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Despite extensive regulatory barriers and massive misinformation on relative risk, consumers are transitioning from cigarettes to safer nicotine products at an extraordinary pace. In today’s episode tobacco control policy expert David Sweanor guides us through the remarkable growth of the U.S. vaping market and issues a warning to those who seek to stand in the way.

David Sweanor
Adj. Professor, Faculty of Law, University of Ottawa Tobacco
Control Policy Expert


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Brent Stafford: Hi, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV. One of the many reasons why the Global Forum on Nicotine is such a unique event in the world of tobacco harm reduction is its focus on the consumer of safer nicotine products. In every way, nicotine consumers are either overlooked or disregarded. by regulators, tobacco control, and the public health establishment. Yet the nicotine consumer is impossible to ignore in one critically important area, where they spend their money. Joining us today to talk through the shifting economics of the nicotine industry is David Sweanor, tobacco control policy expert and adjunct professor in the Faculty of Law at the University of Ottawa. David, it's so great to see you again.

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David Sweanor: Great to be back, Brent.

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Brent Stafford: So David, we last spoke back in 2022 at the Global Forum on Nicotine in Warsaw, Poland. At GFN, the nicotine consumer is top of mind. Why is that important?

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David Sweanor: Well, for various reasons. I mean, part of it is for anybody who's actually interested in reducing the carnage of cigarette smoking. We need to understand what's going on. We need to be curious. We can't just dictate things that we might like to believe. And a key part of this is understanding the people who are using the product. And this is just basic public health. I mean, if you're actually doing public health, you try to understand people's lived experience, you meet them where they are, and you empower them to make better decisions about their health. I mean, it's pretty simple. And you deal with people as consumers, as people who can act on information, respect their agency, treat them as human beings.

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Brent Stafford: It's interesting because they seem to have a difficulty in terms of viewing users as consumers.

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David Sweanor: Well, I think there are many people in the tobacco control area who do have that problem. I think many of us don't. And it depends on the orientation somebody has. If you see this truly as a public health issue where you're trying to help fellow human beings improve their health, it's really easy to see people who are using nicotine products as people as consumers, as neighbors, as people you'd care about. If you see this as an ideological struggle against sin, for instance, and we've talked about this stuff before, if you think you're slaying dragons, you take an entirely different approach. You need to dictate to these people what to do because you've decided what's in their best interest. And there's a long history of this, of people trying to use the power of the state to impose their moral views on the behavior of others. Not just on nicotine, but on a whole range of issues. And it never worked. And it's invariably a disaster and people keep doing it. So it certainly slowed us down on efforts to reduce cigarette smoking.

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Brent Stafford: I've got a line here, David, that I jotted down for this episode. Nicotine consumers are demonized as nicotine addicts whose dependency emboldens an industry that threatens to hook the next generation on their product. So is that maybe not part of the problem? Is because they feel that if it's just simply a consumer product and nicotine consumers are allowed to have access and choice, it just emboldens an industry that that their whole goal, that industry, is to addict the next generation of kids on nicotine.

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David Sweanor: Yeah, well, I mean, part of that is claiming that they're fighting the tobacco industry rather than caring about individuals. Part of it is mischaracterizing why people are using nicotine. And a lot of it comes down to deciding that you're going to dictate to people what they're going to do. And you know better than them what's going on. And you can do that. So, if you're somebody who enjoys a glass of wine, if I refer to you as dosing with alcohol, you'll probably shut me out. If you enjoy a cup of coffee and I say, well, there you are dealing with your caffeine addiction, I am going to bar you from going to Starbucks, you'd probably decide that I wasn't somebody worth listening to. And I think that we can look at consumers for any product to say, that's not the way you reach people by demonizing them, by claiming that they are something that they don't think they are.

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Brent Stafford: Now, we're going to be drilling down on data in the U.S. in this episode. Let's use FDA, for example. And again, still a bit of a higher up question. If the FDA, for instance, chose to change, shift their approach when it came to nicotine vaping products and to treat them as a consumer product, what would be the implications of that?

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David Sweanor: Well, I think we can look to the history of the FDA. What happened when they decided that they were going to treat issues of sanitation as an issue of consumer rights, recognizing the right of people to choose consumer products. I mean, there was a pure food movement that claimed that we need to stop people from moving to cities because they're going to buy manufactured food products. We need to stop the manufacturing of food products. Everybody should just live in the country and breathe clean air and go to church on Sunday and do what they're told. And cities are a den of sin. Well, those moralists got left behind with the FDA saying, we're going to have standards on food safety. And if you can meet these standards, you can tell people that you've met these standards. And that caused a revolution in food. If we look at many of the major food corporations now, they came about as a result of that legislation. Once there were standards, we no longer have to worry about things like botulism and other poisonings. We don't have to worry about lead and mercury and candies. I mean, all the things that were a concern back in the 1800s. And that changed virtually overnight because once people knew that there were some products you could trust, that they met a certain standard, people moved to those products. They moved en masse. They moved very quickly. We saw the same when the FDA decided to move on science-based pharmaceuticals. In 1938, the FDA gave an advantage, the products that met standards of safety and efficacy. And within 12 years, 90% of all the pharmaceutical products sold in the United States were products that did not exist before that law. It gave an incentive for businesses to bring forward products that worked and that consumers wanted to use. So that you were getting something that if your children were ill, it actually helped rather than made them more likely to die. We got rid of the Dr. Graham's pink pills for pale people and Lydia Pinkham's vegetable compound and all the big sellers of the 30s because we replaced them with science-based products that the FDA encouraged. And what's phenomenal now is you've got an FDA that's standing in the way of that to say they've had their law for more than a dozen years. Have we seen 90% of cigarettes gone? Have we seen this mass transformation in the market? And we've seen the opposite. We've seen a law that was set up in part because it was co-authored by Altria, the biggest cigarette company in the United States, and the Campaign for Tobacco-Free Kids, which was an abstinence-only organization. They could agree that the one thing you don't want to do is give people a safer alternative to cigarettes. So we've ended up with legislation that actually flies in the face of the successful history of the FDA in dealing with other products.

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Brent Stafford: David, in the United States, like elsewhere too, of course, but in the U.S., the consumer is king. And by definition, a consumer spends money on products and where they spend it, on what they spend, and how much they spend. These are critical indicators of what's important to the consumer, is it not?

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David Sweanor: Yeah. And consumers will buy what they want to buy. And the ability of regulations, of moral architects in trying to prevent that is really unsuccessful. You know, if we look at issues like, gee, I suppose once marijuana was legalized in Canada, that really changed the market in Vancouver, didn't it, Brent? And of course not. I mean, People were already buying marijuana. They wanted to get it. They were consumers. They got it. If we look at what happened to alcohol during prohibition, it isn't like everybody just quit drinking. They just found another way to get what they wanted, often something that was more hazardous. And we're seeing the same thing happen in the United States and in other countries around the world, including Canada. There's this massive transition to non-combustion products despite all these efforts by the FDA and so-called health groups to try to prevent it, to mislead people, to ban these products, to try to make them non-palatable, etc. And yet, even then, the transition is phenomenal. It's beyond anything we've seen before in terms of how rapidly cigarette sales are falling.

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Brent Stafford: And that transition, I mean, it's showing up in the financial reports and statements from big tobacco companies like Altria and market analyses from the likes of Goldman Sachs and Nielsen. So let's dive into that. I know that it might be a bit of the weeds, but we've got some reports that you've sent us. The 2024 Consumer Analyst Group of New York, it was a presentation by Altria and We have Goldman Sachs behind the counter navigating tobacco nicotine trends, which is Bonnie Herzog. And then America's Tobacco, which is Nielsen IQ data from just actually the first month and a half of this year. So let me ask you, David, how big is the U.S. nicotine market overall?

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David Sweanor: If we look at it in dollar terms, the legal market is around 78 billion USD a year for the entire legal nicotine market as measured by Nielsen data.

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Brent Stafford: That's a huge number. When we look at the total e-cigarette sales in dollars, the Nielsen report is that it's 5.4 billion. And the total smokeless sales, which I guess includes the oral tobacco or the synthetic. So the oral product.

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David Sweanor: And the nicotine pouches now.

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Brent Stafford: Right, right. So and that's 9.5 billion. So e-cigs at 5.4 billion. The total smokeless sales in the U.S. is 9.5. This is 2023 data, is it not?

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David Sweanor: Yeah, this is past year. So we're seeing a change in in trend lines, cigarette sales in total are about 55 and a half billion of the approximately 77 to 78 billion total market. We're seeing a much larger share going into non-combustibles. But Brent, something that's really important to mention in that is that the non-combustibles tend to be less expensive than the cigarettes. And therefore that's a larger share of the market than those dollar figures would indicate, but also a very significant part of the vaping market, now estimated to be over half, is illicit. These are products that are not showing up on the Nielsen surveys because they're not caught in legal analysis of what's happening in the market. So if we look at what Altria has reported with their fourth quarter results, and then again at the Cagney conference, the overall nicotine market in the United States over the last five years has not declined. It's actually increased marginally. And that is despite all these efforts being put into an abstinence-only view, attack any form of nicotine product, the market hasn't declined. But what has happened, and this is fascinating because it's happened at a time that all these alternative products have been just viciously attacked by the anti-tobacco groups in the States and really put at a huge disadvantage by regulators. In that five years, non-combustion products Altria estimates have gone from 20% of the market to 40% of the market. So in five years, they've doubled their market share. They're now 40% of the overall nicotine market. And that is happening despite all the efforts to ensure that consumers don't do things like that. So again, as we've seen elsewhere, we're where the more moral architects try to tell other people what to do. People act as consumers. They decide what they're going to do and they are moving on mass to massively less hazardous products.

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Brent Stafford: Yeah. They vote with their wallets.

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David Sweanor: Yes. They are making decisions and this is not unusual. We we've seen this on so many other issues that people do get better information and it's been written, by various people looking at the Downs and Noons, Big Bang disruption as an example, that in the age of the internet for getting information and social media for sharing that information, you cannot stop innovation. People find out about it. They learn about it on the internet. They learn about it from their friends. There becomes a demand for the product. The market meets that demand. And as Downs and Noons said in their book that, You can't stop innovation. You can slow it, and nothing can slow it more than regulation. No regulation can slow it more than health regulations. No health regulations can slow it more than FDA regulations, but even the FDA can't stop it. And that's what we're seeing, that even all these efforts, and it's doubled its market share in just five years. Millions more Americans are now vaping, not smoking. And that's happening despite all the efforts to try to stop that, which of course raises the question of what could we do if we actually tried to encourage it.

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Brent Stafford: And putting that into some perspective is Altria's CEO, Billy Gifford. And he was quoted as saying, in 2023, our data shows consumers transitioned from cigarettes to e-vapor at over three times the rate of transition to other smoke-free products. So clearly choosing preferring e-vapor over any of the other smokeless products. And in 2023, Altria estimates that the eVapor category included approximately 17 million vapors, with 12 million being exclusive, meaning they're not dual users, they're not smoking. 12 million. So that's, in three years, that's an increase of 7.2 million vapors, of which 6 million more vapors were exclusive to vaping. These are extraordinary.

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David Sweanor: I mean, absolutely phenomenal. And you think if If we had have accomplished something one-tenth of that with a standard anti-tobacco campaign, I mean, people would be over the moon. They'd be wondering when they're going to get their Nobel Prize. And here we've got something that is just working so much better than anything else that's ever been done in trying to reduce cigarette smoking. I mean, I've been around for over 40 years and I've been involved in so many of those campaigns. that we're involved in trying to reduce cigarette smoking. And some, like tax policy, were quite effective. But this dwarfs all of it. You know, many of the things that are done, the standard anti-tobacco policies, we can't even measure an effect. You know, we believe it's probably happening, but you can't measure it. And you look at something like this to say, my gosh, you moved how many millions of people off cigarettes in just three years? I mean, that is phenomenal. And What we're finding is that the most effective thing we can do is simply facilitate people to make their own decisions, empower them to make informed decisions about what they want to do about their own purchasing patterns, their own health.

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Brent Stafford: I want to share with the viewers just a little bit of information on what brands are actually the most popular when it comes to eVapor in the US. And the top products are Views, which is BAT, and Jewel. They're both on top. However, it is VUSE with 40.7% of the market and JUUL with a market share of, 24.4%. So a big difference. And then all the rest fall in underneath that.

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David Sweanor: And of course, that's just the legal market. So keep in mind that's a minority of the overall vaping market now in the United States. But it is, I think, a dangerous situation still when BAT, British American Tobacco, can have the largest market share. British American Tobacco is still losing large sums of money on trying to come up with alternatives to cigarettes. They wrote off the value of their cigarette brands in the United States late last year by over $31 billion because of the decline in the value of those brands because of the shift away from cigarettes. You wouldn't want to count on BAT to be the company most motivated to try to accelerate the transition away from cigarettes. Cigarettes is where they make their money. But what we're seeing are these disruptive players. You know, JUUL played that role very well for a while. But now also the people are just simply ignoring FDA and saying there's a demand for these products. We're going to get them to consumers. And consumers are saying, I want these products. I'm going to buy them.

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Brent Stafford: So let's get to that. FDA has granted market authorization to a puny 23 brands, which are mostly big tobacco and all tobacco flavored. I think it could be argued that in a way there really is no legal market in the United States at all with so few products being legal and the vast majority of them are in the gray area. They maybe have an MDO, maybe they're not, just finished being in the process. And then, of course, you've got the true illicit products, which are being shipped over from China and sold at a local bodega.

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David Sweanor: Yeah, I think the FDA has screwed up royally, but it's screwed up because they were set up to screw up. I mean, their legislation was designed to make it incredibly difficult, if not impossible, to be able to get market authorization for something that could replace cigarettes. And as said, I mean, the legislation was written in part, you know, cooperation between the biggest cigarette company in the country and the most adamant abstinence-only organization in the country. It's no surprise that they came up with legislation that makes it really hard to have an alternative. But even then, some entities have managed to get products through. Others have just decided we're going to market these because there is a market for it. and what's the FDA going to do about that? Because it actually puts them in a pretty difficult situation to say you've got millions of people who have quit smoking. They're vaping. They're reducing their risk dramatically. Many others who have now moved to these nicotine pouches. There's lots of other new products being developed and for sale in other countries that could also greatly reduce cigarette smoking. Are you going to stand in the way of consumers doing something that they want to do that will save their lives. You're gonna come down with a law to try to make it harder for them to do that? You're gonna come up with a law that protects the cigarette business? I mean, I just think that that becomes, I mean, part of the explanation, I think, for why the FDA hasn't been more vigorous in trying to enforce their admittedly silly rules is that they know the downside. They know what will happen if you do this to people. I think they're caught in a quandary, but there really needs to be a rethink about what's the goal of legislation in an area like this. Because what we've seen worldwide is this rush to try to put barriers in the way of the alternative products. You know, often as a result of anti-nicotine people who engage in sloganeering rather than policy development. You know, say, what about the children? You know, without ever having an intelligent conversation. I mean, obviously, if you're having an intelligent conversation, you would say, what's the risk to young people taking up these products? What's the benefit to others if the products are available? And then if we look only at young people, we'd say, well, what's the benefit of the young people who use these low risk products instead of taking up smoking? What's the benefit of the young people if their parents and grandparents and other significant adults in their lives are continuing to be alive because they quit smoking or that they're not in a hospital bed spitting up blood? You know, they're out playing ball with you rather than dying, rather than being unable to breathe. I mean, that's worth a lot to kids. What's the value to young people of not being exposed to secondhand smoke? Because those significant others are no longer smoking in your presence. What's the advantage of not dying in a house fire because somebody dropped a cigarette into batting? I mean, an intelligent analysis would look at risks and benefits and say, overwhelmingly, We've got to focus on people who are middle-aged and older, who are at dire risk of dying very soon if they don't get off cigarettes. And we have to weigh that in a reasonable way. And I think by any way of looking at this to say, everything tells us we've got to focus on helping people get off combustions. And that's priority number one.

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Brent Stafford: I agree with you, David, obviously. It's just after all these years of coverage, I don't think public health and tobacco control thinks one second over a current smoker or potentially dung. They might pay lip service to that. I think they have thrown adult smokers under the bus years ago, and their whole entire goal is to prevent new generations from ever smoking. And they believe that, you know, vaping products has gotten in the way of that they I mean, they really have an abstinent only plan for teens. They don't give one rat's ass for adults.

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David Sweanor: Well, I don't think they actually care about teens. I think they're just using teens as an argument for their abstinence only agenda on the overall market. I mean, if they cared about teens, they'd be saying, What do we do to prevent them from taking up cigarette smoking, which is really hazardous? What do we do to protect them from the people around them dying? It's the cost to a young person of losing a loved one prematurely. And when we talk about the number of deaths from cigarette smoking, that is impacting so many young people. But I think in my experience of dealing with seeing my colleagues go that abstinence-only route, It's a moralistic agenda, Brent. I mean, this is, they're fighting evil. They're fighting a dragon. They don't actually care about young people to any extent that I can see because they won't engage in a reasonable conversation about how would you improve the lives of young people? Or even if you want this measure because you think it will stop young people from using a nicotine product, what is it you're going to do to try to help their parents and grandparents?

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Brent Stafford: If it is about kind of destroying big tobacco or that kind of thing, right?

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David Sweanor: It's not because these groups constantly do things to protect the tobacco industry, the cigarette industry. So they'll say we're fighting big tobacco and then what do they do? Well, in places like the United States and in Canada and other places, they push and successfully pass a law that says it's illegal for these companies to tell consumers about the difference in risk between products. That is a get out of court free card to big tobacco because you can no longer hold them responsible in tort law for cigarettes being an unreasonably hazardous product and them not adequately warning their consumers about the differential in risk because they just say it was illegal. We weren't allowed to tell people. And you know, who gets upset when the giant cigarette companies acted like a cartel, keep raising the prices on cigarettes, disadvantage in consumers, and making returns on capital that are just unheard of any legal business. These groups don't care. And we can just go through so many examples of where they keep doing things that help the big cigarette companies. I mean, all the attacks on vaping and other low risk products. Big tobacco makes a fortune from cigarettes. They are a cartel. And again, their returns on investment, their profitability, is just extraordinary. You know, it makes a company like Apple look like it's fairly profitable by comparison. And what do these groups do? Well, they attack the alternatives to make sure the cigarette business will stay protected. They make sure the cigarette company continues, the companies continue to have a cartel. Well, don't tell me you're attacking big tobacco and say, this is the way to do it. We're gonna make them richer and we're gonna protect them legally. You know, that's like saying, Brent, you know, I'm so angry at you. I'm going to go throw gold bricks onto your front lawn like every night just to make it hard for you to cut your grass. I mean, you want enemies that make you richer. So I don't think their arguments stand up to any sort of scrutiny. I just think, again, it's sloganeering, claiming that they're fighting big tobacco when, in fact, they're protecting cigarette companies.

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Brent Stafford: So let me add this to our nuggets of data here. I have a data sheet. It's a report courtesy of Jim McCarthy from CounterPoint Strategies on behalf of American Vapor Manufacturers, the AVM. We just finished shooting an interview yesterday, and he pointed out that equity research firm Barclays in a report about Altria's fiscal year 2024 EPS guidance that the potential FDA DOJ crackdowns on vaping would provide the single biggest boost to cigarette sales and Altria stock price. So basically the financial analysts are saying, hey, you know, if FDA and DOJ cracks down on vaping, that will have the single biggest boost in Altria stock price.

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David Sweanor: Yes, and I'm very familiar with those reports and stock analysts have talked about this sort of thing for a long time. I've shared some of those reports with the very people who are doing things that keep protecting the cigarette companies. They don't care. But it's very clear that all of the attacks on the alternative products are protecting the cigarette companies. It's maintaining their profitability. It's protecting them from lawsuits. As we move people away from cigarettes, and as the market changed, cigarette companies saw their stock prices just get walloped. They lost over half their market value. That was hundreds of billions of US dollars in stock market value was just gone because the market could say, these guys aren't sustainable. Well, who comes to their rescue? It's the anti-tobacco groups saying, we're going to try to prevent this disruption from hitting you. We're going to try to prevent innovative technology from being able to replace cigarettes. We're going to prevent people from coming up with products that are massively less hazardous and less addictive than cigarettes. That I mean, what are they thinking? And I don't think we can assume that they're just idiots because I mean, I've known many of these people for a long time. They have a different agenda, but they're not about to tell you what's really motivating them because they're not going to get very far with that. So it's far easier to say we're fighting big tobacco and we're trying to protect kids and just hope nobody really questions them on that and why their actions keep looking like own goals.

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Brent Stafford: So what is their agenda, do you think?

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David Sweanor: Well, I think in most cases, it's a very moralistic agenda. Again, this idea that I want to use the power of the state to force you to behave in ways that coincide with my belief of how people should act morally. So they want to change the rules to try to force changes in the behavior of others to align with their moral values.

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Brent Stafford: Is that like fascistic or maybe communistic? Is it in those areas there?

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David Sweanor: It's certainly totalitarian in nature, and it's incredibly naive given the history of past movements. How successful were the Comstock laws in the U.S. that banned giving women information on contraception. You know, women still managed to get that information. Like, was it inhumane to try to prevent this, to put people in jail for helping women control their fertility? Yeah, but people got around those laws. You know, the people will, but we've had this long history. If we look at those Comstock laws, if we look at alcohol prohibition, if we look at the war on drugs, if we look at red scares, I mean, all sorts of things that come along to say, we have decided what you have to do, and we've decided we found heretics, you know, we have to burn them at stake. I think it makes those groups feel really good that they're doing this, because I think they found bad guys, they think they're fighting dragons. And I think the social cost for that action is extraordinary. And it's a basic a lack of curiosity on their part to say if they really believe what they were doing was rational, they would sit down and talk about it. They would come to debates to say why their views make more sense than the views of me or anyone else. And they don't. You know, they deal with it by blocking you on their phone, by not letting you comment on whatever they're putting out on social media, by slandering rather than discussing with people that they're not open for any sort of discussion. You know, they've got a closed view and it's really, it's taking on all the characteristics of the conspiracy theory. You know, they just are not open to talking to anybody with any alternative view. They reinforce it by staying within their own group and what they're doing isn't working, but they don't want to acknowledge it isn't working. They just want to keep imposing it on other people and fighting anybody who would question them.

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Brent Stafford: David, I know you'll be attending the Global Forum on Nicotine again this year for the annual conference on safer nicotine products and tobacco harm reduction. GFN 24 runs from this June 13th to 15th in Warsaw, Poland. I've been told you'll be sharing with attendees some insights on the economics of safer nicotine products. Let me ask you, what are you hoping attendees will take away?

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David Sweanor: Part of the joy of going to a conference like that is you get lots of different views, people who truly are curious, who are open-minded, and we all come away with probably different views than we had going in. I think that part of what I'm hoping people will see is just how much the market is changing, how much consumers are moving, regardless of the barriers that are put in their way. And that I think it's common for people to get quite despondent when you look at how we could so easily deal with the enormous carnage caused by the inhalation of tobacco smoke. It's not hard. We've got the products. Consumers are keen to move. We can do something absolutely dramatic. We could do it very quickly. We could do it at no cost because the consumers would be able to do that. We were just simply empowering people. We would only be following the principles and the enlightenment and the general ethics of public health, but it's not happening. And these people that you see who are smoking cigarettes and you ask them why they're not vaping and they tell you because that's more hazardous, it gets very depressing. The countries that ban the alternatives and therefore keep protecting the cigarette companies, you can get quite down about it. But then if you move away from looking at what the rules are that people are doing or the nonsense papers some people are publishing and calling it science, and look at what's happening in the real world, that's a great cause of optimism. Because even in countries where vaping is bad and re-banned and stronger bans, like Australia or India or Brazil, there's a heck of a lot of vaping. And it's reducing cigarette smoking. And in countries that just try to stymie it, like the United States will allow very few alternatives and will make sure the public is horribly misinformed, et cetera. And it's driving cigarette sales down at a pace we've never seen before. The same in Canada. And then in countries that even allow a bit of room to, how about we actually start telling people the truth and facilitating this, like New Zealand, we see a massive decline in cigarette smoking. You know, we don't need draconian regulations. We don't need to force people to change their behavior. You know, we don't have to do those things. People are willing to move. And again, just like it's happened before on safer automobiles or safer houses or fireproof clothing or sanitary food, sanitary water, science-based pharmaceuticals, railroads that are designed so trains aren't crashing into each other, airplanes that stay in the sky rather than plowing to the ground. We've gone through this on so many things, and it's happening now. It's happening despite the opposition. So what's going to happen is more countries pay attention to this, to look at those countries that have reduced cigarette smoking by over half in less than a decade, because we're now seeing more countries doing that. And that was just absolutely unheard of prior to having alternatives. At what point do we start seeing more countries move to say, This is happening anyway. Why don't we try to encourage it? Why don't we facilitate it rather than stand in the way of it? And so I think we start working with consumers. We start working with markets. We pay attention to the economics. We can have just such a tremendous impact globally on public health in such a short period of time that'll knock a lot of socks off.