GFN 2025 Keynote #2 - delivered by Jacob Grier, hosted by Marina Murphy, response from Harry Shapiro - titled "Tobacco harm reduction and the media - evidence, narrative and consequences".
Jacob will highlight how, despite positive gains made by advocates for drug harm reduction, tobacco harm reductionists face an uphill battle to be heard, let alone get the evidence across. From outdated media narratives to prohibitionist policies and their consequences, he will guide us through the current state of THR and tobacco control messaging, and help advocates create compelling narratives that share the evidence underpinning THR.
Transcription:
00:11 - 02:06
[Marina Murphy]
So it's my privilege to introduce Jacob, Jacob Grier. He's a distinguished voice in journalists and tobacco policy. He has nearly 20 years under his belt on this beat. And his reporting has covered everything from smoking bans and harm reduction and innovation to the often unintended consequences of prohibitionist policies. So Jacob is the author of two critically acclaimed books. So The Rediscovery of Tobacco. and the new prohibition, the dangerous politics of tobacco control. So, today Jacob is going to talk about the disconnect between the, I would say, the positive evidence for tobacco harm reduction and products like vapes and snus and the fact that the media narrative remains stuck in the prohibitionist era of the 1990s. And of course, we all see this every day when modern nicotine products are effectively demonized by the media and journalists amplify or grossly exaggerate rare or non-existent harms like popcorn, lung, et cetera, and increasingly seem to be ignoring the fact that people continue to smoke. It's almost like they have forgotten that cigarettes exist and that people smoke and that people are dying from smoking. So today, Jacob is going to discuss how outdated framing and hostile media narratives shape policies and ask how we, as advocates, can build persuasive, evidence-based messaging that respects both reduced-risk products and consumer autonomy. So please join me in welcoming Jacob for Tobacco Harm Reduction and the Media, Evidence, Narrative and Consequences.
02:12 - 32:58
[Jacob Grier]
Thank you, Marina, for that introduction. It's really exciting to be here. As we mentioned in the intro, I've been writing about these things for about 20 years now, which is really hard for me to believe. And yet I've heard from people all over the years, am I going to see you at GFN? Are you coming to GFN? I've never made it, but this is the first year that I'm finally here. And so it's really exciting to meet many of you for the first time who I've known by email or Twitter before that got taken over in a terrible way and in other places online. after basically living literally and figuratively in the woods in Portland, Oregon, and away from most of the policy talk. So really happy to be here. So I come at this as a writer, as a journalist. I don't work professionally in the field of tobacco control or tobacco advocacy. And when I meet people outside of the field, and they ask me what I write about, and I tell them I write about tobacco and tobacco harm reduction, I pretty much always get the same question, and that question is, Why? Like, why would you write about that? And for people outside the field, they don't really think about this. And they don't think about smoking at all really anymore. And the reason is they probably don't know many people who smoke. They probably don't go to places where smoking happens. And so if they think about smoking at all, they think about it as a problem of the past and a problem that is pretty much solved. So the first issue that we have is just getting people to pay attention and to care about this issue. Now, we all know that ignoring this is wrong and honestly elitist. I won't belabor the numbers, but we all know them. In the United States, about more than 400,000 people die every year still from smoking-related diseases. It's more than 7 million worldwide. So this should be a hugely important issue. The issue is far from solved, but here in the West, people tend to think of it as already solved or it's relegated to people with lower incomes or in faraway countries, and so it doesn't get much attention. Simultaneously, though, we are living through a period of remarkable innovation in tobacco products and nicotine products. And we know if you've read the history of tobacco that these innovations can have really long-lasting effects that change the way people consume nicotine and also have dramatic health outcomes. So consider, I'm going to look back a little bit, at the end of the 19th century, cigarettes then were a really niche part of the market. The biggest tobacco product was chewing tobacco. Cigars and pipes were also really significant. But cigarettes were really niche, and that changed in part because of technological innovations. We'll name two of the most important ones. The first was automated rolling machines that made it dramatically more efficient to sell pre-rolled cigarettes. Prior to that, it simply wasn't practical from a cost standpoint or even a packaging standpoint to do that. And the second was flu-cured tobacco, which produced a smoke that was much lighter and easier to inhale deep into the lungs, which had dramatic consequences in many ways, one of them making smoking much more addictive, but also much deadlier because of the surface area contact with the lungs. So within decades, the cigarette completely dominated the market. By about 1920, their cigarettes surpassed all other forms of tobacco and brought about what we can now call the cigarette century and all the misery and death that that entailed. Now, these innovations were important, but they didn't guarantee the outcome. So initially, cigarettes faced intense cultural hostility as well. Even though tobacco use was generally accepted, especially among men, cigarettes were not. They were stigmatized. They were seen as personally destructive, uniquely addictive, really illegitimate. One history written in 1901 that was pretty much okay with other forms of tobacco said cigarettes were more like the compulsive craving for absinthe and morphine. Yeah. And people forget this now, but cigarette prohibition is nothing new. It was actually tried at the beginning of the 20th century. About 15 states in the United States had had some form of ban on cigarettes, specifically cigarettes. At that time, it was caught up in the same forever prohibition that applied to alcohol. All of those were repealed by about 1930, mostly because they were seen as unenforceable, but also because they were changing narratives about how people perceive cigarette smoking. For men, much of this was due to the First World War. It became really hard to delegitimize smoking when you had millions of young men on the front dying in horrible conditions. So where there was this intense hostility to cigarettes, There was a great quote, well, not a great quote for what it did, but a quote to know from General John Pershing, who was asked, you know, what do we need to win the war? And his answer was, I answer tobacco as much as bullets. And so, as if flipping a switch, suddenly the United States government was supplying cigarettes to soldiers, as were groups like the YMCA. Billions of cigarettes were sent to the front, and that was a huge part of why cigarettes became legitimized and surpassed all the other forms of tobacco use in the early 1920s. Yet a parallel change with women. Before that, smoking cigarettes particularly was not seen as acceptable for women. But as women entered the workforce and started claiming equality, cigarettes became a visible sign of that. The Atlantic Monthly, talking about press coverage here, they had an article in 1916. They described cigarettes as the symbol of emancipation, the temporary substitute for the ballot. And of course, cigarette companies were more than happy to encourage this perception, and they hosted events like parades through New York City with women carrying torches of freedom, as they called it, to legitimize smoking among women. So both these cases, the reason I bring them up is because technological innovation wasn't enough. It was a huge part of the story of why cigarettes became popular, but it had to be backed by changing cultural narratives too, basically saying that the people who wanted to smoke had rights, were legitimate, and had reasons to do it, and that it was culturally legitimate. So today, obvious parallel, we're in a period of innovation as well, this time on lower risk alternatives to address the harms of smoking. Now, most of us in this room are very frustrated that people who smoke are not switching to these safer products more quickly, and there's a lot of blame to go around for that. A member of the media here, I know many of you blame us, often justifiably. We can also blame governments that put in place overly restrictive policies, and we can also blame advocacy groups on the other side that demonize e-cigarettes or nicotine patches. And if you follow my writing, you know I don't hesitate to criticize any of these groups. But today I want to focus on a different angle, which is, you know, we're talking about media narratives, and to understand why they're often so hostile, I think we actually have to look back at the tobacco control movement itself, not just on the really hardline side, but also on the side that is often pro-harm reduction. So I'll give you a bit of an example. I live in Portland, Oregon, which if you don't know, we're a very, very liberal, progressive city. You might know Portlandia or a protest. And we're also one of the most liberal places in the world when it comes to drugs of pretty much all kinds. Oregon was one of the first states in the United States to legalize cannabis. We also recently legalized psychedelic therapy, meaning if you want to come to Oregon and take some magic mushrooms and talk to a therapist on the couch, we are the place to do that. We're very pro-alcohol in Oregon. We have an amazing wine country. We have 100 breweries within an hour of the city. We actually just had an ice cream shop opening, serving boozy ice cream, where each ice cream has as much alcohol as a beer. And if you think about the way alcohol and nicotine are comparatively demonized in the press with kid-friendly flavors, it's really remarkable to see the way boozy ice cream shops are welcomed in contrast to things in our industry. And we even recently decriminalized all drugs across the board in Oregon. Unfortunately, we also reversed that policy not long after, but we did give it a try. But there's one drug that even in Portland, Oregon, is too stigmatized to be acceptable, and that obviously is nicotine. So twice in recent years, I've gone to our county commissions where they had bills to ban all forms of flavored tobacco products and flavored nicotine products, so not just cigarettes, but also vapes, pouches, snus, et cetera. And hundreds of people showed up to these meetings, including the local press. And the takeaway I got reading the press portrayals of this was that they always portrayed it as an argument between two sides. And so one side were the public health advocates, the angels, there to say that we need this ban to protect the children. And the other side was convenience store owners and vape shop owners who were complaining about their loss of profits. And if you frame the argument that way, I think it's pretty clear who's going to win. And indeed, the prohibitionist side did win. It took two attempts, but it happened. So now, even in Portland, where I can buy candy-flavored weed, candy-flavored beers, candy-flavored alcoholic ice cream, but I can't buy a flavored vape or a flavored nicotine patch. You can even buy a regular cigarette. This is obviously a pretty irrational outcome. So when you look at this objectively, you look at the risk of a flavored vape or a pouch next to cigarettes or booze, we need to understand why this is failing, not just in places like Portland, but all over the place, liberal cities, conservative cities, states, countries. And there's two arguments that we're missing. One is obviously the argument for harm reduction, which we all know really well. We've talked about this all week. These get barely mentioned in the press, at least in the local press coverage. And when they were, they were always portrayed as industry talking points. The fact that there are many serious academics who are independent and public health authorities and regulators saying the same thing never registered in the press. But there's another argument also missing entirely, and that was because really no one was willing to make it. And that was the case for autonomy. No one was standing up to say, we shouldn't ban these things because consenting adults have the right to decide what they put into their bodies. The adults who want to buy these products, including those who are using them to stay off cigarettes, were completely dismissed. Their rights were never seen as even being worth considering in these conversations. And so what happened in Portland, to me, is a microcosm of what we're seeing internationally. Taking historical perspective, the big three products that have always been legitimized in the West would be alcohol, caffeine, and nicotine. There are psychoactive substances that we see adults are able to enjoy responsibly, but other substances get relegated to the realm of bad drugs. In recent years, we're gradually seeing that change a little bit. Cannabis has obviously gone up the ladder a little bit to be seen legitimate and more legal, starting to see it with psychedelics as well. But at the same time, tobacco seems more illegitimate, even switching places. So there's an English historian. If you came to my chat yesterday, I recommended everyone read more history of tobacco and other drugs. And one of the books I cited was Demons by Virginia Berridge. Has anyone read that? Hopefully. See if he nods. That's good. I'm going to read you a passage of hers because I think it's really worth considering. She talks about, she says, concept shift took place with new ideas about use and problem use applied to illicit drugs. While conversely, drug-focused ideas of addiction began to be applied to tobacco. So tobacco was changing places to become more like a drug, while drug use itself was becoming normalized and part of a wide spectrum of use in society. So from the 1980s onward, new ideas about drug use tended to see it as more normal, while tobacco smoking became seen as pathological. That's the end of the quote. It's pathological. I think this is worth resting with, because I don't feel pathological a few times a year when I decide to light up a cigar. I suspect that many of you who may smoke, or not smoke, but vape or use snus or pouches, you don't feel pathological when you do it. You didn't seem to be feeling pathological out on the vape balcony when I saw you yesterday. But that's how we're portrayed often in public health and by people in the tobacco control movement. So now I might venture into a little bit of controversial territory with some of you, but I want to suggest that if you want to understand why we have such a hard time advocating for smokers today, we have to look back at how narratives were shaped around smoking by the tobacco control movement for the past few decades, at least to the 1980s and back. And I'm going to start with smoking bans. And regardless of how you feel about smoking bans, talking in this sense about location-based ones, like in bars and restaurants, I want you to consider the rhetoric that was used to promote them. Because there were genuine reasons behind them, right? We wanted to protect workers in bars and restaurants from exposure. But that's not always how they were portrayed. So here's Stanton Glantz, someone you all know and love, talking in 1987 about smoking bans. He praised smoking bans for, quote, implicitly defining smoking as an antisocial act. Here's another activist from Australia. We should not underestimate the public awareness value of having smokers found guilty of negligent actions in all situations indoors and outdoors. Does anyone know about thirdhand smoke? You've heard about that? This is Jonathan Winokoff. He's a Harvard researcher. He popularized the idea. This is the idea that people who smoke have particles of smoke clinging to their clothes and their hair that are dangerous. He was in Scientific American in the New York Times. He said, smokers themselves are contaminated. Smokers actually emit toxins. Not long after this came out, there was a British journalist writing about this phenomenon of third-hand smoke, confessing that she had friends who smoke, and when she had a baby, she didn't feel like she wanted her own friends to hold her baby because of these particles of third-hand smoke emitting from her friends. So very dehumanizing language. And if you look at what the original purpose of smoking bans was, genuinely protecting workers from long-term exposure in bars and restaurants. They quickly expanded beyond that to restaurants, patios, parks, beaches, wide open golf courses, entire college campuses, even see advocates for banning smoking in privately owned detached homes. So in just a few years, we went from protecting workers to protecting families. Here's another quote from Jonathan Farley. He was a commissioner of health for New York City when he was testifying for abandoned parks. He said, families should be able to bring their children to parks and beaches knowing that they won't see others smoking. We will look back on this time and say, how could we have ever tolerated smoking in a park? There's a significant concept creep here from protecting workers to protecting people from the mere sight of someone smoking. These are the things I think about today when I talk to academics in advocacy for harm reduction, and they're incredibly frustrated, right? Because we know you have all this evidence on your side, and then you see the way the press portrays it, and you see government imposing very stupid policies, and you wonder, how the heck did this happen? Why can't we get our story heard? And like I said, there's lots of blame for this. But the one they don't talk about is the field of tobacco control itself and this long history of how they talk about smokers. And what I would tell you is it's hard to advocate for someone's rights when you've been calling them pathological contaminated addicts whom children need to be protected from in a public park. So let's go back to Virginia Berridge. She wrote something on this that I find very insightful. Another quote from her, she said, substances with widespread cultural legitimacy are not easily made the subject of stringent systems of control. But increased regulation in turn impacts on culture and helps to change it. That cultural change in turn opens the door to further regulation. It's an iterative process. So that's the end of her quote. But in other words, there's a ratchet effect or a slippery slope. So every time you put a new restriction on smoking or nicotine, you wound its cultural legitimacy, making it easier to pass the next one. Now, I'm not saying these are all unjustified. I flew here to Poland from the United States. I wasn't thinking, man, I wish people were still smoking on planes. Some restrictions have their use. But there's a danger in erasing the very idea of smokers and nicotine users as consenting adults who have rights of their own that we need to consider. And regrettably, this is the situation we've inherited from the past few generations of anti-smoking advocacy. Nicotine no longer has cultural legitimacy. It's hard to advocate for people to use it. Here's another quote. Historian David Cartwright wrote about the history of drugs at the turn of the 20th century. He said, and this is in his own opinion of smokers, this is him describing their cultural status, he said, tobacco is becoming a loser's drug. And so if we're succeeding as advocates of harm reduction, that's what we're up against, and we need to dig out of this hole. Now, you know this isn't easy, especially if you see how tobacco is portrayed in the press. And the way I like to describe this usually is that the wider public and journalists and a lot of regulators have a 1990s mindset. And I think the 1990s were a really formative era in how people think about tobacco and nicotine today. So let's take a look back on how tobacco was portrayed in the 90s. So everyone knew by then that smoking was incredibly deadly. But you had big tobacco using seemingly infinite resources to shut down every lawsuit. You had tobacco executives testifying in Congress that they didn't know if nicotine was addictive. In 1995, he had Christopher Buckley, famous novel, Thank You for Smoking, later turned into a great movie in 2005 with Aaron Eckhart. You had another great film in 1999, The Insider, with Michael Mann, showed the story of a big tobacco executive turned whistleblower who faced death threats for revealing what he knew. And that was the 1990s image of tobacco. It's a shadowy cabal of shamelessly dishonest executives hooking children on a product that's eventually going to kill them. And the image wasn't wrong. That's basically what the situation was up to the 1990s. And you'd be hard-pressed to name any popular media since then that's come out to change that. So to borrow a metaphor from a different 1990s movie, it's like our attitudes have been frozen in amber since then. But they're not right for the present moment. So the facts have changed, but the media narratives generally haven't. Cigarettes are obviously still as deadly as ever, but there's all these new products that we all know about here that are genuinely lower risk. And there's a lot of debates about each of these products and how they fit into the goals of harm reduction. But there's no real doubt that on an individual basis, they're all much safer than smoking. Now, this is obviously very different from the 90s and before. It changes a lot of the incentives, for one, for tobacco companies. They have incentives now to do demonstrably better science to show regulators that their products are safer. One of the rewards to doing this is also shutting down competition, but that's another story. But it also means we face different choices, like the choice up to the 90s. was you either tolerate smoking or you tolerate mass death. And in that context, prohibition is pretty appealing, even if you're pretty libertarian. That's hard to imagine. So it's not surprising that many of us support an endgame or prohibition, but today that's not the situation. We know that. We can try to shift people to lower risk forms of nicotine. So the good news is that the facts are on our side. If they weren't, I would hope that this would be a mostly empty room. So our first strategy is obviously to emphasize this credible research. The bad news, as many people have hinted at in the past talks here, is that having the facts on our side is clearly not enough. Media tends to find research less exciting than stories about the dangers of vaping. Journalists seek novelty. So if something isn't new, it isn't news. Millions of people dying from smoking isn't a story, but a few dozen people dying from adulterated vapes generates months of media coverage. You're all very familiar with the story of the Evilly epidemic, so I'm not going to go into it here, but it's a perfect example of what we're up against. Something I'd like to point out then was that about 20 times more Americans died every single day at that time than died over the entire course of deaths from evilly, these contaminated vapes, which most of you know are actually caused by illicit cannabis altogether. But it didn't matter, right? Because people, in America at least, don't want to hear bad things about cannabis, which is becoming legitimate, and they do want to believe bad things about nicotine, which is not. So this was summed up in a cover story for New York Magazine. Their tagline showed a woman vaping and it said, who thought sucking on a battery was a good idea? So the implicit gist of the coverage was that vapers were finally getting what they deserve for being so naive as to think that any kind of nicotine use could possibly be safe. And it all comes back to cultural legitimacy, another point of contrast. If you look at how CDC figures of excessive alcohol use in the United States, according to their figures, almost 4,000 young Americans die every single year because of excessive alcohol use. But you don't see calls for restricting flavors, for restricting seltzers, ice cream shops. Drinking is considered fun and normal. But when teen smoking falls to its lowest rates in history, which should be a tremendous press story, it gets barely any coverage. But a small uptick in vaping, again, a reason for endless coverage. So what I'd like to emphasize to you is that we do need to emphasize facts, but also change the way we talk about nicotine and tobacco use. We usually think about tobacco control as divided between two camps, between harm reduction, which is most of the people here, and also the more hardline end-gamer prohibitionist camp, and they often clash. really bitterly but there's one thing they have in common two things really that i think are worth pointing out one is that they tend to resist talking about the pleasurable aspects of nicotine and the second is that they favor a top-down technocratic technocratic approach to dictating for other people what products they should be allowed to use so as an illustration of the hardline side I'm going to quote from Robert Proctor, who's a historian who's done really fantastic work on tobacco regulation, but he's also very hostile to harm reduction and very pro-prohibition, or as he calls it, abolition. This is what he wrote in his book about harm reduction, quote, "'Talk of safer cigarettes is rather like talking about safer terrorism or safer smallpox or safer forms of drowning.'" And I think that's very revealing about the way a lot of activists and academics think about nicotine and tobacco. They see no redeeming value in it to begin with, and so it's seen as senseless to even try to make it safer. It should just be gotten rid of and society would be better off if it were gone. So they can't even acknowledge that people who do smoke or use other products are getting something out of it that's not just a chemical fix. They don't see any possibility of recreation. So Proctor, again, contrasts nicotine with alcohol, where he says, people genuinely like alcohol. Nobody really likes nicotine. So he says that we can end smoking with prohibition with, quote, nothing more than the stroke of a pen. Now, I think it's going to be a lot harder than that. It's a very old idea. You can look at King James or Murad the Cruel had the same idea. There's a reason Murad is known as Murad the Cruel. It was partly because of the way he tried to end smoking. By the way, his name in the early 20th century became the name for a cigarette brand, which tells you how well that worked out for him. You had Lucy Page Gaston, who dreamed of a smoke-free America by 1925. Then we have C. Everett Koop, who moved the goalpost to a smoke-free America by 2000. And then you have today's advocates of prohibition. Every generation of prohibitionists looks back on the past failures and says, this is the time it's going to work. Now, I think advocates of harm reduction have better ideas. But I'm going to end with a caution, which is to not pat ourselves on the back too much. And I'm going to give you a couple quotes from our side as an illustration. The first one is from Mitch Zeller, who was formerly at the FDA in the United States. And, well, I wouldn't say he did great things for harm reduction. He did, at least on paper, agree with it. And he wrote in an academic article, quote, how comfortable are we with long-term use of less harmful nicotine delivery mechanisms if they keep smokers from relapsing to combustible tobacco? Here's another one, Kenneth Warner, somebody I really admire, fantastic advocate of harm reduction, writing that Endgame Strategies. He said, while we struggle today with often widely divergent perspectives and beliefs, we all share the same vision of the final words to this story, the end. These two very thoughtful people. But I want to note about both of these statements is how they slip into the royal we very easily. There's this implicit assumption across all sides of tobacco control that the experts are the ones who should decide what other people are allowed to do. There's no sense that the right of people who smoke or vape are a constraint on their decisions. So in this mindset, vaping is a lesser sin at best. It's tolerated to prevent the greater sin of smoking, but it's still very much a sin. And the fact that some adults might genuinely want to do it is irrelevant. And so I think this is one reason that we struggle to make the case for harm reduction. If one side is advocating for absolute prohibition and all we have to offer on the other side is prohibition light, then we don't have a very compelling vision. And in practice, it often backfires. Once you give up the principle that it's okay to prohibit things, the wrong things often get prohibited, which is why we have states where, for example, flavored vapes are illegal, but flavored cigarettes or menthol cigarettes are perfectly fine. So we have to change this narrative. And the suggestion I'm going to leave you with is that we push a simpler message that resonates across the political spectrum, not 100% consistently, but people do aspire to it, which is that consenting adults should be free to make their own decisions. Some of them are going to use nicotine, and they should not be denied the right to access it in its safest forms. Now, the corollary to this is that prohibition tends to fail or produce unintended consequences. We know this story very well in America. We amended our Constitution to prohibit alcohol, then amended it back 13 years later when it didn't work. It's taking us longer to roll back our disastrous war on drugs, but we're making progress there, too. And even with the milder forms of prohibition that we have on nicotine and tobacco now, we can point to really vivid stories about how it's going wrong. Sorry, Fiona, we can all point to Australia. We can point to more than 100 arsons taking place at convenience stores and retailers. 130 now, yeah. It's hard to keep track. of so many arsons taking place in turf wars by criminal gangs to seize the illicit market. And we can talk about, in our case, Massachusetts, which was the first state to impose an across-the-board flavor ban. We just had our first case there that I know of where a seller of vapes was not only arrested, but also sentenced to six months in jail. And cops actually did a stakeout on his store. And they saw him selling flavored e-cigarettes out of his car outside the shop. And because those weren't taxed, even though the act of selling them was a misdemeanor, selling them untaxed was a felony, he's now behind bars for six months. And that's not the only case. There are many others going along. So this can be very dispiriting to advocates of harm reduction, but I want to end on a couple notes of optimism. One is that many people don't want that. If we can confront people with the reality of arresting vape sellers, we can turn them against the ban. A second point of optimism is that the 1990s mindset is finally fading over time. And this is a risk and an opportunity. The risk is that younger generations don't really have any visceral experience with how truly dangerous smoking is. And so there's a risk that cigarettes could be glamorized again. And there was a really interesting story in the New York Times about this just last week, about cigarettes once again appearing in music videos and movies. And if you came of age in the 2000s, there's a good chance that you don't have any family experience of seeing what smoking can do to people. So that is a danger. But I think there's also an opportunity here, which is that younger generations will be less culturally biased against nicotine per se. So they might be more open to evaluating different products based on their actual risk, and they can see the success of harm reduction in other areas, such as providing condoms and sex education, or providing safe injection sites, needle exchange programs, and Naloxone. So they might be nicotine less ideologically and more pragmatically. So if we can bring attention to the still urgent problem of smoking, we can make a compelling case for safer products. And a big part of that is responding to media alarmism with credible science. We should never stop doing that. But ultimately, we should always approach the problem as liberals. And the aim of a liberal society is to give people space to pursue their own ends, not to insist that they conform to ours. So we can hope that they don't smoke, and we can encourage and inform and tax and persuade. But we should always do this in the context of centering the individual and respecting their liberties, approaching them as equals to be persuaded rather than as degenerates to be controlled. So if we're afraid to assert the rights of consenting adults to make their own decisions, we surrender one of the strongest arguments on our side. So that's what I'll leave you with, and then I will hand it over to our respondent.
33:14 - 51:57
[Harry Shapiro]
Okay, thank you for that, Jacob, which I kind of assume is sort of the libertarian view of tobacco control, to kind of summarise. So, I just want to consider briefly what the general political view is about the idea of the voice of the nicotine consumer. What might that political view be? It might be something like this. Excuse me? What are you talking about? What do you mean, people coughing? I mean, is that the voice of the nicotine consumer? I just don't get it. You know, you buy the product or you don't. You know, it's your money, your choice. And if you don't quit, you might die. Again, it's your choice. It's simple, isn't it? Well, no. Not quite as simple as that. Certainly not since the advent of a whole range of safer nicotine products. And it's not simple when, again, to repeat the figures, you've got 80% death and disease from smoking in the poorest parts of the world. And not only if that metric isn't big enough for you, there's the whole of the rest of the world to consider amongst all the groups whose smoking rates are far higher than the smoking rate in the general population of any particular country. So we're talking about people with drug and alcohol problems, mental health problems, First Nation people, LGBTQ+, a whole range of different groups who, apart from general populations of the poor and people who are disadvantaged for whatever reason, They need to have much more of a choice than they currently get. And what it boils down to is the universal right to health. This is in the WHO founding chart in 1948. And universal, folks, means everyone. Whether you actually like what they're doing or not, whether you approve or you don't approve of drug use or smoking, whatever it is, everyone's entitled to the right to health. But for that consumer voice to be heard more than it often is, at the very least, we do have to try and shift the current narrative. and modify the direction of travel we're going in at the moment, which is something you've heard already in this conference and you will no doubt hear it again before you go home. But it's no easy task. As Jacob pointed out, since cigarettes became okay as a result of the First World War, You've got over a hundred years now, not only of cigarette smoking, but over all that time, economic, political, cultural and social superstructure has been built around cigarettes. That very simple act of taking a few tobacco leaves, rolling a bit of paper around and setting fire to it, That has been a very difficult shift in terms of actually trying to move away from smoking. And what that is matched up against is barely 10 years of a reasonable range of safe and nicotine products being available to, by no means, the whole world. So that is a big challenge. So what does changing the narrative kind of look like? Well, it's complex and it's politically sensitive. Mark Tindall yesterday in the opening session talked about ideology and Jacob has kind of underlined that whole business about the ideology around smoking and tobacco and the people who use them. There's a huge misunderstanding of risk. There's historical mistrust of the industry. And there's institutional inertia, again, something Mark mentioned yesterday, groupthink, a resistance to change, and the threat of change. Quite often when people write about tobacco harm reduction, they talk about disruption. And I don't think we should underestimate just how seismic that disruption has been in a very relatively short space of time. Not just to industry, but to professional academic bodies, medical associations, doctors, health professionals across the piece, and legislators as well. Because life back in the 90s and before that used to be so more straightforward. You had all the good guys and girls over there in white coats and stethoscopes and over the other side you had the bad guys in suits and fat cigars sitting in boardrooms making a huge amount of money. So what does any kind of modified narrative look like? I'll be the first to admit that as soon as you mention the phrase evidence-based, people start falling asleep. That's almost a given. Be that as it may, it is the foundation stone of everything we have to say about tobacco harm reduction. An evidence base that comes from credible and independent sources. We need to be talking about relative risk, not just risk. It's relative risk, and so many academic papers conveniently swerve around the idea that we're talking risk that's relative to the dangers of smoking. We are also very much adult-focused. We hear a lot about teen vaping and all the rest of it, but what we're concerned with is adults in this space. And the other thing which is important to emphasise is that tobacco harm reduction products and interventions are complementary to current mainstream tobacco control measures. They are not posited to be in opposition to it. So we're trying to reframe the public conversation. Like I say, we're helping adults to quit smoking. We're not encouraging young people to switch or do anything. We're just focused on adults and that situation. It's all about reducing harm. And it's not about denying addiction, which is something I'm going to come back to. And again, it's about health equity, what's actually fair as far as the world of people who have succumbed to disease from smoking. And there are certain comebacks that we've got. We can say supporting tobacco harm reduction is not the same as supporting the industry. We can say that science doesn't become false just because someone you dislike happens to agree with it. But maybe the killer question might be, what would it take for you to support tobacco harm reduction? And the answer that might come back is, well, industry has just got to step aside. Just industry out of the way of this. And you say, OK, all right. How about this then? So all the guys with big cigars and shiny suits in their boardrooms decide, the big tobacco companies say, look, this is ridiculous. We're damned if we do and damned if we don't. Let's just get out of this. We're making shed loads from cigarettes all over the world. Just forget it, right? And then some economic meteorite lands in the middle of the vaping industry. And they all collectively decide, nah, we've had enough of this. And they all disappear. They all get into pharmaceuticals or cryptocurrency or AI or anything that isn't, you know, vapes or heated tobacco. And the only outlet now for safer tobacco products are the car manufacturers. So if you want to vape, you've got to go to your Renault dealer or Toyota or Ford or someone like that. And the point about that is it doesn't matter who's producing the product. It doesn't change the evidence. And so your respondent might say, well, yeah, all right, okay, good point. But hang on a minute. Hang on. Nicotine is still addictive. It doesn't matter where you buy it from or who you buy it from. Yeah, okay, fine. Addiction's not the best thing. word to use here. Even the WHO don't use addiction when they're talking about writing about drug problems. They talk about drug dependence. In the 1950s and early 60s, they even called smoking a habit and didn't even call it an addiction or a dependency. But okay, the public narrative is addiction. All right, we'll go with that. Are you seriously telling me that you're lining nicotine addiction up against or in line with drug addiction, alcoholism, gambling, those sort of addictions that cause mayhem and misery to individuals, to families, and in relation to drugs, whole communities. Are you really saying it's the same? And they might go, maybe, okay, all right, but no, no, we don't like nicotine. We're not interested in addictions. We want a nicotine-free world. Okay, in which case you politely make your excuses and leave because you're not going to win that argument with certain sorts of people. But we do want a relentless focus on evidence. And we know about the poster countries out there. We know about Sweden, and Norway, and the UK, and Japan and New Zealand, and hopefully the others may follow, Chile I think as well, Philippines. And you bundle up the evidence from those countries and you've got improving health, you've got government endorsement, and you've got falling cigarette sales, particularly in Japan. So maybe what we should be doing, and I'm sure many of you do this anyway, is kind of working at the middle and not at the edges. So, as I mentioned, you're not going to win with the sort of dyed-in-the-wool ideologues. But nevertheless, we do need to carry on calling out the bad science. And when I went back to my room last night, in my email box was an announcement from Professor Ricardo Pelosa, who just had an editorial published in the Journal of Internal and Emergency Medicine And in that he detailed all the flawed science in meta-analysis when it comes to e-cigarette research. Essentially the message was you put rubbish in, you get rubbish out. And in this room now we have a number of people who are very good at calling out bad science. They can spot crap methodology at 100 metres. And they write to journal editors and they get letters published. As we heard in the oration last night, retraction is possible, but rare and complicated, but it can happen. But beyond that, there are legions of undecided health professionals. An outcrop of the disruption that I was talking about is a huge amount of confusion and doubt about whether health professionals should be recommending these products, assuming they're even available, of course, but recommending these products to people who come to them who desperately want to quit smoking. Maybe they've tried NRT and that hasn't worked either. And they're there to be spoken to, and I'm sure that's happening already. There are policymakers who respect pragmatism and understand the universal right to health. But crucially, and this again plays to what Jacob was talking about, believe it or not, there are journalists who actually do want to write a balanced story. They do exist. Now, I've been spending the last 40 years, most of my professional life in drugs and drug addiction, talking to journalists about that very subject. And in the UK, and I'm sure elsewhere, the government will come out with a proposal. And the journalists know who to go to for a blood and guts, tub-thumping support for whatever that particular proposal happens to be. And they'll know the people to go to if they want to hear a very opposite view. It's awful and terrible and should never happen. But a lot of journalists want what I would call a helicopter view. Someone they can talk to that will actually give them some sort of balanced response. And that's really been the NGOs I've worked for and me in particular because I've been Director of Communications for two or three of these charities over the years. So I kind of created what I called a demilitarised zone in the war against drugs. It's the DMZ. And in the DMZ you will get a balanced view about whatever it is that's been proposed. it's a bit more difficult with tobacco harm reduction because at least from an evidence point of view it's pretty much all on one side there isn't there isn't really a sort of on the one hand this and on the other hand that when it when it comes to the evidence current evidence base tobacco harm reduction however you can if you're talking to journalists you can acknowledge concerns rather than just simply dismiss them as nonsense you can acknowledge The concerns about teen vaping. You might also point out that in the USA, teen vaping has gone down 70% between 2018 and 2024. You might also express, you might acknowledge concerns about, you know, what about these products in 20 or 30 years' time? And you can say, okay, fair enough. But on the other hand, just because we don't know everything doesn't mean we don't know anything. There's a sufficient medical evidence base now that says health professionals can, with a high degree of certainty, be recommending these products because there's plenty of evidence out there that they help people go on the exit ramp from smoking. So the environmental impact of disposables, well, yes, that's a concern. But on the other hand, have you seen the figures for the amount of pollution caused by cigarette butts that are not biodegradable, which we don't actually hear an awful lot about. But I think the other point about of dealing with the media in this respect is you need to emphasise when you're talking about risk, it should be expressed at a population level. Because the journalist who wants to find the vapor with popcorn lung will find them. They'll find the vapor who was vaping cinnamon or whatever it is, caramel-flavored vapes with diacetyl in it before responsible manufacturers took that chemical out. They will find the 17-year-old vaper who's been vaping since he was 13 and can't stop. They will find that person. You might also then point out that, again, in America, official figures, less than 1.5% of teens who vape actually vape on a daily basis. You might also add that most of the research suggests that that small group of vapers would probably have been smoking had they not been vaping. You might not win that particular sort of argument, but nevertheless, it's there to be expressed. So it is a question of, like I say, it's what actually happens to most people, not what happens to the small few, like the Ivali incident that Jacob mentioned. And there are examples where consumer voice has been heard. In the UK in 2010, the agency that regulates medicines recommended to government that within three weeks they should ban babes. They got hit with 1,200 consumer responses that completely flooded the place and their proposal was dropped. More recently, last year, the European Tobacco Harm Reduction Association had a meeting in the European Parliament with members of the European Parliament. They sat down in the same room and had a discussion. So I think there are little victories going on all over the world. And we heard a certain amount of optimism about what's been happening in Thailand. Seems to me that in Latin America, which is a very challenging environment for tobacco harm reduction, there's quite a lot of vibrant group activity going on. When it comes to politics, I suppose I would class my default position as cynical, pragmatic realist. On the other hand, I think more generally that the more the narrative can be shifted, changed, modified, the better chance for the future of consumer advocacy. Thank you very much.
52:06 - 53:36
[Marina Murphy]
Thank you both. Does anybody in the audience have a question before I... interject no um so we've heard uh phrases like evidence base and media a lot and when i hear media it you know it's a trigger word for me because i used to be a science journalist And when I was a science journalist, it was about 20 years ago, which for me seemed like the golden age of science journalism, almost, because you had things like the human genome was sequenced for the first time, and Dolly the sheep was cloned, and there was even a Korean guy who claimed to clone a human child, but of course he was found out to be a fraud. But anyway, it was very exciting, I thought. So you didn't have to make shit up. There was just like amazing stuff going on. But now, for me, it almost feels like if you're a science journalist, there isn't that same source material. So it's almost like science journalists are making stuff up. And, you know, when you talk about vaping or nicotine pouches, the stuff that we see and the things that we know, you're looking at it and you're like, that's not true. So I often think, are science journalists or health journalists, are they just bored?
53:40 - 57:04
[Jacob Grier]
I mean, if that was a question for me, I would say boredom is maybe part of it, but stress and underpay is also probably a big part. If you're in this room and you don't make your living as a journalist, count yourself lucky, because there has been an absolute bloodbath in jobs in the journalism field. And at the same time, pay rates as freelancers have not gone up. I mostly get the same rate as a freelance writer that I did when I started in 2008. So it's obviously very difficult. There's a lot we could talk about there. So I'm going to give a couple pieces of advice here, because there's a lot of temptation to criticize the media in our field, rightly so. And I hold myself to the same standard. I've been unduly harsh perhaps a few times in responses to articles that have come out. But I would urge you to understand where journalists are coming from. A lot of the times, especially if it's local media, they may have absolutely no experience in this field at all. Like yesterday they were covering the dog show, today they're covering vaping, and they gotta cover something else by 5 p.m. And those circumstances, you really can't have high expectations. And the other thing I would urge people to do, because it's a novel topic, and like Harry said, it's not always clear who to turn to. Like if you were a journalist in the 1990s covering a new study about how cigarettes were terrible, it was pretty clear who you talked to. You called up the people who wrote the study, and maybe you called up some public health experts, and you called up Big Tobacco. And you didn't call Big Tobacco because you thought they were going to be honest and level with you. you called them because they had scientists on their team who were going to poke every hole in that story they could. And in that sense, they had almost a watchdog role. And now it's a lot harder. Like Kerry said, it's hard to know as a journalist who to talk to about this much more complex landscape. So what I would say is if you see a journalist who writes a story that you don't really like, before you lash out, maybe at least send them a polite email and give them a chance to be honest and open-minded. Maybe they won't. Give them the chance at least once. And the other thing I'd say, the bias that I see in a lot of journalism, and I'll call out an American publication specifically on this, which is Vox. And I actually really... I have friends who've written for Vox. I really like Vox. I think they have some really smart writers, but they do have this very technocratic mindset. And so there's articles that they wrote, I want to say around 2015, when Australia started implementing plain packaging and putting very graphic warning labels on boxes. And they covered this in this... very excited fashion. We were like, this is the idea that's going to end smoking in Australia. This is an incredible idea to put something in a plain box. And it was, one, it's amazing that they thought that just yelling at smokers harder was going to solve the problem. And two, that something as simple as changing the color of a box is hailed as this great idea, but these amazing technological innovations that are happening with nicotine are ignored or demonized. So almost that technocratic mindset, I think, is the bigger issue we're up against.
57:04 - 62:55
[Harry Shapiro]
Hello. Is this working? Yes. There's a few things to say about that. I mean, we heard last night in the really very good oration just what a car wreck academic world has become in terms of what you're expected to do in terms of funding and teaching and writing and the pressures on publishing and how the universities and the academic institutions, they look for novelty in terms of the research that you are doing. So if you produce a paper that says, yeah, on the one end this and on the other end that, it's not going to get very far. It probably won't get out of the university, let alone anywhere else. But what tends to happen is that, and there's a few examples of this from the drugs world, that researchers are quite often cautious in their conclusions to what they write. But then it gets to the university press office and they look for something that they can make a story out of and they write their press release. And then it goes to the media. So there's a ramping up of novelty and sensationalism. So by the time it gets into the newspapers, you know, if you vape you're going to grow an extra pair of feet or something or whatever nonsense they come out with. But I think the other point that you make about, especially news journalists, who, like you say, one minute it's a volcano eruption somewhere and next it's, you know, dealing with gun control in America or something, and then they get put on the vape beat and there's a new study come out and they need to... find out about it. And they are desperate to talk to people who can actually give them A, something they can write about. So, yes, they could go to the Parents Against Everything and get a good quote from them. But if they're in any way serious, they will want, again, this sort of balanced view. And I've got umpteen examples of how that's happened. But, yeah, I think... It's interesting, really, because what Jacob is talking about, about writing polite emails to journalists and saying, I think you might possibly have got this slightly wrong, does speak to the fact that there is a tobacco harm reduction voice. It doesn't necessarily have to reside simply with consumers. In a way, we've all got a level of responsibility to... to and and it and it happens i mentioned about about the people who have got sufficient knowledge and expertise to be able to to shout down a dodgy scientific paper so i think there's there's a lot of voices going on within tobacco harm reduction community if we can put it like that just targeted at different targets and what's kind of probably still missing is that is the voice aimed at the media. Because I think, to be honest, unlike the drugs world, I'm not sure where. If I was working for the Financial Times, I wouldn't particularly know who to go to now, who are the people you want to talk to, to give you a balanced view on tobacco harm reduction. I don't know, because most of the people who pipe up about this are clearly anti. I do speak to journalists on this subject from time to time, but nothing like as often as I would imagine I would be given the amount of coverage that this subject gets. So there seems to be a bit of a vacuum here in terms of balanced, reliable outlets for journalists to approach. Now, I think there is also a problem here about... I was saying earlier in my thing that just because you support tobacco harm reduction doesn't mean you support the industry. The problem that we've got in this space... is we've reached a point in many cases where simply to support tobacco harm reduction is by definition supporting the industry, which never happens within drugs. I mean, nobody's ever accused me of supporting big heroin when I talk about drug problems. But it is, you know, more than just the elephant in the room, unfortunately. And very little you can sort of do about that, except beating on about the evidence base. It's saying, well, OK, you know, go and have a look at the documents that have been put out by Public Health England, by British Department of Health, and medical associations across the world, New Zealand, even in Australia. And in America, going back quite a long time to talk about the benefits of having non-combustible products. You don't have to believe me if you think I'm somehow some shill for big tobacco. So it does make it kind of more complicated, and that is a particularly hard narrative to shift, I think.
62:58 - 65:51
[Marina Murphy]
You just used the phrase, scientists are cautious. Yes. And I think that at one time, and it was my experience as a journalist years ago, that serious scientists looked down their noses at scientists who courted the media. at the time. But I think that that has completely changed because there's so much more pressure on scientists to, basically to be in the media, to get attention and be part of this like attention economy. So, you know, they're incentivized to, you know, go for sensationalist headlines. And I think the journals have a lot to answer for in that regard. Because if you look at the data and the research, you will see that there is a direct link between media coverage and citations. And so you have citations, you want a bigger impact factor, you want more subscriptions, and at the end of the day, you want more money. So, you know, it's very easy to blame journalists. And, you know, when I was part of the, we'll say, science media... you know, group in the UK, I was one of two people who actually had a science degree who was covering science. So, you know, it's a lot to ask for a journalist to understand, you know, a complicated paper. And they are dependent on the journals, the press offices, and the scientists. So, you know, I think there is more blame to go around, I would say, You know, because we do talk about the media a lot, because it's important, because it's a sad state of affairs, but most people get their scientific information or their public health information from the media. And that's regardless of whether you're a GP or you work in public health or you're a politician, unfortunately. So it's really influential. But we're always hard on the journalists, and we should be, because it's their job to do it right. But I think there is a whole pipeline issue from the source, which is the scientists who are doing the studies, collecting the data, the journals who are publishing the data and notionally having it peer-reviewed by people who are supposed to take an educated view on this, And then it trickles down to the end and then presented to the politicians, the people who are advising smokers what they should do, and every man.
65:53 - 66:44
[Jacob Grier]
I would add to this that going back to what I talked about earlier about a lot of people, including journalists, having a 1990s mindset. One of the problems is that journalists are very attuned, especially on tobacco issues, to looking for financial conflicts of interest and industry conflicts of interest, but not ideological conflicts. So if you think about the 1990s, this pretty much made sense. You didn't think about, oh, are they ideologically opposed to smoking? Of course they're opposed to smoking. Who wouldn't be? And on the other side, you're looking out for all of big tobacco's influence. And that's just a lot more complicated today. I don't think journalists know to look at both researchers and other activists about what are their ideological priors that they're bringing into this discussion of harm reduction, and that gets overlooked.
66:47 - 66:50
[Marina Murphy]
Does anybody have any questions or anything they would like to add?
66:50 - 66:52
[Jacob Grier]
I know there's questions out there. Come on.
66:58 - 67:46
[Kai-Jen Chuang]
Thank you. I'm KJ from Taipei Medical University. My question is from my friend. She doesn't want to show up, so I ask a question for her. Journalists in Taiwan are very busy and are often assigned to report on topics they don't understand, such as THR. So journalists also interview experts who don't understand THR to comment on THR. So THRI in Taiwan now is joke, is lie from typical company, is evil in Taiwan. So as a result, the wrong information is passed on, plus wrong information, plus wrong information. So for this kind of situation, do you have any suggestion for our journalists in Taiwan on this matter? Thank you.
67:49 - 68:38
[Jacob Grier]
I think it's a great question. It's a problem everywhere, and I don't think there's an easy fix to it. I think maybe the best... thing you can do if you can predict who the people, who the journalists are who will be covering this beat is to try to develop a relationship with them and be proactive about reaching out before they write the story. And this is a problem we face all the time where a new paper comes out, it's embargoed, journalists have all covered it, but we don't even know that it's in the works and so we don't know to reach out. And so I think the The only way around it is just try to be proactive, find out who those journalists are, and be ahead of the curve on offering yourself as a source for them so that they know to come to you before they get around to writing the story.
68:41 - 71:21
[Harry Shapiro]
Yeah, it is... I mean, you were talking about the... I can't think of the right word here because I haven't got my tongue around it. But the problems that there are in journalism these days in terms of, you know, the numbers of people who aren't there anymore. I mean, it used to be, certainly in the UK, you know, that Home Affairs editors of various newspapers... I mean, you knew who they were. They'd been in post for yonks, you know, and you could phone them up, you could talk to them. They would talk to me. I was... I get calls from people who I'd spoken to before. I still do from time to time. But it changes so much that you are in response mode most of the time. You're responding to something that's happened out there. But I think it is a question of building relationships and building trust. Even if you don't particularly know... You've only got one journalist contacting you. And they say to me, can I keep your number on my phone? I go, yeah, fine. Here's my email address. Here's where I live. You can come around and walk the dog. Any kind of way of building relationships with people that you, I wouldn't even say you necessarily trust, but if they think they're going to get a decent response from you and you're not going to brush them off. I mean, I remember, it's meeting the media where they are. I remember back in the day when I was working for the Institute for the Study of Drug Dependence, before I decided this is about, we've got to do something about media engagement. the powers that be there ran a mile from journalists because they instantly thought they were going to get stitched up and misquoted. So a journalist would phone up wanting a quote on something and the response would be, fine, we'll get back to you in a couple of days. It's like, what? No, you can't do that. You know, they've got deadlines. So you kind of, without being bounced into things that, you know... make mistakes or come out with stuff that you didn't mean. Always remember that a journalist is always on the record. Always. So you do have to be, you know, and you can start a conversation if you think you're going to get into deep water. you can always start the conversation as, I need to emphasise that this is off the record. Because if you don't, then you're going to be on the record by default.
71:21 - 71:30
[Jacob Grier]
And I would add to that that the journalist has to agree to that too. You saying that it's off the record doesn't make it off the record unless they also come back and say that.
71:30 - 76:01
[Harry Shapiro]
That's absolutely true. But like I say, you've got to be where the media are without being bounced into things. And the trouble is there is this churn in journalism. So the good journalist you spoke to one week might not be there the next month. But it is about trying to build relationships with people. And if, as Jacob said, if you do speak to a journalist and you give them a reasonable story, a reasonable quote, a reasonable context, then they completely mash it up and you read the story. Because the other thing that's important to do, which usually this gets volunteered from the other side, particularly from feature journalists who are writing articles for magazines. It's a bit harder with news journalists, because they're on a really tight deadline. But they will often send you copy. You rarely get copy to sign off on, I have to say. It's normally going to be after the event. But if you do get the stuff back and you read it and you think, hmm, not massively happy with this, there's absolutely no reason why you can't go back to them and say, look, you didn't quite get that right, did you? In the way that Jacob just said. Because they know if they want to come back to you with another story, and this is a very... fluid world we're living in stuff happening all the time they know if they're going to come back to you they need to get it right this time because you won't speak to them again in the future one or two people I've come across like that who I just don't want to speak to anymore because fortunately that hasn't happened for a while but it can happen so there are sort of techniques and workarounds when you are dealing with the media, but you've just got to remember who you're dealing with. They're looking for a story, and some journalists, like I said, you know, they will... In our space, they will go looking for the, you know, the teen vapour and the popcorn lung victim and all the rest of it. And I suppose the other thing to... The other trap you can fall into, which I just mentioned, is when they say... Aren't you concerned that blah, blah, blah, blah, blah? Because if you say no, then it's like, you know, Harry Shapiro doesn't think that teen bathing is a problem, or Harry Shapiro doesn't think this and that. If you say yes, then Harry Shapiro is desperately concerned about blah, blah, blah, blah, blah. So the concern argument is... A bit like politicians. A politician has got a very clever way of not answering a question. So you put a question to a politician and they'll say, that's a really good question. But the main point is, and then you answer something completely different that you want to answer. And you can do that here. Like I said, you can say, isn't it terrible that this little kid up the road... It's been vaping for God knows how long. You say, yes, yes, this obviously isn't... We don't want any young people to vape. But you must realise another important point here is this. So you can always take a deep breath with journalists. The same... There's two things about broadcast journalism. One, if it's pre-recorded, you can always get them to do it again. If it's live, they can't stop you. So live has got its traps as well, because you can suddenly open your mouth and put your foot in it. So you've got to be careful with live. But you can, and you hear it all the time, journalists, you can hear a journalist on broadcast, trying to stop you from speaking. I mean, it hasn't actually happened to me, but... Because I know when I see them begin to twitch, you know, it's about time you stopped. Stop talking. And quite often, you know, you start doing a pre-record. The other thing about pre-records is they will record a lot longer than you actually get in the final cut. So I could be sitting with a journalist recording me for, like, 10, 15 minutes... And when you actually hear it, you get to the end of a sentence and that's it. It's like, well, thank you, Harry Shapiro from Drug Boys. And you think, hang on, I said a heck of a lot more than that. But of course, they've got three other people that are trying to cut into a 10 minutes long.
76:02 - 76:04
[Marina Murphy]
And we only have 10 minutes left. We only have 10 minutes.
76:04 - 76:09
[Harry Shapiro]
So I'm now going to, because Marina has just twitched at me, I'm going to shut up.
76:09 - 77:24
[Marina Murphy]
I'm twitching, I'm twitching. So the other thing I wanted to pick up on was you've mentioned cultural legitimacy a couple of times. And that kind of makes me think of, we'll say, for example, Tesla. So not very long ago, Tesla was considered to be a symbol of environmental progressivism, etc. So now we know where that has gone in the recent past. So I suppose my question is, or my thought is, what could potentially happen with, we'll say, products like nicotine pouches? Because, okay, so vapes, you know, everybody love to, you know, be down on vapes, but nicotine pouches is the new news, right? But also I think the potential, like has massive potential, it's as close to an NRT as we have got so far with these consumer products. So as far as cultural legitimacy goes, what are the dangers that you see, potentially?
77:24 - 79:39
[Jacob Grier]
Right, this is very dangerous. And I think we're going to get into a very particularly US context here that may not apply as much elsewhere, so apologies for that. especially in the US, but also elsewhere. There's been a lot more polarization on everything, a lot of political sorting. So the kind of coffee you drink is politically polarized. The kind of car you drive is politically polarized. And we self-sort in all these various ways. And we can see that happening now, I think, on tobacco, which nicotine and tobacco have always had a little bit of a right coded perception. And I think there's a danger now because you've seen people like Tucker Carlson, for example, or Marjorie Taylor Greene get really behind Zinn. And when their political democratic leader, Chuck Schumer, came out very much against Zinn, and so people on the right reacted against that and said it's time for a Zinn-surrection. And I understand that if you're pro harm reduction, you take what allies you can get. And so you may be tempted to say, oh, this is great. We finally got people on our side. But I would warn you, I think you also don't want nicotine pouches or vaping to become the next Cybertruck. Because that is suddenly something that used to be positive or at least neutral to have an electric vehicle. Now, if I get picked up, like we talked about, if I get picked up in an Uber and a Tesla shows up, I'm like, oh God, I don't want to be seen in this anymore. So I think we do need to be careful about that. And I would urge people to put, I said yesterday, we should always write for a skeptical audience and we should try to get the best, smartest people on our side, which I guess I'll show my political leanings here. I don't think that's Marjorie Taylor Greene and Tucker Carlson. I think harm reduction advocates deserve better advocates than that. So I would warn against that. We need cultural legitimacy, but don't let it get polarized, and that's a tight balancing act. And don't immediately run to the right just if they happen to be the side that seems more welcoming right now.
79:44 - 82:19
[Harry Shapiro]
The only thing I would say about that, at the risk of getting beaten up by both sides as I leave the room, is that it strikes me that there is a kind of ideological split in the general tobacco harm reduction community. There are people who see this, and I think you're probably one of them, as this is basically consumer choice. I've got the right to put into my body what I want, and you really haven't got much right in terms of stopping it. It's a libertarian perspective. And that tends to be, I don't know if this is right-leaning or not, I'm not sure. I'm not sure it's quite so polarised politically. It's just a kind of view of the world, maybe outside of America, I don't know. And the people who see this as a human rights issue tend to be more on the kind of sort of left-liberal side, I suppose, if I can put it like that. which doesn't mean, you know, near the twain shall meet, but I think it is, and you're both, thing is, it doesn't actually matter. There is a bit of a split like that, but you're coming at it, you're coming to the same conclusion from a different perspective. Like, you know, you want people to have the availability of the widest range possible of safer nicotine products to try and tackle smoking. And whether that's I want to choose the product I want to help me or I want to be able to supply the people who really need these products because they're smoking at 60% and 70% because they've got mental health problems. I don't ultimately think that it matters. And I think maybe if a certain CEO isn't around, maybe Tesla will come back fighting. I don't know. So I'm not sure it matters too much within the community. And I think, again, if you look globally, we've got what I would call libertarian MPs who support tobacco harm reduction, but we've got people on the other side who also support tobacco harm reduction who wouldn't agree with a libertarian point of view. But ultimately, we're all kind of in the same game for the same reason, with the same sort of end in mind. And I think that's what we should just kind of focus on.
82:20 - 82:24
[Marina Murphy]
See, there are some questions there, but I actually can't see them because they're so small.
82:27 - 83:36
[Jacob Grier]
We have two. One from Skip Murray. She says, actually both. She says, if a consumer wanted to write an op-ed, what advice would the panelists give them? And is it worthwhile to reach out to a journalist if their work contains misinformation? And if yes, what's the best way to do that? Oh, man. I guess writing on an op-ed part is... What is the best way? I guess I would go back to my advice of just always write for a skeptical audience. I mentioned yesterday that it's more satisfying for me to get an article placed in a publication that would probably be hostile to it. And so you can't always do that. Sometimes you've just got to write the op-ed for the friendly publication and preach to the choir. But if you can, or at least take the swing at getting it in a higher location or a more opposed location. If it's not urgent, if it's not something you need a quick turnaround time on, pitch the New York Times. And they probably won't take it. But take the swing. And then go down from there.
83:37 - 84:36
[Marina Murphy]
Well, I agree because I think that when it comes to dealing with journalists, and like I said, I was one for a long time, I think you need to be proactive because there is like, you know, in business you talk about first mover advantage, but that is also, I think, the case when you are talking about dealing with journalists. Because if, for example, and again... you know, I experienced this myself. If somebody comes to you and they want to brief you on something, right? So they brief you and then that's your baseline, that's your foundation. Everybody else has to come and disprove that because that's just the way we think, right? So I think being proactive is really important and being the first one. Don't wait to be asked, just go and tell them. Tell them what you want them to know because they will already, they will have that in their mind if the issue comes up, the first person they will think of is you, because you were the person who proactively engaged them on that topic.
84:36 - 85:30
[Jacob Grier]
And I think we can go to Skip's second question, which was whether it's worth reaching out to a journalist who's printed something that you view as misinformation. And I would say yes. I'm no longer on formerly Twitter, now X. I don't even know my login anymore, and it's wonderful. But back when I was, I would see people in the vape advocacy space sometimes be really mean to journalists. and like immediately assume the worst about their motivations and you know journalists are people too and don't assume they know anything about what they're writing about because they generally don't yeah but if you know if they're a journalist and you want them to give you better coverage don't be a jerk right they're not going to come talk to the jerk and be proactive yeah go to them before they come to you exactly we have a couple of minutes left does anybody have a question One more, come on, somebody.
85:31 - 86:06
[Mark Tyndall]
Yeah, hi, Mark Tyndall. You've kind of covered more what I think is a standard way to get your evidence out there through journalism, but most people don't get their information like that anymore, and somebody who knows nothing about the topic can do a 30-second clip on their Instagram account and all of a sudden influence... 500,000 people. So how do you see that kind of information being countered?
86:07 - 87:10
[Jacob Grier]
Mark, we have 50 seconds left. I think this is kind of the thing we haven't even had a chance to address here, which is that the information ecosystem right now is in a huge state of flux, and I'm very pessimistic about the current state of things. We've already talked about the loss of journalism jobs. At the same time, we've had a total breakdown in how people even find journalism. Twitter used to be one of the few last good places that could do it, and that's basically become unusable. It's been supplanted in many ways by things that are more video-based, like Instagram and TikTok, where linking out is really hard. We've really undermined the old link-based internet, which I think was really useful. We've gone from long-form blogs and articles to short-form tweets to now videos with no actual link to sources at all. And that's a pernicious problem that goes way beyond tobacco harm reduction.
87:13 - 87:20
[Marina Murphy]
We're over time, so I'd just like to say thank you to Jacob, great speaker, and thank you to Harry for his response.
87:20 - 87:22
[Jacob Grier]
Thanks for having us here. Yeah.