An examination of the health and economic impact of tobacco control measures and the role for proportionate regulation and risk management for alternative nicotine products.
Global Forum on Nicotine 2024 Panel Discussion #2 - hosted by Clive Bates with panellists: David Sweanor, Nevena Crljenko, Konstantinos Farsalinos and Joe Thompson.
Transcription:
00:00:06 --> 00:01:41
Clive Bates: All right, everybody, good afternoon. Welcome to the final panel of the day, which is on regulation, legislation, its impact on health and economics. There are no PowerPoint presentations or lengthy speeches involved. We're hoping to tap into the wisdom of the crowd and sort of gain our collective insights into what good and bad regulation is. We have a couple of folk from the tobacco industry, Joe Thompson and Nevena from PMI. So we're going to have a bit of fun with them, asking them some tough questions about regulation. We have this guy who no one's ever seen before, and also David Sweenor and me. Okay, so... Because there's no presentations, I still want to give everybody a chance just to get started with just a few remarks along the lines of, how should we think about regulation in this field? What are your talking points? If you're stuck in a lift with a minister or a regulator, What is it that you're going to say? Okay? So, David, do you want to kick off? And we're really brief contributions here. Then we'll open up. I'm going to start interrogating the panel. Then we're going to get questions from the audience, points from the audience. And we'll also interrogate the audience. We're not going to put up with any nonsense. You know, there'll be challenge in all directions. Okay? David.
00:01:42 --> 00:02:50
David Sweanor: All right. I think if I were to talk to a minister who's in a position to be doing something on this, finance minister, health minister, we can pretend it's combined portfolio. First, regulation is not something where you can control behavior necessarily. You've got to figure out what's happening in the market. There's a limit as to how much you can move a market. You can facilitate things. But think of the stuff that's worked before. Why is it people are eating sanitary food and having science-based pharmaceuticals and having safer cars? What were the things that worked? How did regulation work with market forces, with consumers? And in terms of thinking this one through, to also say, if you look at your legacy, what are you leaving behind? You know, someday you're going to be done with your political career. You know, you're going to be at your cottage in your plaid shirt and your rocking chair looking back over your career. This is an area where you can make a really big difference. But you're going to be opposed by a whole lot of people who you think should be your allies. So you should be prepared for that. And you have the opportunity to do something really incredible if you get this right.
00:02:51 --> 00:02:54
Clive Bates: All right, very good, David. Joe, why don't you go next?
00:02:55 --> 00:04:10
Joe Thompson: Thank you. I think if I was briefing a minister, I'd be advocating that actually the tobacco harm reduction equation is the framework that shows how alternative nicotine products can have a positive impact on public health by reducing demand and therefore supply of combustible cigarettes. It includes all of the... the elements to the framework that are required, if properly followed and enforced. It addresses product risk, it addresses consumer acceptance, which breaks down into appeal for adults, use, no good having a product with reduced risk potential if no one uses it, and it also addresses the unintended use consequences. So that would be the framework that I'd be advocating. That science needs to be based, sorry, that regulation needs to be founded on sound science, consumer protection, harm reduction principles, not prohibition principles, and needs to allow for communication and for appropriate taxation.
00:04:11 --> 00:04:23
Clive Bates: Okay. I'm getting worried that everybody's going to be in agreement with each other and we're not going to have any fun. So we might have to try and challenge some of this stuff in a minute. Konstantinos Farsalinos, I hope you all know.
00:04:25 --> 00:05:40
Konstantinos Farsalinos: After so many years involved in research in these products, I still don't understand why we pretend and we believe that regulating harm reduction is that complex and that difficult. I think it's much simpler than it looks. What also puzzles me is the paradox of having better decisions and regulations 10 years ago, and I'm referring, for example, to the EUTPD, tobacco product directive. Better regulations 10 years ago with far less evidence in simple things like even the relative risk of these products. We have far less evidence compared to the decisions that today are being made or discussions about decisions that are being made today from regulators and governments even in developed countries like the EU. in a period today that we have so much overwhelming and very convincing evidence on both the lower harmfulness of these products as well as their efficacy as acting as smoking substitutes. And I'm sure Clive is gonna be very impressed that I'm finishing my first statement here.
00:05:40 --> 00:05:52
Nevena Crljenko: Clive, I'm going to disrupt your panel now by asking a question to Konstantinos before I answer yours, because you made reference to TPD and the good things done 10 years ago. What do you expect of the next TPD in the respect of things changing?
00:05:53 --> 00:07:13
Konstantinos Farsalinos: Well, that's my worry. Today's discussion is about flavor, something that, of course, we have discussed for many years that it's going to be the easy target. They're using the arguments that they use for cigarettes, but for products that are completely different. And they're using the same emotional arguments as then, but... All these arguments are completely invalid because the end result, if they implement restrictions or prohibitions on flavors, is that they're not going to protect anyone. The black market that is going to be created will target specifically youth as being the most vulnerable group. At the same time, it will cause harm to smokers. It's a lose-lose situation. I wonder why they're not seeing the examples of countries outside the EU where such prohibitions have been implemented. India is a perfect example. You couldn't see a vapor in India. You couldn't find vaping products anywhere before the prohibition. After the prohibition, there was an explosion of a black market. In every street, in every corner, in all major cities, you'll find vape products in shops selling from textile to cookware to whatever you can imagine, of course. Unknown quality, unknown origin, unknown content.
00:07:14 --> 00:08:42
Clive Bates: And, you know, we are in a weird situation if we have... We're in the position, and we're in this position in Australia, in India, in the United States, where essentially criminal networks are important prime movers in public health because they're supplying... products that are essentially ruled out by the authorities. And that's not a happy place to be, where you have to celebrate organised crime for its positive impact on public health. And we'll come back to all of this in a minute. The outlook for the TPD is pretty bad, but that's because at the moment we're only hearing from technocrats. Let's wait until it gets into the Parliament, when basically consumers can have their say, where the arguments can be made. We have to be skeptical about the EU, and it's nothing to do with anything outside the EU. The EU banned SNUS in 1992 following a moral panic that started in the UK in 1988. It banned it again in 2001. It banned it again in 2014. It defended a legal case that would have lifted the ban in 2017. It shows absolutely no sign of... lifting that ban now even though the evidence is absolutely overwhelming so that you should lift it and you should let it have its its play and that that should give us a sense of some skepticism about the role that science Joe plays in actual regulation as a as done in practice.
00:08:42 --> 00:10:14
Nevena Crljenko: But anyway, I'm interrupting. Never know. So I'll go back to the first question. So what I would say, you're right, it's difficult to be the last. I was hoping not to be after David and Konstantinos in particular. Let's try to take a spin at it anyhow. So I would say that nicotine use is here to stay. It's been with us as humanity for a very long time and not significantly reduced smoking rates for the last decade or two prove it. What we also see in the last 10 years, there has been proliferation of new non-combustible products that are better alternatives to smoking, and people are actually switching to them. So the question to the minister, or rather suggestion, is to really help facilitate that process, because it's for the benefit both of the consumers, of the government, and industry actually has a role to play. Because for any transformation of the industry, industry is the best place to do it. It can be a complete disruptor, Tesla, startup, in terms of electric cars. But what we sometimes hear is as if the Volkswagen or Ford would hear, okay, you're the bad guys, you do the combustion engine, it's Tesla who disrupts, you should stick with what you do and you cannot change. So I think collaboration, exchanges of arguments, science, all the arguments that were brought by the previous speakers should be taken into account. And as David said, we should look at the ministers, should look at the successful policy implementation in the other areas that are built on the same backbone of harm reduction and just copy it. It's happening in the cleaner energy. It's happening in the different spaces. Why ideologically opposing taking the concept that actually works for better of everyone?
00:10:15 --> 00:11:24
Clive Bates: OK. some really good points in that, but I want to draw out one because I think it greatly affects how we think about regulation. And I think you said something to the effect, Nevin, of the demand for nicotine is not going away, okay? Now, if you work on the basis that nicotine demand is sort of persistent and inevitable, rather than something that is either going to decline with smoking or decline just because nobody really wants to do it and they're just doing it against their own will, perhaps you'd approach regulation in a different way. If you think it's possible and you're aiming for the nicotine-free society, do you have a different approach to regulation than if you believe that nicotine is here to stay, maybe like on the evidence of last night, that alcohol is here to stay? or caffeine is here to stay, or cannabis increasingly is here to stay. Do you approach regulation differently in that case? Do you want to comment or just maybe get a couple of thoughts on this from the panel?
00:11:24 --> 00:12:00
Nevena Crljenko: My brief answer is yes, but nobody here gives a very brief answer, so neither will I. So if your approach was in that way, If you think that it should be a nicotine-free society, then the harm reduction doesn't matter because you're not fighting, you're not trying to encourage something that will maintain the level of nicotine because people will continue consuming it but will be less harmful for them because it doesn't matter if your final culprit is the nicotine. And what global form of nicotine has been trying to do for a long time is kind of to clear many of the misperception of the nicotine is. So I think if the end game is nicotine-free society, it's a very different approach to regulation because you won't eradicate the whole thing.
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Clive Bates: Okay, any other comments on that point, Joe?
00:12:04 --> 00:12:35
Joe Thompson: Yeah, I think it's wholly unrealistic. Australia is the great example or case study of where they've tried to stop an element of nicotine in society through prohibition and We've heard over the last couple of days some of the stories of what's happening there. I think it's wholly unrealistic to try and regulate consumer demand for what consumers are requiring.
00:12:36 --> 00:12:49
Clive Bates: All right. Any thoughts on this from the audience? I mean, this tends to be an audience who will say, you know, positive things about nicotine and argue that it's here to stay. But is there any skepticism about that?
00:12:49 --> 00:12:50
Konstantinos Farsalinos: I want to pose a question.
00:12:50 --> 00:12:51
Clive Bates: Oh, I just did that.
00:12:55 --> 00:13:09
Konstantinos Farsalinos: Why should, the question should be, why should we be aiming for a nicotine-free society? I mean, yeah, your question addressed how's the regulation gonna be if we aim for a smoke-free society, but why should we aim for a nicotine-free society?
00:13:10 --> 00:13:11
David Sweanor: Maybe to get funding from Michael Bloomberg?
00:13:13 --> 00:13:15
Konstantinos Farsalinos: That's one argument, yeah.
00:13:15 --> 00:14:45
Clive Bates: Not a very convincing one. Okay. Let me put this a different way. Let's get some comments from the audience. Has anybody... sort of feel that the demand for nicotine is something that, you know, it's a sort of anachronism left over from the 20th century. Nobody really wants to do it. People only do it because they're addicted. I mean, if you listen to the tobacco control view of nicotine, the story goes something like this. Predatory companies use persuasive marketing and packaging to hook youth while they're intellectually immature and while their brains are still developing to turn them into addicts for life and therefore a source of reliable cash flow. And the only pleasure that they ever get from nicotine is essentially relief from withdrawal and craving. And there's nothing else to it above and beyond that. It's just a sort of form of possession by a corporate entity. Anybody got any views on whether that argument is right or wrong or half right or half wrong or what? And then I'll ask the two tobacco folks. I thought you might. Give your name, Flora.
00:14:49 --> 00:15:38
Flora Okereke: You have altered my name out. Flora, BAT. A very simple answer from my perspective. People always want something stimulant, something to help you sleep, something to help you relax, something to help you pick up, whatever it is. And nicotine is no different. So I don't see a scenario where people would not want it. And so is it something in your question that will just, oh, it's only because of those who are addicted to it that you're dealing with. I don't really think so. And so the talk about a nicotine-free society, for me, is so unrealistic that it will not happen.
00:15:39 --> 00:16:36
Clive Bates: All right, let me get something from, I know this feels like a bit of a diversion away from regulation, but believe me, it isn't. I think it's very important if you believe that demand for nicotine is persistent, you're regulating a continuing market in nicotine rather than regulating to eliminate it. So has anybody got a neat way, you know, particularly people who use nicotine in the audience, has anyone got a neat way of explaining why there is a demand for it? I mean, I'm somebody who's never used nicotine, so if I was to put my theory that I just put forward, the way that the tobacco control community describe it, how would you say to me, no, you're wrong about that, the use is for the following reasons? Who'd like to have a crack at that? Oh, all right, we've got one over there. I can't see who it is. Oh, it's Norbert, excellent. Say you are, Norbert.
00:16:37 --> 00:17:15
Norbert Zillatron-Schmidt: I'm Norbert Zillatron-Schmidt, German Consumers Organization, IGD, and I think a nicotine-free society is a rubbish concept, just as much as a caffeine-free society would be a rather rubbish concept. Nicotine is, in many ways, just like caffeine for the user. It is a stimulant. It relaxes. And if you overdo it, you get a headache.
00:17:18 --> 00:17:40
Clive Bates: Okay, that's not bad. Anyone else got anything to add to that? I'll come back to the panel and give audience input here. At the back, Martin, I think... There's a bit of a Bermuda Triangle over there where there's a massive light in my eyes. So you need to gesticulate more violently if you're in that corner or that corner. But I will catch you.
00:17:41 --> 00:18:04
Martin Cullip: Martin Cullip, Taxpayer Protection Alliance. The way I always explain it is, in 2016, they found, architects found nicotine or tobacco seeds being used by people 12,300 years ago, and I don't think anyone sold them to them. So nicotine's been around and in use for years, well before people decided to sell it in a packaged form, so...
00:18:05 --> 00:18:12
Clive Bates: So there wasn't any marketing or fancy packaging in 12,300 before the present era?
00:18:12 --> 00:18:31
Martin Cullip: No, and it's such a popular drug that, of course, Vlad the Impaler didn't put people in spikes if he caught them smoking, but it didn't stop them. So I don't think anyone in this modern world has got any credibility if they think that they're going to be all of a sudden the great godlike people who are going to eradicate nicotine use and time.
00:18:32 --> 00:19:07
Clive Bates: Okay, so I think this is quite a good starting point, because if we all accept that, and not everyone does, in fact, most people don't, accept that the demand for nicotine is essentially permanent and fairly resilient, it's going to change, maybe the next stage is to accept that, well, people can use it in different ways, okay? Now, What stops people immediately going to the safest form? Who wants to have a crack at that?
00:19:10 --> 00:20:28
Konstantinos Farsalinos: the every day, all day propaganda against harm reduction products, which in reality shows that it's becoming more of a goal to attack these products instead of combating smoking. That's what the WHO is doing when three days ago they tweeted What is the product that looks nice, smells good, and is designed to kill? A vape. That was the response. So when you see things like that, when you see delivering dirty, astray awards during COP10 to the countries that raised the issue of harm reduction and wanting to initiate a debate for harm reduction within COP10, And they got the dirty Astri award because they were basically preventing the WHO and the FCTC from taking decisions and accelerating their decisions. Well, it's more than obvious that we're facing an anti-nicotine crusade. And theoretically, we can have an anti-nicotine society in the same way that we can have a non-pleasure society, a free nicotine society, a free non-pleasure society. So eliminate any pleasure effect because it's not essential for survival, but then we're forgetting that it's essential for the quality of life.
00:20:28 --> 00:20:32
Clive Bates: Okay. Do you want to comment, Joe, David?
00:20:32 --> 00:21:00
Joe Thompson: Yeah, I'll comment on that. On your question, I don't think consumers know. I don't think they know which is the least risky form. We can't tell them. I thought the UK, until recently, had done a fairly good job of having a clear and consistent message around switching to vaping. that that's changed of late, but I don't think consumers know. I think that's one of the challenges.
00:21:02 --> 00:21:53
Clive Bates: Can I just follow up on that, David, and then you come in? Do consumers act rationally in the way that public health people think they should? They should, because it's a lower-risk product, obviously they should move to it. Or are they taking a lot of other things into account, what else is going into the mix of what consumers decide to do, and where are the kind of barriers, other than the information barrier, and I think that's pretty obvious, there's a lot of misinformation, but let's say everybody was crystal clear on the respective risks, and the knowledge about the risks was clear and reliable, isn't really, but if it was, would everybody just suddenly flood into these products, and what stops them
00:21:53 --> 00:22:30
Joe Thompson: I think the challenge there is that the products aren't good enough yet. They're not meeting all of a smoker's need. The common view is, well, smokers smoke for nicotine. Well, that's part of why smokers smoke, but it's not the only reason they smoke. They smoke for a whole plethora of other reasons. So I agree. The majority of smokers that are switching are probably not switching because they think it's a less risky product. It might be to do with social pressure. It might be that actually that product offering provides... although they like it and others that they don't, but they're not getting all of their smoking needs met by what's currently on the market.
00:22:31 --> 00:23:11
Clive Bates: Again, by analogy to alcohol, we don't really think of people who like wine as ethanol drinkers, do we? Because there's a little more to wine than the active drug. So I suppose it's a question of looking at the value proposition, to use marketing terms, in the round. And seeing what it is, whether it's convenience, price, you know, what the packaging is like and everything, all comes together to form something that says, well, actually, I'll do this rather than that. Yeah. David, did you have a comment?
00:23:11 --> 00:24:26
David Sweanor: Yeah, a couple of them. I think on the idea of are we ever going to have a nicotine-free society, one of the hallmarks of consciousness is that we seek to alter it. And we alter it in all sorts of ways that we find beneficial, and not just human beings, but any other species where we can determine anything like consciousness. So of course we're going to have these things. Will people move to the lowest possible risks? People can only make as good a decision as the information and the options available to them allows. And it has to be a consumer offer that makes sense to them. And I think that the bottom line is you have to at least start with that and see how far do you get. In the history, when we look at moving to far less hazardous products and services, is that consumers do this. And sometimes they do it very quickly, like to move to sanitary food. Sometimes it takes more innovation, like to move to science-based pharmaceuticals, safer automobiles. But we've seen people make these decisions, and it's the reason we live twice as long as people lived, you know, 120 years ago. So I think we will see those changes, but they are consumers. They are individuals. It's It's a matter of empowering them to make decisions that would be better for them, but it's their decision what they're going to do.
00:24:28 --> 00:26:16
Clive Bates: Okay, I'm going to just change direction slightly. I think we've established that nicotine products, nicotine demand, nicotine consumption is here to stay, at least in this room, probably not in like the rest of the world. We've also understood that there are different types of nicotine-bearing product, and people can switch between them, but they don't instantaneously do what public health people would say was the safest or most rational thing for a variety of reasons okay now what in that in if we take that starting point what then is the role of regulation and I want to I mean when I presented at this conference in 2017 oh my god that's a long time ago I opened up by saying if I had if I had you know, one hour to present on regulation, I'd be spending the first 58 minutes saying why you shouldn't do any regulation that you've already done. You know, almost all of it is counterproductive. But what is, what are the things, if you were regulating in this area, and first of all, is there anyone who thinks that actually You shouldn't have any regulation. You just don't need any regulation other than just the normal general consumer protection regulation. Is there a case for that? Does anybody want to make the case for like a no regulation environment for nicotine products? No. Oh, there is someone. Oh, it's Chris Snowden. Notorious libertarian. Let's get the libertarian perspective on regulation, because believe me, it's worth listening to. Go on.
00:26:16 --> 00:28:16
Christopher Snowden: Well, I don't know if I can really make the case for it. I think people need to make the case for the regulations themselves. I mean, you said that you are taking it as rather than what would be normal consumer regulation, so the batteries aren't going to explode in e-cigarettes and the snus is not going to have rat poison in it or something. So what are we talking about? We're talking about allowing it to be advertised. Well, absolutely, everything legal should be allowed to be advertised. Again, within normal bounds of, you know, it has to be, in UK, the system is based on adverts have to be truthful, honest, and something else legal, perhaps, I can't quite remember. Why would you be against anything that's truthful and honest? So let everything be advertised. Taxes. I assume that you would include sin taxes as part of the additional regulation. Well, there's lots of reasons not to do that. They are regressive for one thing. They are very rarely actually economically justified, even in the case of products which are harmful to health. There isn't, if you look at the overall economics of it, the cost to the state of various public services, you factor in things like pensions and other welfare payments, there is The macabre truth is actually unhealthy products that kill people tend to save the government money rather than cost the government money, so there's no grounds for tax on that basis, or Pigovian taxes, as you would say. What else is there? Stupid things like display bans, plain packaging. A lot of this stuff doesn't even work on its own terms, aside from being unnecessary in the first place, so why would you have legislation that doesn't even achieve its outcomes, particularly when it has unintended consequences? So I can't think of any particular piece of regulations being applied to tobacco products or e-cigarette products which have really done any good at all.
00:28:17 --> 00:29:22
Clive Bates: All right, we're gonna end the session there. No, only kidding. Okay, but I think whatever you think of Chris's views on what does and doesn't work, there's a basic argument there, is you can't assume, or you shouldn't assume, that regulation is inherently justified. It has effects, it limits what people can do, it sometimes limits choice and everything. So a regulation has to be justified on its merits. And those are sometimes simply an illusion. They are not there. And we'll probably be talking more about unintended consequences and trade-offs as we go along. But let's start from Chris's challenging starting point and get a sense of where people... do think regulation is justified and what the arguments for and against that are. And then we'll look at where we think regulation is not justified and what the arguments for and against that are.
00:29:24 --> 00:29:48
Konstantinos Farsalinos: Can I make a comment? I think that before discussing on how to regulate things, it is important to set the goal for the regulation. So why do we want to regulate it? And in my opinion, in the case of harm reduction, The reason and the goal of the regulation is to facilitate consumers to make informed decisions.
00:29:49 --> 00:30:32
Clive Bates: Okay, so that's a very good point, the regulatory purpose. What are, and that's one of them, to facilitate informed... I think it should be the only one, to be honest. Okay, but let's see if other people think there are others. Other people might think... Yeah, well, let's go around. What are the sort of regulatory objectives? So informed consumer choice. So you know what you're getting and, you know, it is what it says it is. And, you know, some of this is covered by normal consumer protection regulation, but maybe you need something different in this field. Nevena, any thoughts from you on where regulation is justified?
00:30:34 --> 00:31:58
Nevena Crljenko: I would have disagreed with Chris if you didn't put this caveat in terms of basic consumer protection, because we have a case, unfortunately, where a great product without any sort of regulation turned out to cause more damage to itself and the other product categories because of it. So I think we have to look at what happened as well. We have to look at that anything that happens in the space where the grandfather product is seen to be a cigarette, which is happening with any nicotine product, it's I think virtually impossible to escape regulation, even if you would want it to, though I don't think it's a good idea, because it comes in the space which is heavily regulated by default. So even prohibition as the worst sort of regulation is such. I would agree with Konstantinos in terms of regulation that is not for only informed choice. That informed choice obviously facilitates something which is good for the person or the consumer, right? Informed choice can be also, you know, it has an added benefit of something which is good for individual and ultimately for society in that respect. So it would stay in this space. It would have, of course, it's not as simple as us saying it because it has many elements of it. I think it should regulate the... I mean, everything that comes in the product and how it can be marketed as well, especially if you look at the history for the last 10 years, because I think not only what the product is or isn't, that should be the most important element, but also who uses it is something incredibly important and does and has triggered very strong reactions from the regulators.
00:31:58 --> 00:32:57
Clive Bates: Okay, so there's a bunch of things to unpack there. I think I picked up something slightly distinct from informed consumer choice, which is something to do with consumer confidence. You can buy the product and be fairly sure that it's a form of consumer choice, but you can be fairly sure it's not going to be full of mercury or plutonium or something. You're not going to drop down dead. And that's important for the category as a whole. Now, the alternative to that is a sort of buyer beware sort of approach where people gravitate to trusted producers and brands and everything. What's wrong with doing it that way? If you follow sort of Chris's logic, what's wrong with doing it on a, you know what you're getting if you buy from a trusted firm? And if you want to buy from a cowboy, that's your hard luck. You take a risk, it might be great, but you might end up Not well.
00:32:57 --> 00:33:37
Nevena Crljenko: If I would be a government, and this is a question in this respect, that's an undesirable scenario, right? Because yes, you leave a full consumer choice, but let's be honest, we like to believe as human beings we are rational. In majority of cases, we are not. And I think you leave it in this buyer beware. It's your responsibility, so at your peril or your success, I think government role is to do a bit more than that. Exactly for the reason that we know people are sometimes making the choices which are suboptimal for them. Back to Konstantinos' point, regulation is to some degree there to ensure, assuming that the government has the authority as it trusteds, which we see unfortunately eroding in many places in the world, that this is something that is better with a stamp, let's put it that way.
00:33:37 --> 00:34:21
Konstantinos Farsalinos: Besides the brand of the country. I'll try to say that in a more polite way, because I found them an impolite towards the consumer. I don't think that they are irrational. They're just not experts or not able to understand what the criteria of choice is. And then they are, of course, influenced by other factors like the cost. And we know that lower quality is associated with lower cost. So this lack of expertise of course, defines the need to create some quality criteria within the regulation. But I don't think it's because people are irrational. It's because people need some guidance for something that they don't understand very well because they haven't studied it.
00:34:22 --> 00:34:58
Clive Bates: So... Regulatory speak, that's about addressing information deficits or information costs. If you want to buy a vape, you can't suddenly train to be an aerosol chemist. and understand all the things just on your way into the shop. So we use regulation to cover over information deficits or information acquisition costs that would be exhausting for people to make these choices if they were to try and do a buyer beware sort of approach.
00:34:58 --> 00:35:07
Nevena Crljenko: Sorry, Clive, do mind, just a second. First, apologies if everybody, I was talking about the rationality of human behavior, not nicotine consumer's behavior, and I hope I wasn't impolite in that respect.
00:35:07 --> 00:35:12
Clive Bates: No, no, no, don't worry about that. Be as rude as you want. Just, Clive, Clive, Clive, sorry, just one more point.
00:35:13 --> 00:35:40
Nevena Crljenko: No, no, no, but just like, we don't expect that nobody should, I have, frankly, I'm not a scientist. I have no idea what's in the food that I eat. That's why I rely on, when I look at the packaging, what all of these unintelligible words actually mean in terms of how they are good or bad. So that's the role, in my view, of informing people in an intelligible language, because there's no way any of us will be expert on anything, everything we consume, not just nicotine products.
00:35:41 --> 00:35:55
Clive Bates: All right, let's carry on looking at the areas and the purposes of regulation, what you might want to achieve constructively. David, have you got anything to add to what we've said so far? It's one big obvious thing, but.
00:35:56 --> 00:36:46
David Sweanor: You know, I think reinforcing the role that regulations play in terms of consumer knowledge, your awareness of what's going on in the environment, the idea that if I go into a grocery store to buy some food for my granddaughter, I can be confident that what I'm buying is something that's not going to kill her, because there's regulation in place that does that. But if we have regulation on nicotine products, particularly regulation that's giving a relative advantage to the lower risk products, that's hugely educational for somebody to look at that, to say, well, wait a minute, the taxation of nicotine There's no tax on this. There's a big tax on cigarettes. I remember something about that. Or these products are more widely available. The regulation is proportional to the risk. That has an educational impact.
00:36:46 --> 00:38:26
Clive Bates: Okay, so there's a really, I think, interesting point that David's pulled out there. That regulation, it can look, depending on how it's done and how it appears... can look like a form of implicit risk communication. So if it's covered in skull and crossbones and black and yellow hatched markings and comes in a lead-lined container, you're kind of saying something to the consumer about what's in the product. And I think this is... The reason I'm mentioning this at this point, because it's important when people regulate for one purpose, let's do plain packaging because it will deter youth from uptake, they may be doing something that they weren't intending to do, which is sending a risk communication that all the other things in the world that have plain packaging, which is almost nothing, except cigarettes, are probably equally dangerous. And there's been some scientific findings on that, that regulation can have these other effects, in particular, risk immunity. And if you put high taxes on, if you put big warnings on, you say, well, actually, this product is like that product. It can't be anything like as harmful as alcohol, because that comes in lovely bottles with pictures of French chateaus. So So it can't be anything like as dangerous as wine or whiskey. And therefore, you've got a problem. We'll come to you in a second, Joe. Let's just go to the audience for views on further regulatory purposes.
00:38:33 --> 00:39:26
Norbert Zillatron-Schmidt: on the topic of regulating communication and advertisements, I think we should look at a very prominent example where it didn't work at all, the prohibition of cannabis. Cannabis had been around for decades and No advertisements were allowed because of the prohibition. There is no packaging, regular packaging or anything, but still people buy it. So what is the effect of regulating advertisements except for truthful advertisements which would be positive?
00:39:27 --> 00:39:42
Clive Bates: Okay. All right. We'll just, let's just jump into advertising for a minute. Was somebody else trying to get a word in there? Sorry. Okay. Oh, Peter, go on. Just get it. Pieter Vorster, let's have a comment from you.
00:39:44 --> 00:39:55
Pieter Vorster: I'm not expressing a view on it necessarily, but I find it interesting that nobody's mentioned age. when you talk about regulation or requirements for regulation.
00:39:55 --> 00:41:10
Clive Bates: Right, so that was the big missing piece that seems to be driving a lot of regulation at the moment, and we were just kind of getting around to outing that, so I think you're right. So one regulatory purpose, and what one needs to examine the validity of that purpose quite carefully, is to prevent certain populations or certain users accessing these products or using them. And typically in the vaping space, that would be children, minors, adolescents, Language is important. Or even non-users. We don't want to see uptake from people who've never smoked or former smokers. That's an objective. Let's get some thoughts about that objective, and then if people think, and they're all different, they're slightly different things, what do people think the right kind of regulation in that area is and what the rationale for it is? Yeah. Why don't you go first on this?
00:41:11 --> 00:41:55
Joe Thompson: Yeah, thank you. Certainly, regulation to protect youth is important. I think what surprises me or baffles me a little bit is that when you look across at other industries, we've got mechanisms as a society to protect youth. young people. We don't want them to drive. There's mechanisms to prevent that from happening. We don't want them to use alcohol. There's regulation and mechanisms in society to prevent that from happening. And yet, with tobacco products, or vaping specifically, the answer is, well, the regulation's not working. Therefore, we need more regulation, which is not really addressing the root cause.
00:41:56 --> 00:43:46
Clive Bates: OK. anybody, let's focus on youth at the moment. I think there's a couple of different objectives associated with regulating to reduce youth use. One is the intention of actually reducing youth use, and let's debate whether that's a good or a bad thing in a minute. The other is essentially because society demands it and the businesses would not have a license to operate if they weren't controlling youth use. In other words, it's a must-do simply to win buy-in. It's not a great reason for doing it, but it might be the reason. What do people think is appropriate? Let me back up, and I'm sorry if I'm talking too much, but I think it's one thing for us, most people I think in this room would express a preference for young people not to use substances, not to drink, not to use nicotine, not to use drugs, not to do a whole load of things, okay? Not everyone, but let's just assume that that's taken for granted. But when should our opinion be translated into the sort of muscular powers of the state through regulation and taxation and prohibition to try and stop that happening? Where is the boundary between a preference that we don't want, and everyone says it, the industry, public health people, nobody wants young people to vape, but when do you take that to the next level and try and force that to happen through regulation, misinformation, taxation, and so on?
00:43:48 --> 00:44:31
Konstantinos Farsalinos: I think the ethical way of doing that is to do it until the point you start punishing other population groups in order to supposedly protect those who need to be protected, like, for example, minors. You can have measures such as ban on the sales, communication campaigns, but you shouldn't get to a point where you're misinforming smokers or preventing adult smokers from making the switch. because then you are trying to protect, I'm not sure if you're even doing it successfully, but at least you're trying to protect one vulnerable group by punishing or sacrificing another group.
00:44:32 --> 00:45:39
Clive Bates: Okay. I wouldn't mind some thoughts from the audience about what kind of regulation, if any, is a pro, you know, it's a common question, I get this a lot. Okay, yes, all very well, you know, you want adults to switch to these things, but what about youth? What should be done to protect youth? So what's, just hang on, what's the measures that people who are pro-harm reduction, pro-vaping, pro-freedom, what's the measures that they should be talking about when it comes to protecting youth? What's the agenda there? Let's have any thoughts from the, there's some obvious ones, so it shouldn't be that hard. So come on. Let's have some views on that. All right. Norbert again. Has anybody else got any thoughts, please? Yeah. Bent. Yeah. Second row here. Second row. Sorry. You have to put your hands up a bit more. So much light here. Okay. All right. Let's go. Let's go with you. You go first. You haven't spoken. And then Ben. And then anyone else?
00:45:41 --> 00:46:55
Chase Wallace: I'm Chase Wallace from THR.net. I think it's a great question. You know what? how does that age-specific regulation take place? I think one of the big things to look at is risk-proportionate taxation and messaging. So that has happened in Sweden, which is obviously a very successful example, where they tax more so the more higher-risk products and less so pouches and vapes, so cigarettes are taxed the most. But as far as messaging, it is very easy with social media, or easier than people think, to differentiate where you're sending certain messages. So if you want to target current smokers, there are algorithms that can do that. So when you're pushing out an advertisement for vaping as a tool for smoking cessation, you don't have to use a broad, you don't have to send that out to little kids. And you can use certain platforms have higher usual demographics age-wise than others. So really, it's about differentiating the groups that get the different parts of the messaging as well as taxation and messaging for different risk products.
00:46:55 --> 00:47:12
Clive Bates: Do you think cigarette companies should be either permitted or required to carry messages inside cigarette packs that encourage switching to vaping or other smoke-free products? Would that be something that you could regulate?
00:47:13 --> 00:47:34
Chase Wallace: That is an incredible idea, I'll say. I think it should be shown that e-cigarettes are proven to be the safer option, and it should be at least encouraged on the packaging, similar to how it says, you know, this product causes X health effects and these things. I think that's a fabulous idea.
00:47:34 --> 00:47:49
Clive Bates: So you're much more at ease with marketing if you can confine it to a specific target audience that excludes youth. Yes. All right, good. Anybody, Ben, you were going to say something? Sorry.
00:47:49 --> 00:47:51
Bengt Wiberg: Bengt Wiberg from Sweden.
00:47:52 --> 00:47:54
Clive Bates: Oh, yeah, okay. Sorry, somebody there. I can barely see you.
00:47:55 --> 00:47:56
Bengt Wiberg: About your...
00:47:57 --> 00:47:58
Clive Bates: Okay, go on, Ben, go.
00:47:58 --> 00:49:16
Bengt Wiberg: About your last comment, could we stick, regulate to put something in cigarette packages recommending something else? That is happening. I think the cigarettes sold by BMI has an information on ICOS as a safer option. I also think, I think it was Atakan Befritz who told me that in Nigeria, there's information that smokeless tobacco is less harmful than cigarettes. And about the age verification, in Sweden, almost all of the e-distributors of snus and nicotine pouches have an obligatory eID demand. It's not just that you click in, yes, I'm 18, when you're actually 12, you won't be able to buy that way. And lastly, you can find signs in stores selling tobacco that if you are under 25, they have the right... If you look like you are under 25, they have the right to ask for your ID. Otherwise, no buy.
00:49:16 --> 00:49:41
Clive Bates: Okay, so... essentially an age regime, an identity verification regime at the point of retail, making sure that people don't sell to young people below a certain age, 18, 21, whatever. Is there sort of like broad consensus on that? David?
00:49:42 --> 00:51:13
David Sweanor: Yeah, I'll just throw a wrench in here that I don't get upset when I see teenagers walking into coffee shops. It's a psychoactive substance. And in fact, when I'm off on my bicycle early in the morning, I see some teenagers who are waiting for a school bus before 7 o'clock in the morning. because of high schools that start at 8 o'clock in the morning. I think there's actually a good case to say it's inhumane that those kids who, as teenagers, we have a body clock that doesn't allow us to function well in the morning, it's probably inhumane for them not to get caffeine. What's the case for somebody who's 14 years old with attention deficit disorder? Isn't going to make it through school unless they have something for it, and maybe there's some reason they're not using medications for that, but nicotine does that for them. Should they be able to do that? Or when you're trying to educate the public, a debate about legislation is really important. You know, one of the secrets about the debates about a cigarette advertising ban is not that the ban itself would have such a big impact on consumption, but the arguments about it being constantly in the media was educating the public about just how dangerous smoking was. So maybe having a debate about what the restrictions should be, because we're now dealing with very low-risk products, would be incredibly important, not so much for whether a teenager get access to this, but for their parents and grandparents to keep hearing this message. There's now products that are so low risk that we're thinking maybe it's like a kid drinking tea. That could be educational.
00:51:13 --> 00:52:25
Clive Bates: Okay, there's a couple of interesting points there. So situations where you wouldn't want to prevent young people accessing vapes or pouches or whatever. Maybe one when they would otherwise be smokers, you know. And then maybe another case where, and we haven't discussed this very much, but where they get some benefit from nicotine. It's stabilizing, it's calming. If they're a certain kind of person, then maybe you want to... I think these things are valid arguments, but they take you into extremely difficult territory at the present time where I think they run up against this license to operate problem that you have to show that the people are not... You know, you're not selling to young people. But that's more to do with expectations than it is to do with substantive reasons for regulation. And maybe we should keep those distinctions in mind. Okay. I think it was Garrett you had your... Oh, God, I can't see anyone over there. Okay, Garrett, you go.
00:52:25 --> 00:53:12
Garrett McGovern: Oh, it's working again. If you look at, say, the biggest allegations against nicotine for young people, the only... things I've heard from the other side about nicotine and the young people is nicotine in the developing brain, the gateway theory, and a newer generation of nicotine addicts. I mean, we've pretty much batted all those harms off. I haven't heard any other harms in young people. They're red herring harms. and I think really we're in the realm of really optics and, you know, giving a concession over to the other side. I mean, if a lot of young people, you know, and they'll probably be around 16, 17, on the cusp of, you know, being adults anyway, are going to use nicotine, I mean, I suppose it does beg the question, so what? So what?
00:53:13 --> 00:53:26
Clive Bates: So what? All right. Yeah, no, spatter of applause for that. At the back there in... I can't really see, but give me your name.
00:53:27 --> 00:54:18
Przemysław Bobiński: Przemysław Bobiński, Vapour Poland. I have some kind of not popular thing to say that's, for me, my point of view. I have a nine-year-old boy, and we can go with common sense explanation how to go with it, so education, education, education, but this is the second point of view. the advertising of the cigarettes. You can go inside any of the grocery stores in Poland. The best-looking shelves, the prime shelves, the first-looking shelves, are cigarettes from the younger age. Every kid who's going into the store scene sees these shelves with the cigarettes. And then you're telling them you shouldn't smoke.
00:54:21 --> 00:54:21
Clive Bates: OK.
00:54:22 --> 00:54:43
Przemysław Bobiński: What... So I'm... Just wait a minute. What... Let's get to the... What I'm trying to say, I'm totally against... Not against. With the ban for all kinds of advertising of the cigarettes. And we should start with that, from my opinion. Then go further.
00:54:43 --> 00:55:00
Clive Bates: Just wait a minute. Let me put the question to you. What... If you're driven, you're thinking about your nine-year-old son, and that's perfectly reasonable, you're worried that they're going to take up vapes and nicotine. No, no, I'm not worried about it.
00:55:00 --> 00:55:42
Przemysław Bobiński: You're not worried about it. But he's used to it. Okay. He grows with it. All right. He grows with seeing the cigarettes on the shelves, the best-looking cigarettes, shelves. Okay. And I have to tell him, no, no, no, you're not going to smoke. Okay, so look. Rather take the nicotine. No. No. Why should I? It shouldn't be a case in the first. This is my opinion. This is the biggest problem that we're facing now, from my opinion, that we are not talking about. Our kids are looking all the time on the shelf of the cigarettes, good-looking shelves, the best shelves on the stores, and we're trying to tell them, This is a cigarette, but don't smoke it.
00:55:43 --> 00:56:01
Clive Bates: Right, just let me play this back to you, just to check that I've understood. Because what you seem to be saying is that the cigarette proposition is so attractive, you need to be very liberal and unconstrained with the non-cigarette proposition. Is that what you were saying?
00:56:02 --> 00:56:28
Przemysław Bobiński: No, no, I'm saying that to begin with, because there was a question, what shall we do now with the young people? There is nothing more that impacts more than advertising of the cigarettes in the stores. We should start with something. And we can then educate them, but the three-year-old... Already? This is what I'm talking about. From the youngest age.
00:56:28 --> 00:56:56
Clive Bates: Just let me press you a bit on this. It's quite interesting. I'll come to everyone else in a second. Okay, let's say cigarettes, you ban all the advertising, you ban, you put high taxes on, you have... No, no, no, I'm not talking about the taxes. Okay, all right, sorry, I'm trying to get to the point of what you would do about the much safer products, the vapes, the pouches, the non-combustible nicotine, would you just do the same thing?
00:56:56 --> 00:57:21
Przemysław Bobiński: But I'm trying to answer your question, and this is... Another question because your question was what to do with the young people about the safer nicotine products Yeah, okay, so they're not gonna would not become we don't would not have a problem with that. We have 24% people in Poland who are smoking now so and It's all right on the same thing in the same spot.
00:57:22 --> 00:57:23
Clive Bates: Okay, so I
00:57:24 --> 00:57:44
Przemysław Bobiński: And what to do with the children, how to educate them? We can't. We're not going to be let to educate the people, even adult people. All right. In any kind of cessation tools. So... What to do? Starting from ban of the advertisement and then go further.
00:57:44 --> 00:57:52
Clive Bates: And you ban all the advertising of e-cigarettes as well? No. Okay, all right. That's the point I wanted to clear up.
00:57:52 --> 00:58:04
Przemysław Bobiński: One thing. We have ban of the advertisement in Poland of any kind of product. And there is still an advertisement in the shops.
00:58:05 --> 00:58:18
Clive Bates: All right, so you enforce them. All right, thank you for that. Let's move on. There was other people who were trying to get in to the conversation. Who's out there? Michelle, is it? Oh, Maria, sorry, yeah.
00:58:20 --> 00:59:37
Maria Papaioannoy: Hi, Maria from Canada. I think what we're doing is trying to do what we've done with tobacco and trying to do it with vaping. The approach is, to me, wrong. If we're going to say that this is safer, this is not like tobacco, why are we looking at the ways that tobacco was regulated back in the 80s? Why are we doing the same thing over again with a product that we're claiming is not the same? We have to look at what we didn't do to help people stop smoking. to make vaping less attractive to young people and more attractive to people who smoke. Because in the country that I live in, you can't do anything. You can't advertise. You can't talk about it. You can't take an ad out. But every single kid who watches these videos saying that vaping is worse than smoking can go on the internet and prove that wrong. We're losing the trust within our kids from the very systems that they're supposed to believe in. We are allowing lies and manipulations to be told by NGOs to young people to stop them from vaping, but that's not working because they're lying to them. We need our governments to step up.
00:59:37 --> 01:00:12
Clive Bates: Okay, so again, this is another form of information deficit in which bad actors intentionally or negligently are filling the space with misinformation designed to achieve a regulatory objective, which is designed to achieve an objective which is to persuade young people not to vape or use nicotine at all. And the role of the government in that is to be corrective. to make sure that there's good information available so that people make the right choice. Is that basically what you're saying?
01:00:12 --> 01:00:23
Maria Papaioannoy: I mean, I think it's the role of the government to stand up to these NGO bullies because I think there's not a single government in this world that's not being bullied by NGOs currently when it comes to tobacco.
01:00:23 --> 01:01:25
Clive Bates: That's very good. I think probably most people would agree with that. I've got a comment from Skip Murray. He's viewing remotely. I'm just going to read it out and maybe get reactions from the panel. Instead of banning products to prevent youth use, Why aren't we making sure that legal sellers don't sell to them? Sellers license fees, pay for compliance checks, cashier business gets fined if products are sold to minors, mandatory electronic age verification in countries where that is possible, available, and loss of licenses for repeat offenders. So... Skip is speccing out here what I think is maybe one of the youth strategies, the important youth strategies, which is age-secure retailing, backed up by licensing, compliance checks, maybe CCTV records and so on. Any views on this?
01:01:27 --> 01:03:00
Konstantinos Farsalinos: I think it's mainly a problem of what are we expecting when we regulate to prevent youth use. Are we expecting that we're going to end up with zero percent use? If this is the expectation, then there is no way that any regulation will work. Skip made some very good recommendations, but I'll tell you a very easy way to bypass this, all these very, very good recommendations. I'm 48, I'm going to go to a store, I'm going to legally buy half of his products and then I'm going to sell it on the streets to youth. This is what's happening in the US. In many cases, it's not the kids that go to vape stores or any other kind of store selling products and buying the products from an official retailer. They have other adults who buy the products absolutely legally because they're adults, and they're just reselling these products to kids on the street, next to schools, wherever they're going. So there is always going to be a way to bypass any sort of regulation. So again, we must have, I mean, governments should have reasonable expectations. If they expect 0% use, they will regulate and regulate again and re-regulate, introducing more and more restrictions with no effect. At the end, they're going to punish, as I said, other population subgroups. So we should, again, start by what we expect the regulation to offer. Yeah.
01:03:02 --> 01:03:50
Clive Bates: I want to actually turn to someone from one of the most dysfunctional places on earth, which is Colin. If he could have a mic down here. The most extraordinary efforts have gone in in Australia to prevent youth having any access to vaping products. Colin, in the prescription model, I guess most of us are familiar with it. Two-part question to you. How has that worked for youth? And then secondly, you're under the spotlight all the time. You're making the case in the media. People say to you, well, what should we do about youth in that particular hostile environment? What's your answer? What do you say? How do you package that?
01:03:50 --> 01:04:52
Colin Mendelsohn: Well, there's two things. One is... What can you say and what do you believe? So we're just not ready to hear that kids should be able to use nicotine. I mean, I would argue that overall, if you do a risk benefit analysis of kids vaping, it's overall beneficial because it's diverting them from smoking above everything else. But they're not ready to hear that. And I think in the real world, we have to acknowledge that the regulators, the parents, And everyone else in the community, given the misperceptions about nicotine, expect us to regulate it and restrict it. So I think, personally, a limit of 18 is a compromise we have to have. And I think we have to have, as you said, appropriate enforcement with third party age verification, CCTV, whatever is required to allow that to pass. Because the alternative is the black market. And the black market is just rampant in Australia with all the problems that's created.
01:04:53 --> 01:04:59
Clive Bates: All right. Colin, thanks. Will, is it? Yeah. So I can't see that well, sorry.
01:05:02 --> 01:05:39
Will Godfrey: Yeah, just to speak to a couple of these points. While I would completely agree in principle with David's point that products that are no riskier than coffee should no more be subject to age limits than coffee, if we're in the business of compromise and license to operate as as Clive put it, I wonder whether some sort of sliding scale of age limits might be a kind of third way. I'm unaware if it's been tried anywhere, but with the goal that if you're going to legally initiate nicotine use, you're more likely to do so with the much safer products.
01:05:40 --> 01:06:27
Clive Bates: All right. What about the idea of... Let's talk flavor bands, because that's a preferred intervention to protect children, if you like, to put it in the way that the advocates of those things. What do you think about the idea of making the products essentially less appealing and specifically less appealing to children, if that's possible, as a way of controlling youth access, or if you like, as part of this sort of platform of measures that you would use to deal with the youth issue. Where do you come down on that?
01:06:27 --> 01:08:05
Nevena Crljenko: I think we come down to something that Konstantinos mentioned before and what we discussed in the beginning. Obviously, when we talked about what these products should be like, acceptability in terms of for somebody who's been smoking all of their life. I'm coming to your question. The product needs to be acceptable enough to consider changing one habit for the other, because obviously that demands certain decision and adaptation. And flavors obviously play a role in that. In terms of how then when you add this element obviously we want and you're absolutely right The company's position is that the miners should not have access to the products and the question of enforceability so how to find the right balance in terms of Ensuring that there is enough variety of products that will meet adult smokers references while trying to really identify And I think it's more about The discussion before was about how to direct the communication, but I think it's also what kind of communication, not who you direct it to. So to me it is, on one hand, how these flavors are communicated, which matters a lot, not just which flavors we're talking about. So obviously, to Colin's words, compromise is something we're ultimately probably going to land on. While from the perspective only of adults, if you look just at adult smokers, obviously there should be plethora of flavors for anybody to find something that will meet them. But then how do you offset this thing that flavors might play a role in terms of children being interested in this? Finding this balance, which will ultimately be compromised, is a very difficult question, honestly.
01:08:07 --> 01:08:55
Clive Bates: If there's a problem at all, is the issue... Because flavors are like... several things, aren't they? They're a chemical recipe that contains ingredients, some of which might be hazardous. They are a sensory characterizing thing, like this vape tastes of apple or whatever. And they're also a descriptor, that this flavor is called unicorn vomit or whatever, whatever, something silly. If they're going to intervene anywhere, if you accept those three type of ways of thinking of flavors and if there's other ways of thinking it do say, where should regulators be going with that? Where should they be intervening?
01:08:56 --> 01:09:39
Nevena Crljenko: I think one extremely important thing is to introduce regulatory intervention while knowing how to measure their impact. I find it very flabbergasting, actually, that many of the regulations in this space are done sometimes overnight, and without really thinking how will you assess the effect of it. I think this definitely fits into that. But to answer your question, I think it really is... I would focus on how these products are marketed, so let's call it descriptors, right? And also, you know, how this communication is actually tailored. Trying to kind of safeguard as much as possible sensory experience, because that's the relevant part for the adult smokers, while trying to reduce maximally the appeal that it might have for those that it shouldn't be intended to.
01:09:39 --> 01:09:40
Clive Bates: Okay, that's good.
01:09:41 --> 01:12:28
Konstantinos Farsalinos: Any other views on the panel on this question? You can find several examples, especially in U.S. liquids, of packaging and labeling of vaping products that everyone would consider in a rather objective way that they are kid-friendly. But if you look at the so-called vaping epidemic in the U.S., the growing popularity of electronic cigarettes, The main culprit was Juul. Juul has the most neutral packaging, labeling, and naming you can find. They don't have any fancy names in the flavors. Their packaging is almost plain. I mean, nothing crazy. But kids went crazy using Juul. So it's not that simple. It's not about cartoons. It's not about fancy names, although there are ways that regulators could intervene in these aspects. But on the other side, you find something that doesn't look fancy, doesn't have any fancy name, is not kid-friendly in any way in appearance, but It attracted kids. So it's a much more complex way of approaching this. I think I will agree with Nevena. It's a matter of communicating and descriptors what they are. And here comes the paradox. Ideally, these products should be presented as smoking substitutes. And you're not allowed to promote them like this. Manufacturers, retailers, they're not allowed to present them as smoking substitutes. It's a therapeutic claim. They are not allowed to say that take this to quit smoking or to reduce your smoking consumption. If they do it, they have to do it discreetly, secretly, but not publicly. So on one side, They accuse the manufacturers of targeting kids and not presenting these products as smoking substitutes. But these have put the laws and regulations that prevent the manufacturers from doing that. So we're at a point where regulation is also creating the problem itself. But it's not a matter, I think, of whether we should regulate or not. The problem is, what kind of regulation should we aim for? And it starts from what kind of a goal do we have? A nicotine-free society? Makes no sense. Zero percent use among youth. It won't happen ever. If you engage into such a goal, the only thing that is going to happen is every year you're going to add restrictions, and more restrictions have no effect. And then add more... Again, with no effect. It's going to be a dead end, a vicious cycle. So set realistic goals and find realistic solutions.
01:12:28 --> 01:13:49
Clive Bates: OK, so a couple of things to draw out of those comments. I was very glad that Nevena raised the question of what you could call intervention research. So a policy's been done, and in the rare occasions where people go back and look at what actually happened, what do we learn about how a market responded, not what the legislator intended, which is often, well, if you prohibit something, it disappears, which it doesn't, but how did the market, the consumers, the suppliers, the illicit providers, how did they respond to that sort of intervention in a complex adaptive system? And actually, that research, I think, is some of the most important for us to get our minds around it. There was a paper that came out, I think on Monday, showing that where flavor bands had been introduced, vaping went down and smoking went up. So the people who want to reduce vaping, it worked for them, but looking at the totality of the system, it didn't work at all. It was net harmful. Sorry, okay, Chris, and then Joe. Sorry, is there anyone else? Just keep waving and I will try and see you.
01:13:51 --> 01:15:28
Christopher Snowden: I want to make what should be a fairly obvious point, which is if you regulate any product with children in mind as being the target, you end up with a society in which everybody is treated like a child. It's the infantilization of public health. And it started with... the anti-smoking lobby i'm looking at you climbing okay until until the anti-smoking lobby started going on the warpath it was just understood in society that something can be advertised but it's not necessarily recommended people could see products on the shelf children could see products on the shelf and understand that they weren't for them and it's pretty much a natural progression, I think, that the same kind of policies, which were said to be about the children, all these policies, the advertising bans, the plane packaging, the display bans, the taxes even, it was all said, we're not trying to stop adults doing this, we're trying to protect the children. the think of the children message was absolutely fundamental to anti-smoking. And it's now, of course, being used anti-vaping, anti-alcohol, all the rest of these things. And I think it was always ever just an excuse. And we can kind of see that now in Britain because it used to be the case, as in most countries, that people initiated smoking below the age of 18. That's no longer the case in Britain. Most people now are 18 or over. So is the tobacco control lobby packing up their tent and saying, good job? We achieved what seemed unthinkable? No. They're now banning 18-year-olds from smoking, then next year it's going to be 19-year-olds and so on, until everybody's banned from smoking. It was never about the children.
01:15:28 --> 01:18:24
Clive Bates: Okay. So children, I think a lot of us would agree with this, that children are used to create emotive campaigns, to create a sort of moral panic, and to justify things that would not be justifiable if they were done to adults. And I think I I showed some figures that if you look at nicotine use in just the UK, there are 18 times as many adults using nicotine products as there are young people, but all of the political focus is on the small number of young people who are vaping, and yet there is this sort of infantilising effect. But it comes back, I think, Chris, I'm going to maintain this, is that the people who want... a more liberal approach here have to have a good story on youth. They have to have something to say. And I think if I was going to just distill some of the discussion, I would say I don't think you get much opposition to age-secure retailing, licensing, the sort of stuff that Colin was saying. I think there is some kinds of marketing, you know, that whether or not it has an effect, people just don't want to see it, and it looks like it's appealing to children, even if it's appealing to the frivolous side of adults. And I think there's another big one here, which we sometimes overlook, which is it's imperative to keep the market legal. The needs of those 18 times as many adults are served by a legal supply chain, responsibly and proportionately regulated with acceptable risk. And that should constrain the sort of prohibition instinct and turning the market over to illicit trade, which is essentially what we've seen in Australia and the United States. They've so constrained the legal sort of authorised market, that everything is essentially illegal and unauthorised. So I think that's a big one, and that should constrain the kind of measures that governments are willing to take, or prepared to take, because it will just trigger illicit trade. Any thoughts on... Actually, Chris, have you still got the microphone? Let me just press you a bit on advertising, because people see advertising and they assume it's there to increase the total size of the market. So what are the function, when somebody's advertising vaping products or tobacco products, what are the different things that they might be trying to achieve when they do that?
01:18:25 --> 01:19:48
Christopher Snowden: In the case of a new product, then the effect of advertising will, if it is effective, will be to increase the size of the market. So when iPads first came out, anybody who was advertising a tablet, whatever brand they were advertising, was likely to generate a larger market because you're just letting people know something exists. But with established markets, it's all about brand share. Economists tend to not pay a great deal of attention to advertising for that reason, because it doesn't actually have any aggregate effects on the economy. It just splits up the market. Now, people in public health simply refuse to believe this, but there are plenty of products such as cat food or toilet paper, which are advertised all the time, and clearly not intending to increase the market, right? You're not going to get cats eating more food just because you've got whiskers on TV. So why are these products advertised? Very obviously to try and take market share from Felix or Andrix or whatever it may be. And exactly the same is true of all these other products. Any established product, the company that's selling... Heineken is quite happy for more beer to be sold, quite happy for more alcohol to be sold, but they're not doing it for that reason, and they'd be very foolish to do it for that reason. They're just trying to sell more Heineken. And a lot of advertising is very defensive, actually. I mean, most advertising, put simply, is a company saying, we're still here, don't forget about us.
01:19:49 --> 01:20:46
Clive Bates: All right. Okay, so I think there's an interesting aspect in terms of advertising regulation, regulating advertising, which is that advertising vapes is essentially entrant products competing with incumbent products and trying to win market share from companies essentially the cigarette market. It's a beneficial thing. So again, when we're discussing advertising, maybe you can make a case for banning cigarette advertising, but vape advertising is a kind of anti-smoking advertising for some people. So should you think about that when we're discussing regulation? Or is it, you know, in Chris's other view, it's a brand new product, vapes. Is it essentially increasing the market for nicotine by hooking kids? Okay, and how would you sort of look at the difference between those? David, any views on this?
01:20:46 --> 01:21:45
David Sweanor: Sure, I think one of the things that we have to keep coming back to is that we're dealing with a population with very high rates of cigarette smoking, over a billion cigarette smokers. And that should be seen as a public health emergency and our number one goal, rather than focusing on an alternative product that is very low risk, that could replace the cigarettes, that could end that epidemic, and thinking, oh dear, what might go wrong here? I think we should be looking at whatever we can do to move people as rapidly as possible to non-combustion products, and other things are a second-order point. And whenever you talk about what we might do to protect young people, Think about their parents and their grandparents and their aunts and uncles and their teachers and their coaches standing behind them with cigarettes in their hands. What impact is it going to have on them? What are the unintended consequences but entirely foreseeable consequences to the people whose lives really are on the line?
01:21:46 --> 01:23:12
Clive Bates: All right. Amazingly, we're sort of getting towards the end of this. I want to ask about big visions in regulation. The so-called... End game measures, okay? So these are things like let's take all the nicotine out of cigarettes. Let's put an age limit of everybody born after January the 1st, 2009 will never be allowed to buy cigarettes again. Maybe we should have a sort of cap and trade system where we just say there's a certain number of cigarettes that could be sold. every year in a given jurisdiction and that number will go down until it eventually reaches zero and they'll be able to trade permits or something. What about these ideas? Surely they would accelerate the transition of the market, maybe in a slightly traumatic way for some of the companies, but who cares about that? They would accelerate the transformation of the market, and people would rapidly move to vapes or pouches or whatever. What's wrong with that? Or do you agree with it? I thought we'd start with... you know, world's biggest badass tobacco company, PMI, on this one.
01:23:14 --> 01:24:04
Nevena Crljenko: So, I think end game measures, and you mentioned many of them, are just an attempted attempt to do more of what was done before, in the more outlets of doing that, and as we've seen, irrespective of majority of countries implementing certain level, quite restrictive measures, primarily on combustible, unfortunately, non-combustible products as well, the number of smokers who smoke remain the same. So these new end game measures might look innovative in the old frame of thinking. Let's try to restrict, restrict more, but the fact is, let's look at the effect of what's been done so far. And if we look at the net effect in terms of number of people who smoke, it hasn't changed. So will this contribute to it? I have my doubts. You would imply in your question that these endgame measures would apply to cigarettes only.
01:24:05 --> 01:24:05
Colin Mendelsohn: Yeah.
01:24:06 --> 01:24:50
Nevena Crljenko: That is an optimistic assumption because in the way, and coming back to our previous discussion where many people defer to the highest authority coming from World Health Organization, it would not necessarily be the case. These measures would potentially be introduced to any product category because the objective is not reduction of smoking, It is, as it moves now, something towards elimination of nicotine, so it doesn't matter how you deliver it. So, in my opinion, Andy, coming back to previous suggestions, why don't we, in any area of regulation, try to foresee and measure the impact of the measure rather than just coming up with more innovative ways to regulate something without truly looking at the potential impacts this will have?
01:24:50 --> 01:24:52
Clive Bates: Okay, so I think you're against.
01:24:53 --> 01:25:58
Konstantinos Farsalinos: Well, yeah, I mean, that sounds too authoritarian to my philosophical and ideological standards, to be honest. What you're suggesting is force people to abandon tobacco use by measures that go beyond any... kind of measure to restrict use. We're talking about forcefully getting them out of cigarettes. And, of course, you also suggest that we should have some sort of less restrictive regulation on the alternative products. I don't think that regulators are even ready to do that. In general, they equate tobacco cigarettes with harm reduction products. But even if, let's say, supposedly they could do that, I think it's too authoritarian. I mean, right now, there are countries which are banning smoking in a plaza, smoking on the beach, smoking in open spaces, which makes no sense. It violates human rights. It's not about public health. They're not protecting anyone.
01:25:59 --> 01:26:50
Clive Bates: All right, so maybe there's two different perspectives in this kind of regulation. There's a sort of utilitarian view, which is, will it work and everything will go wrong, there'll be illicit trade, there'll be biker gangs, there'll be God knows what, it'll all be horrible. and it won't work, people will get the products, there'll be a trade in hand-rolling tobacco. Utilitarian perspective, you don't do it because it doesn't work. And then here, there is more of a values-based view, which is this shouldn't be the kind of relationship that the state has with the citizen. It's essentially, you want the change in this field to come through consent rather than coercion. I think that's quite a good way of thinking about those endgame measures. David, have you got anything to add here?
01:26:50 --> 01:27:47
David Sweanor: I think it says a lot about the sociology of the field that if you look at the endgame strategies, they're all coercive. We are going to force people to act in a certain way. If you look at the history of public health and what works, it's about empowering people. and yet the empowering things don't come in. So it's like a first step, or the first thing we do is we force people to change in ways that they clearly haven't been wanting to do, rather than, what if we told them the truth? What if we gave them better products? So it strikes me a lot like a town that says, we need to get people in better shape here. We're going to start beating them with sticks because they're not exercising enough, as opposed to, what if we designed the city so it was easier to walk and to ride bicycles, and we had nice parks to take children to, empower people? Those sorts of things work. That's what's worked on so many other areas. What's dysfunctional in this field? that the go-to thing is coercion.
01:27:48 --> 01:28:24
Clive Bates: All right, so that's a further strand to this argument about regulation, which is that the state should function as an enabler. And that has come up a number of times. informed choice, consumer protection, addressing information deficits, and so on. Not that it would necessarily always do that that well, but that's a reasonable intention, perhaps, for the state. Joe, have you got any final thoughts on this, on endgame measures, or just maybe where you would like regulation to head over the next five, ten years or so?
01:28:25 --> 01:29:08
Joe Thompson: I think it's been beautifully summarized so far. I completely agree. What have we seen? We've seen declines in smoking rates begin to stagnate. So doing the same, the same, the same is not working. Where we are seeing smoking rates declining is in countries that are embracing harm reduction. And therefore, that's how I'd like to see regulation develop, through that framework that actually enables consumer choice, consumers going to choose, but informed choice. And I do think that the state has a bigger role to play in actually informing consumers.
01:29:09 --> 01:30:15
Clive Bates: Excellent, and I think that brings us back to where we kind of started in this, which is the demand for nicotine is not going to go away. People use it for a reason, just as they use caffeine or alcohol or other substances for a reason, and therefore the question is, how do you ensure that it's made available in forms that have acceptable risk, meet the needs of the people who want to use it, and use the powers of the state to enable that rather than to coerce sort of behavior change through these heavy-handed measures. I mean, that's, I think, how I would summarize our last remarks. And as it's now... 5.32. We have reached the end of our time. I never thought we'd manage to fill an hour and a half talking about this, but there you go. First of all, thank you for everybody in the audience who spoke up and everyone who's watching online. I thought it was a great discussion. And I think with that, we'll just draw, if you could give the panel a clap here, we'll just draw this session to a close.