Safer nicotine products are increasingly popular for assisting those quitting smoking. Evidence continues to support the game-changing effect this can have on individual and community health. Some questions emerge from this. What should be the role of public health in this? Why do some public health professionals continue to ignore or dismiss the emerging evidence? Does ideology cloud judgements? Should personal choice and freedom be a priority? What legitimate role is there for regulation in this area?
Transcription:
Panel #2 – Dealing with the health, wellbeing and ethical impacts of prohibition
2026-06-04 · 16:00-17:30 (Europe/Warsaw) · Global Forum on Nicotine 2026
Martin Cawley 0:00:03
Good afternoon, ladies and gentlemen. Welcome to the last session of today. There are still some people mingling around outside, but I think it best to kick off. Some people still might join us and that's okay. My name is Martin Cawley. I am an independent management consultant from Glasgow in Scotland. I have had a long career in the health and social care sector in Scotland.
working with people with drug and alcohol issues, working with people with mental health problems, people involved in the criminal justice system. I'm also an ex-smoker. I started smoking when I was 14 years of age and stopped when I was 48 years of age, which is about 16 years ago, 15 years ago roughly.
Personally, I used a vaping product, an e-cigarette, the early days of e-cigarettes to help me stop, and it was very successful. So I don't have skin in the game on this subject per se in my day job, but I do have a personal interest, as I say, as a consumer. We have a very experienced and esteemed panel with us today.
I'll introduce them in a moment, but this session will follow the same format as every other one. So what we'll do is we'll ask each of the panelists to just give a few insights, observations, thoughts, and share that with you. And then once we've finished that, we'll just start a conversation, really. A lot will depend on you.
What you get out of this session will pretty much depend on what you put into it. So I'll try and stimulate some conversation with you. And please prepare your thoughts. If you've got any questions that you'd like to ask, if there's anything. We'll make sure we've got plenty of time to do that. We've got an hour and a half pencilled in for this.
Whether it takes us that long, I'm not sure. It doesn't have to, so if it feels as though it's dragging up a wee bit and we finish early, then so be it. This session is called Dealing with the Health, Wellbeing and Ethical Impacts of Prohibition. But we'll look to dig a bit deeper on that, having had a chat with colleagues earlier on, so...
Each of the panelists will come from their own perspective, and that will help us explore that subject in a bit more depth, hopefully. And you will have your own take on that as well, so hopefully your contributions can help us along the way too. The panel, as we run from my right, is Dr. Joe Kosterich from Australia.
Joe is a doctor, a speaker, an author, and extensive experience and background in advising industry, business, government, policy makers, and a whole range of health subjects, including harm reduction. Next to Joe, we have Mark Tyndall. Many of you will know Mark from Canada. Mark has over 30 years experience of clinical research. He's internationally recognised.
He was here last year featuring his book and I saw him autographing a copy for someone earlier today. So I'm sure there's still some available, Mark, if you're looking to move some on. And to my left, we've got Jaggi Sarangapani from India. Jaggi is an independent tobacco harm reduction specialist. He's been a really strong advocate and champion for safer nicotine products.
So welcome, Jaggi. And last but not least, to my far left, is Lynn Dawkins. And again, many of you will know Lynn and her work. A real... experienced tobacco harm reductionist consultant. I think you've had over 80 articles published, Lynn, so you're probably a well-Kent face. Kent, there's a Scottish word that people won't know. A well-recognised face in this field.
One thing I actually usually say at the beginning is that from Glasgow and from Scotland, you'll have experienced by now I have a very broad accent. So I'll try hard to slow down. I find myself getting a bit excited at times and I get carried away and start talking faster.
So I'll try and slow down, take a moment and pause so that we help understand each other a wee bit better. Just to kick us off, what's the big deal here? Smoking's bad for you. It causes untold amount of health problems. Alternative nicotine projects are immeasurably safer, yet we have a situation where that's a real difficult argument to convince some stakeholders of.
So how can we make that a bit more simplistic? How can we not just build that evidence base, there's a strong evidence base there, but how can we use that evidence base to best effect to tackle these health, well-being, social, ethical impacts that sit behind us? And that's sort of the subject matter that we'd like to explore.
I'm going to ask Mark, I'm going to ask you to kick us off, Mark. I think last year you gave us a presentation, I think you touched on the theme of public engagement. You touched on the theme of stakeholder engagement and positive stakeholder engagement.
Whether that solves something that's at the forefront of your thoughts, I'm not quite sure, but why don't you share a few observations with the audience on what you're thinking about now?
Mark Tyndall 0:05:24
Okay. Thanks, Martin. I didn't understand a word you said, so I'll... So, it's great to be here. We've heard a lot about prohibition the last two days, and I just came from the prohibition, the illicit market session, I'm kind of exhausted and scared after that. So people are going to get their heads cut off and things like that. So there's a very scary part to prohibition.
And I've been dealing with the aftermath of the war on drugs for my whole career, basically.
It's got such wide-ranging implications right from the individual who's targeted as a criminal and their lives can be ruined because of prohibition, certainly from a community aspect where we've allowed a big criminal element to be there and a lot of our law enforcement and our criminal justice system is full of non-violent drug offenders and then the session that we just heard of the you know the massive global implications of this kind of prohibition that's really had massive negative effects on whole countries.
And we heard from Mexico and Colombia, Afghanistan, and countries that have been totally ripped apart because of the way we've approached prohibition. But I just wanted to, I think I just want to touch a little bit on the, again, even a broader take on this.
And when I, Martin referred to the book that I had, and this is unabashed promotion, I have some copies if people are interested, but When I tell people that I wrote a book about vaping, they kind of look at me as though I used to be a serious person dealing with real drugs, and now why would I be interested in vaping? People haven't really thought deeply about this.
The problems with tobacco have been around for so long that in the medical and even the broader community, it's not really high on people's list of priorities. That's why the message from large public health organisations and the WHO are so important. When I'm trying to explain to people that in my book, I'm not talking...
Anytime I tell people I wrote a book about vaping, they're, oh, that's really bad, isn't it? Or somebody has to do something about this vaping thing. It's always negative, and people are very surprised. No, no, it's really a harm reduction, but I'm trying to promote vaping as a way to get people off cigarettes. It's very surprising to people.
But what my observation has been, most people, it's not top of their list, even if you're in public health or politics. And when there's messages about prohibition from the WHO, from major NGOs, from political leaders, people just assume right away it must be a dangerous thing.
It really casts a whole shadow over what we're trying to do because why would a WHO want this ban if it wasn't dangerous, if it wasn't problematic? And so it really casts this massive shadow over what the legitimacy of this and how important this is to public health. And we put in sort of mini prohibition restrictions.
And I know in Canada, the retail front of the vape shop looks like it's seriously dangerous. Like we've given this image that these products need to be heavily restricted. The image to the public is that they must be dangerous, and it really makes our job difficult to position these as a really important public health breakthrough that we need to spread quickly.
So I think the black cloud of prohibition really makes our job very difficult trying to promote this.
Martin Cawley 0:09:51
Thank you, Mark. That narrative, it's a very negative, clouded, I think the word that Mark used, narrative. I mean, given the work that you're doing, how do you shift the balance, therefore, in a public health context, really?
Lynne Dawkins 0:10:09
Hello, is this, yeah. You asked me the how question. I'm gonna address the why question, okay? That's a bit easier. So I'm gonna focus on why do regulators, public health bodies, and professionals take this prohibitionist stance, starting with a quote from C.S. Lewis.
And it goes like this, of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. And then he goes on to explain that the robber's cruelty may sometimes sleep, his needs may be satiated.
But those who torment us for our own good do so without end and with the approval of their own conscience. So I think that kind of goes quite a long way to understanding a prohibitionist stance. It's this notion that, you know, we are doing what is best for people, what is best for society. And the problem there is, well, who decides what's best?
And on what evidence basis is that decision made? And what if public health were wrong? Which, of course, we know they are in many countries. And we've seen the misperceptions held by GPs and other health professionals and so on. And of course, we're all wrong on occasions, probably a lot more than we even realise.
But what's important is that we can update our opinions and beliefs based on emerging evidence and information. That's particularly important if you're in a position of authority and you're providing medical advice, of course. But it's hard for anyone to say, I was wrong, I've changed my mind.
It's even harder perhaps for regulators who are not working in an agile environment and for public health professionals to change their mind without feeling like they're losing credibility. I want to give an example here. So my daughter's friend is a third year medical student. And my daughter asked her recently, what have you been taught about vapes?
And she said, oh, we don't recommend those. They're just as bad as smoking. So my daughter obviously knows a lot about this topic. And she said, well, you know, actually, they contain far fewer toxins. There is solid evidence that they help people to stop smoking. But my daughter's friend just dismissed that. So it made me think, well, why is she just missing this evidence?
And I think it comes down to this idea of we know best. This is what my lectures have taught me. My colleagues are GPs. They know what they're talking about. Maybe, maybe if she's not too busy, she might go and research this, look it up. What's she likely to find? If she AIs it or Googles it, she might land on the Royal College of Physicians report.
If she's in the US, she's probably not likely to find correct information from the medical associations. So why do some public health professionals continue to ignore or dismiss the emerging evidence? So I think I've kind of alluded to this with the example of my daughter's friend. Health professionals are busy. They don't have time to look at the research.
Maybe they don't have the inclination, this idea, well, I already know. Perhaps they do have the time, but not the scientific literacy to weed out the well-conducted studies from the other poorly designed studies and dubious findings and interpretations. I think there's also a fixation on the medical model.
So this idea, it was asserted earlier, we have medically approved products for quitting smoking. People should use those. Those are what are recommended. And we've also seen the idea of first do no harm. So if we're really not completely sure, then we don't recommend it. And that's just simplistic thinking without considering the nuance.
And by doing no harm, you are doing harm. I think there's probably a moral objection to nicotine as well, the idea of the harms of addiction and people shouldn't be using nicotine. Final point, I think I said this about, or at least I thought it about 10 years or so ago.
From a regulator's perspective, it's just easier to treat reduced risk nicotine products in the same way as smoking. Nobody's putting their neck on the line by doing nothing. The death and the disease caused by smoking, well, that's the tobacco industry's fault. That's not public health's fault. Nobody in public health is gonna get fired for not doing something about smoking.
But if they support reduced risk products and put their neck on the line, and God forbid something awful does happen, who would want to risk that? So it's kind of understandable in a way. I think public health bodies, public health professionals, for the most part, sincerely do intend to do good.
And to quote my husband, this is an old proverb, the path to hell is paved with good intentions. But good intentions are not enough. And it's incumbent on public health bodies and professionals to be accurately informed so they can pass on that knowledge. Yep.
Martin Cawley 0:15:43
Thank you, Lynn. You just reminded me of a quote that my gran used to say, my grandmother used to say, that life is better understood backwards, but it's just a pity you've got to live it forward, really. So within that context, Yagi, what do you think, to what extent should consumer choice, individual choice and autonomy be prioritised when regulating nicotine products?
Jagannath Sarangapani 0:16:09
Well... I would sidestep a bit to get another perspective. You see, in India, we have a very different interesting dimension here. Much of the global conversation on nicotine policy and so on is centered around cigarettes and about vaping. But India's tobacco challenge is very, very different. The majority of tobacco users in India don't smoke cigarettes.
It's just 10% of 250 million tobacco users who actually smoke cigarettes. Most of them consume smokeless tobacco. and BDs as an alternative to smoking, which are really cheap. Now, smoking is mostly an urban issue. And just 30% of India's population actually live in urban cities.
So when we look at this, the highest incidence of oral cancer, for example, are coming from smokeless tobacco and chewed tobacco like gutkha, kaini and so on. So the question that comes up to me is, are we focusing our policy attention on the biggest drivers of the disease burden in a context like India, or are we sometimes focusing on the more visible products?
that appear, and that's one of the reasons why we ended up with a ban on vaping, which is actually a very, very small problem, in Indian context at least. So that's a question that I think we need to look at. In India, in 2019, we banned e-cigarettes. Now that's very interesting as a case study. Did the demand disappear? Did the use disappear?
Did the health outcomes actually improve, or did it just shift to something else, to an informal oversight? I don't have all the answers to this, but I think we need to be serious about evidence-based public health if we have to really progress this one, and I think that's what we have this debate about, and that's where we should be looking at as well.
Martin Cawley 0:18:30
Thank you, Shaggy, thank you. Joe, we heard yesterday from Fiona a lot about what's going on in Australia at the moment. Perhaps you'd want to enlighten us a bit further and contribute towards this notion of the ethics behind that?
Joe Kosterich 0:18:44
Yeah. Look, firstly, thank you, Martin, and thank you to the organisers for inviting me to come and talk at this GFN. That quote from C.S. Lewis is absolutely brilliant. There's another quote that I think is apt from Upton Sinclair. It's very difficult to get a man to understand something when his salary depends upon him not understanding it.
And there is a massive, massive, massive gravy train out there of people in inverted commas, tobacco control. And they're making squillions and they're getting flown at the front of the plane to conferences and you know, living the high life on the taxpayer dime.
So, of course, they don't want to understand the evidence that says really what they're banging on about isn't useful. But also, history does show, or perhaps to quote, I think, Mark Twain, I could be wrong, history doesn't repeat, but it rhymes. So we're sitting here in this room in 2026, cast our minds back 100 years. We were sitting here in 1926.
We were seeing the effects of prohibition of alcohol in the United States. It didn't stop people wanting to drink, it didn't stop them wanting to access alcohol. What it did do was create a massive opportunity for the Mafia and it basically got them started.
You only really have to watch movies like The Godfather, it was one of my favourite movies of all time, and some of the documentaries to show that it was an abject failure. And that is what we're going through again. So unfortunately there's a reluctance to learn from history. But look, Australia is a lovely place to live. I really do like living there.
But if you want an abject textbook example of how to get it completely wrong, completely wrong, and I say that based on the outcome.
And I think there's a quote, I'm running into my quotes today, from Milton Friedman that, and this may not be absolutely verbatim, but it's one thing to have good policies with good intentions, but every so often you actually have to check the results and the outcome. An Australian policy has resulted in an increase in nicotine use.
There's data out literally in the last 48 hours. from the Australian Bureau of Statistics showing that nicotine use, and this is based on wastewater testing, is up 30% to 40% since about 2016-17. Revenue from tobacco excise, which is now one of the highest in the world. The per stick price of a cigarette in Australia is the highest in the world.
But yet excise, as raised by the federal government, is now down $10 billion annually from what it was some years ago and declining. And the budget, which is a disaster, which came out last month, is projecting further declines. So in about 2019-20... The federal government raised about 15, 16 billion dollars from tobacco excise.
The excise amount has been going up year on year, and this year it'll raise something between four and five billion. And that's in the face of increased smoking rates. And so that's the two arms to number one. We have more people smoking. We have less government revenue.
And the third arm is we now have massive organised crime in Australia, and this has included firebombings of tobacconists and convenience stores. There have been deaths as a consequence of this. Businesses that, for their misfortune, happen to be next door to some of these shops now can't get insurance.
And all the while, the government is saying, what a fantastic job that they're doing, and the ivory tower clowns who call themselves big public health, just put their fingers in their ears and go, la, la, la, la, la, la, la. So at some point, and I think it will come, I don't know when sooner is better, at some point, the pressure to say what we are doing is not working.
And abjectly, by any objective measure, by any objective measure is a total fail. At some point, pressure will rise. And the data this week has probably just made the beginnings of that.
Martin Cawley 0:22:41
If we accept the position that it's not a binary, it's not a ban or a law situation, right? This is a question for the four of you, actually. What would a proportionate regulatory framework look like, or what should it look like? Is that too nuanced, is that overly, is that too simplistic? Mark, anything you'd like to contribute?
Mark Tyndall 0:23:06
Well, I think if we just discovered vaping yesterday, I think we would approach it as a vaccine for cigarettes. And we do a mass vaccination programme for all smokers and get them all off cigarettes in six months. So unfortunately, that's not the way it happened.
Clearly, we can see with regular cigarettes in Canada how we've also got to a tipping point where we're pushing most consumers or 50, 60% of consumers into the illegal cigarette market now because we've overdone it with our taxation and the regulations of the way we've regulated the vaping products and the pouches and the heated tobacco have all been kind of mini prohibition and we're making it more and more difficult so we've really got it wrong too I think you know Australia did it on steroids but Canada's you know coming up pretty quickly from behind and trying to do the same sort of thing it's fascinating the The focus is still on primary prevention and kids.
And really, if people are honest, in the tobacco control world in Canada, we've decided that we're in for the long haul. We'll have a death march for the 3.5 million Canadians who will eventually die. And if we can just stop new people from getting their hands on nicotine, then we'll be fine. 30 years from now, and any public health strategy that includes sacrificing 3.
5 million humans is probably not a very good strategy, but that's basically what we're trying to do.
Martin Cawley 0:25:12
Can I move on to shifting the narrative then that might build a more accepting regulatory, a proportionate regulatory framework, but we'll come to that in a minute.
Lynne Dawkins 0:25:22
Lynn, do you want to come in? Sure. Proportionate or appropriate regulation, that was the question. You choose. Same thing. I think we need regulation, but light touch. You know, we don't need to restrict flavours. We don't need to restrict nicotine levels. Maybe avoiding putting bright, colorful vapes right there next to the suites, things like that.
But I think just some light touch regulation, lower taxes and the more harmful products. I think the Royal College of Physicians quote in 2016 pretty much got it right. Anything that makes a reduced risk product less palatable, less attractive, less accessible, less pharmacologically reinforcing does more harm.
Martin Cawley 0:26:16
Jaggi, do you want to come in?
Jagannath Sarangapani 0:26:20
Yeah. When it comes to this question, of course, we need proportionate regulation. You've got to understand that if you have promulgated a ban, the outcomes of the ban you need to look at and understand. You need to see if your number of users have actually gone up. In India's case, we have definitely had an explosion of the number of users of vapes ever since the ban.
Regulation would mean that you need to go back to the drawing board and look at the outcomes of your ban, whether it was just a knee-jerk reaction or whether it was evidence-based, and you got to re-look at it. Scientific evidence is coming, and you got to be able to pick and choose. You do have a variety of of papers that get published.
Some of them are dubious, like we are all aware of. But when the government throws a line that says that let's cherry pick evidences and then present them as irrefutable evidence, that's where we have a problem. So one needs to have open debates. And one needs to be willing to look at it to be able to then work with regulation.
Of course we do need it, but adults can make their choices. We need to be in a position to guide them. That's about it. Allow adults to make their choices.
Martin Cawley 0:27:49
It's an interesting question if you think about what metrics should be used to measure whether the intended outcomes of restrictive policies are working or not. You know, it's kind of shifting the question around the other way, and I'm interested in maybe, Joe, hearing your thoughts on what those measures might be.
Joe Kosterich 0:28:09
One other point I should have added at the end last time is from the Bureau of Statistics that 80-8-0...
percent of the nicotine market in Australia is now illicit so yeah look Australia is also an interesting example because right next door to us is New Zealand and there's we're sort of like brothers but there's obviously a rivalry they beat us at rugby union we beat them at cricket but they have completely got it right where Australia's got completely got it wrong in terms of vaping We spent a little bit of time in New Zealand and you go there and it is no more difficult to access vapes and heat not burn products than it is to access cigarettes.
And their smoking rates are falling. So in terms of regulation, you make it no harder to access the less harmful product. And most people, not everybody, but most people... will then access the less harmful product. It is no more difficult to obtain. They don't need a prescription in New Zealand. They don't need to go to the chemist.
They can just go to the convenience store or the petrol station. And yes, there are some specialty shops. So you combine that with proportionate taxation. So I wouldn't say that There isn't some excise on vape products, but it's proportionate to risk. And the IMF put out some data early in the year looking at relative risk from e-cigarettes right the way through to cigarettes.
And you also put proportionate taxation on actual cigarettes. which can reduce black market demand. But if you affect demand by giving people an alternative that is easier to access, in turn, by reducing demand, that makes it less attractive to the criminal gangs. Again, it's never going to be completely eliminated.
If people say, well, get rid of the black market completely, no, we won't get rid of it completely, but we can certainly reduce it. So, yeah, proportionate taxation, equal or as easy access to less harmful products, And at that point, you can have effective and strategic law enforcement of what's left because it won't be completely out of control.
Martin Cawley 0:30:12
Given the increase in the black market, Mark, given the increase in organised crime in areas where prohibition is in place, is it too late is the question?
Mark Tyndall 0:30:24
Well, that's a question that's been rising to the surface of my mind the last 24 hours that we listen to people because I'm afraid if we could wave a wand and have reduced regulations and access to every kind of product that we want, the price is still gonna be higher, because there's gonna be taxation, and we're now competing with the legal market.
So we, you know, if we're trying to promote this, we're pushing against our public health colleagues who are putting up barriers and the restrictions and also now we also have to deal with a legal market that's quite well established and they're going to be fairly reluctant to give that away it's going to have to be consumer driven so we're going to have to have high quality products available at a reasonable price and people will pay a little bit more for a quality product everybody wants a a nice can of zin that's real.
And most people will make that decision, but within reason. And so we have to be careful, even if we get our way with reducing some of the restrictions and regulations, that we have to be mindful of what the illegal market can offer. and be competitive. And I think most people will make the right decisions.
And as far as legalization, you know, the regulations, I think we really need to be careful to always have as little as possible. I think the success that Iceland had was really consumer driven and they just didn't classify nicotine products the same as tobacco and the public did their thing and they switched.
So with very little input, as opposed to many public health interventions, which often require a massive government subsidy to make this happen if you wanted to do vaccination programmes or other harm reduction things usually require governments to put in money. But right now, this can all be driven by the private sector.
There's industry there that's interested in producing these things and selling these things. And people armed with the right information will generally make a decision for a safer nicotine product.
Jagannath Sarangapani 0:32:52
Jackie, you want to come in? Yeah. In India, for example, right now, every vape is illegal. And yet they are available in plenty. And the question which Mark also did bring about was, at one point of time, you really got to ask yourself, who's benefiting? Right now, the illegal... mafias or whatever you want to call, they're actually smugglers. They're opportunists.
They're looking at opportunity costs, and that's what they are selling. If it isn't a vape, they're going to sell something else. Right now, vapes are giving them maximum income. So you bring in regulation, you're going to have them to contend with. So you have to worry about price point.
But then, when you do talk of regulation, there is again a question that comes as to, yes, quality and so on. Vapes are safe. There may be illegal vapes, but nobody has had a health crisis because of vaping and illegal vape. So we need to understand that maybe we are kind of missing the bus by delaying these decisions because they are prevalent and well available.
Martin Cawley 0:34:06
I'm thinking there, Lin, is there a risk then in a black market scenario? that product safety is compromised, therefore, just in further compounding the problem?
Lynne Dawkins 0:34:21
Sorry, I forgot to listen.
Martin Cawley 0:34:22
I was just thinking there that if, given what Zaghi said, that if the black market becomes a dominant contributory force in the provision and availability, does it create a greater risk that product safety is compromised?
Lynne Dawkins 0:34:39
It can do, yeah. I mean, not necessarily. Vapes are just obviously considerably less harmful than smoking. We want them to be as safe as they possibly can be. And, you know, in some illicit products, we've seen higher levels of certain heavy metals and so on and... can be on shelves for a long period of time.
So, yeah, I think that a regulated market can certainly help with that. I'm not saying that illicit vapes are necessarily all much more harmful than regulated ones, but they can be if there's lack of quality control there.
Mark Tyndall 0:35:22
I make one comment about that with the experience we've had with cannabis. So in Canada, about 60% or 70% of the cannabis now bought is from retail stores, all illegal. There's still an illegal market, but part of what keeps that alive is not substandard products, but boutique products. There's people that produce outside and advertise their products.
product is better than you get in the stores and that keeps people will pay a higher price for the illegal because it's like supposed to be much better and so I think that could also happen that we don't you don't necessarily equate illegal products with low quality or dangerous products they're often high quality products also.
Joe Kosterich 0:36:16
I think the question, has the ship sailed, is a very good one. And in Australia, with 80% of the market illicit, it's like, is it all, has it passed? But, I mean, in 1932 in America, 100% of the alcohol market was illicit. And I'm not saying that bootlegging has completely disappeared.
I read an article actually on Reason, Reem, I don't know if you're in the room or not, I think last week, that, yeah, there's still some bootlegging in the USA and mainly it's between high-tax and low-tax states. So quite a bit of alcohol goes from Wyoming to Washington state because of the difference in taxations. But once you establish a legal market...
and it's a rational legal market with reasonable pricing, then you can stamp out the illicit market. The other example I would give is in Perth, there used to be quite a lot of illegal gambling dens because there was no casino and people wanted to gamble, and the police were never able to stamp it out.
I suspect probably part of it was that they were on the take, and that's the other issue with corruption. But they also knew that if they closed it down, somewhere would open up somewhere else.
Once they opened the first and at this stage still only casino in Perth, they did get rid of all the illegal gambling dens to the extent that people may gamble illegally in their houses. But essentially, oh, you'll never get rid of this market, you'll never get rid of it, and they did.
And I think history shows that with a functional legal market that you can, if not, maybe not eliminate, but substantially reduce the black market. And Yes, product quality, I would accept that the variance may be less, but at least with a licensed product, you know that what it says on the label is what is in the product and nothing else.
But you make it less attractive for criminals and you reduce the criminal element. And I think reducing the criminal element is a massive win in itself. So there's still time to fight the fight, the good fight?
0:38:13
Yeah.
Joe Kosterich 0:38:14
Oh, look, I think the answer is yes. But it will have to come from public pressure. The only thing that will work in Australia is going to be public pressure at the ballot box. But in turn, that will have to be informed by people standing up and making public comments. And, you know, there's been a little bit more of that in the last...
you know, just over the last probably six to 12 months, it's been growing. But I'll give a plug to Dr. Nick Coatsworth, who has really come on board. He's got a very high profile. He has a segment on one of the national TV networks, and he's come out now quite strongly. There are other people. I've made a number of appearances myself over the years in media.
And I think as that grows and other people start to see, oh, that guy said it and he hasn't been shot, it does self-propel a little bit. And at some point, and I don't know where, but at some point, there does become a tipping point. But no, you can only see that looking backwards. You can't predict it looking forwards.
Martin Cawley 0:39:16
Let's explore that just for a moment, Mark. But audience, I'm going to come to you shortly. So if you've got some questions in your head, please start thinking about that. But so building on Joe's point there, how do you shift the dial in the narrative, Mark, that it becomes a more positive connotation of, safer nicotine products opposed to the equal tobacco.
Mark Tyndall 0:39:38
Yeah, I mean, we're so far behind because many of us who are talking like that have been shut out of a lot of the discussions. So if you're pro-nicotine products, it's difficult to get your voice heard in the general public health. But I think that the way that I've seen harm reduction work in the past is to try to... get a strong community push and a strong community voice.
And I think getting the information out about the risk differential is really critical and give people the opportunity to make the decision themselves. And I think in this case, we've seen countries where that has happened. And whether we spend our time banging our heads against a wall of people who have already made their case and put their line in the sand.
And I think it's come up in other sessions that some of these people probably will never admit defeat and will never change their tune. And we got to be smart where we spend our energy. And I think a lot of it could come with just getting the message out there about relative risk, really pushing to...
free up access, and I think the public will generally move in a safer direction.
Martin Cawley 0:41:06
Let me ask one last question before engaging the audience, and you're not allowed just to have a one-word answer for all panelists. So having established what we've just discussed, is prohibition or highly restrictive policy framework a defensible position ethically? And you can't just say no.
Joe Kosterich 0:41:31
Any policy that causes an increase in smoking rates, and I don't think we need any more evidence to say that smoking is the number one cause of premature death, number two, blows a hole in the government revenue budget at a time when they're wanting to tax young entrepreneurs and take 47% of their sweat after they've worked maybe for years without a salary, and firebombings and destructions of businesses and deaths...
it becomes a bit of a no brainer. So, I mean, in terms of ethics, when you have policies that achieve those three outcomes, And I do accept that for a lot of the public, the concept of harm reduction is, look, they're not interested. I understand it's not their genre. But taxation and crime is something that does interest people.
And so in a similar way that Al Capone didn't go to jail for racketeering charges, they got on tax evasion, I think at home what may eventually get this over the line may not be that vaping is less harmful than smoking, it may be that we need to deal with the criminal activities and we need to do some budgetary repair.
Martin Cawley 0:42:37
Mark, do you want to come in?
Mark Tyndall 0:42:38
Well, I think from just my clinical hat, I mean, I do feel it's unethical not to tell people the right information. If you're faced with somebody with COPD breathing problems and they tell you they're smoking a pack a day and you basically send them out of your office with a patch that you know won't work, it's kind of unethical when you have other options.
And for the physician that doesn't offer people a safer product, I think that's unethical. They really owe it to the person in front of them. And they kind of use the excuse that they're really not sure of how safe it is. And again, that's another message that we really need to switch around. It's frustrating that with a narrative is that you know reduced risk products.
This is a totally different product There's no risk of lung cancer. There's no risk of heart disease.
There's no risk of COPD so basically this is a very safe product and There's really that's really what we got to Convince people that you'll feel better within two weeks And you'll and the chances of you getting a long-term chronic illness are very small And ethically, I think it's unreasonable.
I wouldn't send somebody out of my office with a blood pressure of 180 over 120 and tell them to go home and get their blood pressure down by changing their diet and not offer them any antihypertensive. That would be totally unethical. And basically, that's what I'm doing when I don't offer people a safer product. Thank you, Mark. Lung?
Lynne Dawkins 0:44:22
Is prohibition defensible? No, because it's denying people a choice and it's denying people a reduced risk product. But then I thought, well, what if cigarettes just didn't exist? Is it defensible then? And I'd still say no, because nicotine has beneficial effects for many people. And I still think people should be offered that choice.
Jagannath Sarangapani 0:44:51
See, if you look at it from the ethical considerations, ethics requires us to evaluate not just the harms of the products, but also the harms of the unintended consequences of such policies. I think that's something that we need to keep in mind when we are talking harm reduction.
Martin Cawley 0:45:10
Good. Okay. Let's open this up a bit. So, Alec, have we got someone with a mic that's available, please? No, yes, there is. Just down here at the front. Thank you.
Is that mic on? I'm not sure, Alec, is it?
We'll get a working mic. There we go. There's one coming, I think.
Alex Wodak 0:45:54
Thank you. That's working. I wanted to ask two questions, if I may, about India. India is now the most populous country in the world, and India has the highest population, the largest population of smokers in the world.
But the other thing about India is that you have a significant, you're the only country on the panel, represented on the panel with a significant state-owned tobacco company. And India's also remarkable in that it's got a very complicated tobacco market. and amongst the most dangerous tobacco products, good and biddies.
So my question, two questions really are what can you do in India to try and turn around the state owned companies? That's a problem that the rest of us here or very few of us here have. And secondly, what can be done about the most dangerous tobacco products, good current biddies?
Jagannath Sarangapani 0:47:05
Well, to answer it, we have about 260 million tobacco users, of which just 10% are cigarette users. So one in eight smoke cigarettes. So honestly speaking, cigarettes is a small problem. Three-fourths of them use smokeless tobacco, that's the chewing tobacco. Lessons we can learn are from countries like Sweden that have dramatically reduced snus.
Now that addresses a huge segment of population that are in the lower income category, and that's the people that actually use this. And so that is something that we should be working with. State-owned tobacco, yes, ITC, the government of India owns stakes in it through insurance companies. State insurance companies own stakes in the tobacco companies.
Yes, we have been putting it forward time and time again to work with it, but that's part of their strategy. financial and economic categorization of working with it, but how do we address the tobacco problem in India?
I would say lessons that we can pick up from countries like Sweden that have worked brilliantly And that, I think, would actually address a far greater problem, because we in India have the world's largest oral cancer problem coming from chewing tobacco. And that is something that we need to address very, very seriously.
Martin Cawley 0:48:51
Martin, you had your hand up. Yes.
Martin Cullip 0:48:59
Thanks. Martin Cullip, Taxpayers Protection Alliance. I want to mildly disagree with Joe about black markets. I think Australia is screwed a little bit here because having created an illicit market, I don't think a country can get rid of it.
We saw during prohibition in America that the mafia, once the regulations went and they've re-legalised Australia, they didn't just go away. They went into other enterprises. They went into loan sharking and protection rackets and everything else. Once you've established that black market, I don't think you're going to get rid of it.
So the best thing is not to have it in the first place. I think the only way that you could probably get rid of it is to go all in on harm reduction and have everything much cheaper than cigarettes, lower the taxes all over the place. And I don't think there's an attitude... the attitude or the willingness to do that in Australia.
I just wonder what you have thought of that idea.
Joe Kosterich 0:49:58
I don't think you ever get rid of a black market. I think you can reduce it significantly. And the other example that comes to mind is with movie piracy that was quite significant for a period of time. People thought it was too much to pay for a movie, so they pirated it. Once streaming services, you could access movies at a reasonable price, that amount of piracy went down.
It didn't go away. Look, is there an appetite for change in Australia at the moment as we sit here today? No, no, there isn't. But we don't see these changes in advance. So, look, we'll organise crime, move on to something else if the vape market...
becomes less lucrative I don't doubt that at all but that's a separate issue to whether you can make the vape market less lucrative and make vaping more available through legal channels but no is it going to happen tomorrow no will you eliminate the black market 100% no can you improve upon it can you improve upon the current situation you can and in due course I'm hopeful that that will happen but it's never a perfect world
Martin Cawley 0:51:09
Mark, do you want to pick up on that theme at all? Is there anything you would like to add?
Mark Tyndall 0:51:13
Well, I think we need to treat Australia like an Ebola outbreak and have a naval blockade. I think it's at risk of spreading and we really got to protect the rest of the countries from this.
But it is, I use this example of a safe supply programme that I did in Vancouver, and as I say, it was quite well accepted by the community, but the only threat I had was from the dealers who thought that I was stealing some of their customers.
Once things are well established and people are able to access what they feel are quality products at a cheap price in a very convenient way, I think you need extraordinary measures to compete with that. I think it's possible, but That's what I was referring to.
If we get our way in Canada and get less strict regulations, we really need to be careful with the taxation and the pricing of this thing because that's our competitor now is the illicit market. We did come up about the quality, and I do think there definitely is a risk to get contaminated products out there. So the warning should be out there.
But I think if, there's a difference between organised crime and disorganized crime. And if the people with the illicit drugs are well organised and well controlled, they'll have quality products. If it's chaos, like it is with opioids right now in Canada, it's just opened the door for a lot of contamination and a lot of problems.
If the illicit market gets organised, they're probably going to be really good products. But if we let it be a free-for-all and a lot of different groups get involved, then you run into trouble with contamination and really poor quality products.
Martin Cawley 0:53:12
I think that supports your argument, Martin, about the harm reduction narrative being of paramount importance, really. Go on, Bill, if you want.
I'm afraid you're going to have to repeat all that, Martin.
Martin Cullip 0:53:35
I read, it might be true, it might be not, you know, in Canada, when they legalised cannabis, they regulated so much that many people just thought, you know what, I'm not going to pay those prices to get a low-quality product, I'll carry on using the bloke I've been using as a dealer down the road for all these years.
So I think if they want to get rid of the black market, you have to really offer something that the public is going to go for. You can't go half-hearted and say, well, we'll allow vapes, but... they're going to be massively taxed and we're only going to allow tobacco flavour. You have to go the whole hog.
Martin Cawley 0:54:05
Pricing is going to be a really important factor in that. Sorry, Mark, on you go.
Mark Tyndall 0:54:09
No, that's exactly right. And that's why I'm afraid that the government is still going to be wanting to overtax these products and overregulate these products. And people just need access and competitive pricing.
Martin Cawley 0:54:25
Okay, any other questions? What about this side of the room? Yeah, just the middle row there, if that's... Thank you. And then I'll come to you next, sir.
Mariana Hoyo 0:54:34
Thank you. I'm from Mexico. And I was just taking a few minutes from Dr. Mark outside, but I wanted to bring up something that I just found out. That's what's being a bit ignorant from the law. Well, I'm giving a programme on harm reduction in Mexico to health care providers and to the general public.
But now, after the last panel, one of the lawyers in Mexico asked me this tricky question. He said, well, would you then recommend a patient a vape or any safer nicotine products? I said, yes, of course, maybe. he or she should bring it from the US or Canada or something because we don't have legal product in there.
And he said, well, you know, in the article of the general health law in Mexico that just came in force this January 2026, in the article 282, It says that the prohibition is going not just for the sale and distribution, but also, and I'm going to quote the law, "...
any form of communication, recommendation, or commercial action with the purpose of effect of promoting non-combustible nicotine products by any means." So the word recommendation is explicitly in the legal definition of advertising.
So me as a physician practicing harm reduction, I'm like, okay, maybe I'm facing potential legal exposure, even administrative or criminal, and it said the sanction would be one to eight years in prison.
So now I'm like facing with this thing and even the digital area in social media can be a threat to me and the ones that are wanting to share some evidence because I'm not saying on Instagram or TikTok or whatever, hey, everyone, you should vape. No, I'm bringing the evidence. I'm quoting like data. I'm cocaine and everything.
But now I just find out that these would be like a huge threat
Martin Cawley 0:56:46
You'll end up in jail. That takes you to the very heart of the moral and ethical issues associated with prohibition and that type of restrictive policy. So how is a clinician when your instinct, your natural instinct in training is about health promotion and prevention, yet you've been denied some of the tools available to you to actually pursue that with any given person?
So, Mark, is that something you experience, or Joe, or...
Mark Tyndall 0:57:17
No. Marina just told me about that. That's pretty damaging legislation for sure. We have restrictions as far as discussing relative risk and things as far as the retail part of things go, but the idea that you would advise somebody to use a safer product and get legal sanctions for that is pretty scary.
Mariana Hoyo 0:57:43
Yeah, it is. So I don't know if something about the science or the medical area could protect that. So I have no clue. I need to talk to the lawyer.
Joe Kosterich 0:57:55
I think that's even worse than Australia, is the encroachment of the state into, I suppose, the relationship between the individual doctor and the individual patient. And public health, by definition, is about the public. Well, who's that? Whereas an individual doctor is dealing with a person in front of them.
But the other really important thing there is that, and Mark will be the same and yourself, you see somebody in your consulting room, you may recommend some form of action or treatment and they're going to come back. And if it's working, well, then you continue. But if it isn't, you don't.
You put somebody on a medication for high blood pressure and their blood pressure isn't going down, you might adjust the dose, but at some point you might say, hey, you know what? This drug's been trialled, it's been shown to work, but no medication works for everybody. You're one of those people where it doesn't work. We're going to use something else.
But when you make edicts from some ivory tower, you don't see the results. You are completely shielded from the results and the consequences. As an individual doctor, I'm legally liable for everything I do. I can be sued at the drop of a hat. If I'm a bureaucrat, I'm completely indemnified against doing everything wrong and it doesn't matter. And there's no accountability.
Martin Cawley 0:59:10
Thank you for that rather scary and negative position that you find yourself in. It's quite challenging indeed. The gentleman behind you, I think you had a question, didn't you?
John Dunne 0:59:24
Hi, John Dunne from the UK. We talk an awful lot about governments being led by science, but what happens when governments decide not to be led by science and led by morals? discussions. And the UK is about to enter that realm, in my opinion. We've now got the Tobacco and Vapes Act coming into play, which will effectively, in my opinion, make vaping products look bad.
We have a total ban on advertising coming in as of next year. We have new taxes coming October 1, which We'll make some products 367% more expensive as of April 1st next year. How do we deal with governments when they seem to be more interested in their TikTok or their Instagram following than they are about public health?
Martin Cawley 1:00:21
Lynn, can we pick up on that theme? I mean, you've got a wide body of evidence over a long period of time. yet you still find it challenging to influence policymakers' take on this?
Lynne Dawkins 1:00:35
It's really difficult. I mean, it's such a shame, I think, what's happened in the UK, because I think we were getting it right originally. And with this new tobacco and vape spill, I agree with you, John, it's pretty devastating, really. And everyone in the UK seems to be thinking, yay, this is great. I don't agree with that. I'm in the advertising band for a start.
You pick up accidental quitters that way. Anyway, what can be done about it? It's really difficult because people don't always want to hear the facts and the science. I think maybe we need to start with the medical associations. I know the Royal College of Physicians is taking a reasonable stance and is supportive. Perhaps we can come via that route.
But I don't have the answer.
Martin Cawley 1:01:34
Jor?
Joe Kosterich 1:01:35
I'm going to throw out a challenge. Who thinks government policy is driven by science? Hands up. Anybody? Oh, good. Okay. So I was just about to debunk it and say it's not. It's the other way around. It's driven by ideology. And there's a term which I think was first coined by Murray Rothbard that talked about court intellectuals.
So essentially that's why they fund studies that will support what they want to do. So it's never about the science. I think it was the guy who said it's never about what they say it's about. So when they say it's about evidence and about science, it isn't. It's about control.
And it's about jobs for the boys and jobs for the people on the grave and lunch for the people on the gravy train.
Mark Tyndall 1:02:20
Well, it's also, you know, there's a whole other layer of what are promoted as the experts. So the government is listening to public health for the most part, and this is the information that they're being fed. So the push in Canada to for things like flavour bans and other restrictions, is really driven by the NGOs and the, you know, the chief medical health officers.
And, you know, it's really distressing to think that they've got it so wrong, too, so the politicians can actually hide behind, well, you know, the chief medical health officer of Canada is what's suggesting this. Why, you know, why not? And then it gets into health equity issues.
So the people that, you know, I've said this before, if the richest 13% of Canadians were smokers, then we wouldn't be having these meetings at all. Everybody would have access. So it's really a health equity issue for the most part. The people that need these safer products have the weakest voice or the most marginalised and have the least power.
That's when, like other harm reduction, those of us who are kind of trying to lead the charge really have to help promote the voice of the people who don't have much of a voice. and to really lay it out as a health equity issue. And that's, you know, WHO's decision, to me, is just baffling because I think most people there are very aware of health equity issues.
And you look at the map of who's smoking, WHO comes out and says, you know, we want to ban these products. It's just obscene, you know, how they could do that.
Martin Cawley 1:04:10
Given this is a session about sayings, there's another one that's popped in. It's like, if you tell me something, I'm likely to forget it. If you show me something, I might remember it, but if you involve me in something, I'm going to understand it. So how do we involve the consumer in a deeper, more meaningful way to influence the policy agenda and the regulatory agenda?
Is that something that you're thinking about at all, Jaggi, in some of the work that you're doing, being an advocate and a champion?
Jagannath Sarangapani 1:04:37
Yeah, see if you look at it from an Indian and someone like me who is a former smoker, who is free thanks to vapes. And when you look at the regulatory scenario around you, things are not positive. Yet we find our way to get by, but The bigger issue that we have is when you look at tobacco itself as an industry. In India, that's an entire ecosystem that's working.
And so when we are looking, why don't we ban tobacco? Why don't we ban cigarettes? That's not going to solve your problem at all. We need to understand and appreciate, are people going to stop smoking? No, they're not. I mean, it's like wishing these things away. Now, things you can't just wish away. You have to work with them. You have to work within policy.
And policy needs to be inclusive. You need to take all stakeholders involved, including those who are serious about better health for themselves. And as long as we want health for ourselves and improve health, our health, we should be allowed alternatives.
I think that's something that constantly seems to be missing the point amongst the policy makers and the powers that be, and they're not accountable. And so that's what we have.
We still have cricketers who have been caught in the recently concluded IPL matches, there was sneaking in vapes and they were vaping and they were caught and they were fined 15% of their match fee for bringing disrepute and so on. But that's about it. So people who want to vape are going to vape.
You know, and you've got to understand it, you've got to embrace it, and you've got to be willing to work with it. That's what's missing, and I think that's what we need to be working at and looking at.
Martin Cawley 1:06:38
Okay, okay. Any other questions from our audience at all? There's got to be some. Well, I pick on people. Alec. Excuse me, there's a gentleman behind you, Alec, if we take that. Did you have your hand up, sir? Yeah, up the back there, and then we'll come back to you, Alec, if that's all right. Is there somebody there?
Attendee 1:06:59
Hello, yes, I'm right at the back here. Thanks, sir. This is such an interesting conversation. I was wondering whether beyond the traditional access to the products through the black market channels, have you observed creative ways that the consumers themselves are using to circumnavigate the very restricted regulations.
And I'm particularly, I guess, referring in Canada where you've had flavour bands, et cetera. Do the consumers themselves then start to become a bit creative?
Martin Cawley 1:07:44
Where there's a will, there's a way, Mark. Anything you want to contribute to that?
Mark Tyndall 1:07:50
Yeah, I mean, I think for nicotine liquids, we've done the natural experiment in Canada, different provinces and banned flavours in four of the provinces, and flavoured nicotine liquid is very available because it's so easy to mix up, and people are are quite creative and get around it.
So I think for nicotine products, especially vaping liquids, you really don't even need a legal market. People can figure it out themselves for the most part. I think putting together your own pouch might be a little more tricky. Yeah, so people do get around it. And I don't even know if the government and anti-vaping people are even that worried about that.
So if people want to do that, I don't think they're going to bust into your house and confiscate it.
Martin Cawley 1:08:50
Difficult to police.
Mark Tyndall 1:08:52
Yeah, it's impossible. But there's different attitudes in different countries. And the contrast in Canada and the U.S. is quite interesting in that In Canada, I think we are much more community oriented and we really think about our policies of how it's going to affect the whole community and not quite as worried about individual autonomy and rights.
Across the border, we see in many health policies, it's really the focus is on individual rights to the point where it's okay to refuse to vaccinate your kids or it's you know you can do you know it's okay to ride a motorcycle without a helmet you know and and there's a there's much more of a you know um individual autonomy idea and it's my right to do things and so It's an interesting contrast.
I mean, obviously, the U.S. has very bad restrictions also, but the illegal market is flourishing, and people have access to this, and there's millions of Americans who have decided that they want to use these products, and they get them. So it's fascinating how...
Martin Cawley 1:09:58
You know, that's all kind of... It's a really interesting paradox that, you know, like the fundamental principles of a rights-based society, you know, through the Constitution, yet some of those civil rights have been denied the citizens of the state. Alec, you're waiting in a mic.
Alex Wodak 1:10:22
Thank you. This is a comment, if I may, rather than a question, and it's really a response to the very understandable feeling of negativity about the situation we're in globally and particularly in some countries about a quasi-prohibition approach to this area.
And the comment I wanted to make is that if we look broadly over a period of decades rather than weeks, months, years, and look at many prohibitions, the natural history, to use a medical term, of prohibitions is that eventually most of them do go. And there are so many prohibitions that have gone.
And we think of, in many of the high income countries, abortion, which for many centuries was prohibited, that prohibition has changed in most parts of the world to regulation. It's not completely stable and we've seen, we've gone backwards in the United States, of course, in the last couple of years.
Voluntary assisted dying, which Fiona had a lot to do with ending that prohibition in Australia. And in many other countries, voluntary assisted dying is taking off or spreading to different parts of the country. The prohibition on male to male sex is ended in many countries. And that process is continuing. The prohibition on same-sex marriage is rapidly ending.
That only started in 2001. And there are now about 35 countries that have ended that prohibition. So I think we can be a bit more hopeful about that.
And as I said in my talk yesterday, I think we also can be encouraged by the way that the tobacco industry itself is transforming from combustible cigarettes to a range of safer smoke-free products and that is happening rapidly and is accelerating and we're probably close to a tipping point if we haven't passed that already and we can expect exponential growth as we're seeing now with electric vehicles so Yes, it's understandable that we all feel very negative about the situation now, but I think we can be confident that this situation will not last for much longer.
Joe Kosterich 1:13:20
I absolutely agree, Alex. I think we can be... If we want to say about the situation as it is today, it's quite negative, and if we could only see as far as tomorrow, we might all be negative. But if we can take a bigger picture view... over the upcoming, I don't know, maybe one years, five years, 10 years, but at some point, yes, I agree with you completely.
We can be positive because, and I think I've heard this first from you, what can't go on eventually won't go on. And there will be a tipping point. And you think history has shown this in a whole series of different eras and ways that nobody ever predicts the tipping point. But in the rear view mirror, you can look back and say, oh, that was the tipping point.
And by the way, all these other events had happened in the lead up to it. So yeah, at some point it will change. I don't know when, but it will. So I think we can be positive.
Mark Tyndall 1:14:19
We can look back at Marina after eight years in prison and say it was worth it. It's changed now.
Martin Cawley 1:14:27
The question arises, what do we do in the meantime?
Joe Kosterich 1:14:31
I think we keep punching on as I think we're doing. And I think maybe, and there may be some exceptions, but I think we need to keep talking as we are here. And I think it's useful to be amongst like-minded people, but one can go out, re-energize that we're not alone and bring other people into the fold.
And it's, again there's an adage men go mad in herds and regain their sanity one at a time and and i am seeing at home one by one some people are starting to to regain their sanity and when there is enough then that's when you reach the tipping point so yeah talking to people who are interested if people don't want to come on board you can't force them it is what we're not we're not looking for converts but um you know it it is possible to talk to people and some will say oh i'd never thought of that oh i didn't know that, oh, maybe I'll go and look into it a little bit further.
And some won't. But that doesn't matter. But if one talks to people, promotes the word, does it through social media, then one by one we reach that tipping point stage. Yeah. Len?
Lynne Dawkins 1:15:35
Yeah, I agree. I think there are reasons to be positive. And there are some signs. We haven't spoken that much about the US, at least not in the sessions I've been at.
And I think there are some signs from the FDA's Center for Tobacco Products recently, however that's come about, But the new enforcement discretion where they have suggested they wouldn't go after products if they're accepted for scientific review, I think perhaps that is because youth vaping has come down so much.
And once, hopefully, I mean, youth vaping is used often as a reason for prohibition in whatever way. But if we start seeing, you know, peaks that that was just a fad, you know, it's come back down again. And we're starting to see that in the UK as well.
So maybe that, you know, there are lessons to be learned from that, that we are not creating a new academic of nicotine addicts and, you know, these things just go up and down.
Martin Cawley 1:16:35
I'll tell you guys a wee anecdote while I'll... Oh, is there a question there yet? There's a question in the middle and then we'll come back to where my mind was going.
Magdalena Bartnik 1:16:43
Yeah, hello, Magdalena Bartnik from Poland. May I disagree with last voices? I feel hopeless, and this hopelessness comes from something we already witnessed, the war on drugs. This is war on nicotine, and that prohibition didn't end, and now we don't have inside this, this regime change, and this is something similar.
Just nicotine joined the illicit drugs, and this is war on the substance in the end. And war on drugs makes, I mean, let's be realistic. Really hopeless, actually hopeless.
Martin Cawley 1:17:28
Does the examples that Alec gave you about how prohibition over history has always evolved into shifting the regulatory framework within which the issues arise, whether it's gender, whether it's alcohol, whether it's drugs, whether it's nicotine? So that's a rhetorical question you had here.
Mark Tyndall 1:17:51
Yeah, I think that it's going to become imminently obvious that 1.2 billion smokers can't be targeted for the war on drugs. It would just be too overwhelming. So I really think that... It will explode.
It's going to be really interesting countries that, you know, Bloomberg's gone in and got them to ban, like, places like Vietnam and some, you know, Brazil or countries that are, like, are full of, like, energetic, enthusiastic, well-informed, you know, people will find a way, I think. And... that it's unstoppable, that people will find a way.
And I think that these countrywide bans, especially that are colonial driven, like it just, ridiculous you can go into a high prevalence country and tell the WHO, tell them to ban it. It just can't happen. Obviously, India. This is going to explode in some way, and I really think that the situation will evolve for the better.
Martin Cawley 1:19:00
One of the jobs of a chair is to manage time as well, so I'm very mindful of that. And before I tell this anecdote, just get in your mind maybe some closing remarks that you'd like to make, because when I'm finished, we'll come back to that and start with yourself, Joe.
Yeah, those of you that know me know that I can talk a lot and I was chairing a session at a conference once and I was doing a talk at it actually and I had about 10 minutes to do my talk and I actually was running over, it was about 18, 19 minutes that had gone by and I could see the chairperson getting really anxious and upset and I said, look, I'm really, really sorry but there's no clock in the wall and I don't have a wristwatch on and someone from the back of the hall shouted,
Joe Kosterich 1:19:43
yeah but there's a calendar on the wall behind you mate so I'm very mindful of time just now and we're getting to that point where it is getting to the sort of concluding period so Joe what would your closing remarks be I mean to keep it simple we just need to keep at it I don't think it's any more complicated than that if we keep at it for long enough there is enough evidence from history that what is right will prevail yep
Mark Tyndall 1:20:14
Yeah, I tend to be a bit optimistic that we can move this. I think I've been to enough meetings now that and there's not there's a you know, there's a lot of responsibility that we have. So I just want to encourage people that are here. I think most of us are all on the same page.
We all have a role to play and it'd be important that we move do what we can to push this forward and not go home and just forget about it, so. Jackie?
Jagannath Sarangapani 1:20:47
Yeah, I would say the ethical measure of any prohibition is not what it prevents in theory, but what it achieves in practice. And I would say this too shall pass, you know, the old proverb goes. And Len, last word?
Lynne Dawkins 1:21:05
I guess it's just don't forget the smokers and just keep reminding people. And I was just reminded of my daughter's friend again, who, you know, she's really young. She hasn't got parents who have smoked or grandparents who have suffered the death and disease of smoking.
And I worry over time they, you know, it's good that smoking is declining in first world countries at least. but there may be some collective forgetting and I think we do need to just keep reminding how bad smoking is.
Martin Cawley 1:21:38
Folks, I hope you found this to be an interesting, engaging and thought-provoking session. So I think a panel of experts here have been very open and honest with their opinions and contributions and please show your appreciation in the normal way. Thank you very much indeed. Thank you.