0:00 - Intro
0:49 - The Belgian Superior Health Council now supports vaping as a safer alternative to smoking
5:37 - FDA seems to have backed away from its decision to take JUUL off the market
8:22 - John Summers shares his thoughts on vaping in the UK today
23:48 - Brent Stafford of Regwatch intervies Brad Rodu
47:09 - Closing remarks
Hello and welcome, this is GFN News on GFN.TV. I’m your host Joanna Junak. In today’s news:
The Belgian Superior Health Council now supports vaping as a safer alternative to smoking. Colin Mendelsohn, founding chairman of the Australian Tobacco Harm Reduction Association, has been watching developments and will tell us more.
In the United States, the FDA seems to have backed away from its decision to take Juul off the market, as Will Godfrey will describe
Consumer advocate John Summers will share his thoughts on vaping in the UK today.
And after the news, Brent Stafford of RegWatch interviews Brad Rodu, Professor of Medicine at the University of Louisville in Kentucky and the winner of this year’s Michael Russell Award.
Belgium’s Superior Health Council has delivered a report which supports vaping as a safer alternative to smoking or as a quit aid which can lead to a significant reduction in health risks. The report also states that vaping is not risk-free and is therefore not recommended for non-smokers, especially the young, recommending that further long-term safety data are needed. Dr Colin Mendelsohn, tobacco treatment clinician, founding chairman of the Australian Tobacco Harm Reduction Association commented on the report on his blog. He shared with us his personal thoughts on why Belgium supports vaping while in Australia, the authorities are against it.
Dr Colin: Yes, look, what's happened recently is that the Belgian superior health council did a review of all the evidence on vaping. It took about two years, it was a comprehensive review, and they came to a very sensible, evidence based and balanced approach to vaping. So they concluded, quite rightly, that vaping is a far safer alternative to smoking as we know it is. They concluded that it's an effective quitting aid, which could especially help a lot of the vulnerable smokers in that disadvantaged group and lead to significant reductions in disease and illness in the country. As you would expect, they were very clear it's not for non-smokers, especially young people, but they recognized also that very few non-smokers were vaping regularly. So that's a really important observation. They did comment that the long term risks are unknown, which is quite reasonable. So it's best to use vaping in the short term from a health point of view unless there's a risk of relapsing back to smoking. And they recommended that conventional cigarettes should be more difficult to access than vaping, which is sensible. And they support the availability of vaping as a consumer product for adult smokers. And they wanted to see more education for smokers because there's so much misinformation worldwide about vaping. So that was considered a high priority. And they recommended a proportionate approach to regulation. So vaping to be regulated at a different level to that of smoking, which is of course a much higher risk product and low excise to encourage people to make that switch. Australian authorities came out recently with a very different analysis of the data. So they looked at the very same evidence and came to a very cautious and restrictive view of vaping. They see vaping as a threat. They see it as something we just aren't ready to accept yet. And their assessment and that's of the National Health and Medical Research Council, which is our peak health body, was mostly focused on the potential risks of vaping. The risks were exaggerated. They attributed a number of risks to vaping which are not valid, things like Ivali and seizures. They attributed vaping as a gateway to smoking, which of course we know it isn't, and they fail to acknowledge the benefits of vaping. They are very selective in the data that they selected. So really their assessment is not based on the scientific evidence. It's based more on a traditional ideological approach and moral concerns about vaping. It's based on an abstinence only approach, a zero nicotine tolerance policy. And there are other issues in the background, things like we have enormous financial benefits from smoking, there are huge taxes available from taxing cigarettes, which obviously are a threat to our treasury. There's a huge mistrust of big tobacco, and that's being used as an argument against vaping. Of course it's not relevant, but it's constantly raised and there's political risk. There are concerns amongst politicians. If they allow vaping, there's more harm to the political side of the issue for them. So basically, they've chosen to be over cautious about vaping for all the wrong reasons. And I think it's a very short sighted and misguided approach which will end up costing Australian lives.
Joanna: We will now return to the situation in the United States, where the FDA on June 23 ordered Juul to pull its products from the market. But there have been developments since. What’s been happening, Will?
Will: Things moved rapidly, Joanna, after the FDA's June 23 marketing denial order to Juul caused shock in the THR community. First, Juul immediately sought and obtained a court-ordered emergency administrative stay, allowing its products to temporarily remain on sale. This seemed like the first step of a major legal battle. But the bigger news came on July 5 with an announcement from the FDA itself. After reviewing Juul's legal filings, the agency said that it, quote, determines that there are scientific issues unique to this application that warrant additional review. And so the FDA is temporarily suspending the marketing denial order while that additional review is carried out. This all feels rather extraordinary, given that the FDA had already taken nearly two years in reviewing Juul's PMTA applications. Just two weeks after ordering Juul off the shelves, the FDA appeared to be backing away from its own decision, at least for now.
Joanna: Where do things go from here?
Will: The implications, as so often during this opaque PMCA process, are unclear. Reporting for Filter, Alex wrote that either the FDA could simply be taking time to bolster its marketing denial order before engaging in a court case, or that it could end up backtracking entirely. We don't know to what extent the FDA and Juul, which I'll mention again, has provided grants to Filter, could be communicating behind closed doors. The outcome, as we speak, is very hard to guess. What we do know, as Helen Redmond wrote for Filter this week, is that enormous damage has already been done. Millions of former smokers use Juul and their access is the bottom line. People may object to Juul’s early marketing campaigns and the ensuing PR damage, whereas others, like Helen feel rather that the company should have pushed back much harder against misinformation and teen epidemic claims instead of, quote, pleading for redemption. But as she wrote, how many more smokers would have made the switch if the war to destroy Juul hadn't been waged? That is the real tragedy.
Joanna: According to Public Health England, recently renamed the Office for Health Improvement and Disparities, vapes are at least 95% safer than smoking and in the UK vaping products are recommended by the National Health Service as an effective way to help people give up smoking. We decided it was time to revisit the situation in the UK and so we asked John Summers, a UK consumer advocate, a few questions Thank you, John, for joining us. Can you tell us what you do and what is your area of interest?
John: Sure. My name is John Summers. I'm a consumer advocate from the UK. I work in IT for a wealth management company and I've worked in It for nearly 30 years. But previous to that my area of study was chemistry. So I have a bit of a scientific geeky background. I'm a dad and a husband, and I do a lot of volunteer work with other health organizations. And I've done work with Public Health England, the National Centre for Smoke Cessation Training and stop smoking Bristol. Not so much from a stop smoking perspective, but from the perspective of helping people get the right information about vaping, electronic cigarettes and other safer nicotine products as well. In some cases working with some really quite heavily entrenched smokers, people that are struggling to quit or switch or whatever they choose to do. My approach was met with some interest by some of the old guard smoking cessation people. There you go. I've never worked in the vape industry, never worked for a tobacco company, et cetera, et cetera. I'm just an interested party. I switched accidentally, if you like vaping used for a couple of years very early on with the really rubbish products, the really early electronic cigarettes, and then after two years I just happened to find a better tank, the right flavoury liquid, and without really realizing it, that they stopped smoking. And that's 13 odd years ago. So, having looked back, haven't smoked since, which has had a massive impact on me and my family. In the year before I switched, I had chest infections and bronchitis about five times in a twelve month period. Since then, I think I've had a chest infection apart from COVID once, which okay, to a lot of people is an anecdote, but to me personally into my family, that's one heck of a difference.
Joanna: So can you tell us what the situation is with vaping in England at the moment? Are there any rules about where or when you can vape, for example?
John: Legally it's allowed everywhere because the vaping is not smoking. However, things are interpreted rather oddly. If you are in a workplace, for instance, nine times out of ten, if you are wanting to use an electronic cigarette, you will be put in the same place as a smoker. Now, that is actually against the guidance of the UK Health and Safety Executive, who caution employers that doing so may actually put them at risk of being sued, because by putting the vapers by order in the same place as a smoker, you're intentionally exposing that person to cigarette smoke, which the stop smoking community claim. Second hand smoke, of course, is just as dangerous to smoking. So if that's true, you can't be pushing all of those people into the same place. And it's kind of the same in a lot of venues in the UK, so pretty much most pubs, shops, clubs, restaurants will treat electronic cigarette use in exactly the same way of smoking. So the common thing you will see is a stop smoking sign that also says no electronic cigarettes, to the point that at one rugby stadium, I was stood a good 20 meters away from the nearest person in a completely open area venue with no signage that actually said you weren't allowed to use an electronic cigarette. The wind was howling past me, not harming anyone, and suddenly I heard a shout, you can't do that here. Pardon? What do you mean? Vaping? Yeah, it's not allowed. Me signs don't say so. The next thing I know, I was being frog marched out of the venue, I was banned, I was thrown out because they insisted that if I wanted to do that, I had to go and stand amongst all the smokers. Now, if I chose to do that, that's fine, but was I going to be told that I had to go and do that? No, because I said, no, I'm not happy to do that, I was thrown out. Now, that is against the Health and Safety Executive guidance, but it seems to be the common take. And it's because there are organizations like Healthy, Stadia, like Fresh, et cetera, in the UK who, despite the guidance from Public Health England, as was, and the National Centre for Smoking Cessation Training, their agenda is different because theirs is about quitting nicotine, about not using anything, which, moralistically, may be a great thing, but it's not scientific. It's based around what we don't like it. We don't want people doing that, we don't agree with it. There are lots of things that people don't agree with. There are lots of things that people don't like. I don't like people shouting at me, for instance, across a stadium. I have PTSD, so somebody doing that to me is actually end up throwing me out of a rugby stadium is incredibly damaging to me. And the attitude, people's attitude, you're just going to have to get on with it. Well, that's the same if I make a choice to do something that's not hurting someone in a public place, if I'd been stood inside a room okay, maybe what other people think may come into consideration. And certainly indoors, in a bar or a restaurant. Yes, the operator of the venue has the final decision. It's their space outdoors. No. I have no more control over whether or not somebody vapes next to me or smokes next to me or swears next to me or smells next to me if you can.
Joanna: If UK research says that vaping is a safer alternative for people who want to quit smoking than other replacement therapies, why do many people still smoke and why do many of them believe that e-cigarettes are still dangerous?
John: People will always do what they want to do. I know me, initially I was quite a geeky scientific type person. So when I saw all this stuff about electronic cigarettes, I went away. I did reading and looked into whether or not this would work. But again, we've got this persistent media communication over egging and over exaggerating and misinterpreting what are quite often not scientific studies. They are press releases about a study that somebody would like to do, trying to attract funding. And actually what's being said when you read into what's behind it is nonsense. That sort of stuff puts people off attitudes of organizations like Healthy Savior, et cetera. If you say to someone, right, you're not allowed to smoke here, but you are allowed to do that straight away, you send some really strong messages to that person, positive messages. It's worth switching. Why? Well, because I can do that thing about having to go outside or leave the venue or whatever. Okay, I can do that thing and still enjoy what it is that I'm wanting to do. I can still be socially involved with my mates, with what's going on. That must mean that it's okay to do this. So quite quickly, just a small change, you have an area in a pub where you're allowed to vape. Not hard. We've got to have is an extract panels and we used to do it in some pubs. You probably wish that they still did. They sometimes smell at it. Right. But straight away you changed that message. I've seen this negative messaging have some really strong impact. A few years ago I was outside a hospital in Gloucester where I live, and Gloucester NHS trust policy is that vaping on the grounds is allowed. You're allowed to vape in the hospital grounds, not in the hospital itself, for fairly obvious reasons, because on most of the water there's oxygen in use and any sort of heating apparatus and oxygen is not a great combination. We'll give them a pass on that one. But patients are allowed to use vapes within areas within the hospital and what have you. Anyway, I was outside this hospital using my electronic cigarette and a lady came out and you could see she was incredibly ill. She was very pale. She had one of the stands with her with IV drips. She had about three IVs on there and she wheeled herself just outside the doorway and started to smoke. And I kind of looked and thought, I'll leave that. And she's coughing and splattering and then she's having another cigarette and just stop chatting. I said, oh, you're popular with them. Oh, yeah, they don't like me doing it. Well, have you thought about switching to something else? And just got into a conversation with her about it. I just got to the point where I had a couple of spare disposable type electronic cigarettes on me was just at the point of, yes, okay, she's going to take she'll take one. And suddenly voice from the side screams, you can't do that here. It looks like smoking. So what if it looks like smoking? It's not smoking. And this person is an incredibly heavy smoker who's already incredibly ill, and you've now destroyed that opportunity for that person to switch, that may result in that person's death, who knows? And it was completely counter to the NHS trust policy. It was completely counter to the signage that was around, but it was their opinion and their opinion was being fed by media and by organizations like the BMA who still have this. We don't really want to recommend it, we're going to allow our members to. The BMA is a union, it's not a medical authority, it's a union, same as the Royal College of Nurses. It's not a regulatory body, it's not got responsibility for those things. But they're still doing this push for whatever reason. We can theorize as to what they may be or just flat out ignorance and puritanism, but that attitude really diverts people away from potentially switching to whatever safer product that is. People do the same thing with snuffs. It's like chewing tobacco used to be. Well, actually, no, it's not. Nicotine pouches, it's just another way to get kids up. No, it's not. They don't like them vaping. If people have disposable vapes and they chuck them down on the ground instead of putting disposing of them properly, yeah, kids probably are going to get hold of them. They shouldn't, but, hey, what's the alternative? They smoke. I'll go with that one. Rather than smoking. It might not be politically correct, but from a health perspective, they're going to have a much better outcome.
Joanna: Thank you John for sharing your insights. We’ll come back to you again in a future episode with some more questions. And now, we go over to Brent Stafford and his guest, Brad Rodu. Brad is a professor of medicine and holds an endowed chair in tobacco harm reduction research at the University of Louisville. At the Global Forum on Nicotine in Warsaw last month, Brad was the recipient of the 2022 Michael Russell Award. The Award is given to individuals who have made substantial and innovative contributions to the science and understanding of safer nicotine products and tobacco harm reduction. Thanks to his personal and professional dedication to the field over many decades and despite many challenges, Brad is a very worthy recipient. In today’s interview, Brad shares his views about people’s attitude to smoking, vaping and nicotine. Over to you, Brent.
Brent: Hi, I'm Brent Stafford, and welcome to another edition of RegWatch FM, DCTV. We're here in Warsaw, Poland for the Global Forum on Nicotine, GFN 22. And joining us in person is Dr Brad Brody. Brad, thanks for coming back on the show.
Brad Rodu: It's great to be back with you.
Brent: So tell us, for viewers who don't know where you're from and what you do, fill us in.
Brad Rodu: Well, I'm a professor of medicine at the University of Louisville in Kentucky. I also hold an endowed chair in tobacco harm reduction research at the cancer centre there. I've been conducting tobacco research and advocating for safer cigarette substitutes since 1994. That's 28 years.
Brent: How much of that time have you been on the outside?
Brad Rodu: Oh, for quite a bit of it. It's been a struggle to get this information across to smokers so that they can make choices that will impact their lives and their health.
Brent: So what was it then, I guess, was it from your medical experience that you witnessed some of the ravaging that smoking does on the body?
Brad Rodu: That's right. I'm an oral pathologist and I worked in a cancer centre treating and making diagnoses under the microscope and clinically of many, many kinds of cancers and immunosuppressed cancer patients undergoing therapy. I saw lots of cancers at that and many of them in smokers. And at that point, the two minute warning is over and folks are looking at death. And so that's what drove me to find a way to help smokers quit that didn't involve completely abstaining from all nicotine and tobacco products.
Brent: Now, does quitting smoking actually prevent the cancer or is there too late at some point?
Brad Rodu: Well, obviously, the more you smoke, the higher the risk and the more chance that you're going to have a deadly disease. But to be honest with you, you can quit almost any time before you're 40 years of age and avoid almost all of the risks. That's not widely known, but that's what the data that's what the statistics say. And so the sooner you quit, the better. But quitting at any almost any age, and we've demonstrated this in research reports, quitting in almost any age does improve your chances as opposed to continuing to smoke at that age.
Brent: So say you're a 30, 35 year old male who've been smoking for 15 to 20 years. You quit through nicotine vaping. Would you enjoy the same benefits as if you would just quit smoking altogether?
Brad Rodu: Well, of course we don't have long term epidemiologic studies of vaping, but from everything we know about the chemistry, about what's in the vape, we're pretty sure that the benefits are going to be lifelong and long term with respect to the risk of picking up a smoking related disease. We know that from studies of Swedish snus and American smokeless tobacco products that contain lots of nicotine but no smoke. We know that's a benefit to people who switch.
Brent: So we're here at the Global Forum on Nicotine. And of course, this is its ninth year, I believe is the ninth edition. So that's a lot of time spent on a conference and efforts focused around nicotine. Why such the effort around nicotine? Do people not understand nicotine and what it is?
Brad Rodu: Well, before I get to that question, you know, nine years, especially for American audiences, that's 3.6 million dead smokers. That's why we're here. And that's occurring all over the world. And that's why we need a worldwide effort to move smokers that can't quit or won't quit to safer products.
Brent: So what is it about this issue then, that has so many people up in arms? It certainly appears the FDA doesn't share that view and W.H.O. doesn't share that view.
Brad Rodu: Well, and as you said about nicotine, that's one of the problems. The overwhelming opinion by smokers non-smokers and including a lot of health professionals is that nicotine is not only addictive, which it is, nicotine is the cause of many of the illnesses that smokers have high risks for. That is what's false, and that is what's frustrating, that FDA, which is the regulator of nicotine and tobacco, hasn't tried to correct that misinformation, especially with American smokers.
Brent: So as nicotine safe.
Brad Rodu: I think nicotine is about as safe as another widely consumed addictive drug called caffeine. It's available in coffee. There are lots of people addicted to it, but long term consumption of caffeine results in virtually no serious health effects. That's what we know about nicotine. It's not the same drug. It doesn't affect the brain in the same way. But we think that the lack of serious health effects is almost equivalent to those of caffeine. And I've been saying this with no one pushing back since 1994.
Brent: So if you're an adult of majority age and you're not a smoker and you for some reason decided that you wanted to pick up a mild nicotine habit, is there anything wrong with that?
Brad Rodu: I don't see any major problem with people who find benefit from using nicotine in a smoke free distribution system. I don't see a major impact with that, not with all the other health concerns that health professionals worry about with respect to our patients.
Brent: You know, we hear all the time and it's growing. Actually, the voices on this is that nicotine harms developing brains.
Brad Rodu: Yes, we hear that. And my response has been that there's actually outside of some animal models where they overload developing mice with big doses of nicotine. Outside of that, there is virtually no human evidence that nicotine has affected brain development. And let me give you an example. We have 30 million adult smokers in the United States. We have somewhere about double that, 60 to 70 million former smokers. It has never been shown anything clinically that those that those current or former smokers are different in any way from their non-smoking, lifelong non-smoking counterparts. There's no evidence for it at all. So how can they say the nicotine is affected, their brain development? We have lots of ways to scan brains now, but no one's ever demonstrated any defect.
Brent: So how then can CDC, which does make this claim and it's made by many government organizations that are involved in tobacco control that nicotine harms developing brains. I mean, there's research I've just even seen recently in the last month coming out trying to establish some kind of cause and effect on this when. Common sense. It shows that it can't be the case.
Brad Rodu: Well, I mentioned mouse models. There are also they also try to produce these effects in cells that are grown in laboratory conditions. And I can tell you, I've participated in some molecular biology research. You can take cells growing in a plate. You can torture them and make them do just about anything you want them to do. You can get anything, any impact you want, but when you do that in normal doses to the human, to the entire human, you don't get those same cellular effects. And so I think all of that research is blown out of proportion for two reasons. Number one is to establish that nicotine is a demon drug. And number two, it's to get more and more funding. You have to make your research as relevant as you can so that you can get funded for the next grant and keep rolling in that in that funding stream.
Brad Rodu: there's no credible evidence that nicotine causes cancer. Again, a lot of those studies are taking nicotine and isolating it in cells and trying to produce effects at the gene level or other effects that then they claim is relevant to the cancer development in humans. Take Swedish men. They're probably the highest prevalence of smokeless tobacco use, what we call snooze in the entire developed world. And they've been able to find virtually no impact on cancer incidence or cancer mortality among those men who use snus for a lifetime. So impacts in cells don't translate into impacts in humans. And that's what I believe we should be focused on.
Brent: Let's take a moment to discuss this conference, Jeff. Why is it important to have an event like this?
Brad Rodu: Well, GFN is exciting because it's not just academics or professionals in tobacco control talking to each other. It's a lot of folks interested in tobacco harm reduction or safer substitutes, but they come from all directions. There are professionals here, but there are also consumers. Consumers need to play a role. The usual statement. Nothing, nothing for us or without us. That's very important. And I'm always excited to appear and to discuss these issues with the consumers that are being affected, because that's, again, how I was brought into the issue. I was dealing with the patients, but it's too late. These consumers are have used these products just in time.
Brent: Now, you were recognized last night with Dr Mike Russell Award for your work in tobacco control. What does that mean to win that award?
Brad Rodu: Well, it was overwhelming. I've spent 28 years in this field, and as I indicated earlier, I came into the field as a pathologist who had had experience with the with the end results of a smoking career in comparison to a lot in a lot of folks in tobacco control who are specialists with addiction, medicine, psychiatry, psychology, public health. They have a different focus that and it's a great focus, but they haven't seen as much of the end results as I have. So I always considered myself a little bit separate and never part of the usual groups of folks who try to promote tobacco harm reduction. But this award last night, based on the grandfather of this concept, the visionary who saw this years before anyone else, he's a visionary that when I first published my first paper and I was tobacco naive, publishing this paper I referenced in my articles because I knew who had the best research. And he did. And so I worshipped him like everybody else here did. And to be to have an award with my name in any way in the same universe as Michael Russell's name is just unbelievable.
Brent: One of the things the attendees here at GSN are struggling with is how to figure out a way to somehow bridge the divide within public health on this issue. Is there a divide and what to do about.
Brad Rodu: There is a divide, but the divide is very still very lopsided. I mean, when I came into the field, I couldn't find collaborators or others that had the same the same interests in safer products. Now, there is a small contingent of folks in many countries who are definitely interested in helping smokers switch. That's why this event is so important, because it brings together people and allows us to share ideas and plot where to go next. But it's still a very lopsided when you say public health, I would have to say that the dominant of the dominant numbers in public health are still very much against this. And that means all of the major medical societies, all in the US and Canada, all of the major governmental agencies. It's still a very, very lopsided affair.
Brad Rodu: I think one of the major goals in the United States and adopted, it seems more and more in Canada is this idea of a tobacco free society. And the way the government funds that vision is it uses a fairly substantial budget at NIH, the National Institutes of Health, to fund academic researchers throughout the country. And mainly their goal is to find bad effects of any form of tobacco use. And right now the emphasis is on e-cigarettes and vaping. Now that's being supplemented by a transfer of somewhere around 2 to $300 million in tobacco user fees from FDA over to NIH to feed that pipeline. Now, when those researchers are funded for those effects, and it doesn't matter whether they had an original interest in tobacco or not, they take their research program and they adapt it to the tobacco resources and they get grants. And then the most prominent effect of those grants, the most prominent results are negatives against any tobacco use. And so that tends to that tends to promote more and more outrageous findings, number one, to reach the media and number two, to reach your next grant. And those outrageous findings even at times border on the fraudulent. And that's an area that we've had some activity.
Brent: What do you mean, fraudulent?
Brad Rodu: Well, I mean false results. Results that are simply not true.
Brent: From government funded research.
Brad Rodu: Absolutely. And it's pervasive. And so if a person like me at a university wants to get other colleagues to participate in tobacco harm reduction research project of some sort, other investigators, most of whom are NIH funded, never want to risk alienating the funding agency no matter what their research is, because they know what the NIH intentions are for tobacco. So it's a big problem and it affects nearly all university research.
Brent: So is that then an inherent bias? The government seeks to pay for research that will support a preconceived position on this issue?
Brad Rodu: think largely that's the case. Government funding supports negatives for tobacco research and has never been interested in a battle. Balanced approach toward these harm reduction products. Let me give you an example. In 1994, I published my first article basically suggesting that smokeless tobacco was less dangerous, less hazardous than cigarettes, and should be considered by smokers who are unable to quit. The National Cancer Institute, which is the largest of the NIH agencies, communicated to my university that this idea was unethical, that no one should be talking about this. And they indicated that I was unethical to be on the faculty. They challenged my faculty position in my university and challenged the university that this idea was not to be tolerated. And I don't think that mindset has changed in any way in the last 28 years. It drives everything at universities. And so it makes it very difficult for anybody who's who is balking at the main theme to get anywhere.
Brent: What is your advice? I think for people attending this conference and those watching it online in terms of how to move forward, to secure these kind of rights, for consumers to have access to these tobacco harm reduction products?
Brad Rodu: Well, one thing we have to be vigilant is when a study is published, don't. Just read the headline because the headline is generated by the researcher whose NIH funded is transferred to the university. Their media relations department always wants to get maximum exposure, and then the anti-tobacco crusaders always want to use that to drive down tobacco products. Don't pay attention to the headlines. The second thing that I'm trying to share with participants here is that we need some sort of post-publication review that's systematic. And I'm not just talking about reading the paper and trying to find minor issues. I'm talking about taking their data, the data they use, and conducting a new analysis that checks it. Because when we did that with several studies, now we've come up with major, major problems and we've have published letters to editors at journals. And the Journal editors are very reluctant to change their decisions based on a challenge after publication. But we have a couple in in process right now. As you know, we took care of an especially egregious study claiming that vaping causes heart attacks, which was completely invalid, completely fraudulent, because heart attacks that occurred ten years before those participants picked up an e-cigarette. So that's the kind of review, that's the kind of work that has to be done to keep this anti vaping crusade in check.
Joanna: Thank you Brent and Brad for an interesting discussion. That’s all for today. Thanks for watching and see you next time, for more tobacco harm reduction updates and Brent’s forthcoming interview with Marewa Glover who has worked on reducing smoking-related harm for over 25 years. Thank you and goodbye