Tragically, those who should know better—medical doctors, public health officials, and the media—are reluctant to promote nicotine vaping as a tool for harm reduction. Instead, they make a deliberate choice to ignore or avoid acknowledging the truth about vaping. This problem is widespread, including in Latin America. Learn more in this special hybrid English/Spanish episode of GFN Interviews.
Featuring:
DR. DIEGO VERRASTRO
Physician, General and Emergency Surgery
Co-founder, Latin American Network for THR, RELDAT.org
JEFFREY ZAMORA
President, Asovape Costa Rica & of ARDT Iberoamerica
Director of Social Media, INNCO
@jeffzam8
Transcription:
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Brent Stafford: Hi, everybody. I'm Brent Stafford and welcome to another episode of RegWatch on GFN.TV. We're here in Warsaw, Poland for the Global Forum on Nicotine 2024. And joining me today is going to be a really interesting interview, Jeffrey Zamora and Dr. Diego Verrastro. Is that close?
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Jeffrey Zamora: Very close, very good.
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Brent Stafford: So, Dr. Verrastro, you are a surgeon. Where are you from? What kind of surgery do you practice? Let's start there.
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Diego Verrastro: Well, first of all, good morning to everyone. I am from Argentina. I carry out my activity there in Argentina. I have had training in emergency surgery, general surgery. He's saying that
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Jeffrey Zamora: Well, he lives in Argentina. He's from Argentina, from a formation about emergency surgeries. And he, because of destiny, ended up working in treatment of obesity and on his spare time, obviously, on tobacco harm reduction.
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Brent Stafford: So, when it comes to obesity, what's the tie-in with tobacco harm reduction?
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Diego Verrastro: They have many points in common, because really in the consultation we see many patients with obesity and tabaquistas. And before knowing the tools for reducing damage, the recommendation to the patients was, or you stop smoking and then we lose weight, or we lose weight and then you stop smoking. Today we can make a mix between trying to stop smoking and also losing weight. Before it was a concept that was not possible because the anxiety load that the patient has by not consuming nicotine ends up discharging through the oral route.
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Jeffrey Zamora: He's saying that it does have to do a lot, that it makes a lot because the problem is that before they used to think that when a patient was either, they were either quitting smoking or, you know, kind of transforming their eating habits. but they cannot do both at the same time because once they go on the abstinence approach and kind of quit all nicotine use, obviously they trigger some hunger and problems to actually reduce their weight. So at this present time, it has changed, and now they can actually treat the smoking habit and as well as the bad practices of eating at the same time to make a better benefit for their health.
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Brent Stafford: So are you proactive with your patients bringing up vaping products?
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Diego Verrastro: In Argentina, products are prohibited. The recommendation is informal. I perform my medical consultation by vaping. So some patients Doctor, what is that? Is that bad? Is it worse than the cigarette? No. And there is another consultation within the same consultation. But the reality is that doctors cannot recommend it. Why? Because it is illegal. And no colleague is going to do something that is illegal, Doctors like me, who are outside the health system, because I don't work for the university, for the health system, I do it privately. And privately, I am the king of my consultancy. And I decide what to do.
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Jeffrey Zamora: He's saying that, you know, as a doctor he cannot directly promote the use of these products because in Argentina vaping is bad, right? So what he does is that since he has a lot of patients that actually smoke, what he does is that he realizes the practice with a vaping on the desk. So most of the time, the patients themselves, they ask, hey, what is that? What are you doing? Because I have heard that it's worse than smoking. Is this true? And so that becomes another consultation within the same consultation about some different topic.
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Brent Stafford: Now, that's sneaky. So, you know, I'm just shocked. I know I shouldn't be, but... So, everywhere on the planet, people think vaping is as harmful or more harmful than smoking?
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Jeffrey Zamora: If you think that all over the world, people think that vaping is more harmful than smoking.
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Diego Verrastro: In the vast majority, yes. In fact, recently we had access to a survey made by smokers and about 70% of the smokers did not want to make the change, in this case to vaping, because they believed that vaping was much worse than tobacco by combustion, which It's a pretty wrong message that journalism is providing us with, we already know from where, generating more doubts and misinformation in the consumer and preventing that change to tools of less damage or reduced damage is made.
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Jeffrey Zamora: Recently, he said that recently they got access to a survey among people who smoke that kind of delivered the results that 70% of the people are not aware of the, you know, continuum of risk and how these products are actually less harmful than cigarette combustible tobacco. So, that is a big problem because, unfortunately, the media itself is triggering this disinformation campaign that is building up until the situation that we have now, that 70% of them think erroneously that this is the case.
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Brent Stafford: What about your colleagues, other doctors in Argentina? Are they well educated on this matter?
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Diego Verrastro: When you talk to your colleagues face to face, with a coffee, informal, do your colleagues understand? Do they agree? Do they say OK? I understand, it's good. Now, when it comes to being alone in the decision, in your consultancy, to suggest the tools for reducing damage, there they don't do it.
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Jeffrey Zamora: At the moment that they're sitting, you know, social chatting, having a coffee or something, they do get the point about the harm reduction potential and how, you know, they even say, okay, I agree with you. It is a valid strategy. But at the moment that they got to their office and they're actually with a patient, they kind of are reluctant to promote or to tell them information regarding these harm reduction products.
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Brent Stafford: Redlat was created with professionals from the socio-sanitary field of Latin America to try
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Diego Verrastro: to correctly transmit, and based on science, all aspects of harm reduction, the medical aspects, the scientific aspects, the political aspects, the social and cultural aspects. We are a... association without profit purposes, we do not have a bank account, we do it in the form of ad honorem, And we have been able to talk to several governments in Latin America and be valid interlocutors. Because the truth is that many people talk about harm reduction, but very few really live and feel it as a just cause to save lives. because this is about saving lives or at least dying as few as possible.
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Jeffrey Zamora: He's saying that Red Dot is a non-profit that don't even have a bank account that is pretty much just a volunteer work of several professionals in the medical care and social care that kind of got united in order to distribute information when it comes to aspects regarding to social, cultural, medical and practices in order to help different governments and pretty much the discussions being done in Latin America regarding these products and to deliver them with information so they can take a wiser decision about how to regulate these products because at the end it's about pretty much minimizing harm and saving lives. That's the priority at the end.
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Brent Stafford: I wanted to share with you just a short personal story. Back in 2013, I quit drinking, had enough, and I was after drinking my share for everybody. And about a year later, I was like, well, I need to quit smoking. But I needed to lose weight also. And I went, what do I do next? And my biggest fear was quitting smoking would lead to even more weight gain. So a year after I quit drinking, I changed all my eating habits, exercise, and I lost 40 pounds. And it was only after that that I quit smoking. Because I just, you know, and so it was directly related to the fear of gaining weight from quitting smoking. I often think that some of the pushback from people on vaping are all those people who quit smoking before vaping. And they all put 20 pounds on, 30 pounds. And so they're...
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Jeffrey Zamora: He's saying that in 2013 he stopped drinking. Yes, but not later. but he also had to lose weight, but he didn't want to stop smoking because he was afraid that he was going to gain weight, right? So until he could lose the necessary weight, he tried to stop smoking and he did it. So he says that many of the people who are against these products are those people who stopped smoking and gained 20 pounds more for that. That's a revenge. Of course, what happens is that
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Diego Verrastro: Let's see, there is something that is the stigmatization of the smoking patient. No one put a revolver on your head to smoke. You decided it yourself. And since you decided something that is bad, you have to pay for it. And that is quit or die. Quit or die. Either you quit or you die. So today, everything that is harm reduction, many people don't understand that you can quit smoking pleasantly. And that's a counterpoint, at least until now.
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Jeffrey Zamora: He's saying that the quitter diet approach, right, that some people take it so forcibly, right, because it's a way to punish people who smoke and stigmatize, right, because of the stigma, people think that they deserve to be punished, right, in order to quit smoking. And that's part of the harm reduction idea and approach that is more convenient, right, as it does not stigmatize people and actually deal with these habits on a healthier way.
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Brent Stafford: Let me ask you, why is an event like GFN important? Why is GFN important?
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Jeffrey Zamora: I make the comparison of GFN to the Great Tower of Babel.
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Diego Verrastro: At one point we all get together, those who are in the same direction, to share experiences, to share ideas, to generate a conscience, to work each one in their different countries, because the reality of each country is different, social and socio-cultural. I think this is a space where it adds the experience of other colleagues and that of one's own for the common good. about this issue of damage reduction.
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Jeffrey Zamora: He's saying that GFN is like a Pavel Tower thing that all of these people reunite to share ideas, to share perspective in order to get a deeper knowledge into what could work on their countries, right? So it's like this river horizon and open mind thing that actually involves being in the GFN that helps you to get an idea of what could actually work not only on your country, but on your area of work.
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Brent Stafford: Jeffrey, I know that you've been doing some work with Airtas and Kohar. What can you tell us about that?
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Jeffrey Zamora: Well, the Veritas study is kind of a groundbreaking study. What we're doing is kind of we're evaluating the direct harm, the net harm of these products, of vaping products, because to know that or to say that vaping is less harmful than smoking, that's easy, right? We know that for quite a while whatsoever we don't know what is the net harm of these products because most of the people that use these products that we can say you know according to different surveys about around the world of the United States Canada Europe you know Asia we know that most of the people, probably around 90% of the people that use these products, they used to smoke before, right? So the damages, the harms that they can actually have through a lifetime or a long period of time smoking, right, does not help us to have a direct way of what is the net harm of these products. We need actually cleaner data to know that, and that's quite a predicament. So on a first time and pretty much groundbreaking, a cohort build by coir and the various exotic project what we did is that we got it together people that are frequent users of these products of harm reduction products specifically vaping and they have not smoked before yeah it was not easy to assemble this cohort it is really really difficult to get these people because they're you know Contrary to the narrative of the media, there's not many people on this that actually is using the products frequently and didn't smoke before. So with a lot of effort, we have assembled a cohort of 500 people on the first wave. We're already on the results of the first wave waiting to be published. And then we already have a thousand people with a second wave. you know that like I said frequent users that have not smoked before to get a deeper knowledge of what is the actual net harm of these products and that's what we were working right now Diego so what was the saving lives report the Swedish saving lives report The report from Sweden basically has two stages.
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Diego Verrastro: The first was to show the world What was the strategy used by Sweden over time to become a smoke-free country?
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Jeffrey Zamora: The Quit Like Sweden report has two stages. The first one is to actually show how the approach from Sweden led to the smoking cessation and pretty much having a smoke-free country.
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Diego Verrastro: And those strategies, based on those directives, can be applied in different countries, which is what they call the gift of Sweden. Like ABBA or the security belts. It's a gift from Sweden to the world.
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Jeffrey Zamora: And the second stage is about the gift from Sweden that like ABBA in the group, the musical group, and the security belts, right? That's the gift from Sweden because of how it has worked in Sweden and how it can be implemented in some other countries.
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Diego Verrastro: using the concepts of the directives of the World Health Organization, they went one step further, taking the article 1D, that there are ways to use tools to reduce damage within the framework agreement, and with three fundamental guidelines, accessibility, accessibility and acceptability. The tool for reducing damage must comply with these three guidelines so that the population can accept, take and use it.
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Jeffrey Zamora: He's saying that Sweden, not only taking the approach that is set by the WHO and the Framework Convention on Tobacco Control, but actually referring itself to the Article 1D of the FCTC that mentions harm reduction, that they wouldn't even step farther to provide that harm reduction to the people. And base it on the strategies based on the three pillars that it has to be accessible, affordable, and accessible. Right? So that's the thing that, and that's how they have became to be smoke-free.
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Diego Verrastro: Sorry, a little more. Y la segunda etapa es, una vez logrado ser una región libre de humo, comparar el consumo de nicotina de un país libre de humo con un país que no está libre de humo. The result of that is that the level of nicotine consumption in both regions is very similar, but the diseases derived from the consumption of tobacco by combustion are totally different, the casuistry in diseases derived from tobacco by combustion is much higher than that of damage reduction.
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Jeffrey Zamora: actually to compare the nicotine use on Sweden that is a smoke-free to some of the nations that are not smoke-free and then compare the tobacco related illnesses you know like cancer for example and you know how is it different from Sweden than from the other countries that is actually drastically different and actually is way way lower on Sweden even though that the consumption of nicotine is similar
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Diego Verrastro: arriving to the conclusion that the problem is not the nicotine, but the way to consume it. So, do you have faith in the WHO and the FCTC?
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Jeffrey Zamora: Do you have faith in the WHO and the FCTC?
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Diego Verrastro: Y te propongo un ejercicio mental.
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Jeffrey Zamora: Si pudiéramos volver al futuro o al pasado, If it can go back in time or back to the future.
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Diego Verrastro: Y nos volviéramos 20 años atrás.
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Jeffrey Zamora: And we go back 20 years in time.
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Diego Verrastro: Y estamos en la producción de las directivas para control del tabaco.
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Jeffrey Zamora: And we're writing the FCDC guidelines.
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Diego Verrastro: Okay. We travel back to the future, twenty years later, and we see that the results are not what we expected. There are more smokers, the numbers of smokers are not projected to go down as soon as possible. So, what would we do? Would we continue with the same policies that we implemented 20 years ago that didn't work? Or would someone smart, interested in humanity and their work, make changes? Well, today the World Health Organization is like a monkey. You understand me?
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Jeffrey Zamora: Yeah, because the prevalence of, you know, when we went back in time, we see that the prevalence is not going down and actually the number of smoking is not reducing drastically. So to keep doing what we know that is not working, it's, you know, he even mentions the WHO being some sort of, I don't want to hear, I don't want to see, I don't want to talk about it.
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Brent Stafford: Like a monkey. Like a monkey. Is there a message that you want to deliver to anybody?
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Diego Verrastro: Stop smoking with the method or with the strategy that is possible. We, those who advocate for the reduction of damages, are on that path. We want to save lives, we want people to live better, and with the method that is. If you put on a mask, adentro de tu oreja y te hace dejar de fumar, bienvenido al poroto.
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Jeffrey Zamora: He's saying that whatever method you use to quit smoking, we're in favor of that. We actually encourage you to quit smoking. If putting a piece of garbage in your ear and helps you to quit smoking, go ahead, put the piece of garbage in your ear and just, you know, be encouraged and don't worry about it. The idea at the end of time is to help people quit smoking.
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Brent Stafford: Is it quit smoking and quit using nicotine? Or is it okay to use nicotine in a safer form?
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Jeffrey Zamora: Is it okay to use nicotine in a safer form?
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Diego Verrastro: Of course. There are many people who do not want or cannot abandon the tobacco habit. And they are clearly dependent on nicotine. I do not like to call them addicts. Because when... You catalog a patient as an addict, he is a sick person. And smokers, although they do not have an addiction to nicotine, they do have an organic, psychological dependence. And to be able to fight fire against fire using the same nicotine in a much less risky way is the future. It is the future.
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Jeffrey Zamora: He said they treat dependency because first of all, he don't like to talk about people being addicted to nicotine because he says that when you treat people like an addict, you kind of remove them. the will and the empowerment itself in order to quit their habit. So he says that it's more valid for them to speak about dependency because people are dependent on the nicotine. So for people that is unwilling or on wanting to quit smoking to treat that dependency with nicotine itself, it makes it more easier for them to quit smoking altogether.