Is the science publishing industry broken? Sarah Cooney doesn't think so. Learn more in advance of her keynote at GFN23.
Featuring:
Sarah Cooney
Scientist & Science Communicator
Former Head of Scientific Collaboration & Communication British American Tobacco, BAT
Director, Cooney Scientific Limited
@SarahCooneyMcQ
Transcription:
Hi, I'm Brent Stafford and welcome to another edition of Reg Watch on GFN.TV.
The debate over nicotine vaping and other safer nicotine products can get quite heated.
One side believes these products are addicting a new generation of youth to tobacco and the
other is convinced that these products save lives by allowing adults to kick the deadly
habit of smoking.
With both sides entrenched in their positions, how could a resolution be found?
The most obvious answer would be to turn to science, but the science on nicotine vaping
and other risk-reduced products is contested, despite mounting evidence of their relative
safety and efficacy as tools to quit smoking.
Joining us today to discuss the science on vaping and the challenges of science communication
is Sarah Cooney, the former head of scientific collaboration and communication at British
American Tobacco and director of the consultancy firm Cooney Scientific.
Sarah, thanks for joining us today on Reg Watch.
Thanks for having me.
Sarah, you spent nearly 12 years at British American Tobacco and were charged with finding
ways to better communicate the science behind safer nicotine products to regulators and
to the public.
Top line for us, what does the science say about vaping and tobacco harm reduction?
For me, the science is very clear.
These products are much, much safer than continuing to smoke.
If you just take chemistry, a cigarette smoke aerosol contains at least six and a half thousand
different constituents.
In contrast, the aerosol from a vaping product has between 10 and 100 compounds.
So it's at least two magnitudes simpler than a cigarette smoke aerosol.
And that alone is strong enough for me to tell my friends who smoke that they should
switch to vaping.
Sarah, you're a scientist yourself.
Tell our audience about your background and specialties.
So I trained as a scientist at the University of Toronto.
My background is genetics and molecular biology.
And then I did my graduate work in plant genetics and biotechnology.
In fact, I was in one of Canada's most famous scientists labs, Peter McCourt at the University
of Toronto.
I worked on hormone interactions in Arabidopsis, which is this tiny little mustard weed plant
that is a model system for genetics, for doing genetics in plants.
And some of my thesis research was published in Science, which is one of the world's most
famous science magazines.
But I didn't actually enjoy doing science at the bench.
So when I was finishing up, I was looking for something different to do.
The guy I shared a bench with, he was Italian, and his sister had worked at Nature magazine
in London.
And he said to me, Cooney, you would love London and London would love you.
So I started exploring working in science publishing.
And I wrote to several science publishers and some of those conversations ended up in
interviews.
And then actually just a couple of months later, I moved to London to work at Current
Biology Limited, the first journal that I worked on.
How did you end up then working for a tobacco company?
So I worked in publishing for a long time and lots of different types of jobs, mainly
editorial driven, so content driven.
And then I worked developing new titles.
So identifying emerging areas of science that needed information products to support them.
And I really enjoyed it for a long time, but I got laid off a couple of times.
And then the third time that happened, when I was looking for new jobs, I was like, I'm
not sure.
I don't want to do that again.
I've done that before.
And then a friend of mine asked me to come down to BAT to talk to the senior scientists
about how to get their work published in journals.
And I was like, a tobacco company?
They do research?
Do they do research?
And so as a favor to her, I came down to Southampton to BAT.
I met lots of people.
I had a tour of the site.
And growing up in Canada, you know, I mean, Canada, you know, is very strong on tobacco
control and my dad always hated smoking.
So it was a real surprise for me to find interesting people, really interesting research and an
openness about the dangers of smoking that I did not expect.
So then a few months later, they actually had a job opening.
They were looking for someone to help improve the impact of what they were publishing.
So I thought, well, you know, I was looking for a change and I thought I had nothing to
lose.
So I applied and I got the job and I figured if it didn't work out, I could just go back
to publishing.
So that story wasn't, didn't necessarily jive with the reality then?
No, no, it was, it was very different than what I expected.
Really very different.
So that first visit challenged a lot of my perceptions about what the tobacco industry
was trying to do and how it was trying to change.
And I do think that it is, you know, the whole industry, all the major tobacco companies,
they're in the midst of this massive technology led transformation, trying to move their consumers
away from the most dangerous way to consume nicotine, the cigarette, to a wide variety
of alternative, less risky nicotine products.
And that was very exciting because also, you know, there aren't many industries that are
changing at the rate that the tobacco industry is changing.
So that also made it quite interesting and also trying to communicate, you know, it's
much more interesting to work on a challenging communication problem than, than a simplistic
one.
So there were lots of reasons that suddenly I thought, well, actually this is, this is
genuinely interesting.
And I remember the first, first six months I worked at BAT R&D almost every day or every
other day.
I said, really, really, really?
And there were things that I didn't know.
I mean, even as a, as a well-trained scientist, I didn't realize that nicotine didn't cause
cancer.
I took working in a tobacco company to, to, to realize that that nicotine is not the problem,
that it's the smoke and the tar that are the problem, but I was quite shocked that I, that
I didn't realize that, that, and I think that's because the sort of level of general knowledge
about tobacco and nicotine in the general public is very, very low.
It's also a taboo subject.
People don't really talk about it.
Certainly, you know, 13 years ago when I first went there, it really was a taboo subject.
I've had friends that have lost friends because they've gone to work for a tobacco company.
I think that things have improved in terms of kind of general knowledge in the public
because of products like vaping, you know, they, they, they really are, it really is
a consumer revolution and consumers, smokers are demanding alternative, safer options.
Now when you first started at BAT, that really was at this real start of the impact that
vaping products had on, and in fact, I think that probably even a little bit earlier.
So would you say that the vape, you know, vaping technology, safer nicotine technology
like vaping is responsible for pushing the tobacco companies in that direction?
Well, I think, I think that's fair.
I mean, everybody knows that smoking is uniquely dangerous and, and as technologies have emerged
and people can use sort of smoke-free nicotine or reduced risk nicotine, why wouldn't you?
If you can find a product that delivers nicotine in a way that a smoker finds satisfying, then
why wouldn't you, why wouldn't people switch?
And I think the difference with what tobacco companies are doing is that they're creating
products that are intended to compete with a cigarette, whereas pharmaceutical products
like nicotine replacement therapy, those are designed for short-term substitution to ease
the craving for nicotine.
Whereas, you know, actually, if you're going to, you've got to compete with a cigarette,
you've got to make something that somebody wants to use.
You've got to make something that is as a compelling alternative.
And yeah, sometimes people have to adapt their habits and get used to differences.
But I mean, vaping in particular, there's so much that is similar between vaping and
smoking the hand-to-mouth, the throat catch, all these things that are important for smokers.
You know, that helps compete with a cigarette and you can adapt your, your habit and your,
what you want.
And I think people will accept a difference in the experience if they get enough of what
they want.
And the products are improving all the time, so the, the early cig-a-likes were, were not
great products, but as batteries have improved and as nicotine delivery has improved and
the sensory experience has improved, you know, it makes it easier to compete with a cigarette.
You mentioned competition, i.e. a tobacco company needs to create new, safer products,
reduced risk products that can compete with their own products, which are of course, you
know, deadly combustibles.
So that being said, is there also then not a philosophy that singles it out when it comes
to say nicotine replacement therapy?
As you said, nicotine replacement, replacement therapy is short term, whereas vaping technology,
you can live your whole life consuming that.
So it doesn't, you're not quitting nicotine, you're just quitting smoking.
Yeah, interestingly in the UK, the Nicorette inhalator was the first product that was given
a harm reduction indication.
So I think it was 2010 or 2011, the UK medicines agency said that you can use Nicorette inhalator
forever.
So not just short term substitution, but recognizing that harm reduction, any cigarette that you
don't smoke is fine to keep using the Nicorette inhalator if that helps keep you off smoking.
So that was the first time an NRT product was given this sort of additional harm reduction
indication.
And the UK is ahead in terms of thinking about tobacco harm reduction.
How is it possible that there can be so much confusion around nicotine that that must be
on purpose?
It is very strange because the nicotine and nicotine replacement therapy is exactly the
same nicotine that you find in tobacco.
So I don't really understand why people have trouble separating the two.
I think maybe some of the tobacco control initiatives tied nicotine and tobacco in the
plant really, really closely together.
So it's very hard then to change that.
But I think it's an education thing.
And I think that, I'm not sure who has the responsibility to do the educating.
And I do think that there is a piece of education that needs to be done to help people understand
that the nicotine in NRT is identical to the nicotine in tobacco products.
You purify nicotine from the tobacco plant.
Most of the time.
I know there's synthetic nicotine as well, but most of the time you're getting it purified
from the tobacco plant.
So it is very, very weird that people don't understand the difference, they don't understand.
If a government decided to stick the label nicotine is carcinogenic on some kind of messaging
to the public, from a scientific point of view, would they be accurate in saying that?
That's wrong.
That's wrong.
There's no...
Well, some people are trying to argue that it is, but I think there's plenty of evidence
that it isn't.
If you look at the Swedish experience with snus, the oral tobacco product, traditional
oral tobacco product, there's no link between using snus and cancer.
So there's very little evidence that nicotine is a carcinogen.
Sarah, so overall, do you think that the tobacco industry has embraced tobacco harm reduction?
And if so, what do you think the meaning is that they've embraced?
So I think the industry has.
And I mean, like I said, I think that the whole industry is in the midst of this massive
technologically driven transformation away from the most dangerous way of consuming nicotine,
this combustible cigarette, to these alternative products.
You only have to look at the range of products that tobacco companies offer, the fact that
they're acquiring small startups or established businesses that give them a strength in a
particular type of emerging product.
I think that.
And these are products that then compete with a cigarette.
So that's essentially it's disruptive innovation.
So you're investing in a product that's going to cannibalize your existing dominant product.
But because you know that these are the products of the future, the cigarette is not the product
of the future.
But vaping, heated tobacco, nicotine pouches, those are all products of the future.
And I think that the foundation for a smokefree world have a tobacco transformation index
and they monitor how quickly tobacco companies are moving to embrace reduced risk products.
And I think I was looking at Philip Morris's figures for quarter four, they had 36 percent
of their revenue from smokefree products.
And overall, in 2022, they had over 30 percent of their revenue from smokefree products.
And with the acquisition of Swedish Match, I would expect that to, you know, the rate
of change will speed up because they've now got, you know, a very strong nicotine pouch
product through that acquisition.
So I think that if you look at all the big tobacco companies, they all have offerings
across the different product categories.
Sarah, when you joined BAT, did you have any aha moments?
Well, yeah, all the time.
I mean, the first big one was that I didn't realize that nicotine didn't cause cancer.
And I was that was a big one.
I also began to be surprised.
We brought in a consultant to help us work on the science website, batscience.com.
And his observation in looking at some comments from Cancer Research UK and the British Heart
Foundation, he just said, the normal rules don't seem to apply here with the normal rules
of engagement.
So they were, you know, a web consultancy.
And that always has stuck in my mind.
And it's true, the normal rules don't seem to apply.
And I think that in order to combat that, I think that, you know, this push towards
openness and transparency and sharing as much as possible, I think that's been very important.
And I think, you know, we used to I used to run the visitor engagement program at BAT
and pre pandemic, we had around 60 to 65 visitor groups a year.
And sort of one by one, we could change people's minds about, you know, what's happening in
the tobacco industry.
But this idea of sort of being open and transparent and letting people look inside, sharing as
much as possible.
This is where publishing becomes important, sharing your research becomes important.
And there are there are good ways to do that, that are that are seen as credible by the
wider scientific community.
Yeah, you know, it was a lot of it was a surprise, because traditionally, that the tobacco industry
has been very closed, people haven't been invited in, they haven't really shared, but
you know, I think reduced risk products have really transformed what the companies are
willing to talk about.
And, you know, it's a great story.
It's, you know, the best comment I ever had from a journalist visiting the site was, he
was having trouble holding this new story about reduced risk products in his head at
the same time as the old story about cigarettes.
So you know, that was a pretty good outcome from a single visitor.
Now, I mean, obviously, you've spent now quite a few years working around the communication
about these products and the benefits of tobacco harm reduction.
That promise, the virtues of vaping is what we call it, seem to be destroyed over the
so-called youth teen vaping epidemic and the so-called vaping related lung illness.
It seems to me that tobacco control has made it their priority is to destroy any sense
of virtue when it comes to the use of, you know, tobacco harm reduction products.
I think the problem is the ideology of certain parts of tobacco control who feel that the
tobacco industry has no business being in business and their goal is simply to eradicate
the tobacco industry.
And I think, frankly, that's a bit naive because these are big companies, well-established
companies.
It would be much better to help them transform to selling reduced risk products and to transform
faster than thinking that you're going to put them out of business, that that's just
not going to happen.
And I think, you know, we have to move away from ideology and science should give us a
way to do that because, you know, the data is the data, right?
If you look at the chemistry of the aerosol of a vapor product versus the chemistry of
a cigarette smoke aerosol, there's just no comparison.
There are graphical representations of the difference between cigarette smoke and vapor
aerosols.
And just visually, like a gas chromatogram chase shows, you know, lots and lots of peaks
for a cigarette smoke aerosol.
And then there's like for vapor, there's so little in there in comparison.
And if you show that to a smoker, I mean, you can't help but think, God, I'd rather
be putting that into my lung than that.
So the data is the data.
But I think I don't think you can dispute the chemistry or the toxicological information
about vapor products.
And I think where things have moved on to this, like you said, this question around
youth initiation and gateway.
And I think that it's just too soon to sort of demonstrate that those things aren't true.
For most people that I know who have quit smoking with vaping, vaping has been the sort
of the exit door from smoking.
It's not a gateway to cigarettes.
It's an exit door.
And that's true also of nicotine pouches.
So there's evidence coming out that people that smokers that try nicotine pouches, it's
the same thing.
They just are finding an exit out.
Sarah, so then are risk reduced products shown safe?
I think they're vastly safer than continuing to smoke cigarettes.
And Public Health England in the UK has said for a long time that they feel that there's
a small residual risk, around 5% or less of the risks of continuing to smoke.
And other bodies around the world are starting to say the same sorts of things.
I mean, Canada introduced the Tobacco and Vaping Act to update the Tobacco Act that
differentiated the risks between cigarette smoking and vaping.
But I know that things have got a bit messy in Canada, so that's maybe not a good talking
point.
It's very messy in Canada.
And there really isn't a lot of differentiation when you look at it.
They're both hazards.
So Sarah, what's your impression around the debate around risk reduced products?
I think when you have two entrenched positions that you need to find ways to bring people
together to be able to have civil conversations and civil debate.
And I think that kind of neutral third party spaces are really, really important in these
sorts of scenarios.
So at the beginning, when the Centre for Tobacco Products in the US first took on regulation
of tobacco products, they ran a series of workshops.
And I remember the Chief Science Officer for BAT coming back and saying that the people
that he'd met, that they would never in a million years have gone into a room with him.
But because the event had been convened by the FDA, that was sort of seen as a neutral
space that the industry, the regulated industry could come and some of the public health people
could come.
So these sort of neutral third party spaces are very important.
There are organisations that are working on method development, standardised methods that
again, their workshops will attract the industry, the regulator, scientists, public health,
like the Institute for In Vitro Sciences in Maryland works on this area and their workshops
are very good, but standardised method development is quite a slow process, so it can take years.
It's not something that, you know, a single workshop fixes everything.
But I mean, you need to find a way to bring people together to have a civil conversation.
And censorship doesn't work.
I think it's really sad that the debate around harm reduction is the way it is.
I've seen these, I'm a never smoker myself, but I have seen these products transform people's
lives.
And you know, I have an anecdote about a friend of mine's, so a friend of mine at school,
her 75 year old mother who was a 50 year veteran of smoking, she was never going to quit.
But I gave my friend a vapour product and I said, you know, try this with your mother.
And so she said to her mother, please don't vape in front of your granddaughter.
If you're babysitting, please use this instead.
So the woman looked at it suspiciously and but gradually she agreed to do that.
And gradually she vaped more and smoked less.
And my friend was paying for anything to do with vaping.
So at 75, she was never going to quit for her health, but she might quit to save some
money, but she never intended to quit.
So but over 18 months, an 18 month period, she went from being a heavy smoker to being
an exclusive vapour just because someone gave her a product that was sort of good enough
in comparison to a cigarette.
You know, she was an accidental quitter.
And I think that no one in the family could believe that she had that she had quit.
So I think these products can transform lives and not just the smoker, but the people around
them that hate the smoking.
So, you know, I think it's it's a real, you know, it's a tragedy that that the debate
has become so entrenched and polarized.
There has to be a way to bring people together to talk in a civil way and to find ways forward.
Sarah, I loathe the phrase settled science, as science is always or at least should be
open to challenge and debate.
Is that not correct?
I think certain things are more settled than other things.
And I think that in order for science to advance, you have to accept that certain things that
have been accepted for decades may actually be wrong if new data comes to light.
But I think some things are hard to argue with.
So if you're doing like for the chemistry of an aerosol of a cigarette smoke versus
vapor products, if you've got good standardized methods, if you've got a competent lab doing
the research, I think that I think I think the chemistry of vapor should be pretty settled.
But I think that the research on PBI, so perception, behavior, intention to use, that's more of
a that's an evolving area.
It's newer and it's more social science than than physical science.
So I think that there's more there can be more debate in that.
And I think also sometimes people can kind of twist data to tell a story that they want,
that maybe the data isn't actually saying that.
I mean, there have been times where you read the conclusion of a paper and then you go
and look at the data and you think, well, actually, that doesn't that doesn't actually
support the conclusion.
So I think that there's sometimes people are looking for they've got a story and then they're
looking for data to fit in the story.
And I think I think that's wrong.
And journals should catch that the peer review process should be robust enough to catch that.
But it doesn't always happen.
Peer review is not a perfect process.
That's for sure.
Now, many people actually believe that the peer review process is broken.
Well, the science publishing industry is is is also changing and it's struggling with
with volume.
So many journals are receiving 25 percent more submissions this year than last year.
So with with a 25 percent increase in submissions every year, you know, how do you cope with
that?
So you see journals doing more reject without review because that reduces the burden on
the peer review community for an emerging area like tobacco and nicotine science.
There's a shortage of good reviewers.
And really, the industry needs to needs more of its scientists to be volunteering to be
peer reviewers because there's a great deal of very talented, very experienced scientists
in in the tobacco industry and all the companies.
Sometimes you look at referee reports and you think, well, the referee didn't understand
the paper.
I've challenged rejection decisions before on behalf of scientists sort of saying, well,
this is this is wrong.
And they've never reversed the decision.
But I have seen where a journal has recognized that they lack expertise in an area and have
looked to to add people to their editorial board.
And I know that's been a direct consequence of, you know, writing a rebuttal letter and
a bit futile.
But actually, sometimes things can change.
They're just not obvious to the outside world.
So journals are struggling because there's more and more material being submitted.
The peer reviewers are under there's a conference every year about the peer review crisis, Sarah.
In the past few years, we've heard about journals banning tobacco industry research.
What's your sense of that?
So there are I mean, there are thousands and thousands of of good journals out there.
And there's actually a relatively small number of journals that have an explicit censorship
ban against the tobacco industry or research funded by the tobacco industry.
But a lot of those journals have quite high profile.
They have they've done press releases and they've they've done, you know, kind of PR
campaigns around their decision to censor an industry.
It's quite shocking, really, to me, because good science should stand the test of robust
peer review.
Good science should stand on its own.
And and my observation would be that the journals that have a censorship ban, they tend to be
owned by medical or public health organizations that have a small publishing activity as part
of their suite of activities.
And the profits that they make off their journals are used to subsidize other membership activities,
conferences and so on.
So if you look at the pro the bans, the British Medical Journal, the BMJ Group, all of their
journals won't accept tobacco funded work.
The American Thoracic Society, the European Respiratory Society, so they're all kind of
small medical public health charities.
Large commercial publishers are unlikely to ever institute a blanket censorship ban.
That's not to say that some journals owned by the big publishers don't have censorship
bans or they don't have individuals that have kind of bias, conscious or unconscious.
So, you know, I've I've I've been involved in submissions to journals that don't have
an explicit ban, but the papers have been bounced back, oh, I wouldn't I wouldn't ever
consider publishing something from the tobacco industry.
But, you know, so you have to kind of.
You have to kind of almost it sounds a bit cheesy, but you kind of got to navigate the
landscape of journals because there are tens of thousands of of journals, good ones, bad
ones.
We're starting to see.
So open access publishing is a relatively new movement where rather than libraries buying
subscriptions, authors pay a fee to make their paper available.
But that has meant that the barrier to entry for anyone wanting to be a publisher has become
very low.
So anybody with a computer can become a publisher and a lot you get some publishers are called
predatory publishers and they're just interested in taking the author fee.
They don't do any quality control.
They don't do proper peer review.
And so you can damage the credibility of your science if you are publishing in predatory
journals.
So you need to be careful to avoid the predatory journals.
You need to find good journals that that don't have there's plenty of journals that don't
have censorship bans, but you have to find ways to sort of build relationships with them
and try and make your research come across well.
So I think there are things that you can do to improve the quality of your papers.
And so that's something that I do now is try and help with that to try and make papers
as high quality as possible, give journals fewer reasons to bounce it back.
Sarah, I know you're a supporter of the Global Forum on Nicotine and its annual conference
on safer nicotine products and tobacco harm reduction.
GFN is coming up again this June from June 21st to the 24th.
In 2021, you served on the GFN Broadcast Commentary Team and this year for GFN 23, you'll be delivering
a keynote on the politics of scientific publishing.
Sarah, let me ask you, why is an event like GFN important?
I think GFN is really important because it brings together scientists, policymakers,
but also the consumers and a consumer voice.
And you don't get many conferences that do that.
And I remember chasing after a leading tobacco control scientist who spoke at GFN maybe in
2018, 2019, and I asked him what he thought of the conference.
And he said to me that it'd been very interesting, he'd given a keynote himself, it had been
very interesting and he had never heard a consumer before.
And so this was the big thing for him, how important these products were to consumers.
And I think that it's been growing year on year, and I think it attracts a really good
audience and it always has a good program.
And I really loved being part of that commentary team.
It was great fun.
And I'm really looking forward to giving a keynote.
That's very exciting.
Well, and I'll definitely see you there this year.
Final question, Sarah, is it easier now to make the argument for risk-reduced products
with so many millions of people now using these products?
I think so, yes, yes.
And also there's a lot more science been done on these products that has been published.
So a lot of the big tobacco companies have actually published hundreds of manuscripts
in a wide variety of journals.
And for me, manuscripts in peer-reviewed journals are like the currency of scientific credibility.
So even though there are some issues there, the fact that all that data is out there in
the public domain should make it easier to make these arguments.