Former Iowa Attorney General Tom Miller—America’s longest-serving AG and a principal architect of the Master Settlement Agreement—joins GFN.TV with a clear warning: the U.S. is making extraordinary progress against combustible tobacco, yet the public isn’t hearing about it. Smoking has collapsed to historic lows, youth vaping has fallen 70% since 2019, and millions of adults have shifted to far safer non-combustible nicotine products. By any honest measure, it’s one of the most significant public-health successes in decades. So why isn’t tobacco control talking about it?
Featuring:
TOM MILLER
Former Iowa Attorney General
Founder, Miller Monitoring and Consulting, LLC.
Transcription:
00:02 - 01:45
[Brent Stafford]
Hi, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.tv. It's rare to find a high-ranking public official in the United States who openly supports e-cigarettes and other safer nicotine products. Rarer still when that person is a Democrat and a state attorney general known for taking on big tobacco and helping to secure the landmark master settlement agreement which forced the tobacco industry to pay hundreds of billions of dollars to the states for the harms caused by smoking. Well, there is such a person. Joining us today to discuss America's war on vaping and the remarkable progress being made in the fight against combustible tobacco is Tom Miller, the former attorney general of the great state of Iowa. A.G. Miller is the longest serving state attorney general in U.S. history, making tobacco control and consumer protection the keystones of his long career. A.G. Miller, welcome to the show. Oh, thanks very much for having me. You've got a very, very impressive show. I'm delighted to be on it. Well, thank you very much. Before we begin, a quick note to our viewers on GFN.TV. Today's episode is part one of a two-part conversation with A.G. Miller. Part two will premiere soon on the RegWatch website, YouTube, Facebook, and X. So keep an eye out for that. AG Miller, first question for you. Are safer nicotine products like e-cigarettes and nicotine pouches a benefit for public health?
01:46 - 02:51
[Tom Miller]
They're a benefit, a huge benefit and can be even a greater benefit. And why is because they're so much less harmful than cigarettes. If people switch from cigarettes to non-combustibles, they have a chance of saving their lives. Public Health England gets it best and has for a long time. They did this comprehensive study and came up with the conclusion that e-cigarettes are approximately 95% less harmful than combustibles. And that tracks with our common sense. We know that for the combustible, the smoke has all the toxics, the carbon monoxide and the other toxics. So you take the smoke away, you take all the toxics away. It's sort of right in front of us. And additionally, The measures of toxics in cigarettes and e-cigarettes are roughly conformed with the 95% of public health in England, and other science bears that out as well. It's much less harmful, and people can save their lives. We can save millions of lives, in fact.
02:52 - 03:00
[Brent Stafford]
Would you agree, though, that there's a bunch of turmoil around vaping, and that some of those facts that you just mentioned don't seem to be discussed anymore?
03:01 - 03:30
[Tom Miller]
There's just a terrible fight among the tobacco control community and others about vaping. And there's just a lot of misinformation, terrible amount of misinformation about the harm of e-cigarettes that has limited what has otherwise been a pretty spectacular switch from combustibles to non-combustibles. But public health and the tobacco control community is really divided on this.
03:31 - 03:34
[Brent Stafford]
So if it's an opportunity, do you think public health is squandering it?
03:35 - 04:01
[Tom Miller]
Well, not completely. I think we're going to discuss later the tobacco scorecard that indicates that there's been a terrific shift from combustibles to non-combustibles. But it could be more. If we didn't have this controversy, if we didn't have this division, it could be even more dramatic. So part of an opportunity is being squandered. I hope in the future we don't squander that part.
04:02 - 04:16
[Brent Stafford]
Before we go any further, tell us a bit about your background in the fight against tobacco disease and death. You were one of the key architects of the 1998 Master Settlement Agreement, the deal that finally held big tobacco to account. Tell us about that.
04:17 - 04:54
[Tom Miller]
Well, to be involved in the tobacco case was one of the highlights of my life and my career, obviously. Of course, you know, it was led by Mike Moore and others. And I got involved fairly early on. And what my role eventually was to head up sort of what we call the public health group of AGs, that we were pushing for the strongest possible terms in order to improve public health. Our focus was on public health. And I think we contributed in a good deal in that way.
04:55 - 05:02
[Brent Stafford]
So what is it about being an attorney general that puts you in an intersection with public health over tobacco?
05:03 - 06:35
[Tom Miller]
Well, it was the lawsuit that drew me in initially. I was out of office for four years when it first started. And then as I got back in the office, I knew that this was a big issue and started to study it and figure out what my role should be. And I'm a numbers person. I had to choose between a major in mathematics or political science. I hope I chose the right choice, but I maintained the interest in numbers. I didn't get very far into my research and found out that the estimates at that point, it's higher now, that 400,000 Americans die from tobacco-related disease each year. That drove me. When I was Attorney General, our main focus was on what could we do to help the people of ordinary lives in terms of the law. So that really drove me to be involved and to be involved on what I called the public health group of AGs. We pushed hard for the greatest amount of payments each year, because that would drive the cigarette pack higher. The higher the charge is, the less smoking, particularly among kids. And we also pushed for the American Legacy Foundation that became Truth Initiative as a way to reduce kids smoking. And I've always been focused on kids as well, especially. So that really got me involved in a huge way.
06:36 - 06:40
[Brent Stafford]
So how much of a win was this MSA, in terms of dollars even?
06:42 - 07:25
[Tom Miller]
Well, it was a great win in terms of dollars. Over $200 billion for the first 25 years. And it continues on to today and tomorrow, continues as long as the participants, the defendants, sell cigarettes. But probably even more than that, it was a psychological thing that the tobacco industry had been invincible. They never paid out a cent in damages or judgment. And this made them probably the biggest industry in payments. So it was cracking that invincibility that really had a huge impact on the whole situation concerning smoking in America.
07:26 - 07:33
[Brent Stafford]
Now, you mentioned youth. One of the key things about this settlement was prohibiting big tobacco from marketing to youth.
07:35 - 08:07
[Tom Miller]
It was. It was. There were a number of restrictions, including not using cartoon characters and restricting advertising, restricting any marketing to kids. There was a good focus there. But the biggest thing on kids, I think, was the creation of Truth Initiative to... to really have a campaign, an ad campaign that would change the view of kids and cigarettes, which turned out to be accomplished.
08:07 - 08:16
[Brent Stafford]
Well, let me just quickly ask you, I mean, Truth Initiative, for many on the tobacco harm reduction advocacy side, don't hold that organization in the highest regard.
08:17 - 08:46
[Tom Miller]
Well, I mean, they have tended towards the prohibition side. And after David Abrams, Ray Niara, and I left the organization, it sort of tended pretty heavily towards the prohibition side. But a remarkable person now heads at Kathy Crosby, and I think she's trying to create some balance. I think she understands tobacco harm reduction and is a good leader of that organization.
08:46 - 08:56
[Brent Stafford]
A.G. Miller, you've been quoted saying the tobacco industry was the worst industry in history. How bad were their practices? What made them so bad?
08:57 - 09:22
[Tom Miller]
Well, I think what I was thinking about when I said that is two factors. One is that the tobacco product killed so many people, 400,000 we thought then, 500,000 now, that there was just this enormous amount of death and suffering. And there was enormous amount of dishonesty for a period of time within the industry. So that's what really bothered me, those two things.
09:23 - 09:33
[Brent Stafford]
AG Miller, after leading the charge against Big Tobacco, what shifted your perspective towards supporting products like e-cigarettes and nicotine pouches?
09:33 - 10:41
[Tom Miller]
Well, it was a moment that the light bulb went on. It was a board meeting at Truth Initiative, and we finished the board meeting. And David Abrams, who was the great scientist of Truth Initiative, and Charlie Cook, who was a state senator from Wyoming, the three of us just started thinking about this new thing called e-cigarettes. And it hit us that if there was a mass shift from combustibles to e-cigarettes, we could save a lot of lives, a huge number of lives. And so I became a big advocate of safer, less harmful e-cigarettes and pouches as a result of that. It was, you know, sort of a dramatic moment. And Charlie Cook and I, you know, laughed a little bit among ourselves saying, yeah, here's a liberal Democrat, here's a conservative Republican coming to the same conclusion. But, you know, if you follow the science and follow the facts, that's the conclusion.
10:42 - 10:58
[Brent Stafford]
I've got my own opinion, which is that the tobacco industry has done a lot to rehabilitate that reputation. And they're playing... possibly a very positive role moving forward. What's your take on that? And I do understand that you still do some consulting for the industry.
10:59 - 13:04
[Tom Miller]
That's right. Well, with the advent and initial success of the cigarette, the dynamics of the cigarette industry were changed significantly. And it was because of competition. I'm a great believer in antitrust and competition, so I think this is a good example. What happened when the non-combustibles became available? The tobacco companies could see that they couldn't let a competitor totally dominate that new field. They all had to get in and compete and in half vigorously in the non-combustible area. And also, they could see the future of the noncombustible. The future is best seen now when you look at 18 to 24-year-olds. It's 4.8% use combustibles, and half of them not daily, and 15.1% use noncombustibles, use e-cigarettes primarily. So they were thrown into this noncombustible area and had to compete heavily, and they could see the future. So that's really changed them. I've been a harm reduction consultant for a little over two years now for Altria. I've been impressed with how much they believe in the non-combustibles and how they promote them and how they see their future there. Had some contact with PMI and same thing there. Indeed, they recently announced that 42% of their revenue was from the non-combustibles. So the industry really has changed for those reasons. And I guess I would ask your listeners, your viewers, obviously, for me to say that is sort of a revolutionary thought. So I don't expect you to believe that because I said it. What I would ask is just keep an open mind when you see them and see what they say and see what they do, more importantly. I think you'll see that they're big believers and big promoters of non-combustibles.
13:05 - 13:08
[Brent Stafford]
Is there a war on vaping being led by public health?
13:09 - 13:44
[Tom Miller]
Well, there is a battle. It's sort of a civil war, unfortunately. And it's the prohibitionists against the harm reduction people and tobacco control. And the prohibitionists are largely the advocates. 90% to 95% of the advocates are prohibitionists. And the tobacco harm reduction people are primarily the academics and the scientists. And they don't agree. We fight back and forth. We fight with our old friends and do the best we can.
13:45 - 13:46
[Brent Stafford]
Now, that must be tough.
13:47 - 14:04
[Tom Miller]
It is tough. You know, Matt Myers and I worked a lot together in the MSA, and subsequently we were friends, we were allies. And now we're on the other side of this issue. So it is difficult.
14:04 - 14:29
[Brent Stafford]
So it's interesting because while you mentioned the academics and scientists tend to lean towards the harm reduction side, but yet the prohibitionists claim the science as being on their side. And that seems to be like a prime point of the miscommunication is that they're communicating some doubt around the science and it makes it very difficult for the THR advocates to bust through that.
14:30 - 17:50
[Tom Miller]
Yeah, they do. And They're wrong in thinking the science is on their side. It's overwhelmingly on the side of tobacco harm reduction for some of the reasons I mentioned before. It's sort of obvious that you take away the toxins, you're going to take away a lot of the harm. Public Health England has done that incredible survey. Others have done research that's solid. The research on the other side just is not good. A couple examples is formaldehyde. There was this study that indicated that e-cigarettes had formaldehyde. Well, it turned out that it was a trace of formaldehyde, and there's a trace of a lot of bad things and a lot of good things, and it's not a problem because it's only a trace. that to have any kind of meaningful formaldehyde, you'd have to turn up the volume of the test many times over, which would be impossible to vape. Another example was the lung disease, popcorn lung. Popcorn lung exists, but it's almost exclusively among workers that manufacture popcorn. And the only one I know of, the consumer that got it, took two or maybe it was three, let's just say two, bags of popcorn lung that you heat up and get pops. Two or three bags a day for decades. And so the science just really is not very good. And indeed, I would argue that it's very much like climate change, that the overwhelming side of the science is on our side, much like the overwhelming amount of science in climate change is on dealing with climate change and getting it better. um you know there's there's this this group of academics and scientists that have just have done a great job on tobacco harm reduction side um it's sort of led by clive bates uh who's the one of the great masterminds of this issue uh who's counterfactual as his organization but it has some just enormously talented people, you know, people like Mike Cummings, I believe at South Carolina Medical School, Ken Warner at the University of Michigan, David Abrams and Ray Niara at NYU, Abby Friedman at Yale, Dan Wickler at Harvard, and many others that have just done great work to fight back all the misinformation. The misinformation comes all the time. Part of it Part of it is sort of, as I described it, as a rat-a-tat-tat. It just sort of keeps coming. And I remember when I described that at the new approaches, the woman from New Zealand was nodding her head in agreement. So in a way, it's unfortunate. But it's what we have and what we need to deal with to get to the finish line, which is a tobacco-free country, or at least under 5%.
17:51 - 17:58
[Brent Stafford]
A.G. Miller, your consulting firm has released what you call the Tobacco Scorecard. What is it and what are you trying to measure?
17:59 - 19:15
[Tom Miller]
Well, the Tobacco Scorecard is an attempt to sort of lay out where we're at on tobacco harm reduction in the current time. It compares combustibles to the various forms of non-combustibles. It shows trend lines. Whenever we talk about these issues, it's just so important that we talk about both adults and kids. And we emphasize kids in here in the scorecard. And kids vaping now has dropped 70% since 2019. It's the lowest it has been in 10 years. Kids' use of cigarettes is the lowest in 50 years. Adults' use of cigarettes is the lowest in 75 to 80 years. There's just some enormous success that we're not aware of and should be aware of because it's important to understand that as we debate, but more importantly, that the the regulators understand this as as as they do as they do policy if people want to see see our numbers in in in the entirety they can go to scorecard tobaccoscorecard.com and and and get those numbers
19:16 - 19:35
[Brent Stafford]
Let's take a look at the numbers. In Q4 of 2024, U.S. adult use of combustible tobacco dipped to 9.6 percent. That's 25 million. How low is that and how does it compare to the adult smoking rate when the MSA was being negotiated in the late 1990s?
19:35 - 20:13
[Tom Miller]
When the MSA was negotiated, the adult smoking rate was 24 percent. So the good news is it's been a 60% reduction, which is very substantial. The bad news is it's over 25 years that it took to do this. More recently, since 2019, about six years ago, adult smoking went from 36 million to 25 million, and e-cigarette use went from 10 million to 21 million. So just a dramatic change in the last six years. There's a lot of good news going on, but there could be more. And that's what we're talking about. That's what we advocate.
20:14 - 20:32
[Brent Stafford]
Well, exactly. And as of Q4 2024 in the tobacco scorecard, it mentions that use of e-cigarettes by adults is now at about 8.1%, as you said, 21 million adults. How significant is that? And did it play a role in bringing down the adult smoking rate?
20:32 - 22:03
[Tom Miller]
It's very significant. A few years ago, we never thought at this point, really it was last year, it was 21 million adult users of e-cigarettes. That's an enormously large number, an increase of over 100%, an increase of 11 million in a six-year period. And the estimate is that at least 40% of those are people that have totally switched. So that would be 8 million that have totally switched. The public health benefit of 8 million people off cigarettes is just enormous. It saved many, many, many lives as a result of that. And then the good news continues that what we're seeing now is the rise of the pouch. And that has become dramatic. PMI reported the other day that the increase in ZIN in America was 37%. And they're the market leader. And so it'd be very close to that for the total number. So we've had this great run of people switching from tobacco from cigarettes to e-cigarettes. And now it looks like we're going to have a great run, hopefully, yet to be seen in entirety on tobacco pouches. Brent, there's a lot of good news out there. That's what the tobacco scorecard is about, to give some accurate but good news about what's happening and also an indication of the potential in the future.
22:04 - 22:13
[Brent Stafford]
So together, that's 28.8 million Americans using non-combustible nicotine. I mean, that's amazing. But there's a caveat there, isn't there?
22:14 - 23:06
[Tom Miller]
Yeah, for e-cigarettes, pouches, and smokeless, it's about 28.7 or 8 million, as opposed to 25 million. The caveat is dual and triple uses. And we're really... We're really not quite able. We were working on that. And I have some information that's not public yet that would indicate that the factor would be about 87% of that. And it would be single single users or single people. And that would that would come out to 25.1%, 21, 25.1 million versus 25 million. So there's an argument. There's an argument. that last year in 2024, the non-combustibles exceeded the cigarette use.
23:07 - 23:20
[Brent Stafford]
A.G. Miller, earlier this year, Goldman Sachs made the prediction that sales of non-combustible nicotine products could overtake combustibles by volume in 2025. This data tracks with what you're talking about.
23:21 - 23:56
[Tom Miller]
It tracks very closely. It's two different calculations. We compare cigarettes to non-combustibles. They compare combustibles, which includes cigars and related products. We don't include them because of not as regular use. They're not as potentially harmful as cigarettes. So for them to say it's gonna happen in this year and we saying it probably happened last year is totally consistent with the idea that they include the cigars and related combustibles.
23:57 - 24:22
[Brent Stafford]
Daily e-cig use by teens in high school age is 1.5%. That's 405,000. Past 30-day e-cig use, which in my opinion is not a very good measure, is 5.9%. That's 1.6 million. So how much of a drop has youth vaping had since the big scare in 2019? Is there a teen vaping epidemic?
24:23 - 25:05
[Tom Miller]
then there certainly isn't a teen vaping epidemic because of the numbers you just mentioned. The most significant number is daily and it's 1.5%. That's not an epidemic. And there's an argument that In 2019, there was an epidemic of vaping. There was an epidemic of occasional vaping. The vast majority of them, 82% of them at that point, were occasional users, which, you know, it was of some concern, but it's not addiction, and it was really overstated by a number of people, I think.
25:05 - 25:23
[Brent Stafford]
So let's look at what I think is probably the biggest number to be calling out, and that's youth smoking. It's at 1.4%. 380,000 teens are smoking still. Now that's obviously a lot if it's one, that's too many, but how low is this?
25:25 - 26:19
[Tom Miller]
Well, it's exceptionally low. So often the target has been to get under 5%. And that 1.4% is use at least once in the last 30 days. If you look at daily use, which I think is the more significant use, then it's down to 0.4 or 0.5. So it's one out of a couple hundred or 300, actually. That's not an epidemic. And it's an enormous public health accomplishment to drive kids smoking down to almost nothing. We need to keep working on it, get it even lower. You know, I always thought we should have had a big celebration when that happened, because I think it's one of the most significant public health accomplishments in the last 25 years.
26:20 - 26:28
[Brent Stafford]
Well, certainly Dr. Ken Warner from the University of Michigan, we had him on earlier this year, and he posed that question, where's the parade?
26:30 - 27:44
[Tom Miller]
That's exactly right. We should have celebrated that. And the answer, a number of reasons might be the answer. One is that there's this sort of woe-is-me attitude in tobacco control, that things are really bad. The idea sometimes was tactically to keep trying to state things as bad as possible, because that gives you the best chance of a solution. I don't necessarily agree with that. And also, I think that If there was a celebration, they would have had to confront the factor of e-cigarettes being a contributing factor to that great drop. And, you know, the prohibitionists, you know, that's anathema to the prohibitionists. They didn't want to do that. But I think we should have a celebration and still should. You know, I think truth initiatives should initiate the celebration or global action should initiate the celebration. But we definitely should have a celebration. You can always count on Ken Warner. I've never known Ken to be wrong. He's absolutely amazing. And he's one of the ones I mentioned earlier that has done such great work on this issue to confront the misinformation.
27:45 - 28:05
[Brent Stafford]
It seems very disconnected to live in a world where public health is not, you know, singing from the mountaintops. That adult smoking is collapsing, like right before our very eyes. Youth smoking has collapsed right before our very eyes. And yet nobody knows about it.
28:07 - 29:24
[Tom Miller]
That's one of the purposes of our scorecard. We want to get that message out and have a realistic thinking by people of where we're at. That's really important because when you make policy, being accurate of the current situations is really important. It's also important as there are defeats for tobacco harm reduction in in these bad studies, in some legislation, the recent history of CTP, that we celebrate the things that are going right. But probably most importantly, it's important for policymakers to know It's very important for CTP to know that there's been this amazing success of e-cigarettes and now potentially pouches, and that there's been this dramatic drop in e-cigarette use among kids. And again, what we want to keep going with that, we don't want to stop because it's been a 70% reduction. We want a 90, 95% reduction. In fact, my goal would be to drive e-cigarette use among kids to the same level that we have kids using combustibles today.
29:26 - 29:31
[Brent Stafford]
Overall, do you have concern about adults using nicotine?
29:33 - 30:23
[Tom Miller]
You know, I really don't have major concerns. I think most people would rather have people not using e-cigarettes or pouches at all. The big thing is they use them instead of combustibles. So there's just that sort of wish. But the harm of e-cigarettes and pouches just has not been developed in a significant way. And so you're going to have people that remain on e-cigarettes and pouches maybe for the rest of their life. And I'm not terribly troubled by that based on what we know, and most importantly, based on what the alternative is, combustibles.
30:24 - 30:37
[Brent Stafford]
Well, man, you're able to, at least in the U.S. and Canada, you're able to buy a pack of cigarettes anywhere, and that doesn't look like it's going to end anytime soon. So while that's the case, you should be able to choose a safer alternative.
30:39 - 30:45
[Tom Miller]
Absolutely. Absolutely. And it's consistent with our views of freedom and choices as well.
30:46 - 30:53
[Brent Stafford]
A.G. Miller, what do you hope then comes out of the Tobacco Scorecard Project? And what's next for your fight?
30:53 - 32:59
[Tom Miller]
Well, you know, we've had a good response to it. And, you know, David Sweenor and Charles Gartner worked with me on it. Those are two terrific guys and both very much interested in numbers like I am. So, you know, I hope it's just greater awareness of the progress that we made and the potential. We're going to look at a couple of other things that we've been talking about, and that is that... We're going to try and have a list of countries that become what I call tobacco harm reduction countries, where the non-combustibles are greater than the cigarette use. The next time we come out, I hope we have a list of them. And then also a list of countries that get under the 5% adult use of cigarettes. Then there's a couple of sort of related things that I'm curious about and may try and do something on. One is that we've been talking about this incredible success of e-cigarettes and beginning success of pouches. How can that happen with all this misinformation out there? And I posed that to a group a while back and they said, it's bottom up, it's people. And that's what we want to explore. We think that there's maybe a lot going on at the individual level of smokers and friends and family. that people are grasping this concept and following up on it. But we really like to know how this is working, as well as it has, which is significant in this climate of so much misinformation. And then the other issue that comes up is that The e-cigarettes are not used in a very extensive way by people over 60 and 65. And they are the ones that are closest to death, of course. What do we know about that? What, if anything, can be done about that? We want to look at that as well.