Professor Gerry Stimson, public health social scientist and co-founder of the Global Forum on Nicotine receives the 2023 Michael Russell Award in recognition of a lifetime’s commitment to evidence-based public health interventions. Hear his reaction to the award and thoughts about what’s coming next for GFN and tobacco harm reduction.
Featuring:
Gerry Stimson Co-founder, Global Forum on Nicotine
Director, Knowledge-Action-Change (KAC)
Emeritus Professor
Imperial College London
@GFNicotine
Transcription:
Hi everybody, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV.
We're here in Warsaw, Poland for the Global Forum on Nicotine, the annual conference on
safer nicotine products and tobacco harm reduction, celebrating its 10th anniversary this year.
And joining us today is Professor Gerry Stimson.
How's it going, Professor?
It's going very well, Brent, and it's a pleasure to be with you again.
So you have the honor just recently, as of last night, of receiving the Michael Russell
Award.
Tell us about that.
Well, it was a bit of a shock.
As you know, I'm stepping down from active involvement in the conference and in our other
activities after many, many years.
And I hadn't a clue that I was going to be given this award.
My team, my staff, all kept it a secret from me.
So I was sitting in the audience and suddenly I heard my name and, you know, heart panicked
a little bit.
I've got to get up on stage and say something sensible.
So it's a great honor.
You know, it's a great honor because it reflects not just on me, but on all the work that everybody
does.
So tell our audience about Michael Russell.
Why is he important?
He's important because he kind of is a big marker in terms of the development of tobacco
harm reduction.
He's famous for quotes like, you know, people smoke for the nicotine, but they die from
the tar.
He was an early researcher on nicotine.
He realized that nicotine was a dependent-forming drug.
I was in the same research unit at him in the late 60s, early 70s.
By coincidence, I was doing work on heroin addiction.
And so he made that statement and it really focuses our minds on, you know, the problem
is the smoke and not the nicotine.
Now when he was writing and doing his work, there weren't really, you know, there weren't
really good products available, but he really set the scene that, you know, he said also
in another publication, if there were good products, we could deliver nicotine that would
drive out cigarettes and drive out smoking.
So he was a visionary.
We like to kind of claim him as our forebear, but he had some really good words which really
resonate today.
Now you receiving this award really marks a lifetime of work.
And why don't you talk a little bit about what got you started and, you know, what's
brought you to this point?
It's hard to summarize.
It's 55 years since my first research job.
And I was in London at the time.
I just finished a master's program and was recruited into a new addiction research unit.
And I designed, I got interested in people who were getting pharmaceutical heroin on
prescription.
These are addicts being given pharmaceutical heroin and we know that story, you know, elsewhere.
And I designed the study to look at how well they were functioning.
And some of them were functioning very well, not all of them.
So this is really, it reflects UK harm reduction.
The words weren't there then, the words didn't come until much later.
Jump forward a little, about 20 years, and I was involved in the HIV-AIDS response.
And I was commissioned by the UK government to evaluate the needle exchange program they
set up across the UK.
I did evaluations of methadone and I worked with WHO and UN organizations to kind of get
that drugs harm reduction message.
Jump forward to around 2007 and I heard about e-cigarettes.
And I realized that here was the harm reduction product for smoking.
Because until then, there wasn't really much, you know, it was NRT, gums and sprays and
patches, not very interesting, not very popular, not very exciting, and made you feel like
a patient, you know, somebody who's going through some sort of misery to stop.
And here something comes along.
And I started to talk to people who were vaping and, you know, they said, yeah, it works,
works for me.
So, you know, there were other things around snus, but not in the UK, but in Sweden.
So I got interested in tobacco harm reduction.
And I, if I transpose all my thinking from drugs harm reduction into tobacco harm reduction.
There's a line that you're kind of famous for.
It's a position known as not evidence based policymaking, but policy based evidence making.
What does that mean?
I'm not sure where you found that, but yeah, there was a period, a very important period
in development of medicine and in policymaking, which was, you know, policy should be based
on the evidence.
But the more I looked at it, and the more I worked with governments, it was really sort
of policy based evidence making, you know, you have the policy and you quickly get the
evidence to back it up, or you find the evidence to back it up.
So it was a comment on the relationship between science and policymaking.
And of course, you know, that still happens today.
We like to think that things are driven by evidence, but evidence, but policymaking is
not always that rational.
It's often gut feelings, you know, political leanings and all the other things.
So there's a funny relationship between science and policymaking.
Yeah, I think some people will call it like cherry picking the science.
But when government does it, it's producing the evidence they need to justify the policy.
Exactly.
Yeah, exactly that.
Yes.
And a lot of politicians do that.
They sometimes get caught out, but they don't always get caught out.
When you look back at 55 years in science, is there any regrets to see how science might
have lost some of its way?
I did not really think that until I worked in the tobacco and smoking field, where I
have been very surprised at science and at other things, how there is such a lot of bad
science.
And I really don't know how it gets published, because I was a journal editor for 20 years,
quite a high ranking journal.
And with my colleagues, we were pretty tough on authors.
And I read papers, which I think, how on earth can you get that through?
You know, both the bad science, but even the sort of the more sociological papers are often
pretty, pretty weird.
You know, I think this is more ideology coming through, masking as science, or people who
are, they've got so many prior assumptions that, you know, then they work along those
prior assumptions and they come out with things that fit their prior assumptions.
But it's not a good area of, they shouldn't be proud of the work that's being done.
I'm sitting here with somebody who's like a founder of drug harm reduction globally.
Is that fair, not fair to say?
One of the many people who contributed to it, Brent.
Right.
But you were a president of the International Harm Reduction Association.
Exactly.
Yes, I was.
Yeah.
Yeah.
I had an academic career until 2004 and suddenly decided, I don't want to do this anymore.
I don't like universities anymore.
So I then became head of the International Harm Reduction Association, which was a small
think tanky pressure group, mainly aimed at getting the UN organizations on side with
drugs, harm reduction, HIV prevention, and so on and so forth.
So yeah, from that, and of course, before that, I mentioned that I was involved in,
I was a researcher of harm reduction and then became an advocate for harm reduction.
Now that was at Imperial College, right?
My research was at Imperial College and then I left Imperial College in 2004.
So I became an advocate, which was a bit of a challenge because I'd been like, you
know, scientists.
Well, you know, like we do stuff and we talk to a few people, but we don't push ourselves
that much on the world.
So I suddenly had to learn a whole new set of skills and hiring staff who turned out
to be pretty good and somewhat better than me at some of these things.
So it was a process of becoming active in terms of activation.
Yeah, because I never really thought of myself as an activist.
Perhaps I'm getting more of that recent, but I always thought of myself as kind of the
independent observer, evaluator of programs and the science and so on.
And, you know, I'd been on UK policy committees for AIDS and drugs and things like that.
But it was really in 2004 when I started working on drugs, harm reduction advocacy that I
realized that there were some new skills I had to learn.
And incidentally, I hired in people who had human rights expertise.
So that was another stream of work which I was party to.
So harm reduction not only is a public health program, but harm reduction as a right to
health. And that opened up a whole lot of interesting things, particularly in UN agencies.
And we got involved in research on death penalty and the harms done to drug users under
the guise of enforcement or under the guise of helping them.
So that was an eye opener as well, because that moved me into having to understand all
the international human rights treaties and so on, which is not a natural thing for me
as a sociologist.
But it was interesting.
Interesting. How has sociology, you know, as the foundation of your academic work, how
has sociology impacted your work on harm reduction?
I think it has a lot, because when I was a developing sociologist, I became very interested
in people working in kind of criminology and deviancy.
We wanted to see things from the perspective of, you know, people on the street, people
using drugs, people gambling, rather than taking a kind of a statistical or enforcement
look at those people.
So there was kind of a commitment I had quite early on to look from that side.
And in fact, even when I moved away from drugs research and started to do some work on
medical interaction, I wrote a little paper called Obeying Doctor's Orders, a view from
the other side. In other words, a view from the patient end of things, not the doctor.
So I'd always had that idea that you needed to engage and have some sort of a commitment.
And when I was doing our drugs and HIV work, we pursued that engagement work because, for
example, we hired drug users to go and interview drug users.
You know, so, you know, I realized there was an expertise there we could tap into.
And so, yeah, there was that commitment.
And then coming into this field in tobacco harm reduction, one of my eye openers was
the consumer activists.
Now, they weren't as good as the AIDS activists and they're still not.
But nevertheless, lots of parallels there.
The voice, it's about people, as I say, people do harm reduction, not experts.
Experts and governments can facilitate it or get in the way.
But it's the people out there who are doing harm reduction.
So I never forget that because it's not us.
I'm not a vaper, but, you know, it's people who do harm reduction.
So that there's kind of a thread going through from the research to what I'm doing now.
You mean vapers haven't demonstrated the ability to shut down highways and force
governments to do what they it's.
They're terribly polite.
You might have seen a video during the conference here, which was a kind of a history of
what had happened. And there was a little demonstration in Brussels.
And we helped vapers rent a carriage on Eurostar and they all went off to Brussels and
demonstrate a bit in a very polite way.
Not like the fishermen or the farmers who had dumped manure or dead fish outside of
Parliament. They were very polite.
I think there's many things going on.
One is that a lot of energy goes into social media rather than chaining yourself to the
gates of Parliament, that kind of thing.
So it's a different mode of operation.
And I don't mean that you should be chaining yourself to the gates of government or
whatever else. But there's a lot of vaping activists like single folk, you know,
bloggers and social media people on Twitter and so on.
And there are some consumer organizations as well.
There's about 50, 55 consumer organizations around the world.
But they're very fragile, very under-resourced and don't really know the way forward to
develop because nobody will give them the money to develop.
And so they remain rather weak.
Big problem. We did a survey.
The total income for all the 50 plus vaping organizations globally, $350,000 for all of
them together. That's compared with the Bloomberg funding campaign for tobacco free kids
and I think, you know, millions and millions of dollars.
So it's a real David and Goliath situation.
And there's a quandary for them because, you know, they need backing in order to become
more powerful.
Now, we've been hearing a lot during our interviews here in Warsaw, a real, you know,
OK, I asked the question, why is it the problem?
The answer from that chair has been big tobacco.
Well, why is there an issue with public health in the in the US?
Why are they so, you know, hate it?
It's because of big tobacco, you know, every single, you know, interview, it's been big
tobacco. But yet, you know, big tobacco didn't invent vaping.
No, they didn't invent it.
They weren't the first to bring it to market and they're still not the biggest players.
So there is a amongst those who are opposed to tobacco harm reduction, they often say
really the tobacco industry is behind this, you know, that it's a ploy to addict another
generation. And so they're seeing it as a threat.
I mean, there's a lot of paranoia, I think, about what's going on because, you know, vapors
are, you know, they're independent spirited.
They're not funded by big tobacco or anything like that.
So, yeah, it's a real it's a problem because many people in public health immediately bring
out this idea. Well, you know, it's a big plot of big tobacco to addict a new generation.
It's a pity because big tobacco has done lots of things which are wrong.
But to my mind, and lots of people would see this, there should be an end game.
You know, suddenly, somehow these industries will be so clamped down on that they'll
disappear. These are billion dollar industries.
They're not going to. So the plus side to tobacco harm reduction is if you if by sort of
economic forces, big tobacco has to move into this arena, there is an advantage.
There was a disadvantage.
One of the advantages that these companies start to see themselves in slightly different
way. They're nicotine companies.
They develop scientific expertise, amazing laboratories, some of them amazing R&D
facilities. And they're almost becoming on the road to some sort of pharma company, some
sort of new industry.
And, you know, maybe 10, 20 years down the line.
And that's perhaps a parallel to other industries where you're moving from, you know,
gas or fuel, you know, to oil, to, you know, industry transformation is the key to the
way forward here. And I think there are interesting parallels with, you know, with
other kinds of industries which are moving from combustibles to non combustibles.
It seems to me that there's no room in the heart of a tobacco controller for redemption
for big tobacco.
No, there isn't.
And there's no room in the heart of a tobacco controller for redemption for anybody
who's ever had the slightest of links with big tobacco.
There's confession of conflicts does not lead to absolution.
The conference right from the beginning had an open policy that we wanted to engage all
stakeholders. And naively, I think on my part, I thought, well, it's a good idea.
And people will go along with that because public health people, parliamentarians need to
talk to industry, to consumers.
So everybody's got something, you know, some part to play here.
And we are still the only major conference which allows anybody to attend.
And we get criticized for that because there are other conferences which completely ban
any participation from people in tobacco companies or even with the slightest link with
tobacco companies. But, you know, if you look at, again, you know, Phil's at climate
change and so on, you know, the oil companies are at the climate conferences.
They might not, you know, you might not say that you might be careful about that, but
they need to be confronted and engaged.
You don't say you can't come.
You've got to engage with them because you want them to change.
So it's always been my philosophy to engage all stakeholders.
And again, that goes back to when I was doing drugs, harm reduction advocacy, because
we'd have a big annual conference and you'd have drug users, have police, have
magistrates, you have, you know, Ministry of Health people all in the same room.
And often they had not talked with each other.
Was there a comparable boogeyman?
Not really.
No, I don't think there would have been, not in the same way that I can think of.
But there were fascinating conversations.
So you'd have like a drug user and a judge talking or sharing a platform and kind of
why not is my view.
And I've seen fascinating conversations here between people who in their usual life
would never have been able to come face to face and have a chat.
And so I'm a great believer in getting everybody around the table.
But there are people in tobacco control who don't believe that there is an
international legal convention on tobacco, the Framework Convention on Tobacco
Control. And as an Article 5.3, which tries to keep tobacco industry at arm's
length from public policy, good, argues for transparency in dealings and so on and so
forth. It's been overinterpreted by many in tobacco control to mean that nobody
should have any contact.
You know, it really only applies to governments and government agencies.
But there are some in tobacco control who apply to all and sundry, which is a
mistake.
You can't. Let me ask you this question, because COP10 is coming up later this year.
I would imagine that India is prevented from going.
So is China, Vietnam, all of the government, you know, governments that make a lot of
money with their tobacco monopoly.
Are they welcome at the WHO?
They are welcome because they are signatories to the convention.
I mean, these are countries which have major, sometimes, you know, the owner of the
tobacco industry in their country.
And, you know, as is the way with international meetings, kind of people try to
forget that or put it to one side or whatever.
But, yeah, it is bizarre that you have countries which own tobacco companies who can
come to this meeting, which is anti-tobacco and says there should be a division between
governments and tobacco.
But, you know, there are ways that people in their minds can kind of ignore that, you
know, in international fora, because they're not going to say to China, don't come, not
going to say to India, don't come, because they need to be there.
Professor Stimson, if you had an opportunity to send a message to the delegates at COP10,
what would that message be?
That there are a billion smokers hasn't changed much in 20 years.
We've tried lots of things to reduce smoking and had some successes, but one in five of
the adult population still smokes.
We've got to focus on smoking, not on tobacco.
And we've got to look at the opportunities that are provided by the shift to
non-combustible ways of using nicotine, to safer nicotine products such as snus, heated
tobacco products, e-cigarettes, nicotine pouches.
These these products are opportunities.
They are not threats.
Now, one of the things that comes up often in our coverage is recreational nicotine.
And when I look at that, I go, well, I mean, it's there's already recreational nicotine
everywhere. That's what a cigarette is.
Yes. We're just trying to remove, move that recreational nicotine from something that
kills you to somewhere else.
I don't understand why it's so hard to not make recreational nicotine the sole focus of
the act of activism.
I think it's partly strategic and partly people haven't thought that through because
we've seen in many people's minds, nicotine is addictive and it's bad.
But of course, it take it away from the combustion of tobacco.
Then it's not going to be harmful.
And the tobacco harm reduction is a language that we're using at the moment, but moving
from tobacco harm reduction to seeing nicotine as a as a consumer product, which it is
already. But once you strip away the harm that's caused from the delivery system, you
can then begin to think about it as a consumer good and as a recreational drug, if you
like. And, you know, we're not anywhere nearly going down that road.
I mean, people at WHO would throw their hands up in horror at that suggestion.
But if you look forward 10, 15, 20 years, there'll be, if you like, the rehabilitation of
nicotine. And it won't be thought of much differently to, say, coffee or any other or
energy, caffeine, energy drinks or coffee or tea or something like that.
So once you strip away the harm, what case is there against it?
And it's clearly something that I don't like.
I don't use words like addiction.
I try to avoid words like dependence.
For me, I just say, well, there's a lot of people who like it.
Some have a strong liking for it and it's functional or pleasurable.
But it's clear that it's one of the top three drugs in the world, alcohol, caffeine,
nicotine. And I don't see nicotine disappearing, but I see the delivery system changing.
Gerry, one of the things that you and Patti Kostal and your team kind of innovated on
was the scholarship program, the KAC scholarship program.
Tell us about that program and who've been in it and where could it possibly go?
It's really kind of like the jewel in the crown of what we do.
We had the idea for the scholarship program back in 2018 because we looked at the
landscape. You look at the landscape of tobacco control, tobacco research, smoking
research. There wasn't like a workforce or a capacity in tobacco harm reduction.
So the idea was to run a scholarship program to introduce people to tobacco harm
reduction and start off with 15 people a year.
It's now 25 people a year on the basic program that we have.
Then there's an enhanced scholarship program and then there's an even higher level,
which is the Kevin Malloy Fellowships.
And we've had, I think, something like 120 people through the program.
And some of them are real stars.
It's been quite extraordinary whether they're working.
It's a mixed bag. Some are doing academic research.
And one of our people who started off in the basic scholarships now eventually has just
been offered a PhD place at a UK university.
You know, great career track.
It's building the research capacity in tobacco harm reduction.
But some people are working on networking and communication, you know, helping to raise
awareness of tobacco harm reduction in their country.
So they have little projects where they're setting up maybe an advocacy group or working
on messaging. And some people have been working on messaging through film, through
popular film in particular, which I never thought would happen because I've seen
dozens and dozens of videos, for example, on, you know, Made by Vapors.
But there's one of our stars who I think you have interviewed who did a soap opera on
tobacco harm reduction. You think you can't do this.
Can you do a soap opera on tobacco harm reduction?
And that that series has won awards and it's been shown everywhere.
It's based in Africa.
So that's really great.
The other thing that's great about it is that it is truly global.
And the majority of people on the program are from low and middle income countries.
Eighty percent of the smokers are in low and middle income countries.
So that's good. And the gender balance is pretty good.
So it's been a real gem, if you like.
And, you know, in some ways, if I was younger, I'd like to go on.
I'd like the scholarship myself.
So then my last question for you is what's next?
And you're going into this as your second or third retirement?
It's my third retirement.
I'm a serial retiree, some sort of serial starting something else after retirement.
But all my things that there's been a steady stream that I will be doing much less.
But I will still be involved in an advisory way with the program of work that we've
developed through KAC and through GFM.
It's it's hard to describe that when you've been in something like this for so much of
your life, you can't kind of drop it and go and play golf or whatever you do.
So I would be doing much less.
But I will still be on the periphery and keeping keeping interested.
Your work has touched many lives and saved many lives.
Well, my work and work of others, I see a lot of what we do as bringing people
together and sprinkling a bit of the magic fairy dust and energizing people, you know,
and getting other people, you know, a small group can't do everything.
So it's energizing and nudging and infusing people to to to carry that task forward.