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Could tobacco control be facing impending irrelevance? It may be the case considering safer nicotine products solve a problem many have spent entire careers trying to fix through blunt force and turning smokers into patients.

Clive Bates
Tobacco Control Policy Expert, Counterfactual Consulting
Former Dir. of Action on Smoking and Health (UK)


Hi, I'm Brent Stafford, and welcome to another edition of RegWatch on GFN.TV.

And this is our last episode before we pack up the studio here in Vancouver and head off

to Warsaw, Poland for GFN 2023, the 10th anniversary of the Global Forum on Nicotine.

And we're excited to be going for many reasons, but I think the most important

is getting to spend some face time with guests on this show. And one of the people we always

look forward to meeting in person is Clive Bates, tobacco control policy expert and former director

of Action on Smoking and Health UK. Clive, it's great to see you. Are you looking forward to GFN

this year? Brent, I am totally looking forward to it. I always look forward to it. It's a

it's a standing fixture in my calendar. I get so much from it. I learn so much from the presenters.

I learn so much from the conversations in the margins. It's a it's a great event. It's really

good. Yeah. Let me ask you, how often have you attended? I'm pretty sure I have a 100% track

record and I've been to all of them so far, including well, including the online ones during

Covid and the hybrid one in Liverpool. So I have a 100% track record. And I go I go not because I'm

forced to go, but because actually I find it very worthwhile. In particular, the emphasis is very

much and has increased over the years on consumers and consumer insight. And it's a great place to

meet the consumer advocates and the sort of experts on what the users of these products

and essentially the beneficiaries of tobacco harm reduction actually think and feel about everything.

And to be honest, if you're not interested in that, then I don't see how you can do your job

in tobacco control or public health. You know, you really ought to be curious and hungry for those

insights. And that's why I find the conference so useful. You know, often, Clive, it kind of feels

that tobacco control doesn't see smokers. The smoker is kind of invisible in a way.

And so it would be really harder for them to even see vapors in terms of their purview.

Well, look, I agree with that. I think I think, you know, having, you know, started my career in

public health in as as director of action on smoking and health, I was very conscious that

we didn't really have anything to do with smokers other than see them as an enemy. And it was partly

they were organized by to the extent they were organized, they were organized by the tobacco

industry and really functioned as a front group with the interests primarily of the tobacco

industry to the fore. And, you know, couldn't really kind of, you know, and there was also,

I think, in in our business, in tobacco control is also quite a strong non smokers rights

current in there, which is different to the public health. I mean, I see myself as

someone who's engaged in public health and concerned about cancer, heart disease and so on.

But if you're a non smokers rights, what you're really concerned about was somebody smoking near

you in a plane, in a restaurant, in a pub or something and being really fed up with that

and wanting to drive smokers out of the public spaces so that you could have clean air or at

least drive the smoking out of public spaces. So that, by definition, put those interests

loggerheads with each other and often created conflict. Then you've got the whole sort of

anti-corporate, anti-tobacco industry thing, which runs deep in tobacco control.

And that just basically sees the industry and its customers, sees the industry as a predator

and its customers as sort of gullible sort of fools, if you like, or victims that have been

sort of trapped by the industry. So, again, there's not much room for empathy there either.

Clive, let me just ask, it almost sounds like you're describing that tobacco control considers

smokers and now vapors as the useful idiots of big tobacco.

That's off. I think it's very common to see that narrative and it's very common for vapors,

you know, people who are active online or campaign to be accused of being shills.

So not even useful idiots, just sort of, you know, hacks and shills and paid accomplices.

A famous Australian activist refers to people as quizlings, which is a term, a disparaging term

used in Europe for Nazi collaborators. So you can get a sense of the sort of mood there that

was coming from tobacco control towards smokers and vapors. And I've concluded, you know, I didn't

think this way when I was director of ASH, but I do now, that your whole process of public health

and tobacco control needs to proceed through a mixture of empathy and humility, that you,

you know, you need to understand where people are coming from and kind of just walk in their shoes

a bit and try to see how they see the world before you condemn them, condemn what they're doing,

and try to make it impossible for them to solve the problem in the ways that they have solved it.

And I, you know, come to see that whole enterprise is incredibly arrogant,

and a massive antidote to that is going to conferences like GFN. And I wish to be honest,

a lot more of them did because they would think differently about what is actually the course,

the core subject of their work. And the fact that they don't to me is unprofessional.

And that is one of my next questions is, does tobacco control attend these GFN events?

Well, actually, you get a few people, you get people who are interested in harm reduction,

that will come, you don't get as many as you used to, because, you know, they've, they've,

people have recoiled because they have like, they have more industry people are giving the

industry perspective, and so on. And they, you know, that they have an industry exhibition,

where people bring the latest technology along and display it and everything.

So rather than think about why they're doing that, and why it's important to understand all

that stuff, and how it's not basically harmful, they've just gone into the usual sort of reflex,

which is, well, that's industry, we can't be seen anywhere near that, which I think is a shame.

And it's they lose, the conference loses, but it's their losses, the bigger to me, the conference

is still incredibly valuable, and informative. And I'll say this, it helps out the industry people

there, because you get their insights as well, you don't have to believe them. And you should

always be skeptical about them, but you shouldn't shut them out. In a way, the Global Forum on

Nicotine is treated as harshly as any other industry group would be treated by say, the WHO,

they're kind of shunned. People aren't allowed to attend, you know, for the sake of, you know,

somehow being tainted by industry. Yeah, I mean, they do that. I mean,

it is, it is ridiculous, because if you are in public health, and especially if you're an

academic, your job is curiosity. You know, your your job is to understand things. And you don't

do that by excluding yourself from insights that you can get from a conference like that. It's a

completely stupid way of doing things. It's like, it would be like trying to do anthropology,

without ever visiting the people that you're studying, you know, be like trying to do it

from a distance or from a, from a helicopter or something, you know, be just

it's a ridiculous way of doing it. And I think, I think it's, it's not, it's not because they

actually have a credible objection to the way the industry works in these things. It basically are

more for it, they work quite constructively. It's because they don't want to hear these messages.

Because these messages that they get from consumers and get from the industry,

is that the world is changing and moving on without them. You know, this is this is where

they would come face to face with their own impending irrelevance. And the fact that people

can now solve the problems that they have spent decades and sometimes entire careers working on,

without their involvement, and in a way that they don't like, you know, it's it's hard to

express this, but the harm reduction approach and the mood music you get at GFN is totally

countercultural for the tobacco control community. Okay, their modus operandi, their playbook,

is primarily one of punishment with taxes, coercion, restrictions, stigma, you know,

defining you as a patient and controlling you. I mean, the word is tobacco control and control

is essentially what they do. It does what it says on the tin. Now you flip to the mood and the modus

operandi that you will be hearing about at GFN. And it's like, well, consumer empowerment,

consumer choice, it's people taking control of their own health at their own initiative at their

own expense, by interacting with private sector, entrepreneurial, innovative companies, producing

products that solve the problem that those people want solving, i.e. the health and welfare and

stigma in a way that works for them. And there is really not very much room for your average

tobacco control activist or academic in there. Of course, some are very curious about that process.

You know, well done to them, they are at least thinking about the field they're working in.

And, you know, whether it can be used to solve really difficult problems, like smoking in

communities of people with mental health problems, smoking amongst homeless prisoners,

veterans, you know, all the really tough nuts to crack. Those are the academics doing the most

interesting work. But the people who just don't like it all, there's nothing for them at those

meetings other than other than threat and challenge. It's really about forced behavior

is really the point for them, isn't it? I would say there's a model of tobacco control,

which is I put this crudely, but we will punish you. We will hurt you. We will restrict you

until you do what we say, which is to quit. And then we'll let the pain stop.

You know, so we don't care about your welfare. We're going to hit you with a massive tax bill,

you know, in hundreds of dollars, thousands maybe of dollars per year for, you know,

for being a smoker. And our offer to you is if you do as we tell you, we'll make that pain stop.

And we call that the best tobacco control policy. That is basically the premier Rolls-Royce tobacco

control policy that everybody agrees with. We hurt you like hell in your pocket, in your

household budget, in what is almost always a poor household. And when when you stop and do what we

say, then we'll make the pain stop. When you get down to it, that's the model. And that, I think,

connects very strongly with a kind of belief that I have. And that is that nicotine vaping

removes the harm that comes from smoking cessation. And that harm that comes from smoking

cessation is everything that tobacco control and that you just laid out vaping. You can just step

right out of that. It's really interesting. I mean, when when when we talk about harm reduction,

we should take a holistic view of harm, which isn't, you know, it's not just the cancer,

cardiovascular, respiratory disease that you get from smoking gets dramatically reduced. Of course

it does. OK, but remember, we there's a whole lot of other aspects. So how bad do you feel about,

you know, being in a place and smoking and everybody staring at you or feeling you feeling

stigmatized or antisocial? Then so there's so there are those welfare aspects to harm.

Then there's a whole range of harms that are deliberately induced by policy.

OK, so I mentioned taxation is one that is a great big rod to beat you with.

And the deal is that when when you stop smoking, we'll stop beating you with that rod,

even though you're probably already very poor to start with. We're going to use financial pain

to get our way. So that's another form of harm. And it hits the household budget and it hits the

kids in the household as well as taking food off the table and so on. Then you've got the campaigns

which are often referred to as denormalization. So people will glibly trot out what we're

denormalizing smoking or tobacco. But what they mean is they're stigmatizing it.

Denormalization and stigmatizing are one and the same thing. They're just one is a more respectable,

respectful way of saying the other. So those harms count for a great deal.

And then then you've got then you've got other more subtle harms such as, well, let's call it

the loss of autonomy. What what if you liked smoking? Even if I disagree with you and I don't

like it or you don't like it or I've never tried it, you are entitled to want that and like it if

you want to. And I am pushing you to stop it. There's the material aspects, you know, welfare

loss associated. This is more controversial, but the feeling of loss and craving and withdrawal

and then loss of something that people experience when they quit smoking. Well, vaping helps with

all of that. It deals with those sorts of harms. You've not lost something, even if you think

if you'd never had it, you wouldn't miss it. The fact that you've had it and it's been taken away

or you've had you felt you've had to stop it, then you still feel as though you've lost something.

Anyway, I'm rambling a bit, Brent, but what I'm getting at is there are a wide range of harms

and feelings that people get when they are engaged with tobacco control and engaged with

protecting their own health in their own way. And that's where I would go. That's what conferences

like the GFN and there are others where you can talk to people and really get a feel for what they

feel about it. Why? You know, ask a question in the academic community. Why do you like why do

people like nicotine? And you'll get a really dumb answer like, you know, well, because they

because they were hooked on nicotine when they were a child by a predatory tobacco industry.

And now they're addicted and they can't stop. OK, there's much more to it than that. I've never

been a nicotine user. I've never been a smoker or a vapor. I don't intend to start. However,

I feel obliged to listen to people at GFN at the other conferences and find out what they think

they are doing and why they do it. And you get you know, it helps me relax. I feel stress and

anxiety controls my mood. I can concentrate better. Calms me down. Goes well. You know,

certain times of day, I really like to have it. It breaks up the boredom of life. All of these

things give a much richer picture of what's actually going on and helps you to understand

why there is even a demand for nicotine. You know why that demand is like frankly, why that demand

is likely to persist, not going to die out, because when people explain why they're doing it,

it kind of makes sense. Clive, at this year's Global Forum on Nicotine, you'll be hosting a

rather unique plenary pre-conference session titled The Big THR Conversation. How can the

last decade influence and inform the next? What's this session all about? I think the idea is is to

it was kind of like a bit of a nostalgia trip. You know, there's been people, there's some people

who've been in the room, have been on a journey, you know, maybe 15 years now. The earlier doctors,

they've been through evolving events, you know, whether it was the attempt at medicalization

in the EU that vapors saw off, whether it's the deeming rule in the United States,

whether it was the crazy stuff going on in Australia, whether it was the

bullish policy, followed by cautious policy, followed by thoughtful policy in Canada.

You know, so people have been through a lot. There's also been an incredible evolution in the

products. You know, any science that was done on the products in 2012 tells you very little about

the products that are available now. It would be like doing, you know, science on a Ford Model T

to understand the latest Tesla. You just wouldn't. There's nothing to learn there.

And you've also you've also got incredible development of scientific insight. So stuff

that we stuff that we've learned. And with that, the arguments that go with, you know,

with the public policy discourse. So in 2013, we weren't really talking about flavors very much.

We were. But we are now. We weren't talking about disposables. We had cigar-like

product. We've kind of come full circle because we had cigar-like products.

Then we then people got into more rechargeable. Now we've got the disposables, you know,

kind of mass markets and so on. So I think the idea is to sort of synthesize all of these

changes that we've seen in different areas of the landscape, whether it's, you know, technology,

policy, big, you know, big events in history, the scientific understanding, the landmark reports.

And rather than just have a like a nostalgia fest about what's happened over the last 15 years,

to try to think what we can learn from that about what to do over the next 10 to 15 years

and what kind of threats are coming up and why they are like they are, you know, what have we

what what have the tobacco control community revealed about themselves? What what is WHO

revealed about itself? What do we know about what have we learned from the kind of campaigns that

the Bloomberg complex runs? You know, those are all quite interesting things to digest at this

point, to try and understand what the underlying motivations are and what to do about them in the

future. Also, where is the optimistic story? I'm pretty optimistic. I have to say I'm pretty

optimistic. Why? Why is there something to be optimistic about? That would be good to draw out.

Now, I've been told that what will make this session a bit unique is the participation from

the audience. Tell us about that. One of the best sessions I've I've been in at

GFN. This is a trade secret here was I knew that the week after I was going to have to write a

briefing for a consultation on flavors. And I thought, OK, a really cool way to do this at the

at the GFN would be to crowdsource that from the audience. And I tell you, Brent, it was amazing.

The clarity, the range of issues, the insights and everything. And,

you know, I just I just thought it was a brilliant way of doing it. It requires it does require some

skillful moderation because you don't want people to go off on tangents and, you know, make sort of

lengthy speeches or whatever. So the art of it is to draw out of the audience, the collective

knowledge, you know, the wisdom of the crowd, if you like, and the wisdom of the crowd in the GFN

audiences is massive. OK, it's there to be taken. It's it's it's a mixture of technical knowledge

of science, but mostly tacit knowledge from experience or or battle ready knowledge from,

you know, the fights they've been in, in in disputes over policy and politics. And if you

can get that out of people and get it into some kind of orderly fascia, I think it's very powerful.

I don't know quite how we're going to play it. I mean, my approach to this, it's probably the

most difficult chairing thing I will have done at GFN and probably ever. But it will be to try to

help the audience find its own sense of direction in this by, you know, really challenging them in

a way with the answers that I'm getting and then going to people who can address those challenges.

And one of the things I understand is that's going to happen is that

members of the audience are going to come up on stage and share short anecdotes connected to what

you're talking about. So if anybody's out there watching this, you know, and you're coming to the

actual event, you better start preparing now. There's a couple of things you better be. One,

one is prepared, two is concise, and three is interesting. Okay. And I'm, I'm going to be very

tough because as the chair in these in these sessions, you're really there on behalf of the

audience, the rest of the audience, those who aren't speaking. And you're trying to get people

to be as interesting and to the point as possible. So I'm very much looking forward to getting people

up on stage. But I really want to see people at their very best. And at their very best is,

you know, concise, interesting, and to the point and give people give people something

memorable to take away, write down, give me something to put in the synthesis that

will produce at the end of it. If you could provide some specific

advice to what they might want to share on stage, what would that be?

My advice to to to vapors always in, in politics is to share your experience,

okay, and share what's happened to you. That's probably not what we need here. What we really

need is, how did you share your experience? How did you? How did you make it land? Okay?

What are the what are the arguments and that you have found persuasive? And how did you?

How did you make them? When you when if you use science, what are the arguments that that you

found compelling? And that people, even though they're good arguments, people either didn't

understand or didn't like? What, what have you seen by way of change in the in in the environment?

And why do you think that change has occurred? Why? Why do you think people who disagree with you

disagree? And what is their motivation? You know, and if you can go further, how do you think that

could be changed? You know, what are we dealing with out there? So those are the sorts of things

I want to get into. I don't, I don't want, you know, I feel like a long account of a specific,

you know, political battle, what I want is the is to get into the insight that you that you drew

from that, and something that we can capture that sort of general interest, and something,

if possible, that has a forward looking view. It almost sounds like taking stock in building the

going forward battle plan. It's exactly that. Yeah, I think it's a chance to take stock,

learn what we've learned, understand what's changed, and why. What are our deepest insights

into the direction of travel, the nature of the opposition, the nature of the allies as well,

for that matter? What's, you know, what's worked, what hasn't worked? What kind of environment

would be acceptable? What do people think are the right kind of, let's say, compromises between

somewhere between complete laissez-faire and a total prohibition? There is a kind of sweet spot

of optimal regulation. What should, what do we know now that should be in that? You know,

I mean, I'm there. These are just my thoughts. I'm there to get everybody's

thoughts in the room. But what I want is insights rather than accounts of circumstances. I want to

try, what can we all take away from the experience you had or the insights that you used in a

particular situation? Live, looking at the whole conference, the organizers have placed an emphasis

on science in the main program this year. Is this an underserved topic? I think getting to the,

the question is, what is the right science? You know, I mean, there's a huge amount of science

out there that isn't worth the paper it's written on. It's just, you know, it's full of errors and

mistakes and everything. So what is the, what is the informative science? And what, what is the,

the subset of scientific insight that is most relevant to, you know, consumers and the evolving

policy landscape for, you know, for, for future nicotine products? And, you know, the basic claim

of reduced harm, how, how robust is that? And, and, and why is it? Why do people, why do people

make out when they find a few, you know, picograms of cobalt in it, that the product is somehow

deadly? You know, so, so there's that. You've then got, you've then got, is, are these products

displacing smoking or adding to the total amount of nicotine use? You've got the, what are our

insights into, into disadvantaged populations, poor socioeconomic status, mental health,

people with mental health problems and so on. What can we learn about them? Then there's the

whole story about nicotine and some of the best sessions I've had have been at GFN on

why do people use nicotine? You know, it's an amazingly underserved question in the tobacco

control literature. And it gets to understanding what the basic demand function is. And if you

don't understand the demand function, you really don't know what you're dealing with as a phenomenon

or how, or what the appropriate regulation is. So I think there's a, there's a, there's a lot of

stuff like that. The kids thing, what have we learned about young people? And just a brilliant

paper just out that went through all the arguments about kids. And of course, it's much more

complicated than the campaign for tobacco-free kids narrative, which is just basically for

simpletons. And you can tell they're not serious about kids, by the way, because there's no subtlety

about kids. You know, what about the disadvantaged kids, the kid, the kids whose parents smoke,

the kids whose parents and their, their parents and their parents have smoked for the last five

generations? The kids were in estates and housing projects where nearly everybody smokes.

What about them? What about the kids who have very high substance use

behaviors, you know, likely to be using cannabis or other drugs? What about them?

You know, if you were really interested in the welfare of kids, that's where you'd be.

That's the stuff you'd be interested in, in particular, rather than using the transient,

frivolous, experimental behaviors of largely middle-class kids to create a massive stick

to be adults with, which is essentially what they are doing. So yeah, I think you've got to be

discerning about the scientific insights that you want, and also inconvenient truths.

You know, what are we learning that is disturbing, if anything? What do we think

about things like disposables and waste? What, how big is that waste problem? Is it a big problem?

It's bigger, it's bigger than not having them, but is it big compared to other forms of waste?

You know, so those are the interesting questions that would be, you know, on the mind of anybody

thinking about policy. Then these mega ideas, you know, should you do a smoke-free generation,

reduce nicotine in cigarettes, close down most of the retailing outlets for smoking?

Should you do plain packaging for vapes? Should you reduce the nicotine concentration or use

nicotine flux as a way of regulating vapes? Should you ban flavors other than tobacco flavor?

You know, there's lots of science around those issues that could keep a whole conference going for months.

Clive, as we've been discussing, you are hosting a plenary pre-conference session titled

The Big THR Conversation. How can the last decade influence and inform the next?

At the Global Forum on Nicotine, the annual conference on safer nicotine products

and tobacco harm reduction. GFN 2023 starts on June 21st and runs to the 24th.

If you can't attend, you can watch online. Go to to register.

Clive, last question for you. Why are you optimistic about the future of tobacco harm reduction?

I think that there is just a basic, steady movement of people, markets,

companies that basically are engaged in the process of creative destruction and

diffusion of innovation. So in this massive nicotine market of over a billion people,

there is going to be, whether the regulators, the tobacco control activists or WHO like it or not,

there is going to be a technology change. And that happens because it's in the interests of

consumers and producers to change the technology. And those processes are incredibly difficult to

resist. You can slow them down with dumb regulation, you can derail them to some extent

with misinformation. But the underlying problem for them is that you cannot stop them.

And those processes are because people want to improve their health, safety, welfare, well-being

at their own expense, on their own initiative, while doing something they want to do,

which is to use the recreational stimulant nicotine. That's the underlying process that's

happening. And I think of it like tectonic plates, the slow-moving land masses. You can't

stop that happening. Maybe they can get in the way with the deeming rule or a TPD or something,

but they won't stop the fundamentals changing. All they can do is slow it down. I wish they

didn't slow it down, but they won't stop it.