In Canada, youth vaping dominates the public health debate—but what about the millions of adult smokers left behind? Dr. Mark Tyndall reveals how fear, misinformation, and political convenience are obstructing access to safer nicotine products. Is Canadian public health failing its most vulnerable by rejecting harm reduction?
Featuring:
DR MARK TYNDALL
Professor UBC SPPH, Infectious Diseases Doctor
Advocate for Human Rights
@DrMtyndall
Transcription:
00:10
Brent Stafford: Hi, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV. We're coming to you today from our RegWatch studio here in Vancouver and joining us is a very special guest, Dr. Mark Tindall. Dr. Tindall is a Canadian physician, an epidemiologist and a public health expert with a distinguished career in harm reduction. He's the former executive director of the BC Center for Disease Control, and he's a longtime advocate of safer nicotine products, which includes vaping. Dr. Tyndall, thanks for joining us again on Red Watch.
00:44
Mark Tyndall: Oh, great to be here, Brent.
00:45
Brent Stafford: Well, you're one of the only guests that we have here in studio. When we first met or around the time we first met in 2018, it was for an event that you hosted at the BC Centre for Disease Control, designed to kind of facilitate dialogue within your industry about safer nicotine products. And one of the key things that I took away from that is that for public health, smoking is a forgotten crisis. Has things changed at all in the last eight years?
01:15
Mark Tyndall: You know, probably not much. I mean, as you saw from my attempt to get some dialogue going, people already had fairly entrenched ideas about what tobacco control entailed, and they saw and still see vaping and safer nicotine products as the enemy, basically. that's disrupting their usual narrative about smoking cessation. And I don't think that's changed very much. People are still quite dug in on one side or the other, although in public health it's 90% against and maybe less than 10% for. So it's still, we're up against quite an entrenched idea about what should be done.
02:01
Brent Stafford: Now take us back a little bit. I think it's really important for our audience to understand your background in harm reduction starting in the 2000s.
02:11
Mark Tyndall: Sure. I mean, I consider myself sort of an accidental vaping advocate. My career is really about HIV prevention and I started out in Africa when there was no treatment and the harm reduction there was condoms and education. And then I moved to Vancouver in 1999 and started working in the downtown east side for HIV prevention among people using drugs. At that time, obviously, it was quite a serious problem there. And I've continued that basically for the last 20 years or so and got quite involved in needle exchanges and supervised injection sites and safe supply work. But probably over 10 years ago, I ran across vaping and noticed that pretty much everybody I was doing research on or following clinically were smokers. And instead of dying of HIV and hepatitis C, most people were dying of smoking-related causes. And I turned some of my attention at least to trying to promote smoking cessation through vaping.
03:22
Brent Stafford: And so you're actually one of the pioneers of safe injection sites. The first in North America was here in Vancouver.
03:29
Mark Tyndall: That's right. Yeah. 2003 Insight opened. I was not responsible for setting it up, but I was part of the leading a team to evaluate it. So that's yeah, that's a long time ago.
03:43
Brent Stafford: So and then just last on this, because it's going to come up in this interview, is also the issue around safe supply of drugs. So you definitely pioneered some areas in there.
03:55
Mark Tyndall: Yeah, my last project down there that wrapped up 18 months ago or so was called MySafe, which was a series of vending machines, biometric vending machines that were allowing people to get dilaudid pills or hydromorphone from on a regular basis. And clearly in response to, you know, all the deaths were happening with fentanyl and Although there's been so much backlash to Safe Supply, it's still to me sort of ethically obvious that if we were confronted with people who every day put themselves at risk of death and we have some alternative that we could offer them and refuse to, It's just a really backwards way of doing things. So I'm fully committed to pursuing this and promoting this idea that people shouldn't be buying dangerous street drugs if we can supply them with a safer pharmaceutical grade drugs.
04:57
Brent Stafford: So how important are nicotine games to the battle against smoking?
05:03
Mark Tyndall: Yeah, I think it's the public health breakthrough that nobody wants to recognize. So, I mean, to me, it is the way to go. And what I've learned from harm reduction is that people, you want to start off with... options for people that are most like what they're doing at the time. So when we start off with people using drugs, for instance, and tell them that we won't really help you until you do abstinence, it's kind of upside down. We should start off with offerings that are closer to what they're doing now. So for instance, if they're using heroin on the street and it's dangerous, we should supply them with heroin inside in a pharmaceutical, and then we could work their way up from there. And vaping is so like smoking a cigarette that it's the obvious first step that people should to use before they, when they're trying to quit cigarettes. So to me it's like the perfect harm reduction solution. It's much like, the experience people have with vaping is even better than cigarettes. I mean, there's advantages to it. You get flavors and you don't have to light up the whole cigarette at the same time. And it's much more, it doesn't affect other people around you as much. So I mean, there's so many advantages to vaping that I'm just shaking my head when I see people light up a cigarette. when they should be using something that's far safer.
06:31
Brent Stafford: You often tell, in our world, a very famous story about how you came to the realization about nicotine when working with your patients from the downtown Eastside.
06:44
Mark Tyndall: Yeah, well, actually, the story that I first heard about, I was working in Ottawa at the time. I spent four years living and working in Ottawa, and again, in HIV prevention world, and I developed a community advisory group of eight people, all smokers. There are people from the community. They all used other drugs also, but... smoking was part of it. And within the first few months of starting this advisory group, three could no longer come because of smoking-related issues. One person had a severe heart attack, one person was confined to their house because of COPD, and one person got lung cancer. And so my whole advisory group was devastated by smoking, nothing to do with HIV or heroin or crystal meth or all the things that we were so interested in. And it sort of hit me that this is Just watching everybody slowly kill themselves with cigarettes when we had options. So, yeah.
07:41
Brent Stafford: So, Dr. Tindall, is tobacco harm reduction a valid application of the harm reduction principle?
07:50
Mark Tyndall: It's so crystal clear to me that it is, but as you're well aware of in the public health world, people who support other harm reduction initiatives don't seem to see it that way and don't really view this as a harm reduction at all. And their only response is that people shouldn't be using nicotine at all. And so this to them is not really harm reduction at all. Although it's so crystal clear that the health implications of vaping are just so much different than smoking cigarettes.
08:27
Brent Stafford: Yeah, it's certainly dismissed at the public health level. But even the forces on the ground that are right on the street helping people with harm reduction for drugs reduction, they seem to... I get the sense that they think smoking is just this longer-term thing. It's not as acute as an overdose.
08:48
Mark Tyndall: Yeah, and I think, well, there's obviously truth to that, that all my career dealing with people that are smoking, my focus was always on other health-related issues with them, and smoking was kind of in the background. But if you really compare something as serious as HIV and smoking, there's not that much difference. HIV, once you get infected, you don't even know you got infected. It's a very protracted course for most people. Many people don't have any symptoms for like 10 years. And then they slowly start to develop. This is that people untreated, which we don't see that much anymore. But we launch in and give them treatment for it. And we can stop that trajectory in its tracks. Smoking, we just kind of allow it to happen. So it's even though it's In our minds, it's not nearly the seriousness of a drug overdose or HIV or hepatitis C. It's still a grumbling, protracted, long-term decline. And it's not that much different than some of the viral infections that I treat.
09:56
Brent Stafford: Dr. Tindall, I understand that you're writing a book.
09:59
Mark Tyndall: What's the title? Vaping Behind the Smoke and Fears.
10:05
Brent Stafford: So where are you at with the book and what are you dealing with?
10:09
Mark Tyndall: So I've been working on it for two years. I've sort of gone quiet for a couple of years. I lived in Bali. I just moved back to Vancouver a few months ago. Little did I know when I decided to move to Bali with my family that I'd be going to the most prevalent cigarette country in the world. So the number of men smoking in Indonesia is about 70%. In Bali, it's 70-75%, almost everywhere I went. young men are smoking cigarettes and advertisements are everywhere. It's super cheap. So I spent a lot of time sort of doing my own little research project in Bali looking at cigarettes and how they affected that population and how behind they were with any kind of information about how serious it was to the people smoking. So anyways, I worked pretty much for the last two years on this book. It should be out in like two months. So yeah, that's my goal.
11:21
Brent Stafford: So are you trying to talk some sense into public health?
11:26
Mark Tyndall: You know, it's... Well, you can be the judge, but it's really designed primarily at smokers who need to understand how compelling it is that they should stop smoking and start vaping or using other products. But there is quite a large undertone of messaging that as public health people, this is really a breakthrough that we should be embracing and not consider it a disruption to our tobacco control programs.
11:58
Brent Stafford: Dr. Tindall, in 2019, you sat in this very studio and called the concern over youth vaping to be a moral panic. Is that still your assessment today?
12:11
Mark Tyndall: Yeah, I have a whole chapter about that. So I mean, there can't be a more clear definition or description of moral panic than what's happened with vaping. So we've developed this right from the get-go with highly exaggerated claims about the prevalence of vaping, highly exaggerated claims about how dangerous it is, and highly exaggerated claims about the gateway effect for smoking. So all this has really become part of the narrative of vaping. And almost all the opposition we face is about youth. And so trying to, yeah, trying to talk about that head on. And I think moral panic is a great description of how this all happened.
13:03
Brent Stafford: So is moral panic a technique of public health?
13:11
Mark Tyndall: I think... Nobody would admit that's a way to do it. I mean, this guy Stanley Cohen was one who created this idea. There's five steps to it that I go through in the book, but we follow that quite closely. And you get to a point where moral panic has its own trajectory and it's very difficult to stop. So the narrative has gone so deep in public and the way people feel about vaping that it's now very difficult to turn that back.
13:45
Brent Stafford: What impact do you think the so-called vaping-related lung illness, or EVALI, had on public's perception of vaping and even public health perception?
13:57
Mark Tyndall: Yeah, I mean, we're talking about something that happened like five years ago, and it's still, people will tell you that they think that youth vaping can be fatal. Like, you know, what about all the kids who died of vaping, you know, and... Clearly, that had nothing to do with vaping nicotine. And still to this day, if you go on to a CDC website or some of the more authoritative websites around this, they will mention that this was due to vitamin E acetate. But they're always at the end, there's a line, they couldn't rule out vaping nicotine as a possible cause for some of it. And because they didn't have samples from the 250 people. And so there's still this question that for a few people, it wasn't proven that it was vitamin E acetate. But clearly it was all the same thing. And it's really unfortunate that the major public health agencies haven't come totally clean on this.
15:05
Brent Stafford: Well, it's striking because, of course, with so much unknown, you would have thought that the public health agencies would have taken blood samples or urine samples from all of these kids that had fallen sick, but they didn't.
15:19
Mark Tyndall: No, there's a very, some of the supporting documentation is very poor around some of these cases. And at the beginning, a lot of people didn't know what was going on. They were, it happened in like 50 states. So, you know, there was difficult with communication and coordinating it all. So I sort of understand that. But at the end of the day, it's quite clear that this had nothing to do with Juul or vaping nicotine. But it's really unfortunate that that narrative has been so ingrained that people still carry that belief.
15:52
Brent Stafford: You're familiar with those pictures of the young people with all of the tubes coming out of them and stuff like that, that was around a valley. Are you familiar with that?
16:04
Mark Tyndall: Oh, yeah.
16:05
Brent Stafford: All of these pictures of these kids who are debilitated and ventilators and all that stuff could be released like that in an era of privacy and so forth. What kind of campaign must that have been? Some official... had to be involved with putting those out there. And we never saw any pictures like that with COVID.
16:29
Mark Tyndall: That's interesting, isn't it? Yeah, I never really thought about that. But clearly, this was very strong messaging against vaping. And people who were anti-vaping advocates before Valley saw this as a great opportunity to prove their point that this is very serious and that we need to do something about it. Yeah, those images are shocking. And I feel terrible for those young people who were affected by this and their families. It's a terrible thing that happened to them. But it was nothing to do with vaping nicotine.
17:03
Brent Stafford: So those pictures, they're blasted out on every single newspaper, in a lot of cases worldwide. It sure felt like propaganda. Is propaganda being used in this war against vaping?
17:17
Mark Tyndall: Well, if you look at the major campaigns against youth vaping, the Truth Initiative and Bloomberg's initiative and things, yeah, it harkens back to kind of the reefer madness cannabis stuff where they seem to be able to make up any kind of – any kind of story that they want, and based on really no data whatsoever, and use it to scare people. That's their attempt. And it seems that some of it's comical, what they have in these kids' videos. And the irony is that you see right through it, right? So it's so... It's so over the top and exaggerated that kids look at this and go, well, this clearly isn't the experience of anybody I've ever seen vape. So they ignore it. And so it's a very ineffective way to deal with messaging. I think kids need education about nicotine and vaping, for sure. But the way they've gone about it and used these shame and scare techniques has backfired, basically.
18:28
Brent Stafford: And what about within public health? I believe that you've used the term groupthink before. What does that mean?
18:35
Mark Tyndall: Well, what's also interesting to me is many of my colleagues or physicians who I talk to this about are very surprised when I give them the information because they haven't really dug into it. They've been used to people smoking for their whole careers for the most part and have been fed by major public health organizations. agencies including the WHO that this is a you know a scourge and that they probably haven't really looked into it very much and it's kind of sad but medicine is quite compartmentalized and people focus on their own area of expertise and most doctors feel that smoking cessation is not their thing and they haven't taken the time to question what they've been told.
19:26
Brent Stafford: Dr. Tindall, the Public Health Agency of Canada just released a statement from the Council of Chief Medical Officers of Health on nicotine vaping in Canada as a part of the National Non-Smoking Week. Let me just say it's pretty harsh. They advocate for stricter regulations, including banning flavors, except tobacco, of course, and they emphasize that only approved cessation methods should be promoted. In your professional opinion, is this statement evidence-based?
19:58
Mark Tyndall: Well, these are people that I know and work with. In addition to my role at BCCDC, I was a deputy provincial health officer, so I dealt with a lot of chief medical health officer issues. issues and so I'm not really surprised but again the idea of groupthink and that people just fall in line I don't know how I would doubt that the chief medical health officer has much input into this they were given this script and said sign it and okay we can endorse that so without many questions asked so I think it's terribly outdated. I did read it. I mean, there's all this what-if kind of idea, and vaping's been around now for like a decade. So the what-if questions become less and less relevant. We kind of know quite a bit about this now. We know that it's not a gateway to smoking because smoking rates in young people are almost unmeasurable. And the harms to do with vaping, clearly nothing's showing up. And so, yeah, so it's disappointing that they come out with these kind of statements. But I think they haven't, most of the chief medical health officers across Canada haven't put a lot of thought into it.
21:17
Brent Stafford: So you say that a script was handed to them. Was that script handed to them by the Public Health Agency of Canada?
21:23
Mark Tyndall: Maybe. There's a lot of the information comes from charities. The Physicians for Smoke-Free Canada are probably involved in this kind of messaging. So yeah, it ultimately comes out of Ottawa, but somebody collected all this information and sent it out to all the provincial health officers to sign onto.
21:47
Brent Stafford: So the Physicians for Smoke-Free Canada, are they actually physicians?
21:51
Mark Tyndall: Well, it's difficult to figure it out. On their board, there's people that are physicians, but the main person who runs it, Cynthia Collard's her name, she's been a lobbyist for a lot of years, and I think she's the... prime head of it. I know it's funded through the federal government, so basically the federal government's funding an organization to lobby itself. So it's not like a charity that doctors across Canada are sending in their donations to.
22:25
Brent Stafford: So it does seem to be that group, obviously, Canadian Cancer Society. There's a group in Quebec. They're the ones that really seem to be behind this push of demonizing and calling for flavor bans in Canada.
22:40
Mark Tyndall: Uh, yeah. I mean, it's, uh, I know that there's, uh, there's a lot of discussion within Ottawa and Health Canada about this. And there's people there who are, uh, pro-flavor bans, people that are not. But, um, I think back to the moral panic question, um, it's kind of an easy call for a politician. Most Canadians don't smoke. They don't have any interest in people vaping. Um, they, uh, And they really want to protect kids. So from a politician's point of view, anything that protects a child is a political winner, basically. So the flavor ban question is really part of the moral panic campaign to make it sound like tobacco companies have created these flavors to addict kids, a whole new generation to nicotine, which is a totally made up story. If you go to any vape shop and ask them if they're selling flavors or not, they would go only flavors. So I mean, it's no secret that that's what people are attracted to and what makes people try vaping in the first place, what makes people continue to vape. So stopping flavors or banning flavors is the same as banning vaping, basically. It's the same thing. So you can't really say, well, we've never banned vaping or restrict vaping, but it's only tobacco. Basically, banning flavors is banning vaping. And so we have to challenge people on that. And if they are against banning vaping, then they have to be against banning flavors.
24:20
Brent Stafford: Well, Canada certainly is building up quite the reputation for being against nicotine. We just had Health Minister Mark Holland basically banish all nicotine pouch products to behind the pharmacy counter. I can say as somebody who's just gone through this vocal surgery and so forth, I relied on nicotine pouches because I could not vape. And they were hard to find. And I went to Shoppers Drug Mart, which is a national chain, only got stock for the first time on December 28th, almost six months after they were banned. And when I walked into London Drugs, which is a huge chain in British Columbia, I got a lecture about the evils of nicotine pouches, and they are self-righteous in going, we decided to not carry that product.
25:12
Mark Tyndall: Yeah. No. I mean, it would be like not carrying blood pressure medication or diabetes medication. I mean, to me... The pouch idea, as a harm reduction strategy, I don't think is as effective as vaping. But it's still, if people can use that and get away with it and stop smoking, I mean, great. So for the health minister to try and like limit or ban that, it makes absolutely no sense. Like they've totally lost the way. And it's, yeah, it's hugely frustrating to see that happen.
25:55
Brent Stafford: So much to the delight of our viewers, I've got those clips from Mark Holland, and I think we should just run a couple of minutes of it and see what you think.
26:06
Mark Tyndall: Okay.
26:06
Brent Stafford: So let's take a listen.
26:09
SPEAKER_00: Thank you so much for the opportunity to speak today. I had said that I would be coming and speaking about actions we're taking with respect to nicotine pouches. And I'm pleased to be able to speak with some additional details on the action that our government is going to be taking. The tobacco industry yet again used a loophole to try to create innovation in the space of cessation to get people off of these products to create a brand new line of products that addicts particularly kids to products that are deadly for their health. The tobacco industries have been successful in addicting a whole new cohort of young people to these products. To me, it is absolutely essential that we see these products move behind counter. And let me be really clear about the size of this problem. I am talking to oral health professionals as we're rolling out a national dental care program. And what do I hear in those conversations? But that young people, under their tongue when they're playing hockey or baseball or sports, have these products and they're destroying their oral health. They're putting them at risk of cancer and all kinds of illness. And these are kids who have no exposure to tobacco or nicotine before. That's entirely unacceptable. I was with Heart and Stroke when we dealt with the issue of vaping. And there were many voices at that time when information was uncertain who said, let this exist as a cessation tool. Don't take action. The result of that, unfortunately, was that the tobacco industry was able to addict a whole new cohort of young people who had no exposure to nicotine to something that's absolutely deadly for their health. My objection in this instance is that the marketing that was done by the tobacco industry around these tobacco pouches had nothing to do with cessation. It had everything to do with trying to create a lifestyle and an attraction to a new product that's going to addict people who have no exposure to nicotine or tobacco as another delivery mechanism to that product, which is an agent of death. I would say to the tobacco companies that continue to look for ways to use loopholes to addict people to their products, Get away. Stay the hell away from our kids. And so there's a few things that we're going to be doing. I'm seeking authority to restrict products so that they are solely for the purposes of cessation. We shouldn't be seeing flavors that are targeting kids. Flavors like, you know, winter berry splash or whatever, tropical fruit, whatever that they're putting out there. Hopefully you can hear my voice and my intention. I don't ever want to go through this again. What we saw happening in vaping, all the illness, the death, the sickness, we cannot allow that to happen in nicotine pouches. So I'm saying through you to the tobacco company, If you do not hear in my voice the concrete nature of the action we will take to meet you, to stop you from going after our children, then you do not understand my determination. I am sick of it. I am absolutely sick of it. Watching and talking to parents dealing with sick children who've been addicted to these products, who've had their reward systems hijacked because they've got companies using their billions of dollars to addict them, it's done.
29:27
Mark Tyndall: Yeah, it's quite incredible that he can do that. You know, you need politicians who are, you know, committed. It's just that he's unfortunately committed to the wrong thing.
29:42
Brent Stafford: Well, as the Minister of Health, doesn't he have some duty to be truthful?
29:47
Mark Tyndall: Well, I don't know where he's got his information. His loose use of deadly and rewiring your brain and all these kids with sickness. I mean, it's just fabricated. It just hasn't happened. And it's really if he started the first part of what he said, how committed he was, if he had a said, he's so committed to, you know, eliminating combustible tobacco, you know, and this is what we're going to do. And we're going to get patches out there. We're going to get vaping out there. And I won't be fooled again by the tobacco company, you know, if he came out, you know, with with that. with that information then you know go for it but uh just propagating these basically nothing he said in that what he was how angry he was uh was based on any kind of evidence or truth yeah i mean clearly nobody has died in canada because of apia nobody not one person and uh Yeah, all this stuff about kids and oral health and cancer. Nobody in Canada has got cancer from an oral pouch. His commitment to this is just going in the totally wrong direction. He's lost track of the fact that we should be really committed to getting rid of cigarettes.
31:18
Brent Stafford: Is there an ideological component to this?
31:22
Mark Tyndall: Well, you know, the history, you know, we've been, society has totally been trained to cast dispersion and stigma and shame upon people who smoke. So it's pretty easy to make that into any nicotine. So the public is already, you know, primed to be... against any kind of product that's associated with tobacco. The tobacco industry has been so vilified. They're obviously an easy target. There's nobody coming to their rescue and saying, oh, no, the tobacco company wouldn't do that. I mean, you know... So yeah, it's really difficult to push back because I don't want to be in a position of defending tobacco companies. But the irony is the information on the Philip Morris website about safer products is far more accurate than the Health Canada website about safer products. The information and the evidence and things are far better than the Cancer Society and the American Lung Association. I mean, which is just all inaccurate information. And so it's actually the tobacco companies who are putting out the more truthful material, which is kind of weird to say, but that's the truth. One of the other premises of the book is that you could argue that Canada is winning as far as our tobacco control. And probably in 10 years, doing nothing new, that cigarettes would get below 5% because we're letting a whole group of people just die. And so the prevalence goes down. So you stop newcomers from using cigarettes. And eventually, just by attrition, the prevalence will go down. But that's basically telling 3.5 million Canadians that, screw you, you're going to die. We have something that's way safer for you and could prevent you from dying prematurely, but we're not going to give it to you right now. We're going to hold off on that and just let it go. We'll go down 1% per year because a bunch of you are going to die. That, to me, is an unethical approach to things when we have something that can save lives. If HIV, for example, that we had a way to prevent people from ever getting HIV for a vaccine, and we had all the people with HIV out there and told them that, unfortunately, we're not going to be able to treat you anymore, but our next generation will be fine because we have a vaccine. And the rest of you millions of people, I'm afraid you're just going to have to die off. And our graph will look great because every year there'll be less and less people with HIV. We wouldn't accept that as a reasonable approach. But basically, that's what we're saying to all the smokers in Canada right now, that we have something that could prevent disease. But yeah, we're going to just let it take its course.
34:26
Brent Stafford: It's interesting because as a group, smokers, they're being marginalized. And if you look at marginalized communities, there's a lot of smoking there. Oh, yeah. And shouldn't public health be paying more attention?
34:39
Mark Tyndall: Well, that's why I write a chapter in the book about health equity. And basically, in a country like Canada, it's really a health equity question. And it's that we have groups in Canada that have a lot of smoking. Our First Nations community has a lot of smoking. People with mental illness have a lot of smoking. People who use other drugs have a lot of smoking. And these are already fairly marginalized groups. And to me, it's an ethical imperative that we step up and try to level the playing field for those groups. And somehow public health has not seen it that way.
35:16
Brent Stafford: Just reading a story published by the CBC just a couple of days ago, lamenting the fact that possibly a flavor ban in Canada is on hold if ever to come. And in that article, they called the groups nicotine control. It's the first time, I mean, to be honest, that's what they are now, is nicotine control. But to see mainstream media referring to them that way.
35:43
Mark Tyndall: Yeah, yeah. No, yeah, we've really lost the story here. And so I read that article too. There was nothing in there about harm reduction. It was all to do with how the government is failing youth because they're not banning flavors. And the people that they had quoted there were, you know, just the... regular prohibitionists. There was nobody there to have any other opinion about it and nobody who had, even talking to one person who had switched from cigarettes to vaping and uses flavors would be highly compelling to me and they don't bother to talk to anybody like that. So it's frustrating the way the media has continued to vilify this and to be not open to any other opinions.
36:34
Brent Stafford: Should we not be looking at recreational nicotine as kind of the solution? And I preface that by saying that nicotine in its recreational form is already legal in Canada. It's called smoking.
36:49
Mark Tyndall: Yeah, yeah. Well, as I've dug into this further, the paranoia around nicotine is also heavily overstated. I've been socialized to believe that people who smoke are just hopelessly addicted to this. They stand outside in the freezing cold with their cigarette, because they can't do anything else. They're enslaved to this thing. And every puff they're taking, they're going, I hate this. Why can't I stop? But no, they're going, this is really enjoyable for me. And so nicotine serves purpose for people. It's not a ball and chain for most people. They actually enjoy smoking. And the effect that they get from smoking is very positive for them, whether it's reduced anxiety. And I think it's well-recognized that nicotine functions much like caffeine. So it would be like telling people, you can't get up in the morning and have a coffee anymore. You have to stop. And I think that nicotine itself, it's very unfortunate how it's been so integrated with tobacco and so vilified. And you know these surveys of health care professionals who will tell you that nicotine causes cancer and heart disease. It's just totally made up, fabricated stuff. It's not. People should think of nicotine like caffeine. And unfortunately, people require more of it. to keep going so instead of having a cup or two in the morning and then forget about it people who are using nicotine can't forget about it by the afternoon so it does have a ball and chain effect in that way but it does serve purpose for people and if people could use nicotine pouches which probably have no other effect other than delivering nicotine and enjoy it or get some benefit out of it I don't know. We let people drink coffee and have a beer and smoke a joint. I mean, so I don't know. To me, it's people's personal choice. And they should go into those choices fully aware of what they're getting into and that there is an addictive quality to this thing. And it can be quite inconvenient for people. I mean, but... If we get away from smoking cigarettes and blowing smoke in everybody's face and just put a little pouch in your cheek, I don't know. People want to do that. It shouldn't be a huge public health dilemma.
39:30
Brent Stafford: Dr. Tindall, as you know, the 12th edition of the Global Forum on Nicotine, the annual conference on safer nicotine products, takes place again this year in Warsaw, Poland, from June 19 to 21, 2025. The conference theme is challenging perceptions. In your mind, what are some of the solutions to address the misunderstandings, misconceptions and mischaracterizations that are holding back progress for safer nicotine products?
40:02
Mark Tyndall: That's a great question. I mean, I think there's a real role for advocates to get out there with the message. And I think one-on-one, I can be quite... You know, I can change people's minds. But it's a slow, very slow process. So it's very important that we get people out there talking about it, that we enable grassroots community vaping groups to have a voice. I mean, because after all, it's basically, you know, I also write about this in a book, like it's a human right. Like if you're smoking and you know it's killing you and you have something that's safer for you to use, how can we tell people not to do it? Or how can we restrict people from getting access to it? It really makes no sense. So I think that the health equity argument, the human rights argument, the interest in getting people off cigarettes, all this information needs to be revved up, I think. But there's people who are so entrenched that maybe it's not worth the time and effort to try to change their minds. I mean, some people are, they've really put their foot down. This is how they're going to do it. I think health medicine people are not that quick to say that they were wrong. And so I think we're going to be dealing with this barrier and this backlash for a while. But if we can get the public thinking in a different way and get people who are smoking to understand you know I think one of the tragedies of this is the information that is going to people who smoke because I also you know I've talked to hundreds thousands of people who smoke and they will tell me that they don't think vaping is any safer and where they you know they've been you know, they've been receiving the same information as everybody else has. If you talk to doctors, they won't say vaping's safer. So how you have, you know, if you were a family doctor and somebody came in with high blood pressure and you didn't give them any antihypertensive medications and they died of a heart attack because of their high blood pressure, it'd be malpractice. So somebody comes in smoking, you know they're dying of their cigarettes and you don't offer them a safer product and they die of a heart attack, Isn't that malpractice? What are you doing? To me, we owe it to people to offer them a safer product, and right now that's not happening.