Speaker 1: Hi, I'm Ethan Natalman, and this is Psychoactive, a production
Speaker 1: of I Heart Radio and Protozoa Pictures. Psychoactive is the
Speaker 1: show where we talk about all things drugs. But any
Speaker 1: views expressed here do not represent those of iHeart Media,
Speaker 1: Protozoa Pictures, or their executives and employees. Indeed, heed, as
Speaker 1: an inveterate contrarian, I can tell you they may not
Speaker 1: even represent my own. And nothing contained in this show
Speaker 1: should be used as medical advice or encouragement to use
Speaker 1: any type of drug. Hello Psychoactive listeners. Today we're gonna
Speaker 1: get into an issue that's not about illegal drugs, at
Speaker 1: least not yet. It's an issue that I kept an
Speaker 1: eye on all those years I was running the Drug
Speaker 1: Policy Alliance and dealing with the consequences of the war
Speaker 1: on draws US. But this one has to do with
Speaker 1: tobacco and nicotine and the question of whether or not
Speaker 1: the whole idea of harm reduction applies as much to
Speaker 1: tobacco products and smoking as it does with the illegal drugs. Now,
Speaker 1: around the time I was stepping down from DP about
Speaker 1: four years ago, the whole phenomena a jewel came around
Speaker 1: kids Jeweling and using East cigarettes. I mean, these cigarettes
Speaker 1: have been around for a while, but there was this
Speaker 1: explosion of adolescent vaping with Jewel and some of the
Speaker 1: competing products, and this public hysteria in the United States
Speaker 1: that resulted in all sorts of localities and even states
Speaker 1: starting to ban these products, and with people kids and
Speaker 1: adults being told that these cigarettes were as are more
Speaker 1: dangerous than cigarettes. And meanwhile, there's all sorts of evidence
Speaker 1: out there that adults who have had a really hard
Speaker 1: time quitting smoking could really benefit from making the switch
Speaker 1: to eat cigarettes. So this issue has been seriously in
Speaker 1: the news. In fact, but for the COVID pandemic, we'd
Speaker 1: probably still be talking about the vaping epidemic. Now, it's
Speaker 1: the f d a's job to regulate this industry, and
Speaker 1: they delayed doing that for many years. But they're supposed
Speaker 1: to issue a ruling, uh fairly soon about what this
Speaker 1: entire e cigarette industry is going to look like. You know,
Speaker 1: which flavors can be sold, if any of these things
Speaker 1: can be sold at all, how much nicotine can be
Speaker 1: put in, whether just to allow tobacco flavors, what restrictions
Speaker 1: on access to kids, So whenever the FDA rules. This
Speaker 1: could fundamentally reshape this entire industry. Until then, though, I
Speaker 1: want to provide some introduction to the issue, and I'll
Speaker 1: tell you that as I was learning more and more
Speaker 1: about this issue over the last few years, it was
Speaker 1: just one name that just kept popping up, left, right
Speaker 1: and center. And that's my guest today. His name is
Speaker 1: Clive bates Uh. He was a leading figure in the
Speaker 1: United Kingdom in late nineties and only two thousand's in
Speaker 1: the fight against smoking and big tobacco. He ran the
Speaker 1: leading anti smoking organization, which in the UK is called
Speaker 1: Action on Smoking and Health or ASH, and he stayed
Speaker 1: active in this area ever since and really emerged as
Speaker 1: really perhaps the outstanding expert and in some respects propponent
Speaker 1: of tobacco harm reduction. His website, Clyde based dot com
Speaker 1: is probably the best resource in the world on this issue.
Speaker 1: There's probably nobody I've learned more from on this issue
Speaker 1: than Clive. So Clive, thank you so much for joining
Speaker 1: me today. Him it's a real pleasure to be here.
Speaker 1: I've been a long stunting admira of you into your
Speaker 1: work on the war on drugs. So I promised our
Speaker 1: audience that with people whom I agree with a lot,
Speaker 1: I'm going to avoid this being any kind of love
Speaker 1: fest or disagreement fest. So what I'd like you to
Speaker 1: do is start off by just laying out the overall
Speaker 1: argument for why things like jewel and others were maybe
Speaker 1: good things, and why maybe people shouldn't be as worried
Speaker 1: about the whole kids thing or about this as most
Speaker 1: of my country and many other countries seem to be. Well.
Speaker 1: First of all, we have to start off with a
Speaker 1: definition of the public health problem, and that is that smoking,
Speaker 1: even now is a massive killer worldwide. W h O
Speaker 1: says eight million deaths per year um. Typically. I think
Speaker 1: in the United States they would typically say four under
Speaker 1: an eighty thousand premature deaths per year, and in developed
Speaker 1: countries tobacco would be killing or smoking would be killing
Speaker 1: more than obesity, alcohol, road accidents, drug misuse, and HIV combined. Now,
Speaker 1: the pattern of illness, it's a sort of late onset problem.
Speaker 1: So the median lifelong smoker would typically be losing around
Speaker 1: ten years of life in their seventies, so that's the
Speaker 1: sort of shape of the problem. But really after the
Speaker 1: sort of mid thirties to forties, people who smoked all
Speaker 1: their lives are starting to die prematurely from cancer, from
Speaker 1: heart disease, from serious lung ailments like emphysema, and so on.
Speaker 1: So that's the basic problem. Now, that problem is caused
Speaker 1: by smoke, not by the underlying drug using pattern. Okay, Now,
Speaker 1: just to unpack that slightly, People are smoking and using
Speaker 1: tobacco for the nicotine that is the recreational drug habit involved.
Speaker 1: You know, it's a relatively in drug terms, a relatively
Speaker 1: benign drug. Doesn't cause intoxication, and it doesn't cause people
Speaker 1: to lose control, it doesn't cause violence, it doesn't call
Speaker 1: family breakdown typically, and so on. But the harm is
Speaker 1: done by the mode of delivery, and the mode of
Speaker 1: delivery is to set fire to tobacco in the tip
Speaker 1: of a cigarette and inhale the products of combustion in
Speaker 1: the form of a kind of nicotine bearing aerossault. And
Speaker 1: those products of combustion, the tar and the hot gases
Speaker 1: that you inhale, those are the things that cause the disease. Now,
Speaker 1: what we have now is a range of products that
Speaker 1: don't involve combustion but allow users to consume nicotine. So
Speaker 1: these would be vaping products, heated tobacco products, smokeless tobacco
Speaker 1: products like snooze, and these new oral nicotine products are
Speaker 1: kind of pouches that don't contain tobacco but do contain nicotine.
Speaker 1: You're put in your mouth and absorb the nicotine through
Speaker 1: the mouth, And if you can take nicotine without the smoke,
Speaker 1: then you are likely to be avoiding all or nearly
Speaker 1: all of the disease risk that affects smokers. So there
Speaker 1: is a massive harm reduction potential in these smoke free products,
Speaker 1: of which the product Jewel that you mentioned, Ethan is
Speaker 1: you know, one amongst many, but one of those that
Speaker 1: has had the most spectacular success in terms of switching
Speaker 1: smokers from a smoked product to a smoke free product.
Speaker 1: And the more of that we can do, the more
Speaker 1: that we can convert the world's stock of around one
Speaker 1: billion smokers to smoke free forms of nicotine, the more
Speaker 1: that we're in in play to get a massive public
Speaker 1: health dividend out of migration from combustible to noncombustible forms
Speaker 1: of nicotine. So that's the basic public health problem and
Speaker 1: the harm reduction premise explained in overview terms. So now
Speaker 1: when I look at public opinion polls in the United States,
Speaker 1: we now see that a majority of Americans think that
Speaker 1: vaping are using a jewel or e cigarette is as
Speaker 1: or more dangerous, and cigarettes we see a majority of
Speaker 1: people believing that nicotine is why cigarettes cause cancer. So basically,
Speaker 1: what you're saying is that these public perceptions are the
Speaker 1: opposite of the truth. Those public perceptions are completely wrong,
Speaker 1: and they are very dangerous because people act on the
Speaker 1: basis of their perceptions, and if you hold those perceptions,
Speaker 1: you would be indifferent to whether you're consuming nicotine by
Speaker 1: smoking or by vaping, or by heated products or by
Speaker 1: smokeless tobacco, and you should not be indifferent about that.
Speaker 1: The health risks are radically different. And we know this
Speaker 1: really beyond any reasonable doubts. So if you measure hazardous
Speaker 1: agents toxicants that you find in the blood urine saliva
Speaker 1: of people using these products, you'll find dramatically lower levels
Speaker 1: amongst people who are using smoke free products. Then you
Speaker 1: would find among people who are smoking cigarettes almost the
Speaker 1: same in many cases as non smokers, or down to
Speaker 1: the levels where people quit smoking. And therefore it's just
Speaker 1: completely implausible that there would be the same disease risk. Now,
Speaker 1: some people say, well, you just don't know about the
Speaker 1: long term future, and of course, you know, we don't
Speaker 1: have time travel. We can't go forward forty years and
Speaker 1: find out what happened from prolonged use of products that
Speaker 1: were only invented, you know, ten, fifteen years ago. But
Speaker 1: if you have dramatically lower exposures, it's a pretty reasonable
Speaker 1: assumption that you're going to have significantly lower disease risk.
Speaker 1: And maybe you're going to be below the thresholds that
Speaker 1: the body can deal with and have negligible disease risk,
Speaker 1: you know. And if you're losing from lifelong smoking ten
Speaker 1: years of life in your seventies, maybe you'd be at
Speaker 1: worst losing a few months. And then you start to
Speaker 1: get a risk behavior where the risks are kind of
Speaker 1: in the noise of other things that you do in life,
Speaker 1: whereas smoking is not in the noise. It is an
Speaker 1: outlier in terms of personal risks are assumed through substance
Speaker 1: use or consumption, or lifestyle or behaviors of any sort.
Speaker 1: So I don't buy these ideas that anything like equivalent.
Speaker 1: One final thing to say about this ethan, though, is
Speaker 1: that this is not accidental. People have those perceptions because
Speaker 1: those perceptions have been implanted by an expert community of academics,
Speaker 1: of activists, of public health officials who don't want you
Speaker 1: to think that these products are lower risk. They don't
Speaker 1: like the harm reduction concept. They think everybody should cease
Speaker 1: using nicotine completely, and therefore a much safer way of
Speaker 1: using nicotine in their world works against their ultimate goal,
Speaker 1: which is a nicotine or drug free society. And it's
Speaker 1: no accident this people work tirelessly to confuse the public
Speaker 1: about the risks of using these products. It's despicable, it's irresponsible,
Speaker 1: and they're not accountable for it. But that's what's going on. Yeah,
Speaker 1: I will say. I mean, it's been stunning to me
Speaker 1: when I look in the political environment and see that
Speaker 1: some of the most vociferous anti harm reduction folks in
Speaker 1: the tobacco field are the people who are my allies
Speaker 1: on drug policy reform. You know, the governors, the senators,
Speaker 1: the congressman, the local legislators who were my allies on
Speaker 1: legalizing marijuana for medical purposes and more broadly, on advocating
Speaker 1: for needle exchange and harm reduction with illicit drugs, are
Speaker 1: the ones introducing bills and banning these cigarettes. So before
Speaker 1: we get into why that's happening, let me just ask you,
Speaker 1: in greater specificity, some of the things that I hear
Speaker 1: from this other side. Right, one of them says, Okay,
Speaker 1: maybe east cigarettes are good. If you're smoking and you
Speaker 1: can't quit entirely, then it's good to switch to an
Speaker 1: east cigarette or a heated tobacco product. Many of them
Speaker 1: will admit to that, but they'll say, what about the kids.
Speaker 1: I mean, first of all, you now have kids vaping
Speaker 1: who never would have touched a cigarette, but they're getting
Speaker 1: into vaping, and then they're getting addicted to vaping, and
Speaker 1: it can't be healthy for you to just be inhaling
Speaker 1: this stuff through these electronic devices where we don't really
Speaker 1: have long term studies. I mean, how do you respond
Speaker 1: to that class? Well, I don't think anybody approves of
Speaker 1: any kids doing anything risky, you know, drinking, taking drugs,
Speaker 1: drink driving, having premature sex. There is a whole range
Speaker 1: of risk behaviors that young people enter into that adult
Speaker 1: society generally would rather they didn't. But the problem is
Speaker 1: they do, and they do that partly because adolescens are
Speaker 1: in a kind of graduation process from being children to
Speaker 1: being adults. Adults use these substances, so they do. Therefore,
Speaker 1: I I think you just have to recognize that risk
Speaker 1: behaviors are part of life. They happen to be concentrated
Speaker 1: in kids that have usually had a bit of a
Speaker 1: tougher life. They haven't done well at school, their families
Speaker 1: are not always as sort of robust as you would like.
Speaker 1: They may have some mental health issues, they may be
Speaker 1: in poverty or so on. So you see, the underlying
Speaker 1: causes of these things are pretty fundamental. And therefore I
Speaker 1: would start from the position, and this is an unpopular view,
Speaker 1: I I you know, I don't deny that that some
Speaker 1: kind of drug use, you know, is a given in
Speaker 1: all societies everywhere, from ancient history onwards, and will probably
Speaker 1: continue to be. And therefore the sort of job of
Speaker 1: adult society is, to the extent it can not just
Speaker 1: to condemn it with a sort of just say no message,
Speaker 1: but to ensure that the options available are as safe
Speaker 1: as possible, are not outrageously dangerous. At least there are
Speaker 1: good options available if you want them. Now, with vaping,
Speaker 1: there's a lot of very frivolous behavior going on, it's
Speaker 1: a new thing. You can do silly things like blowing
Speaker 1: big clouds with them. They're slightly funky tech gadgets and
Speaker 1: so on. So what we find with youth vaping is
Speaker 1: that there is a lot of infrequent use. So this
Speaker 1: is kids basically being kids, messing around at parties, blowing
Speaker 1: big clouds and being silly. It's not an unusual thing
Speaker 1: for kids to do that, and it shouldn't be causing
Speaker 1: people to go mad with concern about what they're doing.
Speaker 1: When you look at more frequent users, so people who
Speaker 1: are using the products you know, most days or every day,
Speaker 1: what you find is that those are the kids who
Speaker 1: did or would be using tobacco anyway, and they're they're
Speaker 1: you know, around a one third of us teenage vapors
Speaker 1: would otherwise be typically smokers. Now for them, the intriguing
Speaker 1: thing here is that vaping maybe a diversion from doing
Speaker 1: something worse i smoking. And there's some evidence in the
Speaker 1: time series data that suggests the arrival and rise of
Speaker 1: products like jewel or vaping products more generally has caused
Speaker 1: a diversion re effect in the trajectory of smoking. In
Speaker 1: other words, it's accelerated the downward trend in smoking and
Speaker 1: vaping is effectively displacing smoking in the teenage population, and
Speaker 1: that's a good thing. So I think when people talk
Speaker 1: about youth vaping, you have to take a much more
Speaker 1: nuanced view of it. How much of it is frivolous,
Speaker 1: how much of it is more you habituated, and of that,
Speaker 1: how much of that is a diversion from smoking? And
Speaker 1: for goodness sake, let's take youth risk behaviors in context.
Speaker 1: Vaping is amongst the most innocuous things that kids do,
Speaker 1: amongst the whole spectrum of dangerous things that you know
Speaker 1: kids do, and it's not Honestly, I think government agents
Speaker 1: or anyone else should really be focused. Look at the
Speaker 1: opioid epidemical, you know, binge drinking. I mean, I hear
Speaker 1: you talk about you know who, who's who's smoking, who's vaping?
Speaker 1: And I think we know from the evidence that smoking
Speaker 1: at this point, I mean, when I was growing up,
Speaker 1: I think he was likely to see upper middle class,
Speaker 1: wealthy lawyers, doctors, teachers, professors smoking as poorer people. But
Speaker 1: now it really is among people lower income, white and black,
Speaker 1: right is among people mentally ill, among LGBT community, etcetera, etcetera.
Speaker 1: But what struck me about the phenomenon and jeweling, and
Speaker 1: here I should say, you know, like jewel is to
Speaker 1: eat cigarettes, right more or less, like Kleenex is two tissues,
Speaker 1: or xerox is to copy machines, or maybe even like
Speaker 1: produce pharmace. Oxy content was toxy codon right where it's
Speaker 1: plays a big role in the market, but it seems
Speaker 1: even more dominant because it's become a generic name. What
Speaker 1: I was struck, especially in places like San Francisco and
Speaker 1: other cities, and even where I live in New York,
Speaker 1: was that what was happening was that middle upper addle
Speaker 1: class kids, kids go into the private schools that you know,
Speaker 1: living in the fancy neighborhoods, that they were beginning to
Speaker 1: vape and getting into jewel and sometimes having a hard
Speaker 1: time stopping. And their parents, I mean their parents either
Speaker 1: had never smoked or hadn't done it in decades. They
Speaker 1: basically don't hang out with people who smoke or vape.
Speaker 1: They think they don't know anybody who smokes are vape.
Speaker 1: I mean, the only people they know smokers are vape
Speaker 1: are probably the people who work for them, and those
Speaker 1: people don't do it in front of them. So these
Speaker 1: upper middle class who can call their local legislator are
Speaker 1: finding their kids vaping and they're totally freaking out that,
Speaker 1: my god, my kid was not going to smoke at all,
Speaker 1: so he's doing this stuff. And then they read like,
Speaker 1: oh my god, the adolysts and brain is vulnerable, and
Speaker 1: what do you say about that? All right, So there's
Speaker 1: a couple of things that even I mean, first of all,
Speaker 1: you're absolutely right. You know, the concerned soccer moms have
Speaker 1: enormous political cloud and their definition of the problem, which
Speaker 1: is that their kids doing this is you know, a
Speaker 1: national crisis of aping epidemic. Is how that has played
Speaker 1: in the media. I don't think the data is fully
Speaker 1: in on that yet, but I don't think that will
Speaker 1: actually play out. When we have all the data. What
Speaker 1: we'll see is that most of the better off kids
Speaker 1: will be amongst the more frivolous users. And also they
Speaker 1: will be the ones who give up, you know, fairly quickly,
Speaker 1: either after they leave school or after they leave college,
Speaker 1: that they get serious jobs, they settled down, have families
Speaker 1: and so on. That's at least what the history of
Speaker 1: smoking has told us. If you go back to the
Speaker 1: time when you know, you had twelfth grade, you might
Speaker 1: have had thirty of young people smoking. What you'd have
Speaker 1: seen is a fairly even social economic distribution, which then
Speaker 1: consolidated into a sharp socioeconomic gradient as the better off
Speaker 1: kids gave up as they entered you know, if you
Speaker 1: like middle class society, and I suspect that we will
Speaker 1: see that again as those kids age into their twenties. Again,
Speaker 1: if we're really concerned about this would be focused on
Speaker 1: the disadvantage kids, the kids who would be smoking now
Speaker 1: and are now vaping instead, or at least now have
Speaker 1: the option to vapor instead of smoking. That's where there's
Speaker 1: a public health win. And of course the soccer moms
Speaker 1: who are you know, running points on this campaign, pay
Speaker 1: no attention to them. They're not really interested in the
Speaker 1: class basis of youth vaping. They're interested in the middle
Speaker 1: class basis of youth vaping, and they're missing something really
Speaker 1: important because of that. You know, I was gonna say,
Speaker 1: I mean, you know, it's obviously people are worried about
Speaker 1: their own kids, and obviously when upper middle class people
Speaker 1: are worried about their own kids, that's a politically great significance.
Speaker 1: But you know, one thing is Jewel came up with
Speaker 1: his product right there was particularly innovative, like a little
Speaker 1: thumb drive a good effect. But what argument could be, Okay,
Speaker 1: let's ban the products that kids seem they are so
Speaker 1: attracted to, even if the adults like them as well,
Speaker 1: but allow the products that don't seem as appealing to kids,
Speaker 1: like these heated tobacco products, heat that burn, right. Philip
Speaker 1: Morris just guide its product called icos right, which is
Speaker 1: a kind of bulkier product and seems to be effective
Speaker 1: as a harmonduction device. Why not just allow the heated
Speaker 1: products and say no, you can't do those, these cigarettes
Speaker 1: or things that where kids are going to be drawn
Speaker 1: to them. Well, I think the first thing to say
Speaker 1: about that is that vaping is enormously popular with adults,
Speaker 1: and the dual product has had amazing success in converting
Speaker 1: adults smokers to vapors. And the reason is that it
Speaker 1: the whole package of it works very well for smokers.
Speaker 1: It's easy to use, delivers it can if you want
Speaker 1: it to deliver nicotine roughly the same levels that cigarettes can.
Speaker 1: It's small, it's compact, uh uses low volumes of liquid,
Speaker 1: and it looks Okay, so that package has been very,
Speaker 1: very attractive with smokers. It's not obvious that, you know.
Speaker 1: I think one of the things that smokers are trying
Speaker 1: to do is they're trying to get away from the
Speaker 1: experience of smoking. So the heated tobacco products are very
Speaker 1: good and they work for some people some of the time,
Speaker 1: and one of the reasons that they work is the
Speaker 1: experience is closer to smoking. So for people who want
Speaker 1: something that is a closer substitute, they work very well.
Speaker 1: But the whole bunch of other people who want to
Speaker 1: migrate away from smoking and end up using a flavor
Speaker 1: that is, I don't know, peach Melbourne or something that
Speaker 1: has no echoes or cues associated with smoking whatsoever. So
Speaker 1: I think you've got to be really careful before you say, well,
Speaker 1: on the basis of these kids using these products, we're
Speaker 1: going to stop the adult smokers who are actually the
Speaker 1: at risk population from having access to these products that
Speaker 1: they really like and work for them. And at the
Speaker 1: same time, you've also got to keep coming back to this,
Speaker 1: You've got to be mindful that there's a lot of
Speaker 1: kids who would otherwise be smoking, otherwise doing other risk behaviors.
Speaker 1: And I think if I was one of these concerned parents,
Speaker 1: if you were to sit down and rank the list
Speaker 1: of things that you should be worried about as a parent, Okay,
Speaker 1: drink driving would be up there at number one. I mean,
Speaker 1: kids getting smashed up in cars is the number one
Speaker 1: cause of death in the age range from fifteen to
Speaker 1: twenty four, and that's driven by reckless driving, often fueled
Speaker 1: by alcohol, So that I think would be my number one.
Speaker 1: I would be really concerned about vulnerabilities caused by alcohol,
Speaker 1: the risk of violence, the risk of sexual assault, and
Speaker 1: so on. I would be concerned about some of the
Speaker 1: things that are going on now, like cyber bullying, some
Speaker 1: of the things that go on in terms of the
Speaker 1: way social media are used. I would be really concerned
Speaker 1: about kids mental health status, what's going on with self
Speaker 1: harm and kids being depressed and suicidal ideation and so on,
Speaker 1: And be extremely concerned about any uptake of opioids and
Speaker 1: use of fentanyl. As I say, I think it's important
Speaker 1: to get these risks, the risk associated with vaping, which
Speaker 1: are very very low in context with the whole panoply
Speaker 1: of youth risk behaviors, and behave accordingly and recognize that
Speaker 1: for a whole section of the population, these vaping products
Speaker 1: are extremely beneficial and maybe life saving for them. So
Speaker 1: it's not just that vaping is a lesser public health
Speaker 1: problem and smoking. It is actually a huge public health
Speaker 1: benefit for smokers who managed to switch. And that's the
Speaker 1: kind of grown up discussion we need to have about
Speaker 1: these products, including with parents and the flavors issue, because
Speaker 1: sometimes hear people saying, Okay, allow the tobacco flavored eat cigarettes,
Speaker 1: but band you know all the ones that the kids like,
Speaker 1: what's your response to that. Well, I mean, there's a
Speaker 1: lot to say about that. But obviously the purpose of flavors,
Speaker 1: I mean, it can't be denied, and it's trivially obvious.
Speaker 1: Flavors are put in the products to make them more attractive.
Speaker 1: And if you have an unflavored vape doesn't really taste
Speaker 1: of anything. So what you're trying to do is create
Speaker 1: a rival proposition to smoking. Now, smoking is full of flavor.
Speaker 1: It's not added flavors, but it's full of flavor that
Speaker 1: comes from the smoke, the actual products of combustion. So
Speaker 1: to satisfy somebody who smokes, you need something in its place.
Speaker 1: You need the products to actually taste interesting and be good,
Speaker 1: otherwise no one will use them. It simply won't play
Speaker 1: a role in displacing smoking and driving down smoking related disease.
Speaker 1: The interesting thing about the flavors debate in the United
Speaker 1: States is that the activist community, the anti aping activist community,
Speaker 1: started off saying, well, we shouldn't have things like gummy
Speaker 1: bear or cotton candy flavors because these are obviously childish
Speaker 1: type things. And then they discovered that kids were or
Speaker 1: adolescents were taking up duel. But duwel comes in fairly bland, well,
Speaker 1: fairly bland sounding flavors, so cucumber, mango, crem so these
Speaker 1: flavors were not in any way targeted at kids, but
Speaker 1: because kids were using them, the activist organization said, ha ha,
Speaker 1: those must be kids appealing flavors too, so we need
Speaker 1: to ban all of those. So what started off as
Speaker 1: a niche proposition that you would ban things that were
Speaker 1: obviously childlike like gummy bear or whatever, suddenly massively expanded
Speaker 1: in scope to include every flavor that wasn't a tobacco flavor.
Speaker 1: So the real fanatics in this field now, so you
Speaker 1: should ban every flavor that isn't a tobacco flavor, And
Speaker 1: for some reason they think it's a good thing that
Speaker 1: the only vaping products you should have on the market should,
Speaker 1: as far as possible, resemble cigarettes. I simply don't understand
Speaker 1: the logic of that, so I don't agree with flavor
Speaker 1: bands where I think you could do something. There are
Speaker 1: basically three ways of controlling flavors. The first is as
Speaker 1: a chemical So do the chemical agents in this flavor
Speaker 1: cause cancer? Are the immutagenic? Are they reprotoxic? Are the
Speaker 1: respiratory sensitizers? So treat them as toxic agencies? And if
Speaker 1: they are, then don't allow them or restrict them in
Speaker 1: some way. Secondly, you have a flavor sensation, so you
Speaker 1: subjectively decide that this product taste of apple, or it
Speaker 1: tastes of key lime pie, or it tastes of tequila
Speaker 1: sunrise or something that is a much harder thing to
Speaker 1: interact with that that's a subjective opinion of what the
Speaker 1: flame that is, and I don't think you should be
Speaker 1: trying to ban that. The third area that you can
Speaker 1: regulate in terms of flavors is the flavor descriptor. So
Speaker 1: you know, we call this gummy bear or we call
Speaker 1: it cotton candy, or we call it unicorn vomit, or
Speaker 1: we call it something that is designed to capture the
Speaker 1: imagination of kids. Now, that is an area where I
Speaker 1: think you could justify intervention, not so much the flavor itself,
Speaker 1: but the communication about the flavor and the attempt to
Speaker 1: appeal to kids. Now, I happen to think that a
Speaker 1: lot of adults like childish sounding things, as well as
Speaker 1: a lot of nostalgia and retro in there. But if
Speaker 1: you're going to regulate anywhere, I think it should be
Speaker 1: on the descriptors, not on the flavors themselves. We'll be
Speaker 1: talking more after we hear this add So some people say,
Speaker 1: I mean, the UK seems to be United Kingdom seems
Speaker 1: to be one of the models for embracing to some extent,
Speaker 1: a harm reduction approach. You know, even e cigarettes tapes
Speaker 1: can be sold in hospital shops, and you know, the
Speaker 1: governments started behind getting people to transition, and it appears
Speaker 1: that the uptake among young people is much lower than
Speaker 1: in the US. But some people then say, well, that's
Speaker 1: because the UK limits the nicotine level of these cigarettes.
Speaker 1: You know that jewel or others are what is it
Speaker 1: fifty milligrams or whatever. In the UK, it's got to
Speaker 1: be half or a third of that. So what about
Speaker 1: restricting the nicotine content. Well, again, there's a lot to
Speaker 1: say about that. I mean, people have noted that there's
Speaker 1: a limit of on the strength of nicotine in the
Speaker 1: cigarettes in Europe and still including in the UK. It's
Speaker 1: very difficult to show that that is the reason why
Speaker 1: there is a low level of the cigarett at uptake
Speaker 1: in UK kids. We do have the problem that I
Speaker 1: don't think products like the Jewel product have been anything
Speaker 1: like as effective at converting smokers in the UK as
Speaker 1: we've seen in the United States. It's a bit hard
Speaker 1: to really understand why cigarette smoking or vaping goes up
Speaker 1: and down anywhere, but I suspect it's something to do
Speaker 1: with fashion, with the way group preferences are are formed,
Speaker 1: and I have to say I think it's probably something
Speaker 1: to do with the near hysterical levels of moral panic
Speaker 1: about vaping in the United States. C d C did
Speaker 1: a survey I think it was two thousand and eighteen
Speaker 1: and looked for the reasons kids said that they were
Speaker 1: taking up vaping, and the number one reason was curiosity
Speaker 1: and flavors were number three, and you know, less than
Speaker 1: half of the kids cited that compared to curiosity. Now,
Speaker 1: if you've got every newspaper, every parents, every teacher, every agency,
Speaker 1: every TV station blasting out at you, hey, kids, all
Speaker 1: other kids are doing this. People think it's fashionable. People
Speaker 1: think it's really cool. Look here's how you hide it
Speaker 1: in your rucksack. There's a whole bunch of kids that
Speaker 1: can even do it in class. You've got these sort
Speaker 1: of bizarrely weird anti vaping campaigns that sort of, you know,
Speaker 1: hark back to sort of reefer madness, kind of levels
Speaker 1: of bizarreness. I just suspect that that may actually be
Speaker 1: a contributory driver, because which respectable kids says, well, this
Speaker 1: is something I must now try. If adult society is
Speaker 1: this upset about it. In the UK, the whole thing
Speaker 1: is much more mundane. The government advertises e cigarettes on
Speaker 1: television and pitches it at rather uninspiring kind of forty
Speaker 1: plus year old people. It looks like something that kind
Speaker 1: of more older people do as an alternative to smoking,
Speaker 1: and we don't have everybody losing their minds about it.
Speaker 1: It's seen as something that's good for health, and something
Speaker 1: that you should do if you're a committed smoker. That's
Speaker 1: how the positioning has been. So I think those reasons
Speaker 1: are probably more likely than the nicotine reason. I mean,
Speaker 1: going to why I think the nicotine reason is less likely.
Speaker 1: I mean the nicotine strength thing is a little bit
Speaker 1: of a red herring in understanding this. Just because a
Speaker 1: nicotine liquid is stronger doesn't mean you consume more nicotine.
Speaker 1: It means you consume less liquid. It's a little bit
Speaker 1: like whiskey. You know, you don't consume whiskey by the
Speaker 1: point you consume it by a few millilitres at a time.
Speaker 1: It's not something that you glugged down like you would
Speaker 1: glug down beer. And it's the same kind of thing
Speaker 1: with stronger vaping liquids. So the dual product uses a
Speaker 1: strong liquid, but the user will get about the same
Speaker 1: nicotine that some body using a weak liquid in a
Speaker 1: much larger device would use. Well, some people have come
Speaker 1: back and you say, Okay, I buy your argument about
Speaker 1: the benefits for adults, but why not just make it
Speaker 1: available by prescription. That will help keep it out of
Speaker 1: here as kids and adults can still get it just
Speaker 1: as easily as they get other drugs that doctors prescribed
Speaker 1: very easily. Why not? Why not prescription only? The reason
Speaker 1: is that if you're dealing with a population of smokers,
Speaker 1: you're trying to get them to do something that they
Speaker 1: may be reluctant to try. If you start to put
Speaker 1: barriers in the way of people accessing the alternatives, or
Speaker 1: if you misunderstand their drive to use these products, then
Speaker 1: you will get a much lower rate of switching. So
Speaker 1: there are really two kind of competing models for quitting smoking.
Speaker 1: One is this sort of medical route in which you
Speaker 1: get a nicotine replacement therapy or a pharmaceutical prescription only
Speaker 1: preparation like verenically or be appropriate, and the idea of
Speaker 1: those is to manage withdrawal and craving while you move
Speaker 1: from smoking to abstinence. The e cigarette public health model
Speaker 1: works in a completely different way. It works by replacing
Speaker 1: one pleasure smoking with another pleasure, vaping that has many
Speaker 1: of the same characteristics. So it's branded, It comes in flavors,
Speaker 1: it has a nicotine delivery that you like, It has
Speaker 1: throat sensation, hands and mouth movement, It forms part of
Speaker 1: behavioral rituals, and so on. It replaces many things that
Speaker 1: people get from smoking, but with a lot lower risk.
Speaker 1: So it's an alternative consumer proposition. Now, if you suddenly
Speaker 1: try to take that and cram it into the medical box,
Speaker 1: you're breaking the basic appeal that that proposition has to
Speaker 1: smokers who do not always see themselves as sick and
Speaker 1: in need of treatment the healthcare system. Okay, so Clive,
Speaker 1: the people selling these cigarettes right are ultimately gonna be
Speaker 1: Big Tobacco. They didn't start it right. It got started
Speaker 1: as something that was almost challenging Big tobacco, and the
Speaker 1: whole vaping world was anti big tobacco. But when big
Speaker 1: tobacco saw the opportunities and maybe saw the writing on
Speaker 1: the wall, and what I also hear from people is
Speaker 1: so okay, cigarette markets are declining, Big tobacco is trying
Speaker 1: to save its ask by getting people addicted to something new.
Speaker 1: They are now going to be doing ever more sophisticated
Speaker 1: east cigarette and other types of devices. They're going to
Speaker 1: be hooking a whole new generation to a new set
Speaker 1: of nicotine products that they'll be making money on. And
Speaker 1: in the same way that decades ago Big Tobacco experiment
Speaker 1: it would how to make cigarettes more addictive. Now they're
Speaker 1: gonna be trying to figure out how to make these
Speaker 1: e cigarettes more addictive so that a young generation starts
Speaker 1: like they did with cigarettes, you know, decade and generations ago,
Speaker 1: and they become lifelong consumers with a product debt is
Speaker 1: still of you know, safer than cigarettes, but we don't
Speaker 1: know how much safer. So Big Tobacco is a burden
Speaker 1: that all of us who work on the public health
Speaker 1: side of this have to contend with. They worked tirelessly
Speaker 1: to acquire a truly dreadful reputation over smoking and disease,
Speaker 1: and they deserve their pariah status, and their involvement in
Speaker 1: this makes things much more difficult. Ironically, I think in
Speaker 1: a way that cartel involvement in in the drug trade
Speaker 1: hasn't actually been a barrier to harm reduction, and may
Speaker 1: be wrong about that, but I feel that the salience
Speaker 1: of Big Tobacco in the nicotine and harm reduction debate
Speaker 1: actually has been very negative. But there's not much they
Speaker 1: can do about that. Their incentives are to go where
Speaker 1: the consumer goes, and if the consumer is switching their
Speaker 1: preferences for nicotine, you from smoking to vaping too heated
Speaker 1: tobacco products to other noncombustible products. Then that is where
Speaker 1: the tobacco companies will go. And I think what we're
Speaker 1: seeing is that they will evolve, and they are. This
Speaker 1: is happening already. They are evolving into nicotine companies and
Speaker 1: to varying degrees. And the companies are not monolithic. There
Speaker 1: isn't really a big tobacco They're all different and they
Speaker 1: all compete with each other, but to varying degrees. The
Speaker 1: companies are trying themselves to make a transition from combustible
Speaker 1: to noncombustible products. So Philip Morris International, biggest company in
Speaker 1: the world outside China, I think, now has something like
Speaker 1: twenty three percent of its net revenue from non smoked products,
Speaker 1: up from you know, a tiny fraction in around point
Speaker 1: one percent in two thousand and fifteen. So those companies
Speaker 1: are undergoing a transition, and that is base sickly a
Speaker 1: good thing. It is good that they are trying and
Speaker 1: hopefully increasingly driven out of the merchant of death business.
Speaker 1: The more that we can encourage them to do that,
Speaker 1: the less heavily their footprints will tread on global mortality.
Speaker 1: That would be a good outcome. We get back to
Speaker 1: sort of fundamentals here, What are we actually dealing with.
Speaker 1: Are we dealing with something that would simply go away
Speaker 1: if the tobacco companies went away, Well, I don't think
Speaker 1: we are. I think nicotine is amongst the legal recreational
Speaker 1: drugs that have proved popular in society, had been popular
Speaker 1: for you know, many centuries, and I think in trying
Speaker 1: to sort of wish away nicotine us, we're making some
Speaker 1: of the same mistakes that the sort of abstinence only
Speaker 1: crowd in drug policy have made. It's much better to
Speaker 1: work with the assumption that people will wish to use
Speaker 1: these drugs and in the case of nicotine, is a
Speaker 1: relatively benign drug, and try to make arrangements so that
Speaker 1: they can be used safely with some sort of accountability,
Speaker 1: quality control, redress, taxation, and regulated management of the risks
Speaker 1: and the noncombustible products allow us to do that and
Speaker 1: create a platform I think for people who want to
Speaker 1: use nicotine for the foreseeable future, in which the tobacco
Speaker 1: companies are bound to play some sort of role. But
Speaker 1: that's a good thing. They have an enormous reach, and
Speaker 1: if they manage to convert most of their customers, we'd
Speaker 1: see the smoking disease epidemic fade away pretty quickly, and
Speaker 1: it kindly seems to me there's the dynamic you wide
Speaker 1: is that you wid startup companies, very disruptive companies like
Speaker 1: Jewel wise or if you think about like Tesla wise
Speaker 1: with respect to electric vehicles, right, that you want these
Speaker 1: independent companies who are committed to taking over the world
Speaker 1: selling their base sickly safer product to be challenging the
Speaker 1: traditional companies that are selling their more dangerous product. And
Speaker 1: then you want the big tobacco companies are the same
Speaker 1: thing with the big auto companies. You want them feeling
Speaker 1: so challenged that they see no choice except to move
Speaker 1: in that direction as well. Yet, at the same time,
Speaker 1: if it's left just up to big tobacco, if they're
Speaker 1: taking over the whole East cigarette and harm reduction product market,
Speaker 1: I mean big tobacco, their bottom line is the shareholder
Speaker 1: is profits. Right, So even when they say they're committed
Speaker 1: to moving the harmonduction direction, even when they're doing stuff
Speaker 1: to do that, they still may not wanted to move
Speaker 1: too quickly in that direction because that might undermine their profits.
Speaker 1: They would seem to have an interest in moderating the
Speaker 1: transition because cigarettes are immensely profitable to them, more than
Speaker 1: the East cigarettes are at this point. So I mean
Speaker 1: the question is, how does one incentivize the big tobacco
Speaker 1: companies to move as quickly as possible as are there
Speaker 1: things that government can do or there are other ways
Speaker 1: to do this? Look Ethan, I agree with that not
Speaker 1: very strongly. I think the example of Tesla is a
Speaker 1: really interesting one because what you have there is, you know,
Speaker 1: radical innovator, but the worldwide impact of electric vehicles will
Speaker 1: be felt through whatever Toyota and Volkswagen do, what General
Speaker 1: Motors and Ford do, not what Tesla does. And so
Speaker 1: I think that model is exactly right. And we've had
Speaker 1: that up through the previous decade. The smaller, if you like,
Speaker 1: insurgent e cigarette companies have changed the game and completely
Speaker 1: changed consumer expectations. They've made this a thing, and now
Speaker 1: the tobacco companies have to follow, and they'll follow by
Speaker 1: acquisition or by innovation in their own labs. And that
Speaker 1: is a good dynamic. That is how you get a
Speaker 1: technology change. That is the process of creative destruction working
Speaker 1: as intended as new innovations diffused through the user population
Speaker 1: to obsolete the old technology. The question then is how
Speaker 1: do you incentivize that process so that it works faster,
Speaker 1: better and the change is more rapid and deeper. And
Speaker 1: again here it's about taking the incentives of all the
Speaker 1: companies involved and aligning them with transition from high risk
Speaker 1: to low risk products, both as consumers and producers. And
Speaker 1: this is one of the frustrations I have. My frustration
Speaker 1: is coming over here. It's one of the frustrations I
Speaker 1: have is that so many people in the public health
Speaker 1: world seem to be working against that huge amounts of
Speaker 1: money seemed to be going into slowing this highly desirable
Speaker 1: creative destruction process from high risk to low risk products.
Speaker 1: If you take the situation in the United States, the
Speaker 1: process for licensing and e cigarette product is massively burdensome,
Speaker 1: requiring a huge authorizing shan process running to millions of
Speaker 1: dollars per unit that really only the biggest companies can afford.
Speaker 1: The FDA itself is creating a dynamic that will restore
Speaker 1: the tobacco industry oligopoly in the e cigarette market, replicating
Speaker 1: the oligopoly it has in the cigarette market. We see
Speaker 1: who going around the world applauding every time a developing
Speaker 1: country outright bands e cigarettes, effectively introducing a regulatory protection
Speaker 1: of the incumbent cigarette trade. I mean, nothing could be
Speaker 1: more mad than that. Yet, in theory, the top public
Speaker 1: health body in the world, that's its favored policy prohibit
Speaker 1: e cigarettes outright leave the cigarette trade relatively untouched. Yeah. Well, Clive,
Speaker 1: I think we're getting to the issue of the elephant
Speaker 1: in the room here, which is a fellow named Michael Bloomberg.
Speaker 1: You know, my distinguished mayor for many years in the
Speaker 1: Ark City. But here's a guy who's what maybe the
Speaker 1: tenth wealthiest guy in the world, you know, fifties sixty
Speaker 1: billion dollars a year. He put a lot of money
Speaker 1: into trying to get people to quit smoking, which I
Speaker 1: think we can agree was a very good thing for him.
Speaker 1: But he's now spending, you know, committed hundreds of billions
Speaker 1: of dollars to banning vaping. And then I look deeper
Speaker 1: and you see that he's given a hundred million dollars
Speaker 1: I think, to the w h L World Health Organizations Foundation,
Speaker 1: and he's given a hundred million dollars to the CDC,
Speaker 1: the foundation of the Center for Disease Control, and he's
Speaker 1: funding all these groups that we're talking about, right, So
Speaker 1: it seems to me there's a powerful, corrupting thing going
Speaker 1: on here with somebody who's been very committed in other
Speaker 1: areas to public health and even to harm reduction, but
Speaker 1: who has a kind of ideological prohibitionist abstinence view here.
Speaker 1: And I'm wondering if there's you know, how far does
Speaker 1: this influence go. I mean, you look at the medical societies,
Speaker 1: You're the ones, the cancer societies, the heart associations, I mean,
Speaker 1: even these organizations that should be leading advocates for protecting
Speaker 1: health buying into the anti harmonuction thing. Is all that
Speaker 1: just about this money? Or is it? I mean, what
Speaker 1: is it? M So Look, I mean Mr Bloomberg, I
Speaker 1: don't doubt for one minute his intentions and his motivations
Speaker 1: are good. I think he's trying to do good in
Speaker 1: the world. He's trying to spend his fortune in a
Speaker 1: way that improves things, and I think everyone should acknowledge
Speaker 1: that he's done a lot of really good work. But look,
Speaker 1: he's a financial services billionaire. He is not well connected
Speaker 1: with public health or with the lived experience of people
Speaker 1: who live in poverty and various forms of disadvantage. He
Speaker 1: doesn't know what it's like to be a smoker or
Speaker 1: a vapor and yet he's a kind of instinct player.
Speaker 1: He is putting an immense amount of money into this field,
Speaker 1: but matched by kind of billionaire confidence that what he's
Speaker 1: doing is right and that the problem is that not
Speaker 1: everything Mr Bloomberg does do is right or has the
Speaker 1: effects that he expects it to have. You know, I
Speaker 1: just say one example recently, so he has put a
Speaker 1: hundred and sixty million dollars into campaigning to ban e
Speaker 1: cigarette flavors in the United States. Now, in advocacy terms,
Speaker 1: that is a gigantic sum of money to try and
Speaker 1: secure a policy objective that is sort of relatively obscure
Speaker 1: in kind of most people's thinking. Yet, we have just
Speaker 1: had some early data in from San Francisco where they
Speaker 1: did introduce a ban on e cigarette flavors, and you
Speaker 1: know what happened, Youth smoking when up When surrounding districts
Speaker 1: that are not bandy cigarette flavors, smoking rate continued to
Speaker 1: track downwards. So there we have the example of an
Speaker 1: unintended consequence arising. We can't say for certain about cause
Speaker 1: and effect, but it appears very strong Lee related that
Speaker 1: we had a policy measure favored by Mr Bloomberg, and look,
Speaker 1: it's turned out to have an unintended consequences that causes
Speaker 1: the public health impact be worse, not better as a
Speaker 1: result of his investment. Now, Bloomberg also told The New
Speaker 1: York Times during his run for the presidency that he
Speaker 1: thought that vaping should be outright prohibited and that it
Speaker 1: would be good if the future president of the United
Speaker 1: States did that. Now, prohibition comes with just the worst
Speaker 1: kind of possible unintended consequences. Yet he is promoting these
Speaker 1: kind of policies around the world. He's put in over
Speaker 1: a billion dollars worldwide inter campaigning, including into the World
Speaker 1: Health Organization, including into the World Bank, including into a
Speaker 1: large network of supposedly civil society organizations who really are
Speaker 1: just kind of AstroTurf for him, all pushing these kind
Speaker 1: of ideas, and they create a kind of out call
Speaker 1: it a sort of Bloomberg anti vaping propaganda complex. It's
Speaker 1: a gigantic enterprise funded by enormous quantities of money and
Speaker 1: ideological commitment to actually marginalizing these products and marginalizing the
Speaker 1: harm reduction concept in favor of his own preferred package
Speaker 1: of measures which he thinks will lead to total abstinence.
Speaker 1: So he's an abstinence only campaigner in a world of
Speaker 1: public health that generally favors harm reduction in all other areas,
Speaker 1: whether it's HIV, sexual health, drugs, alcohol, and sort on,
Speaker 1: we tend to favor harm reduction and not him in
Speaker 1: this area. And he is really causing an immense amount
Speaker 1: of trouble, and his legacy, I'm afraid to say, will
Speaker 1: be dominated I think by a reanalysis at some point
Speaker 1: in the future that no one did more to protect
Speaker 1: the incumbent cigarette trade than he did, and he will
Speaker 1: bear responsibility for hundreds of thousands, maybe millions of deaths
Speaker 1: as a result. Yeah, no, I mean claim. I agree.
Speaker 1: It's a tragedy because you know, we look at the
Speaker 1: evil work of big Tobacco over all those years and
Speaker 1: how many people have died, and now to see Bloomberg's
Speaker 1: philanthropic money basically, you know, standing in the way of
Speaker 1: what would be an effective public health campaign, apparently because
Speaker 1: he's just surrounded himself with the wrong people in this area.
Speaker 1: Let's take a break here and go to an ad
Speaker 1: When you look at the Heart Association the longer associated.
Speaker 1: I mean, why are these medical associations, which should be
Speaker 1: focused on the science and the evidence, why aren't they
Speaker 1: getting much more behind tobacco harm reduction. Either. It's a
Speaker 1: great question, and actually it's the question I'm most often
Speaker 1: asked because a lot of people are like, you know,
Speaker 1: can't understand why, why why can't everyone just get behind
Speaker 1: this and will have dealt with smoking in a couple
Speaker 1: of decades, it will be gone completely from the world,
Speaker 1: you know, or it will be highly marginalized. I think
Speaker 1: there's lots of reasons behind it. I think there is
Speaker 1: a strong gut instinct of disgust about smoking that came
Speaker 1: from people who were, you know, perhaps non smokers rights campaigners,
Speaker 1: the fact that people had to grow up in smoky
Speaker 1: environments and so on, and I think those people, their instinct,
Speaker 1: their gut visceral instinct, is that they just want the
Speaker 1: whole thing gone. Then I think there's the medical establishment view,
Speaker 1: which is, look, we know best, you should give up
Speaker 1: this habit using a medicalized approach that we favor. You
Speaker 1: are our patient, you are in treatment, do what we
Speaker 1: tell you, and you will recover and be cured. Unfortunately,
Speaker 1: that model doesn't really work very well for most nicotine uses.
Speaker 1: Most of the time, the success rates of that are
Speaker 1: extremely low. And medically you're talking about things like nicotine
Speaker 1: patches and arms and some of the parmaceutical products to
Speaker 1: help people quit. Yeah, I think there's a medicalized model
Speaker 1: behind this that says, oh, look, this is tobacco use disorder.
Speaker 1: It's a psychiatric ailment. We will cure you using pharmaceuticals
Speaker 1: that will deal with your withdrawal and cravings, and we
Speaker 1: will get you from being a user to being abstinent.
Speaker 1: That's a model. It's not one that says, actually, we're
Speaker 1: cool with nicotine use, just don't smoke because that's what's
Speaker 1: going to give you cancer, heart disease and respiratory ailments.
Speaker 1: That is not the way medical people think about this,
Speaker 1: and they've they've aligned around that. But I think I
Speaker 1: think there's even bigger reasons for this. So and I
Speaker 1: was part of this. I as you said in the introduction,
Speaker 1: I used to run Action on Smoking and Health in
Speaker 1: the UK in the late nineties to early two thousands,
Speaker 1: and basically we built a massive fighting machine for fighting
Speaker 1: big tobacco and fighting the cigarette trade and smoking and
Speaker 1: we were all, you know, basically in the Gray Tobacco Wars,
Speaker 1: and it was, you know, a big conflict with a big,
Speaker 1: bad industry. The trouble is that machine still exists, and
Speaker 1: I think what it's done is, rather than say, look,
Speaker 1: there's no more war to fight, it's sort of swiveled
Speaker 1: its gun turrets towards the new thing and has now
Speaker 1: started blasting away because that's what it does. That's what
Speaker 1: you do in the anti tobacco, anti smoking movement. You
Speaker 1: go into battle against big businesses and behaviors that you
Speaker 1: kind of disapprove with. And so there's a kind of
Speaker 1: institutional inertia that sort of sits behind this in the
Speaker 1: same way that there isn't a kind of caffeine control
Speaker 1: industry or the alcohol control industry is much smaller and
Speaker 1: weaker because it doesn't fight the same kind of battles
Speaker 1: that we used to fight against big tobacco. And then,
Speaker 1: I don't know, money plays a role. I mean, many
Speaker 1: of those organizations that you mentioned, you know, Lung Foundation,
Speaker 1: Heart Foundation, they have taken significant money from Bloomberg for
Speaker 1: joining in this anti vaping effort. So you can't rule
Speaker 1: out the effects of money. You also see that happening
Speaker 1: in academia. Food and Drug administration and National Institutes for
Speaker 1: Health are a huge source of funding for research. But
Speaker 1: the kind of research they want is research that finds problems,
Speaker 1: that finds reasons to regulate, that finds bads. They are
Speaker 1: much better at research that develops a problem than research
Speaker 1: that acknowledges or investigates an opportunity. You just don't see
Speaker 1: research looking to kind of round out and quantify the
Speaker 1: opportunities at anything like the scale or with anything like
Speaker 1: the financial backing that you see form from problem orientated research. Clive,
Speaker 1: I'll tell you when I started getting involved in this
Speaker 1: area a few years ago, what really struck me was
Speaker 1: that I was meeting these wonderful researchers, distinguished academics who
Speaker 1: are pro heart reduction, and they reminded me a lot
Speaker 1: of the people I had met in the academic world
Speaker 1: who were doing the work on harm reduction and needle
Speaker 1: exchange and over those prevention in the eighties, nineties and
Speaker 1: and adds. I mean, basically, when people who were focused
Speaker 1: on how do we most effectively reduce the harms associated
Speaker 1: with the consumption of tobacco in our society, and that
Speaker 1: was the focus balancing these the kids, these the adults,
Speaker 1: you name it. And then what I saw on the
Speaker 1: other side was this kind of massive establishment fronted with
Speaker 1: government money and Bloomberg money, who also wanted to reduce
Speaker 1: the harms of tobacco, but who diverged a because where
Speaker 1: they had started off being just anti smoking, now they
Speaker 1: had adopted a sort of ideological anti all nicotine approach,
Speaker 1: a kind of abstinence only approach. That Secondly, it seemed
Speaker 1: like they were so traumatized by their multi decade battle
Speaker 1: with big tobacco that basically driving a stake through the
Speaker 1: heart of big tobacco seemed to be a greater objective
Speaker 1: for them than was adopting a really comprehend of harm
Speaker 1: reduction approach. And now, as you say, they have the
Speaker 1: money to fight this battle, But I mean, is that
Speaker 1: the way the world looks to you as well? Honest? Yes,
Speaker 1: it does actually, and I think I think it's a
Speaker 1: very good assessment of the current situation. It's harder and
Speaker 1: harder for them to maintain the argument about harm reduction
Speaker 1: in the nicotine and smoking area. Evidence is coming in
Speaker 1: all the time that vaping is displacing smoking with the
Speaker 1: net public health benefit. And you know, I'm sure that
Speaker 1: evidence will get stronger and stronger over time. There's no
Speaker 1: real doubt about it. There's multiple strands of evidence that
Speaker 1: confirm that that is the case. So what we've seen
Speaker 1: is the people who oppose these developments, the anti harm
Speaker 1: reduction abstinence only groups have gravitated to two basic sets
Speaker 1: of arguments. One is kids and the vulnerability of kids
Speaker 1: to nicotine, in which I think we've discussed that quite
Speaker 1: a bit, but I think you have to just take
Speaker 1: a much more nuanced view of youth th behaviors to
Speaker 1: work your way through that. And the second, and you
Speaker 1: hear this getting louder and louder, is the tobacco industry. Essentially,
Speaker 1: tobacco industry comes with such terrible reputational baggage they form
Speaker 1: an almost perfect enemy. And it's almost as if you
Speaker 1: can dismiss an entire public health concept like tobacco harm
Speaker 1: reduction just by mentioning the word tobacco industry or suggesting
Speaker 1: that the tobacco industry may benefit from selling the products
Speaker 1: that are harm reduced, low risk alternatives to smoking. That
Speaker 1: almost for some people ends the argument cligant Before COVID
Speaker 1: came along, right, The sort of epidemic before the pandemic
Speaker 1: was the epidemic of vaping, right. It was on the
Speaker 1: headlines and TV shows and magazine covers in the United States,
Speaker 1: And then towards the end of that in mid we
Speaker 1: saw this whole thing about, Oh my god, people are
Speaker 1: landing up in the hospital, right and their lungs are
Speaker 1: getting destroyed. And the CDC, the usider Disease Control labeled
Speaker 1: the disease and E cigarette and vaping E Valley. I
Speaker 1: can't remember what a L stands for, but they labeled
Speaker 1: it that thing. Now, it turned out, of course, that
Speaker 1: virtually the entire thing was not about nicotine vaping. It
Speaker 1: was about illegally produced th HC vape cartridges, which some
Speaker 1: knuckleheads were producing and mixing with vitamin E oil because
Speaker 1: that way they could, you know, basically cut their costs
Speaker 1: and make more profit. And what struck me about it
Speaker 1: was the evidence that this was about tainted, illegal th
Speaker 1: HC vape cartridges and not about the cigarettes seemed incredibly
Speaker 1: apparent from early on. Yet health authorities and political officials
Speaker 1: and even the Center of Disease Control kept obscuring that fact.
Speaker 1: I mean, what was going on there. I think this
Speaker 1: was an information sort of black operation. Basically, you're quite right.
Speaker 1: There was a cause, you know, maybe around three thousand hospitalizations,
Speaker 1: over sixty deaths, very very severe acute respiratory disorders, and
Speaker 1: therefore there was a massive concern about it. But all
Speaker 1: the evidence, and it's not just even some of all
Speaker 1: the evidence is clear. This arise from the addition of
Speaker 1: a cutting agent to th HC vaping oils. Cutting agent
Speaker 1: was vitamin e acetate. It's used to dilute the oil
Speaker 1: for economic reasons, a normal sort of you know, drug
Speaker 1: production kind of economics. It was done in the illicit
Speaker 1: market by you know, the criminals that produce and market
Speaker 1: these products. Had absolutely nothing whatsoever to do with vaping nicotine.
Speaker 1: There's no link at all. You can't add that additive
Speaker 1: to a nicotine vape. It just it's not soluble in
Speaker 1: the liquid, and there is no economic purpose to doing
Speaker 1: it whatsoever. So, having defined the cause, and I agree
Speaker 1: with you, this outbreak kind of came to light in
Speaker 1: probably around June two thousand and nineteen. By August two
Speaker 1: thousand and nine, ten, it was pretty clear what the
Speaker 1: problem was. But I would say that CDC, in particular,
Speaker 1: were maintaining a kind of ambiguity about the cause which
Speaker 1: persists to today. I mean, they've never said, which they
Speaker 1: should definitively, that nicotine vaping liquids were nothing to do
Speaker 1: with this, And it's just not possible that there would
Speaker 1: have been a separate cause in the nicotine vaping supply
Speaker 1: chain that happened in the same geography in the United
Speaker 1: States and exactly the same time mid two thousand and
Speaker 1: nineteen to early two thousand and twenty, with exactly the
Speaker 1: same symptoms, but was caused by something else. Now, there
Speaker 1: was some confusion because some people denied using THC. What
Speaker 1: a surprise. If you admit to using cannabis, you can
Speaker 1: get in trouble with your employer, with the police, with
Speaker 1: your college, with your school, and with your parents. So unsurprisingly,
Speaker 1: some people said no, no, no, no, I was never
Speaker 1: vaping th HC, and therefore that was used to maintain
Speaker 1: the myth that this may have been something to do
Speaker 1: with nicotine vaping. But the fact that it never occurred
Speaker 1: anywhere else, the fact that the cause in the illicit
Speaker 1: th HC vaping supply chain is clear, tells us what
Speaker 1: we need to know, and that incident is over because
Speaker 1: not even criminals want to actually kill their customers. So
Speaker 1: as soon it was clear what was causing it, they
Speaker 1: stopped doing it, stopped using that thickener, the supply chain emptied,
Speaker 1: and the problem tailed out in early two thousand. Hasn't
Speaker 1: really been seen since except the odd thing that's been
Speaker 1: lingering in somebody's cupboard. It just seemed like an opportunity
Speaker 1: for the anti harm reduction folks, right, and they really
Speaker 1: took it right. I mean, it was a myth. They
Speaker 1: propagated and perpetuated, essentially a lie, even though they knew better.
Speaker 1: They promoted misinformation. They did this from the Center for
Speaker 1: Disease Control, and they said, well, if we're not being
Speaker 1: so successful of discouraging them with whatever truth we have
Speaker 1: on our side, let's take advantage of a myth and
Speaker 1: a popular fear and run with that. And I think,
Speaker 1: you know, I haven't seen the latest surveys, client, but
Speaker 1: I think probably in the jority of Americans still believe
Speaker 1: that that long damage, that long problems resulted from nicotine vaping.
Speaker 1: It just hasn't been corrected. No, I think you're right.
Speaker 1: I mean that that has created the perception that these
Speaker 1: products are highly dangerous, and there's been good measurements on
Speaker 1: how risk perception shifted in the United States, and actually
Speaker 1: it flows across the Atlantic of course, so we get
Speaker 1: this in the UK as well. People think these products
Speaker 1: are much more dangerous than they are and that is
Speaker 1: one reason why. And the fact that CDC has never
Speaker 1: definitively sort of crushed that idea, which they could do
Speaker 1: if they wanted to, the fact that they have let
Speaker 1: it roll and let it run tells you that they
Speaker 1: have found it useful as part of their anti vaping campaign.
Speaker 1: The problem is the unintended consequences of making people fear
Speaker 1: vaping is that you get relapse from vaping to smoking,
Speaker 1: and you get fewer smokers willing to switch from smoking
Speaker 1: into vaping. So you know, the idea that that was
Speaker 1: a good thing to do is actually an incredibly a
Speaker 1: responsible thing to do. And then also for the people
Speaker 1: who are used as an illicit th HC vapes, diffusing
Speaker 1: the problem across nicotine vaping, th HC vaping, any kind
Speaker 1: of vaping has not given the sharp public health message
Speaker 1: which should be watched out when you buy an illicit
Speaker 1: th HC vape you know, that message was lost as well,
Speaker 1: so there was a harm associated with not warning vaping
Speaker 1: cannabis users properly about the danger. So the whole thing
Speaker 1: is grossly irresponsible in my opinion, and it's one of
Speaker 1: the reasons why it's effectively pans out as another form
Speaker 1: of defense of the cigarette trade. It gives people the
Speaker 1: reason to say no, no, no, no, I'm going to
Speaker 1: stick with this. And one final point on this ethan
Speaker 1: if if you don't mind, it's also been conflated with
Speaker 1: another lung related thing, which is popcorn lung. So people
Speaker 1: have this big fuzzy idea. You know, normal people don't
Speaker 1: get into the detail or read papers on this, quite reasonably,
Speaker 1: but they've heard about something called popcorn lung being associated
Speaker 1: with vaping, which it isn't. It's associated with one additive
Speaker 1: use sometimes in vaping when you're exposed to massive levels
Speaker 1: of it. But you've heard about popcorn lung, and then
Speaker 1: you hear that there's people dropping dead from vaping because
Speaker 1: of this VALI thing. Put two and two together and go,
Speaker 1: I'm not even going to take that risk. I'll stick
Speaker 1: with the lung disease that I know and like, which
Speaker 1: is cigarettes. Yeah, you know, I guess what it comes
Speaker 1: down to, Clive, is we think about it. There's over
Speaker 1: a billion people still smoking cigarettes or other combustible tobacco
Speaker 1: products around the world. There's thirty five to forty million
Speaker 1: smokers in the US, which is roughly equal to the
Speaker 1: entire population of California, or almost the same as the
Speaker 1: entire population of black people in America. And if all
Speaker 1: of them were to suddenly switch to vaping or using
Speaker 1: these oral products or heated products, it would probably be
Speaker 1: one of the greatest public health advances in human history.
Speaker 1: And it seems that what stands in the way is
Speaker 1: just the same sorts of ignorance and foolishness and self
Speaker 1: interest that drove the war on drugs for many years.
Speaker 1: Would you agree with my formulation that way? I agree
Speaker 1: with you. I think the more you look at this,
Speaker 1: the more it has the feeling of war on drugs mentality.
Speaker 1: We we used to be in a battle against harm.
Speaker 1: I mean, I got into the business because you know,
Speaker 1: it was about cancer, about heart disease, about people living
Speaker 1: in utter misery with emphysema, and so on. My father
Speaker 1: died smoking related disease associated with heart failure. There were
Speaker 1: real public health reasons to be involved. Now, as we're
Speaker 1: beginning to solve that problem with these noncombustible products, we're
Speaker 1: seeing a big shift to a war on drugs mentality,
Speaker 1: which is that we don't think people should use the
Speaker 1: drug nicotine. Now, that's a very different public health proposition,
Speaker 1: and it's not one that I think we should be pursuing.
Speaker 1: I think we should be pursuing reduction of harm, aerial
Speaker 1: disease outcomes, a life expectancy outcomes, and not worrying ourselves
Speaker 1: about nicotine so much. I mean, I'm not recommending nicotine use,
Speaker 1: but people are going to use it in the same
Speaker 1: way that they use alcohol. Not recommending that either, but
Speaker 1: people do like it. People do use it. Question is
Speaker 1: can you keep the harm under control? Yeah, claud you know,
Speaker 1: I think also for me growing up, my basic exposure
Speaker 1: to addiction was seeing my dad's relationship to cigarettes center food,
Speaker 1: and he died of a massive heart attack when he
Speaker 1: was fifty eight as a result. I probably he can't
Speaker 1: prove it, but probably of his packet day cigarette habit
Speaker 1: and his obesity. And I oftentimes have thought in recent
Speaker 1: years that my dad would have been a good candidate
Speaker 1: to have switched to an east cigarette or a heated device,
Speaker 1: and it might have made the difference in his living longer.
Speaker 1: Sounds like your story somewhat similar. I think exactly the
Speaker 1: same about my father. He would have loved the innovation.
Speaker 1: He'd have been an earlier adopter, and had he done
Speaker 1: that early enough in his smoking, rarely have these things
Speaker 1: been availably still be alive too. Now I'm convinced of it. Yeah,
Speaker 1: I mean I looked at a very powerful politician like
Speaker 1: Senator Durbin who said that he hates vaping and the
Speaker 1: cigarettes because his parents died from smoke gay, and I'm thinking,
Speaker 1: why didn't he come down where we are? He's missing
Speaker 1: the point. Yeah, So, Clive, you know I should say
Speaker 1: at the end, it is that you really are one
Speaker 1: of my heroes here. I mean, seeing the extraordinary amount
Speaker 1: of work that you pump out and the ways that
Speaker 1: you're engaging with the World Health Organization, the f d
Speaker 1: A and all folks and covering the literature and reading
Speaker 1: it is basically a one man operation. So I just
Speaker 1: hope you're going to keep doing this and keep doing
Speaker 1: it until this battle is one. Um. You know, I
Speaker 1: think we both know that sometimes these battles can feel quixotic.
Speaker 1: But I'm incredibly grateful for the work you're doing and
Speaker 1: also for taking the time to have this conversation with me,
Speaker 1: So thank you very much. Thank you, Ethan. I wish
Speaker 1: it wasn't necessary, It shouldn't be necessary, but unfortunately is.
Speaker 1: Psychoactive is the production of I Heart Radio and Protozoa
Speaker 1: pic Shirts. It's hosted by me Ethan Naedelman. It's produced
Speaker 1: by Katcha Kumkova and Ben Cabrick. The executive producers are
Speaker 1: Dylan Golden, Ari Handel, Elizabeth Geesus and Darren Aronovski for
Speaker 1: Protozoa Pictures, Alice Williams and Matt Frederick for I Heart
Speaker 1: Radio and me Ethan Nadelman. Our music is by Ari
Speaker 1: Belusian and a special thanks to a Vivit Brio, Sef
Speaker 1: Bianca Grimshaw and Robert Beatty. If you'd like to share
Speaker 1: your own stories, comments, or ideas, please leave us a
Speaker 1: message at eight three three seven seven nine sixty. That's
Speaker 1: one eight three three psycho zero. You can also email
Speaker 1: us as Psychoactive at Protozoa dot com or find me
Speaker 1: on Twitter at Ethan Nadelman. And if you couldn't keep
Speaker 1: track of all this, find the information in the show notes.
Speaker 1: Next week we'll be talking with Larry Krasner. He's the
Speaker 1: District Attorney of philadel Fia and playing a pioneering role
Speaker 1: among the progressive prosecutors who are reshaping the face of
Speaker 1: criminal justice in American cities. You think most people, I
Speaker 1: mean most of the cops and prosecutors and judges in
Speaker 1: Philadelphia would now vote for legalizing marijuana. Are we going
Speaker 1: to count the retired ones. If you count the retired ones,
Speaker 1: I would say no, no, But the current ones probably is.
Speaker 1: I think that there are subgroups, maybe younger officers, probably
Speaker 1: officers of color, who would vote for it. I think
Speaker 1: overall they would vote against it, And to be honest,
Speaker 1: they have a specific financial interest in voting against it
Speaker 1: because they don't simply get paid to arrest people. They
Speaker 1: get overtime, and they get a lot of overtime for
Speaker 1: going to court to testify when they're not on shift.
Speaker 1: I mean, honestly, I think if they could arrest people
Speaker 1: for blue shirts. I'm wearing a blue shirt today, some
Speaker 1: of them would be mercenario up to say, hey, it
Speaker 1: sounds like a good plan. Let's arrest people for blue shirts.
Speaker 1: I want a beach house and they would do it.
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