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Cliff Douglas is, as they say, the “real deal”. An essential attorney in the tobacco wars of the 1990s, an adviser to the U.S. FDA and Surgeon General and vice president of tobacco control at the American Cancer Society. He is a tobacco control veteran and now the leader of a global organization dedicated to reducing tobacco harm through harm reduction.

Clifford E. Douglas
President & CEO, Foundation for a Smoke-Free World
Former VP, Tobacco Control, American Cancer Society


0:00 - Recap of 2021 RegWatch Episode
2:16 - Introduction
3:05 - Cliff's Position at the Foundation for a Smoke-Free World
4:38 - Who Are the Major Players in the Struggle on Vaping?
11:15 - What Is Tobacco Harm Reduction?
15:47 - Tobacco Control Narrative
18:53 - Have Safer Nicotine Products Played a Significant Role in Bringing Down Combustible Tobacco Use?
23:16 - The Curious Case of Nicotine
29:54 - Misinformation About Nicotine
34:04 - Are Anti-Vaping Forces Winning?
36:19 - Stigma Surrounding Tobacco Harm Reduction Advocacy
41:08 - Why Is GFN Important?


00:00:09 --> 00:02:14

Cliff Douglas: I got started 33 years ago as the assistant director of the Coalition on Smoking or Health, representing the three large voluntary health organizations, the American Cancer Society, the American Lung Association and American Heart Association. I worked at that time, for example, on coordinating the National effort to remove smoking from airplanes. I spent time working in Congress as a special counsel. I'm an attorney by background on tobacco issues. I helped get started, for example, the investigation that was conducted by the U.S. Department of Justice into the decades of misconduct by the major cigarette companies in the U.S. and around the world that eventually led to a racketeering conviction, civil conviction. in a federal court in 2006. I've served as the consulting tobacco control policy advisor to the U.S. Assistant Secretary for Health, who actually oversees the Office of the Surgeon General. And then I played the same role for the U.S. Surgeon General. I also worked over many years as an attorney in litigation, including some of the major cases brought by the state attorneys general in the United States that led to the Master Settlement Agreement in 1998 and also served as an attorney representing or assisting behind the scenes several insiders from the cigarette companies and working with them to assist the Food and Drug Administration and the Department of Justice and others in helping the public understand more about the cigarette industry and the harms caused by cigarette smoking. And so I've been involved in many aspects of this. Call it the wars for many years. And most recently, until last year, had served for five years in the senior leadership at the American Cancer Society, leading tobacco control efforts, therefore, for the one of the oldest and largest voluntary health organizations in the US.

00:02:16 --> 00:03:02

Brent Stafford: Hi, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV. The cold open clip we just played for you came from a RegWatch episode in May of 2021 featuring Cliff Douglas, a deeply experienced tobacco control veteran calling on colleagues within public health to cease fire in the war over vaping. Yet three years later, the battle rages on with misinformation and abuse directed towards vaping and tobacco harm reduction only increasing. Joining us today to talk through the issues and impacts of the battle over safer nicotine products is Cliff Douglas, the President and Chief Executive Officer at the Foundation for a Smoke-Free World. Cliff, it's so great to see you and thanks for coming back on the show.

00:03:03 --> 00:03:04

Cliff Douglas: Thanks, Brent. It's great to be back.

00:03:05 --> 00:03:12

Brent Stafford: Absolutely. And we have a lot to catch up on. First off, tell us about your new position at the Foundation for a Smoke-Free World.

00:03:13 --> 00:04:37

Cliff Douglas: Well, thanks again for having me. Well, this is a very interesting and actually a very promising time. In October of 2023, I joined the Foundation for a Smoke-Free World, as you noted, to become its new president and CEO. And this is to take an organization that was founded in 2017 and really help lead it in close teamwork with a wonderful staff and other leadership at the organization into a new phase, a phase in which we're going to really renew and turn to the public about the fact that we are focusing on a mission that joins with my colleagues in, if you will call it traditional tobacco control, in trying to end this terrible epidemic. And we're going to be doing it in ways that I'm sure we'll talk about, but I can tell you now, we've already begun to focus on trying to better educate the public, better educate clinicians in this field, because we all understand there is really some terrible widespread misunderstanding out there in the world, among the majority of folks, whether they're lay people, people who are smoking, or professionals who are actually involved in tobacco treatment and taking care of patients. We have a lot of work to do and we're excited about where we're headed.

00:04:38 --> 00:04:50

Brent Stafford: Cliff, back in 2021, you called for a ceasefire in the war on vaping. Who are the major players in the struggle and how did your call go? Was it unheeded or was it taken up?

00:04:51 --> 00:11:14

Cliff Douglas: Well, it's a good question. And it's always helpful to, you know, three years later, be able to do a little bit of a retrospective. Well, what I was looking at at that time, having spent five years as the Vice President for Tobacco Control, the leading official for the American Cancer Society in the United States, and spending some time back at the University of Michigan School of Public Health as an adjunct professor, where I have been affiliated since 16-17 years ago, I was looking at what was going on in our world and clearly it had become very polarized and the polarization to oversimplify it. But I think people understand that it revolves around this in some ways had to do with the fact that a component or a contingent of my community has really focused very specifically on concerns around children, around youth and their exposure to nicotine and their concern that the burgeoning marketplace for alternative nicotine products has been placing them at risk. At the same time that much of the scientific community with whom I work and have been part of, even though my background is as an attorney, been doing research, advocating, engaged in public discussion, have been focusing on the urgent needs of tens of millions of adults who smoke in the US and then over a billion worldwide. And I note that because this is a global issue, needless to say. And I can tell you, because I want to add this important focus to the discussion, the Foundation for a Smoke-Free World has a very specific focus on global action and on the significant challenges in LMICs - the low and middle income countries, where much of the smoking in the world takes place. The players who were involved, who I was trying to address, were what I described as both of my communities: the community of tobacco control organizations and the leaders and folks who work within that field, the Campaign for Tobacco-Free Kids, whom I have been closely affiliated with over the many years. My first mentor in this field was Matt Myers, the founding longtime president of the organization. The American Cancer Society, where I not only served in the senior leadership for five years in recent years, but also over many years served as a legal counsel, representing them in court when they went in to defend as an amicus, as we call it, smoke-free laws that were being challenged in court, and the American Lung Association, where I also served as the number two national public affairs official for them in the early 1990s. And then close colleagues at the Truth Initiative, the American Heart Association, whom I also represented when I was the number two with Matt Myers at what was then called the Coalition on Smoking or Health, representing the cancer heart and lung charities in the U.S. Now, on the other side, if you want to term it that way, I kind of hate to term it that way, but on the other side, we've got a lot of scientists, a lot of researchers. There are organizations who are focused on the promise of the alternative tobacco and nicotine marketplace, chiefly involving products that contain nicotine. That would include e-cigarettes, pouches, lozenges, low nitrosamine or low cancer-causing smokeless products such as snus and others that we understand through some years of experience now and also through a lot of scientific research demonstrating that they are substantially less harmful than any combustible or burned tobacco product ever could be. There are folks who are really focused on trying to promote under carefully regulated circumstances, the availability of those products to the millions of people who really could benefit from them. And in fact, millions have benefited even in an environment which has tended to be hostile. So I was trying to encourage folks from these two areas that I was already straddling and appreciated the value of on, if you will, both sides, to come together and meet in the middle. So thinking of it from the perspective of a Venn diagram, there are some areas where you don't overlap. But there's going to be a pretty sizable middle where we do and we should. People don't often tend to look at it that way, or at least not enough. And there are other colleagues in the field who have been working very hard to bring together folks from different perspectives to find common cause, because having, and forgive me for this type of reference, especially in this day and time, having a circular firing squad in an arena where we're dealing with what remains the leading preventable cause of death, where 8 million human beings are dying every single year, and not moving forward in ways where we can join hands and find ways to work on this together. Well, that's a terrible outcome that I think we can do better on. And that's what I was encouraging folks to do. And in my very small way, trying to offer myself up to engage in that discussion and with the substantial help of leading scientists in the field, whom I would be happy to talk more about because I stand on their shoulders anytime I speak about these issues, who have found that there's a lot of promise in this area. And we have to find ways to make it work better.

00:11:15 --> 00:11:26

Brent Stafford: Let me ask you, Cliff, what's your definition of tobacco harm reduction? And is it actually a real thing? Is it a strategy that should be embraced by tobacco control?

00:11:27 --> 00:15:47

Cliff Douglas: Well, tobacco harm reduction, people refer to it as THR, three letters that for too many people have become a four-letter word or reference. And that's challenging. Because way back when I was in law school, for a year, while I was in law school, trying to look for something a little bit more pleasurable, I taught writing courses to undergraduate students. Intro, you know, composition, and then a course in persuasive writing. And one of the very basic things that we talked about way back then and have remained kind of mantras for me ever since is, first of all, you've got to speak to your audience. What will people understand? What will people care about? What is the language that resonates with them? And that's just being respectful, you know, and what's the point of communication is to communicate. You want to have a back and forth and engagement with the folks you're communicating with. And that involves as well, the choice of language. Well, tobacco harm reduction has increasingly, if anything, been associated by folks who just feel differently or see the world differently for the various reasons they do than some folks like myself. They have tabbed tobacco harm reduction as an industry plot, almost a conspiracy. And one of the things that you can do or one of the only things you can do in this space while seeking to be strategic is tell the truth, speak from the heart. Talk about what you understand based on the most objective, factual evidence that we have available. And that, by the way, we're also seeking to enhance through funding grant work from our organization. But to address it that way, but there are folks who have been very skeptical because who produces at least some of the products that become part of the harm reduction discussions? in the area of tobacco and nicotine, and it's tobacco companies. It's the large manufacturers. We've talked a little bit already and we talked three years ago about the fact that much of my career, if you will, has been devoted to giving the tobacco industry as hard a time as possible. Look, I mean, when I started in this and I was a youngish guy, much younger than now, one of the things that drove me was, oh, you know, there are black hats and white hats, almost in the old cowboy movie sense in this field. There are bad guys. They're lying to people and they're trying to addict them. And they may not want them to die, but essentially they're taking actions that they know are going to kill a lot of them. That motivated me for years. That's still in my heart. A lot of bad has been done. But here's the deal. The deal is that what we call tobacco harm reduction is dedicated to saving lives. It isn't an industry plot. I would also ask some folks, by the way, if you do trust and at least the concept of reducing harm from smoking the leading preventable cause of death, and it's going to involve the use of alternative products that will work for people and enable them when they need it, when they aren't finding other options either accessible or appealing or just effective for them, for them to be able to wean themselves using alternative products, who do you think is going to make them? It's going to be the industry that's equipped to do that. What that points to, my final point on this one is that not that you throw the entire industry out, but that you move to a system that's going to work effectively for them to participate in this arena in a carefully regulated way that holds them accountable and enables them to do the right thing by us so that we can improve the world in which people who smoke are seeking to reduce their risk and save their lives.

00:15:47 --> 00:16:38

Brent Stafford: So the tobacco control narrative around THR is that it is a big tobacco plot, almost conspiratorial. And we've seen that if you followed the COP10 down in Panama, which is WHO's Framework Convention on Tobacco Control, that narrative was pushed heavily amongst the COP members that were there. So that's interesting, but it really kind of boxes everything in because, you know, you can't really. If you are a vaper and part of the vaping advocacy community that has nothing to do with big tobacco, hate big tobacco, you're boxed into this, this definition that tobacco control has, which gives you no place, no room to move.

00:16:39 --> 00:18:52

Cliff Douglas: It's important to understand that when we talk about tobacco harm reduction, the concept emerges from the broader area of harm reduction. And that's a tried and true, increasingly accepted and normalized public health approach. It's a public health approach. It's also, if you will, a private health approach that's taken at the on the ground community level to assist people who, in the most well known example, are, for example, addicted to, dependent on heroin or other lethal drugs, street drugs. And this is an approach whereby harm reduction is executed by making available to them safer versions of the drug delivery, methadone, for example, the use of cleaner needles, and the not sharing of needles. There are other areas of harm reduction that are well understood, although people don't always necessarily classified this way when they're just thinking in general. Every time we drive a car, if you're driving responsibly and following the law, in most places, you are wearing a seatbelt. That is harm reduction. A car can be a lethal weapon. There are a lot of car accidents, and many people die each year. But because of seatbelts, the mortality rate is much lower. People's lives are being saved. The same would be true of the inclusion of airbags in cars. There are many other examples, riding a bike or a motorcycle and wearing a helmet is harm reduction. But what's happened is that the notion that we apply that concept, that tried and true and very effective public health approach to tobacco products has gotten conflated with the suspicion and the, in some ways, unique and very troubling history involving the tobacco industry. And I think that some of my good friends, good friends and colleagues from my tobacco control community have found it difficult therefore, to countenance the involvement in any way of that industry in promoting the availability of harm reduction for tobacco.

00:18:53 --> 00:19:10

Brent Stafford: So say for nicotine products, such as nicotine vapes and the pouches and the list that you just laid out there, have they played a significant role in bringing down combustible tobacco use? And what would be the impact if these products were more readily accepted?

00:19:11 --> 00:23:15

Cliff Douglas: I think the impact of alternative nicotine products, whatever they may be across that continuum of risk, and particularly the group of them that are much lower risk on that spectrum. They're becoming more normalized, I would say regulated in appropriate and effective ways, which I would not attribute that characterization to the Food and Drug Administration, for example, and some other health authorities around the world. Some are doing better than others. If that were done well and these products were understood to be what they really are, which science has now proven. I think beyond the shadow of a doubt, even though we don't have the full long term to look at, you know, at our fingertips to consider any possible eventuality that might take place after 30 years, it would help public health tremendously. So here's an example, a concrete one that applies to current events. The FDA has proposed a menthol cigarette ban. And what they've said is, based on the research that I was part of, I was a co-author of at the University of Michigan, in collaboration with Georgetown University, we found that if that ban were implemented in the U.S., we projected out through modeling science that it would save several hundred thousand lives based on the fewer number of people who smoke in the U.S. I believe that was accurate. We have other information to support it as well. So the FDA relied on that. But what they chose to ignore when they proposed the menthol cigarette ban was the other part of our study, the very same study that found that the saving of lives would increase significantly if there was a robust off ramp of a marketplace for e-cigarettes, for alternative far less hazardous nicotine containing products. that people who smoke menthol cigarettes could turn to to assist them in staying off of cigarettes so that they didn't instead go and smoke other non-methylated cigarettes or use other very hazardous products. The reason that they didn't include it in their proposed regulation and are essentially choosing to ignore that today is a good question. You know, why? Why are they doing that? Well, one thing we know is that the FDA has focused on the harms that they allege of nicotine to kids. And while they give lip service to the continuum of risk and do note the fact accurately that these products are not all created equal, that they are in vastly different places when it comes to relative risk, they are not in any way promoting even the very few e-cigarette products that they have authorized as being appropriate for the protection of public health. A mere handful out of all of the applications they've gotten, but instead have implemented a de facto ban, first of all, on all flavored alternative nicotine or e-cigarette products in particular. But by the way, for all intents and purposes, they have implemented a de facto ban on all e-cigarettes. Because to give authorization to approximately six actual different products in the face of many thousands, if not millions, of often illicit products being out there in the marketplace is not really being serious about doing the best thing for public health. It just isn't. So many of us are working hard to try to right that ship. And I think it's important for decision makers that would be in the US Congress and in comparable situations in other countries to understand the facts around this. But so far, it's been a real challenge.

00:23:16 --> 00:23:55

Brent Stafford: You hear, we will not tolerate another generation of young people becoming addicted to nicotine. But you never hear people say, we will not tolerate another generation of young people to be addicted to heroin. We will not tolerate another generation of young people getting addicted to alcohol. We will not tolerate another generation of young people to develop a cannabis problem. Why is it nicotine? They don't seem to care about heroin, alcohol, cannabis, social media, porn. The list goes on. Why is it nicotine?

00:23:57 --> 00:29:53

Cliff Douglas: Well, it's, it's interesting. Nicotine has gotten pretty bad rap over the years. And let me just reflect personally. I believe it's safe to say I played a pretty significant role in damning nicotine way back in the day. And it was for good reasons. I'll just note that, for example, back in 1994, I was responsible for an expose that aired on ABC News, so one of the prominent, obviously, broadcast networks in the United States. In fact, The host of ABC Tonight, the main anchor show, was Peter Jennings. And he was involved in this behind the scenes, a good Canadian who came down and took over the media world in the United States. And he was just a fantastic journalist. And that program reported on the fact, for the first time in that format, that the cigarette companies were carefully controlling nicotine in their products with the intent to addict millions of, in many cases, unsuspecting members of the public, consumers. Why were they unsuspecting? Because most of the people who started to smoke were 12 or 13 years old. First of all, they were going to live forever. And second of all, they had no appreciation, and why should they, of the harm that they were embarking upon. And then they became addicted before they were able to make a rational adult decision about whether to use this product. Now, Surgeon General C. Everett Koop, back in 1988, released the Surgeon General's report, the first one focusing on nicotine addiction. It became very heavily focused on the fact that these products work and continue to be, and I'm talking about cigarettes. By design, they're engineered to addict people who use them so that they become permanent or to the extent possible, permanent customers. And that's just a fact. I wouldn't diminish the importance of that. But here's the challenge. Here's the challenge. Now, as Mike Cummings and co-authors wrote, the past is not the future in tobacco control. In an important journal article in recent years, that history helped bring us to where we are today. We must have that understanding about the science, about the nature of these extraordinarily lethal products. But nicotine is not killing people. Nicotine is not killing people. We know now even better than we did then that nicotine when it is contained in the dirty needle of a cigarette, or other combustible products that could be hookah, it could be cigars and some others, fuels the use of those products because, it is highly dependency forming but when you separate the nicotine from the dirty needle, then you have things like nicotine gum. You have the nicotine patch, or as it's called, plaster in some countries, which in the United States by the Food and Drug Administration is carefully reviewed and regulated and approved as safe and effective. So clearly, nicotine can't be the reason that people get sick and die when they use it. It's the reason that they become addicted to some products that cause that terrible outcome. But when you use it in some alternative products, it's used in medicines to help people quit smoking. It's used in alternative nicotine-containing products like those we've talked about, people are familiar with, e-cigarettes and pouches, in substantially less hazardous smokeless tobacco products like Snus, which has very low nitrosamine, content and other products, lozenges, the whole range of those products that people can use and many actually do use in spite of a poorly misunderstood environment and a lot of hostility to wean themselves off of cigarettes. So the focus on nicotine for kids revolves around the addictive potential, which is true, And we don't want nobody whom I know wants and will do what they certainly can do personally and on the policy level to ensure that kids don't use nicotine. That's the policy of the US government and pretty much every government as far as I know and should be. But the fact that it's been damned as something that is conflated with the illness and death caused by smoking by that awful form of tobacco use is highly damaging to people's understanding, including the majority of physicians whom our own research and research out of Rutgers has shown, the majority of whom believe that nicotine causes the illnesses resulting from smoking, the death that results from smoking. Well, we have to right that ship because that misunderstanding, which continues to be widely encouraged, and I have to say, by the many Bloomberg Philanthropies supported organizations, it's become their mantra that nicotine is practically tantamount to the devil. But in fact, it can be a safe and effective, very useful medication. And it can also be used in other products that are far less hazardous than combusted tobacco products to save people's lives.

00:29:54 --> 00:30:26

Brent Stafford: A Bloomberg Philanthropies employee or advocate could be walking across the street and step over three people addicted to heroin in their early 20s and don't even think about it and then go into their office and spread misinformation about nicotine. There's just something really sick and demented in my mind about that. It's like not a true understanding of the risk that's associated with certain substances. Nicotine, it's like coffee. I just don't get it.

00:30:27 --> 00:34:02

Cliff Douglas: Well, what I would say at the outset, and I have discussed it with and read the works by Neil Benowitz, for example, who is probably the leading recognized expert on nicotine science globally. And he was one of the two leading editors of the US Surgeon General's report on nicotine addiction way back 36 years ago. Well, Neil has said that Nicotine and caffeine are not identical. Nicotine may not be as quite as benign as caffeine, but this is just to emphasize, really relative, okay? Nicotine is still, if you look at that continuum of risk that generally we're all familiar with, that is still promoted as the way to look at this marketplace by the US Food and Drug Administration, nicotine is way down at the bottom. So let's not fool ourselves and think that this is some horrible, lethal drug that is imposing on millions of unsuspecting victims in our society. And I'm not belittling that in any way, but really trying to look at the fact that we need to consider this scientifically, maturely, reasonably. Now, the reality, I think, is again, going back to the fact that the tobacco industry is still around and it's still big time and it's involved in the space really ends the discussion for a contingent, a sizable, not small contingent of my friends and colleagues in tobacco control. And then there are groups like Parents Against Vaping E-Cigarettes or PAVE who are really pretty non-scientific about this. I don't think that they, or most everyone in this arena, on any side you look at, has bad intent. I really don't. I have more faith in human nature. I think that there's opportunism that takes place. I think that folks end up siloed in areas that grab their interest for whatever reasons occurred in their lives. It might have been a dad or a mom who I had a kid who became dependent on e-cigarettes. I've had my own concern. My now young adult son started vaping in high school. And I was concerned about it. I remain concerned about it. Look, there are better things that you can do, especially when you haven't been smoking cigarettes before and you're not reducing harm. You're adding something that's not clean air to your diet. And folks get concerned about that. Their kid is not using heroin. A lot of the folks in the PAVE sort of orbit, I think, come from more well-to-do families. The challenges they face are very real, but they're different. They're not like a kid. In the neighborhood, I grew up in Chicago and Uptown, which had one of the highest crime rates in the United States at the time. I joke that that's where I became a serious runner because I got mugged by other kids a couple of times. Well, that was the nature of that. And if you looked at where I grew up right now, you'd probably be seeing a lot more use of hard drugs. And I don't think vaping would be considered high on the agenda. But it depends where you come up and what your focus is.

00:34:04 --> 00:34:10

Brent Stafford: Based on what you're seeing, Cliff, are anti-vaping forces winning?

00:34:11 --> 00:36:18

Cliff Douglas: Well, you know, I would say that thus far we have really been up against it. When working as hard as we can to better educate the public and educate the doctors and other healthcare practitioners who take care of them, who treat them, and the media and decision makers at all levels of government. We have really been up against improving understanding and improving the policy and the healthcare delivery environment around the the menu of alternatives that are there not only to be available to people who smoke but also, are deserving of careful review and I think standardization, quality control at a level that isn't happening now because so much of the market in a lot of places is an illicit market. Well, an illicit market by definition It's just not being managed properly in the interest of protecting and serving people's health. So no, we're not winning. We're not winning that area. I try not to think of this. I really actually just don't tend to think of this as a winning and losing situation. Everyone who works with me, my incredible staff at the Foundation for a Smoke-Free World, scientists, communications experts, just terrific people know that I'm an optimist. And we even joke about it sometimes because for me, however full that glass is, it's at least half full and more so most of the time. I'm really eager to keep moving ahead and especially in the new phase of our foundation, which we will soon be announcing as a new name and a new public approach to helping and supporting people and clinicians to ride the ship. But no, we're not winning right now. We're having a tough time.

00:36:19 --> 00:36:47

Brent Stafford: So let me ask you then about the foundation in earlier in the interview, you made a strong argument that anything associated with big tobacco is demonized and thus THR is demonized in a way. Nicotine of course is associated with big tobacco. Nicotine is demonized. Now the Foundation for a Smoke-free World is associated with Big Tobacco, PMI specifically, in terms of that's where the original funding came from. Are you guys being demonized?

00:36:49 --> 00:41:08

Cliff Douglas: Well, the Foundation for a Smoke-Free World has in some ways had a tough time since it was founded in 2017. We all know that. And the tough time that it faced was more than anything attributed to the fact that the funding it received and continued to receive over a period of time came from Philip Morris International. So one of the major cigarette manufacturers internationally. And the result of that was I think it impeded the good intent and the independent work that was engaged in by this organization. Now, when after a number of changes had taken place along the way, I was approached to consider taking over the leadership role for the organization. I looked at it very carefully and I wasn't at the outset inclined to make a change. I was well set as a faculty member and a researcher, co-investigator on the FDA-funded research center at the University of Michigan. And I'd been there for a number of years. But I was working very hard on these issues and finding that it's been very frustrating because of the overwhelming resource imbalance and the fact that public understanding and the understanding of the clinical immunities out there and others was worsening, not getting better. So I talked to the Foundation. And then I'll just say that over a period of many months, worked very hard to find a different way where the Foundation could really live to its clear potential to increase its effectiveness and its acceptance, its credibility, its deserved legitimacy out there in the world of public health in fighting to save more lives. And what I was able to work with their board of directors, a very supportive board of directors on, was to arrange a brand new arrangement with PMI. And that was for PMI to give a final payment to the organization and end its relations with the organization. There was something called a pledge agreement, which guided the relationship over time that continued to have a variety of responsibilities in both directions. It didn't change the independent actions of the organization, but publicly created question about its independence. And so we ended the severance agreement the day that, or just before I joined the organization on October 12th, 2023, and then importantly, worked with, again, a very supportive board of directors who want to see this organization succeed in its effort to save more lives, whereby the board adopted a new policy that the organization will not accept future funding from any manufacturer of a tobacco or even a non-medicinal nicotine product, even an independent vape manufacturer, could not offer and have their contribution accepted by this organization. That's how much we wanted to emphasize and I wanted to emphasize the independence and separation from industry. So I've seen this as a natural extension of my career in this cause. And through stressing the strict independence of this organization, I just am incredibly optimistic, and we've already been making some real progress, that we're going to strengthen our position as a stakeholder and help people contribute to this cause of ending the illness and death from tobacco use.

00:41:08 --> 00:41:26

Brent Stafford: Cliff, I know you are familiar with the Global Forum on Nicotine, the annual conference of safer nicotine products and tobacco harm reduction. #GFN24 is coming up again this June 13 to 15 in Warsaw, Poland. Let me ask you, why is an event like GFN important?

00:41:26 --> 00:42:55

Cliff Douglas: Well, the event like GFN is important and I'm delighted to be able to be coming this year and giving an address to the participants. I'm honored by the invitation. Because GFN has for some time now been focusing on, I think, understanding and promoting accurate science in this arena, the reality and the importance of what we call the continuum of risk, of relative risk, and trying, again, to educate not only ourselves based on the emerging and cutting-edge science that continues to come forward, but also to educate the world about the promise of these products in appropriately, carefully regulated environments to help the more than a billion smokers around the world stop smoking. And for those who simply won't or cannot entirely quit nicotine, which for the reasons we've discussed is by the way, in many cases, actually okay to move to a product as far down that continuum of risk or products as far down as possible to obtain the nicotine that they want or perhaps need. But in the course of doing so, again, reducing their risks substantially and in many cases, saving their lives.