Chapters:0:00 - Intro with Joanna Junak 0:40 - Teenage smoking in the US 1:47 - Action on Smoking and Health (ASH) 3:10 - Panic about youth vaping 5:00 - Brent Stafford interviews Ernest Groman 25:42 - Closing remarks
Hello and welcome, I’m Joanna Junak and this is GFN News on GFN.TV. In today’s programme, Will Godfrey of Filter will share his thoughts on developments around youth vaping and Brent Stafford of RegWatch interviews Ernest Groman, amedical doctor and professor of public health at the University of Vienna.
Joanna: First, let’s turn to Will to talk about youth vaping. Hi Will, what do you want to highlight today?
Will: Hi Joanna. Of course, the spectre of youth vaping is a perennial focus of anti-vaping advocacy. We’ve published a number of recent articles in Filter that both analyse this and speak to some of its consequences. Charles Gardner, director of international consumer group INNCO, asked why we’re not widely celebrating all-time-low levels of teenage smoking in the US. “Teens basically don’t smoke now,” he wrote. They “will not die horribly from smoking-related cancer, heart and lung disease. We should all be dancing in the streets. ”We’re not, he went on to explain, because this public health victory has been totally obscured by a youth-vaping panic that bears an “uncanny resemblance to 1930s Reefer Madness.” In a data-heavy article, Charles showed that not only has US youth vaping declined in recent years, but that total youth nicotine use, for what it’s worth, has fallen. You’d never know that from media headlines.
Joanna: Is the decline in youth vaping universal?
Will: No it’s not. Actually, there has been a recent uptick in youth vaping in the UK. But the fallout makes an instructive trans-Atlantic comparison, as advocate Martin Cullip described in another piece. Just as we’ve previously seen in the US, he wrote, the rise in youth vaping was greeted by sensationalist media reports—not only from the tabloids, but from outlets like the Guardian and the BBC. But here the similarities end. Because whereas the FDA, the CDC and US public health nonprofits have in various ways jumped on the media bandwagon to spread panic, UK public health has reacted sensibly. An August ASH briefing, endorsed by the Royal Society of Public Health and numerous British public health and tobacco control organisations, emphasised that smoking remains the real threat to public health. It refuted a number of myths about vaping harms and took a direct swipe at FDA scaremongering. UK policy remains relatively vaping-friendly, as millions continue to replace cigarettes with vapes. “If the US public health community fails to develop similar maturity on this issue,” Martin wrote, “more American lives will needlessly be lost.”
Joanna: Where does panic about youth vaping lead us?
Will: In all kinds of negative directions. One high-profile example recently has been the $400 million multi-US-state settlement tentatively agreed by Juul (without admitting wrongdoing) over allegations of stoking youth vaping. The company, which, however you feel about it, provides millions of former smokers with a safer alternative, has long been a prime target of US prohibitionist attacks. “It’s not about the teens who have mostly quit vaping and smoking,” wrote Helen Redmond of the case, in which prosecutors doubled down on youth-vaping panic. “It’s about the money.” And we’ve also seen a dramatic escalation of FDA enforcement efforts this month, as Alex Norcia exclusively reported for Filter. The agency has enlisted the Department of Justice to target companies selling unauthorised vapes with threats of lawsuits and orders to destroy their own products, under FDA supervision. FDA authorisation under the PMTA process, we should remember, has been reserved for only a handful of tobacco-flavoured products made by the largest companies. The two companies known to have received these letters hadn’t submitted PMTAs, probably assuming they would be rejected, like every other smaller player. “If the FDA were to take this all a step further,” wrote Alex, “it could target the many manufacturers that have received PMTA denials.” Charles recalled Reefer Madness in his article. And harking back to a similar era, the notion of organised vape-destruction sessions rather conjures up those images of US agents pouring liquor onto the streets during alcohol Prohibition.
Joanna: Thank you, Will. And now, we go over to Brent Stafford and his guest, Ernest Groman, a medical doctor and professor of public health at the University of Vienna. In today’s interview, Ernest discusses the debate over nicotine and the war on vaping. Over to you, Brent.
BRENT: Hi everybody. I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV. We're here in Warsaw, Poland for the Global Forum on Nicotine FM 22, and I'm here with Dr. Ernest Grohmann. Hello. Hello. You're from Austria, professor of Public Health at Medical University of Vienna in Austria and scientific director of the Nicotine Institute. Thanks for joining us.
ERNEST: Thanks for your invitation. It's a pleasure to be here.
BRENT: So, wow, I think you're my first interview with somebody from Austria and huge history there.
ERNEST: Bela To be honest, we have a broken history because we had this empire which broke down and it stayed the capital of the empire and all the bureaucracy, but not nothing to do.
BRENT: So you kept all the bureaucracy?
ERNEST: Of course. Of course. Yeah, but we did. But there was very little to organize.
BRENT: Well, it's fascinating because I mean, obviously, for centuries, a lot of medical innovations came out of Austria.
ERNEST: Yes. Medical school, Austrian Viennese Medical School was very famous throughout the world. And we did many innovations. And but it also has to do with the communication. You have to imagine this was also a very broad market with all the connected countries with Slovakia, Czechia, Hungary, parts of Ukraine, even so to say the eastern part. So the market was bigger and therefore the communication was also better. And to be honest, it was also more important for industry because if you have a big market now nowadays we have the small market and even when we look at our projects, we are quite successful. But of course we have capital of 8 million people and even if you double or triple A successful compared to Germans or Germany, it doesn't matter so much.
BRENT: Describe for us your focus on nicotine. Why is that?
ERNEST: Well, it happened. I have never planned it. I was working in hospital and then I was specializing in a little project at the Public Health Institute. And my former head professor, he set up an outpatient clinic and I was sitting there with the smokers and I realized it's difficult with them because I said, do this, do that. And usually as a medical doctor, you are used to patients not exactly doing what you tell them, but here it was completely different. And then we found out that this was the time of nicotine replacement of nicotine gums. And at that time it was forbidden to continue smoke according to product information. If you used nicotine gum and we found out we had patients, they used five nicotine gums per day and smoked 20 cigarettes instead of 40. And there was the question of what to do with them. Usually when you were going according to product information, you would have to tell them, stop nicotine gum, continue smoking. And we realized that some something missing or some like risk reduction, harm reduction. And we also did the in Australia the first publications on harm reduction because the alternative nicotine delivery systems at the time in the 1998 was the first publication.
BRENT: You're describing dual use. Yes. Of smoking. Yes. And nicotine gum back in the late nineties.
BRENT: Yeah. And even then that was an issue from critics.
ERNEST: Yeah. Yeah, it was. It was. And but you have always the theory the people developed some construct and then you suddenly if you do it. You are confronted with reality and that always interested what happens in real life not what some academic ideas you develop. As my my professor counsellor once told me it's better to talk about it, not seeing it, what really happens. But if you really want to get the knowledge, which can be a pain, if you realize this very exact models, in reality it looks quite different. It does not work that way.
BRENT: So help me understand, is there a difference, say, in the field in Austria, say opposed to the US or the UK or Canada, where it seems that public health bureaucrats have lost their mind over Vaping?
ERNEST: Well, when you look at the difference, maybe it has also some I'm not an expert here. Maybe it's also the religious background. You know, Protestants are very. Yes, no, black, white, in my opinion. And I apologize if I'm wrong. Of course, if you are a Catholic, you can consider your sins and say I'm sorry and you get forgiveness. And maybe this is also in the field of drugs. If you use little nicotine or little cigarettes, it might be okay. So it's not so black and white. It's more grey. And maybe it's easier for us because most people nowadays agree if you cut down from 40 cigarettes to ten, it's a positive thing to do and do not need not to be punished. But you deserve some positive emotion that you are doing it. And maybe we also found out that people who were able to reduce, make quit attempts then because they have a first success and then they eventually in 2010, even if they didn't discuss it before, to say, well, maybe I tried to quit completely. And the same here is with vaping. Here we have the issue in Austria, this restriction of communication, because of course, we public health people we can talk about, but we lack the significant budgets to do it. And if the industry is not allowed to do it, who should who should inform the people? Of course I do not talking about big advertisements saying take this, take that, but good scientific information for the people because otherwise, for example, I like the examples of real love. I have a neighbour who is using e-cigarettes since four years. He also tells me he saves money and last time together at home I met him. We met a lady who took some deliveries and she told him, Are you using e-cigarettes as harmful as cigarettes? And I thought, No, it isn't. And so he also always has a lack of information. He always has to defend himself for doing it, which is bad. So we need a communication and we also have this bureaucratic way we have to overcome, which makes rules for the people, and otherwise they obey or they don't. And if they don't. So we have also similar situation in Austria. I've been totally to the US sometimes, but maybe it's easier to overcome it.
BRENT: Is there retribution from the government or the public health agencies if you don't follow their instructions?
ERNEST: Sometimes it's good that the population does not care to say they do what they want. And if they realize, for example, if you are a smoker with COPD and you take nicotine pouches or e-cigarettes and you realize it gets better, then you will continue.
BRENT: So but is that actually real science? I mean, do we find that the critics don't take that seriously? You could line up 100 people who had COPD and will testify to the fact that their vaping has eased that horrible medical issue for them. But yet it seems that the critics don't take that into any account.
ERNEST: No. Well, of course. I guess you always can say we need additional studies to prove it. And of course, we need long term observation. But long term observations are also a killer argument because usually you cannot say we should not use e-cigarettes because in we do not know what will happen in 30 years. You never know it in any innovation. So although we have many new medications in medicine and how should I know what happens if a person's 30 years later? So it was really enemies of innovation who reject this. And so and so we must come from the moment to the point of science, which is, okay, if I reduce the substances in it, then hopefully it also reduce the risk. And it would be quite logical that this happens. And we know nicotine itself is a relatively harmless substance. Of course it's addictive.
BRENT: Is it harmful?
ERNEST: And it's relatively harmless. Yeah, of course. And as another question would be, humans have always used psychoactive substances. As soon they realize to improve the mood, what would people use instead? So sometimes this smoking about this as what is this smoking activists, they simply focus on smoking. So and I would say from all the psycho active substances easily available, it might be comparable from the risk to coughing. And we do not talk about coffee and we just say how bad nicotine is and it's completely wrong. It's the delivery system, you know, when you have here, before here, I guess. But if you burn the cigarette or you produce it, depending on the measurements, 20 years ago we said 5000 substances, 30 carcinogens. Nowadays it's 75. Because again, of course, you have to question to what concentration is the amount of carcinogens relevant. But if you do not burn the tobacco, you save a lot of this substances and usually you can reduce it to two or three. And it would be quite and logical if this wouldn't improve the health of the people. And a second issue is all we did this question and Austria several times we have of our smokers, we have a smoking rate of approximately 25 to 30%. So we have a high smoking rate. And approximately 60% of them are not willing to quit or they cannot quit. And we must not leave them alone. We have to do something, offer them something, some substitution that they can choose.
BRENT: Can you choose to vape nicotine in Austria?
ERNEST: Yes, e-cigarettes are available, but they are restriction because it's regulated according to tobacco law, which is a pity because the based on this was the framework convention on Tobacco Control in 2002 and no alternative products have been available at the time. So we didn't have been there. We didn't even consider it. Besides of nicotine replacement, of course.
BRENT: Course, are there independent shops selling vaping devices and E-Juice and all that?
ERNEST: There was some conflict because we have our tobacconists, which are traditional shops, usually veterans from the war who got some disability, got them, who sell tobacco products. And then we have these little vendors and there was conflict even at the court. But the court decided even this little vendors can sell e-cigarettes.
BRENT: What about the kids or the kids all hooked on vaping in Australia?
ERNEST: We do not see many. We have no good data on it. I have to say honestly, maybe we should invest.
BRENT: Is the media scare in Austria focused on the kids?
ERNEST: Yes, always. It's always it's the killer argument. And it's like you tell people. So if you do not start, you do not have to stop. This is quite logical. But if it's the same, if someone you know, we have many s in Austria, if someone falls down the mountain, if he wouldn't have climbed it, he could not fall down. So yeah, but it's the young people, a real killer argument if you want to do something. And we did different projects also with schools and they were more or less successful. But honestly, nobody and nobody can tell me he knows exactly how he can prevent it. Young people start to smoke. The only thing we really found was the price of cigarettes. So we found that high prices prevents. We also did a new study now here and published it. So for our you can find it for free on the internet. Best things in life for free. And we see if the prices are high, then it prevents young people starting to smoke.
BRENT: So we're here at the Global Forum for Nicotine. Have you ever been to one of these events in person?
ERNEST: I have been at this event. I think it was before the pandemic and enjoyed it very much, really, because I have never seen this dynamic before and also this consumer groups, it was not existent before, really. It was I was really impressed because so to say, it was nothing in Austria at least less cool than going to a pharmacy and buy a nicotine gum. But now we have this dynamics that people, especially with e-cigarettes, they have some of them have even this specific way how they use the clothes. And it seems to at first I was not sure if it is good or bad, but when you when you look at the acceptance, it's good that the that it develops in this direction, of course.
BRENT: Have you noticed that within the debate over nicotine and the war on vaping, that there's quite a bit of a process going on where researchers and so forth are getting shunned from withinside the community?
ERNEST: Yes, we see this witch hunting, which is something which is really I'm not sure of the strategy. It's regrettable, it's shameful people for exposing people who have a different opinion. It's also undemocratic, so to say especially problematic in a country like Australia or Germany. You have to hear the other side before. And simply especially these activist messages are sometimes quite limited. So and it's always the same. So for example, tobacco industry is bad because it sells cigarette. Oil industry is bad because it produces oil. You can nutrition industry has sugar. So you do not need to know a lot to do this work here. And it's so simplifying and so, so banal sometimes and then saying, yes. And this person, I'm sure he took some money from something. So you should look if it took some money from someone, you should look at his work and what he has said and what is reasonable. Was he right? Was he wrong? And then you can discuss if it's wrong, you can say maybe he was influenced in an improper way…
BRENT: it seems that they believe. That. Research that is funded by industries that they disagree with is biased, whereas if it's funded by the government then it's okay. It's pure as gold, right? I find that these critics never take a look at any of the research that's churned out by the national systems.
ERNEST: Well, I would say I don't speak in my case now, but governmental fund is also very politically influenced, especially what is mainstream at the moment. And when you look at medicine, to be honest, without industry and industry research, we would have we still would be on aspirin, you know, and there would be no new medications. And yeah, I would be say I'm not a fan of capitalism, but it's the thing. It's the way things work today and how you can raise capital for different. And you also have the risk. And for example, we did a very big thing on smoking information with our chambers of 4 pharmacists. And I guess it was even the biggest thing in maybe Central Europe. And there was some critics and that was what the government did. Yes. Give me public money. I'm happy to do it with public money. But there is no so some things even would not take place if you do not get some funding for some form, some industry or something. So yeah. Yeah.
BRENT: Well, you know, my opinion on this after all these years covering this issue is that public money comes with its own set biases.
BRENT: That the critics of vaping products never seem to consider at all. So wrapping up the interview, let me ask you this last question. What do you see in the next couple of years when it comes to this war on nicotine? Is it going is there a path in which that this is going to ease up?
ERNEST: Well, it might not ease up. There might be even more polarization. But at the end of the day, it depends what the people do. And I guess the people will decide. And you cannot restrict the information for all the time, but it might need longer time if we are not able to tell the truth. The truth. Yeah. Yeah. And if we are not able to communicate it. But people, I guess in the end they will find out as they found out with smoking. Because when you look at cigarette smoking maybe and I guess also maybe every family has someone who suffered from smoking. You do not discuss it openly. Then you say it was the stress, but behind it. Yes, I know he smoked 60 cigarettes per day and it didn't help him. But maybe it needs longer. And I see this development we have seen in Sweden where people come to a surprisingly. A surprisingly low smoking rate and of course, the consumer snus and nicotine pouches. And I still have some morality issue because we have been in favour of the lifting of this new spend 20 years ago. And I always think maybe we could have nowadays a very similar development like Sweden, maybe not 5%, but maybe 15% of smokers. And how many lives could have been saved if there wouldn't be some moralists or people who didn't dare to speak up in some institutions because someone told me I'd done it. So the institutions understand, no, you are right, but I won't stick my neck out here. I have a good position and I want to keep it. How many lives could we have saved if we were able to implement this in Europe in a proper way?
Joanna: That’s all for today. Tune in next time, here on GFN TV or on our new podcast, for more tobacco harm reduction updates. Next Tuesday, Albert Chan consultant to FactAsia will tell us what’s been happening in Asia, in particular China, over the last six months. Thanks for watching - or listening! See you next time.