD

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