According to harm reduction consultant and developmental neurobiologist Charles Gardner, there's a particular piece of information you are not supposed to talk about, promote nor expect public health to acknowledge. What is it? That nicotine is not carcinogenic and, when consumed outside of a cigarette, is relatively benign. Gardner considers it likely that nicotine is no more harmful than caffeine - and in his opinion, it could have significant health benefits. Gardner believes it's time to 'de-demonize nicotine'.
Charles A. Gardner, PhD
Consultant, Harm Reduction Strategies
Chapters:0:00 - Intro 0:52 - Is it time to de-demonize nicotine? 7:41 - Do researchers struggle to analyze nicotine? 10:56 - How does research affect public perception? 13:35 - Is nicotine benign? 19:43 - Charles's cash offer challenge 21:26 - Message to COP10 delegates 25:10 - Availability of nicotine
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Brent Stafford: Hi, I'm Brent Stafford and welcome to another edition of Reg Watch on GFN.TV. If there is one thing that best describes the current state of our culture, it would have to be fear. We are enveloped in a culture of fear, but forget the fear of hate. Absolutist aggression, terrorism, or even the potential of a new pandemic. The fear gripping the hearts of many within public health is fear of nicotine. Joining us today to discuss this unsettling affliction and what to do about it is Charles Gardner, a tenacious supporter of safer nicotine products and expert in the machinations of public health. Charles, it's great to have you back on the show.
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Charles Gardner: Good to see you again, Brent.
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Brent Stafford: It's always our pleasure. So Charles, you published an article recently on Medium titled, Is it time to de-demonize this drug? It's an excellent walkthrough of prohibitionist tactics and tendencies over the past century. Let's start with today. Is nicotine being demonized by public health?
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Charles Gardner: It is my strong impression that nicotine is now more demonized than alcohol, cannabis, heroin, cocaine, possibly even opioids, which is a little strange if you think about it. Possibly more demonized than all of them combined.
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Brent Stafford: So how did the war on smoking turn into a war on nicotine?
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Charles Gardner: Part of it's laziness on the part of the people in tobacco control, most of whom I still respect, There has been over the past three, four decades, a tendency to use the words smoking, tobacco and nicotine as if they are synonyms, which made a little bit of sense many decades ago when the main source that anybody was getting nicotine from was a deadly combustible tobacco cigarette. Doesn't make any sense now, didn't make any sense as soon as really snus came along. But there's a tendency to, I'm always grasping for the right word here, but to think of, there are toxic forms of tobacco, there's no question about that. But to then think everything related to tobacco is as harmful as those toxic forms of tobacco. And everything related to nicotine is as bad. And then there's also the demonization of the industry. So basically, anything they do, it must be bad, because we know they did bad things in the past. I mean, they actually did in misinforming the public and so on. And, you know, their products do kill people. So all of this gets in a kind of gamish. Everybody is confused about nicotine.
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Brent Stafford: So Charles, I'm taking it that demonization is actually a process, is it not?
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Charles Gardner: Yeah, that's what I tried to touch on. You know, it's very briefly in the article, but this is a process we've gone through over and over again. So always around a particular moral panic. United States Americans, we love our moral panics. And we had a massive moral panic in the, what would you call them, in the 1910 to 1920 period over alcohol. And a lot of the tactics that are used by prohibitionists were kind of honed to great perfection there. This is kind of like a playbook. A big one is obviously the innocence of our children. And then, you know, the harms to women. And in those days, most people who were drinking were men. Women were less likely to drink, would never go into a saloon. So then we get Prohibition in 1920. And then there are speakeasies, And speakeasies totally changed the gender ballots because they were full of men and women. And we finally, since pretty much everybody in the country was drinking alcohol during Prohibition, and bottles of whiskey were regularly delivered to the Senate offices in the Capitol, but once a week everybody was thumbing their noses at this prohibition and so the United States rescinded it in 1933 and then pivoted immediately to demonizing cannabis. So now alcohol is okay. We needed a new thing to fear and this time it had really strong racial overtones. Cannabis was associated with those Mexicans and with black people and bad behaviors and the mixing of the races. And so we get reefer madness, right? And it's, again, the same kind of tactics. This is a gateway to, you know, insert bad thing here as part of this kind of the standard playbook of prohibitionists. And that it's, you know, ruining the lives of our innocent angelic children. And we move on from that. That one lasts 90 years. It's kind of shocking. We had, we dabbled with something called the Great Comic Book Scare in the 1950s. And there were hearings in Congress about how comic books were corrupting the minds and the lives of our children, the bright colors in the comic books, It was all nonsense. And now we look upon comic books as being just innocent childhood memories. And we, there's a little bit, and you know, now we're de-demonizing cannabis, but you know, it's a slow process. And the thing that tilted that needle is actually that there are some health benefits and getting the voices of people who, let's say, recovering from chemotherapy to talk about their experience. This helps me. And they're not teens. They're like 50, 60 year old people. There was less of a scare around psilocybin, you know, magic mushrooms. But we made that illegal in 1968. It's around, you know, the 60s. Everybody was doing drugs in the 60s and it was kind of lumped into all of those drug fears. And the thing that has always intrigued me with all of these is with cannabis, with psilocybin in particular, and I think also with nicotine, how that colors and tilts and changes the research priorities around these, they're all psychoactive drugs.
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Brent Stafford: Often we heard with regard to cannabis is that governments didn't allow research funding to go to institutions to do proper research on the benefits of cannabis. And that's obviously changed in this kind of transition to de-demonizing cannabis. But with nicotine, I've heard recently we've had on our show people who have said that there is some struggle to get research funded for the benefits of nicotine. It almost sounds like the old battle days with cannabis.
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Charles Gardner: It kind of becomes a self-fulfilling prophecy. If 90% of your research is focused on finding harms, you know, if all you have is a hammer, everything looks like a nail, then you're going to find harms. And if very little of your research is focused on exploring potential health benefits, then you're not going to find, you're just not going to learn that. The psilocybin story is the one that really intrigues me because from 1968, when it was made illegal, to very recently, only in the past 10 years, no research was allowed. And which means that what we're finding now could have been discovered three decades ago. And so I think, you know, with nicotine, it's the same thing. It's really important to think about the priorities that advocates and activists had during the HIV AIDS crisis - the 80s-90s, right at the top of their list was changing research priorities. And that's something we we talk about sometimes in the tobacco harm reduction field, but it needs to be moved up in our priority list. And, you know, this goes back to Larry Kramer calling Tony Fauci a murderer, just like 30 years ago, because the research priorities were wrong on HIV AIDS. In the same way, our research priorities on nicotine are wrong. Now, there are some exceptions to that. So, for example, the National Institutes of Health has invested over $10 million to test nicotine patches for people with early-onset dementia because nicotine is neuroprotective, certainly reduces Parkinson's disease, and probably, maybe, Basically, NIH would not have invested $10 million if the evidence wasn't already very strong. So, this is a final kind of proof of principle, proof of concept of the effectiveness. It's a big investment. And there are dozens and dozens and dozens of studies in the literature But it's on nicotine's health effects. For example, weight control, Parkinson's, lots of neurodiversity issues.
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Brent Stafford: How does research on recreational drugs or therapeutic drugs, however you want to frame that, but nicotine specifically, how does research affect public perception?
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Charles Gardner: Here, I'm going to go out on a limb and say, because I think I can say this fairly, and I think a lot of people would agree with me, because I've worked most of my career on topics like HIV, tuberculosis, malaria, dengue, child nutrition issues. So, 30 years of my career, I'm reading scientific journals. And, you know, not every peer-reviewed publication is solid. I just expect that. And you learn to look for, you know, where they might have misinterpreted the results, blah, blah, blah. In tobacco control, the field is so full of junk science right now. All of it's well-funded. Because in the United States in particular, actually, according to a study that hasn't been published but was conducted by somebody quite senior in the National Institutes of Health, the U.S. accounts for about 85% of all of the tobacco control research on earth. And that's due to the Tobacco Master Settlement Agreement of 20 years ago, and so the tobacco companies have to give money to FDA, and the FDA gives money to the National Institutes of Health for this kind of research. The research is driven by the FDA's regulatory priorities, and it's prioritized toward finding harms. So, you can imagine there's an army of researchers out there who have been doing research on deadly combustible tobacco cigarettes, and suddenly along come these potentially safer nicotine alternatives. So, they all get grants to, you know, use the same methodologies and study those things. And, of course, they're going to find or invent harms. The field is full of junk science now. And so extrapolating to humans from studies in mice or rats, studies that don't have proper controls, studies that draw causal inferences from cross-sectional surveys that cannot possibly show cause and effect. And all of this gets funded and all that gets published in peer-reviewed journals.
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Brent Stafford: Let me ask you Charles: is nicotine benign?
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Charles Gardner: Well, it's a mild stimulant, but so is caffeine. Someone who has a severe heart condition, that person's doctor should tell them don't drink caffeine. Don't take caffeine and avoid nicotine as well. Otherwise... I have a thought experiment I often suggest, which is what would happen if we put every adult on earth on nicotine patches every day for the rest of their lives? What would happen? Well, I can tell you right away, smoking rates would drop. Nicotine increases focus, attention, and memory, and improves, it's a performance enhancing drug. That is actually it's if you're tested for drugs and you're in the Olympics, and there's nicotine in your system, that's fine. Nobody cares. And but what what else would happen? Parkinson's disease rates would drop about 60 percent worldwide. And probably Alzheimer's and other aging dementias would drop. And then a whole raft of what are called neurodiversity conditions, symptoms would drop. So here we're talking among adults. We're talking about ADHD and autism and bipolar disorder and Tourette's syndrome and schizophrenia. Rates of epilepsy would drop. Rheumatoid arthritis would drop. Ulcerative colitis symptoms would drop, and that's an extremely painful disease. The majority of this is backed up by dozens of studies that have just tested nicotine patches. I often wonder why the pharmaceutical industry doesn't take its nicotine replacement therapies like patches, nicotine gum and get them approved for other conditions. And I think part of this is just that nicotine can't be patented. You really can't make a lot of money on it. But I think the other thing is that nicotine is so demonized. They just don't want to go there.
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Brent Stafford: It appears to me that the very people that demonized cannabis Now, not the same people, but the same trajectory, the same people who demonized alcohol, then demonized cannabis, then demonized psilocybin, that now have flipped on both of those drugs and are very much behind recreational use of cannabis and maybe even psilocybin, are the ones that are actually demonizing nicotine. Do I have that right?
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Charles Gardner: Yeah, I think that's a, that's a puzzle to a lot of us. The very same people, who want to legalize those drugs are all in on the demonization of nicotine, which is ironic because it's already a legal drug, right? It's on the World Health Organization's essential medicines list. It's approved by the Food and Drug Administration and nicotine patches, nicotine gum and now recently nicotine lozenges and nicotine inhalers. are available in every pharmacy over the counter in America and Canada, right? And the FDA says that those products are not dependence forming or subject to abuse. The CDC is full on with those products, pointing out that they don't cause cancer, don't cause heart disease, don't cause lung disease, and actually the CDC calls them medical nicotine. It's the same pharmaceutical grade nicotine that's used in nicotine vapes and nicotine pouches. There's not a lot of logical thinking going on right now in the field of tobacco control.
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Brent Stafford: So how does any of this square with the fear machine around nicotine?
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Charles Gardner: Well, the fear machine is, We have the end result of several decades of tobacco control messaging, so that now 80% of American physicians believe that nicotine causes cancer and heart disease and lung disease because they used these words as synonyms, tobacco, smoking, nicotine, as if it's all the same thing. So if four out of five doctors are that profoundly misinformed, think about the public and what are those doctors telling the public? What does the public think or know? Well, it's interesting that the FDA has been talking about it, yes, we know that the public is, in fact, I think there's one quote from Brian King saying 90% of the public is misinformed about nicotine. Okay, well, what are you going to do about it? Their concern is that they want adult smokers to be better informed. that, okay, nicotine is not the thing that kills you. It's all the other crap that's in a cigarette smoke. But they want to make sure that teens don't hear that. That's their concern. And I think there's some interesting ethical issues around truth telling that aren't really being explored and should be explored by a bioethicist there. We want to tell adults the truth, but we don't want teens to learn that and kind of let that sink in.
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Brent Stafford: Charles, you posted a cash offer challenge last year on X formerly known as Twitter, for and quote, proof of one verified human death from inhaling nicotine vapor over the past 20 years. So the idea here is that you don't believe that it is as dangerous as being claimed.
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Charles Gardner: Okay, so... Nicotine vapes were invented 20 years ago. They kind of hit the market in the United States in 2007 and around the world. And at this point, there are at least 85 million adult nicotine vapors around the world. Hopefully, ex-smokers are on the journey. That's a lot of people. So surely, if these are harmful products, after, there are some people who've been vaping for 15 years now, there would be some deaths. So I offered $100, and that's nearly two years ago now, right? Then there have been no takers. And other people started chiming in and saying, well, yeah, I'll put in 100. And somebody else says, I'll put in 200. And so I kept tabs on that. I didn't do it, I did it in a very cumbersome way, just trying to use Twitter to help me keep track, so there's a long thread where I've kept track of them all. The offer has now grown to $9,300, for anyone who can find verified evidence of a single death ever caused by inhaling nicotine vapor, and there have been no takers.
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Brent Stafford: Charles, COP10 is coming up next month in Panama, The Conference of the Parties for the WHO's Framework Convention on Tobacco Control. If you had an opportunity to send a message to delegates there, what would that message be?
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Charles Gardner: Here, we need to reflect on and I need to shout out to everyone in the tobacco harm reduction advocacy space all over the world. Especially in Latin America for this coming event, but LATAM, North America, Europe, Africa, Asia, a lot of, you know, people who I know and love in those places, and all of us need to be reaching out to try to influence the membership of those delegations to COP10. There should be a consumer advocate there. There should be someone who is an informed, at least an informed ex-smoker who uses a safer nicotine alternative, whether it's snus or pouches or vapes. And some countries are trying to do this. That could begin to change the messaging. Some countries like the UK, New Zealand, Sweden, Norway, Iceland even, and increasingly, although it's kind of a mixed message in Canada. Canada, you canookers used to be really good guys at the COPs. Those delegations need to stand up and say, we think FCTC is going in the wrong direction here. It needs a rethink. Because, you know, harm reduction is part of the very definition of tobacco control. And 5.3 is not being interpreted according to the original intent of the signatories of the FCTC. And what would I tell them? I would tell them that this whole process is off the rails, that there were 1.1 billion smokers on earth 20 years ago, and there are 1.1 billion smokers today. Whatever they're doing isn't working. And they should be looking to the countries where... The World Health Organization and the FCTC congratulate themselves by measuring how many countries have conformed to what they call the empower guidelines or power recommendations. So they're measuring, what countries are doing to at least put on their books on their and their laws but a lot of countries can't enforce those laws they're not measuring or ranking countries by how rapidly their cigarette smoking is declining and if they did that they'd find Sweden, Norway, Iceland, Japan, New Zealand smoking rates increasingly, United States and the UK are plummeting. And there really looks like product substitution is the cause of that. Nobody in public health wants to admit that there might be product substitution going on here. Just like digital cameras replace film cameras and electric cars are in the process of replacing combustion engine cars.
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Brent Stafford: Charles, let me ask you plainly, should nicotine be made legal for recreational use?
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Charles Gardner: Well, first of all, it's already legal. Cigarettes are available on every street corner and every country in the world, including even Bhutan now where they used to be illegal. And so nicotine is legal and it's on the World Health Organization's essential medicines list. And it's been authorized and approved by the Food and Drug Administration for smoking cessation for decades now. And we have very good post-marketing surveillance in the United States. It doesn't cause cancer. It doesn't cause heart disease, doesn't cause lung disease. And the thing is, we're going to have to grapple with the fact that a lot of us enjoy our nicotine. The same way that I enjoy my morning cup of coffee, if you try to take that away from me, there's going to be a problem. And there are at least 1.3 billion people on Earth using nicotine. That, maybe alcohol, I don't know what the numbers are for alcohol, and caffeine. Caffeine is the most widely used psychoactive substance on Earth. It is used by 90% in some form or another 90% of all adults on Earth. And it's a psychoactive drug. So the demonization of nicotine and people talking about the end game of tobacco control is to end all nicotine use is a pipe dream.