Joanna: Hello and welcome to GFN News on GFN TV. I'm your host, Joanna Junak. In today's news, sales of both cigarettes and safer nicotine products, or anyone born after 2005 may be banned in Malaysia. The Coalition of Asia Pacific Tobacco Reduction Advocates (CAPHRA) is supporting the Philippines vaporized nicotine product. For Cardiologists and researcher Konstantinos Farsalinos, it's clear that flavors are essential to the success of vaping for harm reduction. The european parliament has voted to adopt the final report of the special committee on beating cancer. And after the news, Brent Stafford of Reg Work interviewed Canadian Dr. John Oyston. Malaysia's Health Minister has recently announced that his government plans to legislate to ban smoking and the possession of tobacco products for people born after 2005. This may include nicotine vapes, heated tobacco or oral products that are much safer than combustible tobacco. Four international experts on tobacco and nicotine policy have written to the Prime Minister of Malaysia to comment on the plans, saying they could do more harm than good. David Sweanor, Clive Bates, David Abrams and Raymond Niagara argue that prohibition does not make band products disappear. The letter also argues that age restrictions aren't always effective at preventing use among children and young people. What prohibition or age restrictions do is change how products are supplied, who supplies them, and at what price. If taxes are illegally avoided, prices can sometimes drop. The Philippines are still waiting for the President's signature on the Vaporized Nicotine Product Bill, which will regulate the manufacturer's sale and use of nicotine, vapes and heated tobacco products. The Coalition of Asia Pacific Tobacco Reduction Advocates, CAPHRA, sent a letter to President Rodrigo Duterte calling on him to sign the Vape bill. The letter stated that enabling Philippino smokers to choose less harmful alternative nicotine products would prove President Duterte to be a leader who puts the health and well being of his people above the special interest of foreigners. Let's hear Nancy Loucas, executive coordinator of CAPHRA, as she explores what this bill means for people in the Philippines.
Nancy: The importance of this bill in the Philippines when the President signs, it is not just for the people in the Philippines, but also for the wider Asia Pacific region. And I say that because if and when the President signs this and it becomes law, it will set a precedent in the Asia region for tobacco harm reduction and safer nicotine products to be considered an integral part of public health policy. So there is only good that can come from the passage of this legislation, and it being made law.
Joanna: Thank you, Nancy, for sharing your insights. Filter magazine has recently published a video by Hellen Redmond, who interviewed Dr. Konstantinos Farsalinos a leading vaping researcher from Greece. In it, he explained flavors universal appeal and why they play such an important role in helping smokers quit. Let's cross over to Will Godfrey from Filter magazine. Hi Will, why is the subject even controversial?
Joanna: Well, it shouldn't be, Joanna. As Dr. Farsalinos went on to note, flavors are obviously present and popular in all kinds of products other than vapes, including alcohol, without complaint. But here in the United States, as elsewhere, flavors have become a political and media scapegoat for the perceived youth vaping epidemic, a term that set odds with reality with youth vaping on the decline. The problem with this perception of flavors and the bans and restrictions that follow is that we know the large majority of people who switch from smoking to vaping come to prefer flavors other than tobacco. The latest iteration of flavor crackdowns in the US has been the federal move to bring synthetic nicotine products under the FDA's jurisdiction, which some fear will amount to a de facto ban. Dr Farsalinos mentioned in the video that he vapes fruit flavors while his mother quit cigarettes with the help of cappuccino flavor, which I can only imagine. Such preferences may sound trivial, but they really matter because giving people access to safer options that they enjoy more than cigarettes is simply critical to maximizing harm reduction.
Joanna: Thank you, Will, see you next time.
Will: Thank you, Joanna.
Joanna: On 16th February 2022, the European parliament voted to adopt the final report of the special committee on beating cancer. This means that vaping products have for the first time being recognized by the European union as helping smokers to quit. The report states that electronic cigarettes could allow some smokers to progressively quit smoking, a clear acknowledgment of the harm reduction potential of safer nicotine products. Tom Gleeson from NNA, Ireland tells us what the report adoption means for tobacco harm reduction. Hi, Tom.
Tom: Hi, joanna. Yes, the short answer is that this means for the first time, vaping products have been recognized as helping smokers quit smoking. Electronic cigarettes could allow some smokers to progressively quit smoking through the exact phrase that's a clear acknowledgement of the harm reduction potential of e six. What's more, the report recommends that risk evaluations must compare safer nicotine products to smoking. The default position up to now has been to evaluate them in the context of non smokers and abstinence. This, of course, is the entirely wrong metric to measure these products by. This is a huge advance for THR, but as welcome as this is, it's worth noting that the amendments tabled by the social and democratic group would have removed all wording acknowledging the potential of reduced risk products. They would have paved the way for a full flavor bank. These amendments were narrowly defeated. Instead, we have a reference to examining the issue of flavors, which are particularly attractive to non smokers and youth with a view to banning them. This moves the needle quite a bit in our favor, but it's not enough. The tobacco products directive is being reviewed and there will be a huge effort to get flavor bans, taxation, public use bans, the entire lot. We gain this in the Becca report by the work of advocates and advocacy groups and we're going to have to keep doing that ongoing.
Joanna: Thank you, Tom, for your thoughts. And now we go over to Brent Stafford and his guest, Canadian Dr. John Oyston. In June, John will be joining us at GFN 22 on a panel discussing misinformation around tobacco harm reduction. In today's interview, however, John will share his thoughts on how Canada's proposed ban on flavors and nicotine vapor products. Over to you, Brent.
Brent: Hi, I'm Brent Stafford, and welcome to another RegWatch segment on GFN.TV, and I'm joined here today with Dr. John Oyston, a Canadian anesthesiologist. Hi, Dr. Oyston. So for our audience out there globally on GFN TV. Who are you? Why are you so passionate about tobacco Harm Reduction?
John: Ok, so I'm retired, but I spent 40 years working in the operating room and I worked in a hospital that dealt with vascular surgery and dealt with cancer surgery. So I spent way too much of my life in the operating room dealing with people who smoke cigarettes who are now suffering as a result. And so I've been there while my surgical colleagues have removed a line or part of a line, they've amputated a foot or leg. These are horrible operations. They're disfiguring, disabling painful procedures. And it just appalls me that the reason why we're having to do these operations is that these people started smoking as teenagers and they probably tried to quit when they were 30 or 40 or 50. But they weren't able to. And because they weren't able to quit before cigarette smoke did permanent damage to their bodies, they've now ended up in the operating room and I'm caring for them while they're having these procedures done. And in all too many cases, because they're so dependent upon nicotine, they're going to continue to smoke and they're going to continue to come back. Repeat this E-Juice. So it just seems to me incredibly wrong that, you know, two generations after we realized how harmful cigarettes are, there still was eight million people in the world who die from. Yeah, eight million people have died from cigarette smoking every year, and we're really not doing enough about this. In Western countries, we have a whole pile of somewhat halfhearted initiatives, which are slowly cutting the cigarette smoking rates. But meanwhile, in developing countries, people as soon as they have enough money to buy their food and shelter are then buying cigarettes. Overall, the number of cigarette smokers in the world is still going up. So I've always thought this was appalling and I've always thought, Well, what can I do about it? So the first project I did was a thing called stop smoking for safer surgery, because that was sort of in my wheelhouse. And this is very interesting because if you can get people to stop smoking maybe four to six weeks before elective surgery, you can actually halve the risk of post-operative complications. Quitting smoking before surgery decreases the risk of ICU admission, it decreases the risk of post-operative pneumonia and also decreases the risk of wound infections. So it's a very important thing to do. And I campaigned for this for several years. Canadian Anesthesiology Society and the Ontario Medical Association supported me for this. And this has now become standard of practice, particularly for elective joint replacement surgery, because most people wait for several months before they get their hip or their knee replaced. And this was last time for them to quit smoking before they come for their surgery. And this then reduces their risk of post-operative complications. So I then started looking at other things to do, and eventually I came across Vaping and I thought, this just makes so much sense because there's two things about smoking. One is the nicotine that people are dependent upon. That's the thing that gives them the cravings when they try to quit. And the other is just the habit of smoking. It's having something to do with your hands, having something to put in your mouth, having some smoke to blow out or some vapor to blow out. And it's to seem to me straight off the bat. But this was such a logical way to deal with cigarette smokers that it would be a way that they can have the nicotine that the dependent upon. But without the seven or 8000 toxic chemicals that are present in cigarette smoke and they can maintain most of the ritual that they used to it, they can continue to have something to fiddle with, have something to put in their mouth, have some cloud or something to blow out. So I think it almost immediately that this is something that was going to be big and was going to work. And then the research came along and, you know, people said, Well, this is 20 times safer than cigarette smoking. This is almost twice as effective as nicotine replacement therapy in a way of getting people to quit. In the UK, they're saying there's an extra 50000 people every year who quit smoking, who wouldn't quit smoking without Vaping. And so I've been a strong supporter of Vaping, but unfortunately many of my medical colleagues see only the dark side of Vaping. They are overly concerned to my mind about the risks of vaping for teenagers. I think that is a problem, but it's a relatively small problem and they're not using this new tool. And I just think it's appalling that physicians are so conservative about changing their practice and the data is there, but somehow they're not taking it on board and they're not using it as a way to change what they're doing.
Brent: Right now, one of the things that we know around the world is that physicians don't seem to have a proper understanding about the risk of Vaping and the risk of nicotine in general.
John: Yeah, absolutely. This is really appalling. There've been studies that say that 80 percent of physicians in the United States think that nicotine causes cancer, heart disease, COPD and it doesn't. Right. Nicotine is the stuff that makes cigarettes addictive, and it's not the stuff that kills people, you know? And we've known that since the 1970s, people smoke for the nicotine and they die from the tar. But this isn't getting across to people, and if you don't know that, then you don't have the basic concept that if you could supply people with a nicotine, then they wouldn't crave cigarettes. And that's fine, and it's not for adults in particular, using nicotine is close to harmless. It's certainly much less dangerous than using cannabis or using alcohol, which are accepted in society. So. Unless you understand the relative risks of nicotine and the other components of cigarettes and the relative risk of Vaping compared to the relative risk of cigarette smoking, then you're kind of lost. You're not going to appreciate why Vaping should be encouraged as a way to get people to quit smoking.
Brent: Dr. Oyston, to the extent that doctors are supposed to do no harm, is that actually the case when it comes to Vaping or is there harm being done by medical doctors? I fucked up once that. Dr Oyston, to the extent that medical doctors are supposed to do no harm, is that the case then when it comes to Vaping and some of the opposition?
John: I think it is true. I think that there are people who are so preoccupied by the issue of Teen Vaping that they will do anything that they can to try and scare teens out of Vaping and they'll tell lies about popcorn. They'll pretend that EVALI, which was caused by contaminated THC products and has nothing to do with legal Vaping. They'll pretend that those cases of severe lung injury were caused by regular nicotine Vaping, so people are prepared to tell a whole pile of lies in what I think they consider the good overall purpose of trying to scare teens against vaping. And whilst stopping teens, vaping is a reasonable goal. First of all, it's better that you do that by actually explaining what the real risks are rather than inventing fanciful and exaggerated risks. And secondly, when you start doing that, and particularly if you start looking at things like flavor bans as a way to prevent teens from vaping, you have to look not only at the effect on teenagers, but you also have to have a look at the effect on adult smokers and adult vapors. And I think often what people are doing is scaring people so much about teen vaping that they are doing harm. And I guess the biggest example of that was the CDC, you know, when in the fall of 2019, there was this outbreak of disease amongst young men, particularly in the states. They attributed this to Vaping, and they started telling people not to Vape. And they gave the idea that, you know, while cancer may kill you slowly and decades, Vaping will kill you tomorrow. And we know from a pile of sources that this created so much anxiety that thousands of people have switched from smoking to Vaping switch back to smoking. And so that absolutely was the case of people causing harm by scaring people out of Vaping. You know, one of my neighbors, his wife, actually was Vaping and started cigarette smoking. After all, the talk about EVALI and I had a hard time persuading her to go back to vaping because from the media and from the CDC, which should know better. They were so scared.
Brent: And it's true. And. And it's true that the EVALI scare had an impact on countries around the world, not just the U.S. and Canada.
Brent: How far have we gone over the precipice or have things pulled back a little bit, considering that Health Canada did host that webinar late last year, that did provide a little bit of hope.
John: I think there's a lot of stuff that's still up in the air. There was still a lot of legal cases that have to be decided. I think a challenge to the New Brunswick ban and I think Health Canada may be beginning to see the light and beginning to see some of the pressure that Vaping fans are just crazy and illogical. OK, we're concerned about the number of teens who vape, although in fact, it seems like the number of teens vaping in both Canada and the United States has probably peaked, and it's probably on the downswing now. But nevertheless, it's a fair thing to be concerned about. So we have laws that say it's illegal to provide vaping products to kids who are under 18 federally, 19 in some provinces, 21 in P.E.I.. So why don't we just enforce those laws? Why do we need to invent other laws when we already have a law to say effectively that teenage vaping is illegal? Nobody can sell or provide Vape to teenagers, so let's enforce that rule. But for some reason, instead of doing that, they want to go this flavor ban right now. This is just completely crazy. So people say 90 percent of kids, or 95 percent or 98 per cent of kids who vape use flavors. Yeah, that's pretty much true in the same way that the vast majority of people who drink alcohol drink flavored alcohol, whether it's wine flavored alcohol or flavored alcohol or, you know, lemonade flavored alcohol, it's part of what makes alcohol attractive. When you say that 95 percent of kids Vape with flavors, that doesn't mean that 95 percent of kids would stop Vaping if flavors weren't available. And the flip side of it is you also have to look at what's happening to adult smokers. And the evidence here is quite clear that in the early days of Vaping and people who just transitioned from smoking to Vaping, people tended to like tobacco flavors. They wanted something that was familiar. But then very quickly, smokers started to realize that the reason they were quitting smoking is they didn't like the taste and smell of tobacco, so they wanted something different. And so even people who smoked and are switching to do Vape are now much preferring desert fruit flavored, totally unrelated to tobacco flavors. And that's great because once they get away from exposure to tobacco flavors, that actually makes them less likely to relapse to smoking. The sooner you get used to something that is, I don't know, mango, strawberry or vanilla or whatever. The quicker you begin to hype tobacco and you don't want to have that smell on your clothes, you don't have that smell in your house. So the flavors are an important part of helping adult smokers to switch to Vaping. The idea that the only two flavors were going to allow is menthol and tobacco is completely crazy, and I can't understand how anyone thinks otherwise.
Brent: And based on the actual language in the proposed regulations, Health Canada is adamant that those flavors that would be allowed must be disgusting. Basically, it's they can't be sweetened with any kind of sweetener. And the more disgusting, the better in their mind.
John: Yeah, exactly. I think. Somewhere in the bowels of Health Canada, there's somebody who thinks. That enjoying Vaping is morally wrong or ethically wrong or unacceptable, and that we can't allow people to actually enjoy Vaping because that's the only explanation I can think of. They want to make Vaping deliberately disgusting, and they're removing all sweetness. So I mean, first of all, it's important to realize that tobacco flavored Vape doesn't actually contain tobacco, it only contains artificial flavors, and it needs a sweetness to create a tobacco flavor. And if you're going to ban the sweetness, then I think it's 85 percent of all Vape E-Juice is going to have to be reformulated and. Tobacco flavored Vape isn't really a very good substitute for tobacco to begin with. It's going to be even worse if you take the sweeteners away, so it's queasy.
Brent: Well, let's dive into that, just a hair, a hair more, somebody deep down in the bowels of Health Canada believes that Vaping enjoying the pleasure the activity is maybe immoral.
John: I think so, I mean, I think. That's the only explanation I can find for the way that they're behaving, that they don't can't get the concept, that we could actually have a medicine for smoking cessation, which is also actually enjoyable. And we've known that for a long time in medicine, you know, Mary Poppins, a spoonful of medicine, say a spoonful of sugar helps the medicine go down. You know, cough medicine has cherry flavor, which I personally hate. You know, throat lozenges are flavored with honey. So in medicine, we understand that sometimes to make a medicine acceptable and palatable, you have to give it an artificial flavor. And That's logical, but that's logical, and I don't know why we have a hard time accepting that the same thing applies to Vaping. there's no conceivable way that what they're doing can end up being a public health benefit.
Brent: It very well could be a public health disaster.
Brent: Now, do you think and you kind of intimated it to it a little bit earlier in the interview was that Health Canada may actually be not only feeling the pressure but reacting to it.
John: It's so hard, Health Canada is a bit of a black box, but certainly it was talking about the webinar that Maria organized with some representatives from Health Canada, and they were certainly quite a lot on the defensive. They didn't say very much in the whole thing, partly because, you know, the current legal processes are underway. So perhaps they can't. But very much you got the idea that they were backpedaling and delaying and, you know, even saying that this isn't going to be something that's going to be happening early in the new year. So it gave the overall impression that they were beginning to have second thoughts about this.
Brent: Now, if he were to be able to give some advice to some of our global tobacco Harm Reduction advocates that are watching this segment, what would that be?
John: Keep up the good work and keep on following the data. I mean, look to the leaders, which is obviously Public Health England and now perhaps New Zealand. And I think every country has to follow its own course, but you have to have a clear message that. If you look at it realistically and objectively, the evidence is absolutely crystal clear that Vaping is significantly safer than cigarette smoking, even managed to get Stanton Glantz to say that he thinks that that's true. He thinks it's only maybe 25 percent safer. But even he says Vaping is safer than cigarette smoking.
Brent: So do you think do you think it's possible then that, you know, Vaping might find a permanent home and usage around the world?
John: I sincerely hope so, because it's crazy that at the moment, we still have so many people dying and suffering death, and so at so many people suffering disease, disability and death due to cigarette smoking. And what we've been doing for a long time isn't really working all that well. You know, we've had nicotine replacement therapy, we've had varenicline, we've had propofol for literally decades. And if those things were going to be effective at stopping people smoking, then we wouldn't have any smokers now. But clearly, the fact that we still have people who have been through regular smoking cessation clinics and regular smoking cessation programs and are still smoking means that we have to do something different. I don't think the status quo is acceptable, and I don't think continuing to do the same thing that we've done for 20 years is a reasonable approach. So we have to look at something different, and Vaping is very definitely something different with a whole pile of data to show that it works and it's effective. And the people who are arguing against it are. In many cases, using blatant misinformation, which demonstrates how weak their case is, what they can't actually make a real case that Vaping is dangerous, so they make a fictitious case of Vaping as dangerous. So one of the things that I come across lately, which I kind of like, is...people who are against Vaping say we know don't know the long term risks of Vaping, so I come back to that is we don't know the long term risks of the COVID vaccines either. We know a heck of a lot more about the long term response of the body to Vaping than we do about the long term response to the Vape of the body for COVID vaccines. But in both cases, we know exactly what's in these products, and we have sufficient similarities between these products and previous products that we can predict pretty accurately exactly what's going to happen. And in both cases, the alternative is something that's going to kill literally millions of people. So you have to balance absolute certain risk of millions of people dying with the very, very small possibility that maybe there is some risk in the COVID vaccine or there is some risk in Vaping that we haven't noticed or we haven't worked out yet. But given in both cases the fact that millions of people have had the COVID vaccine without problems and millions of people are Vaping without problems, we can be pretty sure that both the COVID vaccine and Vaping are safe and that there are effective ways to treat a condition which kills millions of people.
Joanna: Thank you, Brent and John. Looking forward to more discussions in Warsaw in June. That's all for today. Tune in next time for more tobacco, Hamilton action updates and Grant indepth interview with our Fred GFN 22 keynote speaker. Thank you for watching and goodbye for now.