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GFN 2024 Michael Russell Oration - delivered by Cliff Douglas - President and Chief Executive Officer of the Global Action to End Smoking - titled "Bridging the Divide: Taking Global Action to End Smoking"


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David MacKintosh: Okay, thank you. My name's David MacKintosh. I'm one of the directors at Knowledge•Action•Change, and it's a great privilege to be introducing this year's Michael Russell Oration, which is one of the highlights of GFN, as those of you who've been here before, but there are many highlights at GFN, but it's undoubted when you look at the excellent speakers we've had over the years delivering the oration that it's a particular highlight of the event, and this year is certain to be no exception. Before I go any further, I'd like just to remind ourselves a little bit about Michael Russell. A psychiatrist and research scientist, he worked at the Institute of Psychiatry in London between 1969 and 1989, and his work had a huge impact. It fundamentally changed the understanding of the pharmacological and the psychological nature of smoking. He was very clear that nicotine in itself was not driving the vast amount of disease and mortality. Rather, it was how people consumed it, essentially via the cigarette. As such, he recognized early on the potential for safer nicotine products. Now, sadly, Mike Russell died before technology and innovation produced the range and type of products which has now made effective tobacco harm reduction possible. But there is no doubt at all that he helped provide the foundation upon which so many of us are working. Now building on this work and seeking to deliver on the ambitions of ending smoking-related deaths, I'm delighted to be introducing Cliff Douglas, President and CEO of Global Action to End Smoking, who will be delivering this year's oration. Cliff has an incredibly impressive track record, going back 36 years in tackling tobacco use. He has led key legal efforts in the US and elsewhere, which have limited tobacco use. Appointed President and CEO of the then Foundation for a Smoke-Free World back in October, he has wasted no time in demonstrating his determination and enthusiasm to drive forward on reducing smoking. His energy and positivity are hugely valued in a field which can often feel irreconcilably divided, despite having an agreed end goal. So, without me going on any further, please let me hand you over to Cliff and let's give him a warm welcome.

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Cliff Douglas: Oh my, that was a very gracious introduction. Thank you so much. And before that, I just had a hug from Roberto Sussman. So I'm good for the day. I appreciated that so much. Thank you. Last year's oration. Well, good evening and thank you, David. I also want to express my sincere thanks to the organizers of this excellent meeting and all of you who are here in person and also virtually for allowing me to spend a few precious minutes sharing some personal thoughts before the exciting award presentation in what I understand is the world famous GFN party. I'm truly humbled by the invitation to speak with you today, especially in the name of Dr. Mike Russell, whose vision and innovative approach to reducing the toll of the smoking epidemic were so critical to the decades of progress that followed, as you've just heard. So exactly one month ago today, my organization that was known as the Foundation for a Smoke-Free World relaunched as Global Action to End Smoking. And this is the name that we decided best represents the top line goal of our charitable mission, which is to end combustible tobacco use, which is, as most people here will know, responsible for somewhere in the neighborhood of 98 to 99% of also called tobacco-related deaths. Changing our name also reflects our new identity, which emphasizes the fact that we are 100% Let me say that again. 100%, and again, 100% independent. We are beholden to no one. And I ask, because I can't help but ask, how many public health groups can honestly make that claim? So last October, when I joined the organization, we terminated the prior agreement with PMI. And having made a final payment, the company walked away, eliminating any connection. And this separation was essential to my decision to take on this special role. I then worked with our strictly independent board of directors to adopt a formal new policy to not accept any further funding from manufacturers of tobacco or even non-medicinal nicotine products. So that means independent vaping companies And while I might have some mixed feelings about that, we wanted to make, and I wanted to make, eminently clear where we stand on independence. So, when I took on this new role, some colleagues, not to mention some journalists and others, asked me why. Why, after 35 years, and now in my 60s, too young to run for President of the United States, but still, you know, a veteran, Would I take such a controversial step? Why not just go play golf? Well, for one thing I told them, I don't play golf. The last time I tried was 48 years ago. I'm rusty. But more importantly, I said taking the helm of this organization to help accelerate the end of the world's leading epidemic was simply a logical next step in my journey to educate people and and save more lives. As part of this talk, I was asked to say a bit about my career. I hope you won't mind. Older people have to reminisce. Every step I've taken since that first day in February of 1988, when I became the new assistant director of what was called the Coalition on Smoking or Health, it was a predecessor of what later became the Campaign for Tobacco-Free Kids. has been dedicated to defeating this epidemic, including many years in the trenches in which I worked with others to hold tobacco manufacturers accountable for a devastating history of fraud, conspiracy, and misrepresentations to the public and government health officials. As a lawyer, I represented individuals and classes of people sickened by smoking, as well as families of some who had already died. in cases against the cigarette manufacturers. We fought one case all the way to the US Supreme Court. It went up to the court three different times before we won on appeal almost 10 years to the day after we had received a verdict at trial. As a policy advocate with the American Cancer Society and the American Heart Association and the American Lung Association, I championed the regulation of tobacco products, in the US and eliminating smoking in restaurants and other public places, including coordinating the national campaign to remove smoking from commercial airline flights. I was also the first to highlight how cigarette manufacturers engineered their products to deliberately cause dependency in millions of unsuspecting consumers, including children. And for those efforts, which led to a major news expose, I was targeted along with ABC News in a 10 billion, with a B, dollar defamation lawsuit by Philip Morris. I was subjected to a subpoena that was thrown at me in the presence of my mother. I was cross-examined under oath for 16 hours and had my phone tapped. So that's a little background. Moving to the present, it's tragic that despite valiant efforts all around the world, this toll from smoking is not only not receding, it continues to grow. And so for our part, we are developing new approaches to strengthen our life-saving work in collaboration with many others who are similarly committed, including people in organizations who are here today. It's been great seeing some of you in person, whom for years, I've only had the opportunity to know virtually. As Global Action, we're maintaining our focus on funding cutting-edge health and science research, but we've also embarked on a new area of focus under the umbrella of what we broadly refer to as cessation education. Unlike some other programs that employ similar names, however, this involves addressing the widespread misinformation and disinformation regarding nicotine and relative risk that continues to confuse and mislead millions of people who smoke, their healthcare providers, and, of course, decision makers. We are going to be promoting research and related educational efforts to accurately inform people about the continuum of risk among different tobacco and nicotine products, and to objectively and compassionately inform people about the wide array of options available to support them on their personal quitting journeys. We're going to continue to support and promote robust, cutting-edge scholarship. But let me also emphasize this. We are stepping down from the ivory tower to meet people where they are, based on their actual personal lived experience, needs and preferences. One size does not fit all, as you know. But too many others don't. We owe it to people to listen, to understand their challenges, to understand how they can reduce their health risks if they can't or don't otherwise choose to stop smoking. And we must recognize and build upon the reality that well over 100 million people, I've heard closer to 120 million people across the globe, have already made the decision to use vaping as well as other non-combusted nicotine products in their dedicated personal efforts to avoid painful and early deaths from smoking. These varied alternatives may or may not in some cases be the very best possible remedies, especially where they aren't effectively regulated for quality control, safety, and health effects. I mean, in the United States, about 99% of our entire marketplace is either illicit in the black or gray market. That's kind of a challenge. But people deserve to know what they're putting in their bodies and what the effect will be And we also know that those products are more appealing, popular, and effective for many people who are in urgent need of practical options to save their lives. And we also know that in many cases, as reported by the Cochrane Reviews and others, e-cigarettes for their part are often more effective than nicotine replacement medications in helping people stop using combustible tobacco products. In the course of my nearly four decades fighting this epidemic, it became clear to me that one of our biggest challenges has been identifying knowledge gaps in the field so we can take corrective action. One of the most common misconceptions is that we have, quote, solved this epidemic, which results in part from the fact that those with more years of education and higher incomes, who are not incidentally Also, those who have more power and influence don't see much smoking around them. Developed nations have generally done a pretty good job of reducing smoking prevalence since the 1960s. But this success has not applied equally in many low- and middle-income countries and across different population groups. Many of the people who smoke today come from disadvantaged communities. While I was leading the annual Great American Smokeout, for the American Cancer Society while serving as its vice president for tobacco control, we came to call this the hidden epidemic, as it disproportionately affects people with less education, with mental health and substance use disorders, from certain racial and ethnic groups in the LGBTQ plus communities, and in the military, and that's especially among those in the lowest pay grades. People who smoke are not a monolith, and their off-ramps will vary considerably. In the U.S., smoking rates are highest among indigenous communities, though only 11% of the U.S. population smokes today. The figure is in the high 20s, about 27%, for American Indians and Alaska Natives. In China, about a quarter of the population smokes, but among farmers, that figure is about 30%. And in Pakistan, smoking rates are less than 10%, but within that figure, nearly 30% of men smoke, compared to just over 6% of women. By the way, you can find these data and much more information for dozens of countries on our increasingly consumer-friendly new website, which is The fact is that with over a billion users of combustible tobacco products today, many, many people have been left behind in the fight for health equity. The status quo is not acceptable. But to address their needs, we must first understand what's really going on and meet them where they are through targeted new research, product innovation and dissemination and much more effective communications. At this point, however, as we've been discussing at this conference, and as I touched on earlier, misinformation and disinformation about nicotine is a global problem. It's itself been referred to as an infodemic. That's interfering with progress to end smoking. Last year, a survey of nearly 15,000 doctors across 11 countries conducted by CIRMO with our support found that about two-thirds of physicians, and in some countries far more, even in excess of 90%, mistakenly believe that nicotine causes the death and disease associated with smoking. But of course, this is flat rock. It isn't true. The science is clear. Nicotine causes the dependency that drives the repeated exposure to the 7,300 chemicals roughly 70 known human carcinogens, those chemicals that cause cancer, produced by the burning of a cigarette. But when separated from the dirty needle of the cigarette, as Mitch Zeller himself called it a few years ago, nicotine is approved as, quote, safe and effective for use as a smoking cessation medication. It doesn't take a rocket scientist to know that nicotine itself cannot be both lethal and safe and effective. The spread of the false belief that nicotine is what kills rather than the toxic soup of cigarette smoke is harming our public health efforts and everything that everyone in this room is seeking to accomplish. Too many healthcare providers and the consumers they serve believe that their only options for quitting are either going cold turkey or using a medicinal nicotine replacement product such as nicotine gum or the patch, or maybe they'll try hypnosis. But we know, probably everyone in this room knows, that there are many individuals who either can't or won't quit smoking using those options. And I would submit that it is a moral imperative that they not be forced to choose between those limited and too often ineffective options or nothing at all. With so many lives on the line, we must step up our game. And just as knowledge, action, change, and others among you have done, global action has crafted resources and information for consumers who want to learn how they can most effectively quit smoking, and when helpful, as it is for many, to move down the continuum of risk to minimize the likelihood that they'll become ill and die before their time. One thing I know for sure, requiring people who smoke, in effect, to simply quit or die is inhumane and it's unacceptable. So we'll be consistent in encouraging consumers to take the healthiest step possible for them and respectfully meeting them where they are. For those who want or need nicotine and won't otherwise stop smoking, we'll deliver unbiased facts about the evidence-based options available to them that can help save their lives. This sounds simple, doesn't it? But unfortunately, it isn't because of what some have aptly referred to, as I noted earlier, as the infodemic that currently plagues the global discussion. And no matter how much poor and false information is spread, including by some global health authorities and their benefactors who know, or damn well should know better, we will be relentless in simply telling the truth. telling the truth. People deserve the truth. People need the truth. People rely on the truth. And people must be told the truth. So let me now just say a word about the subject reflected in the title of my talk, Bridging the Divide. When I embarked on this more recent phase of my journey following a critical learning stage while I was leading tobacco control at the American Cancer Society, I issued a personal statement of March of 2021 that I titled, it is time to act with integrity and end the internecine warfare over e-cigarettes. In it, I appealed to my friends on both sides of the internecine divide over tobacco harm reduction. My use of the word internecine led to some humorous discussion about what the hell that meant, but it basically refers to destructive conflict within a group. Now, there may be some different opinions about whether we are all actually part of a single group, But for me, as a tobacco control specialist who was always very much involved in pursuing or also very much involved in pursuing the promise of innovative alternatives that would help accelerate the end of smoking, this was all, for me, part of a whole. I invite you to read the not very long original statement online if you're interested, but this is how I began it. I decided to go back and see what it was I said three years ago. We are now neck deep in intractable internecine warfare between the mainstream tobacco control community, whose primary focus is on protecting youth from the dangers of vaping, and the tobacco harm reduction community, some of whose scientists are also committed participants in mainstream tobacco control efforts. The THR community emphasizes the potential benefits of vaping for adult smokers who cannot or will not quit smoking otherwise, it seems that ne'er the twain shall meet. I urge all of us in the tobacco control community to climb out of the bunker, come to the table, and try to genuinely work together. Stop skirting the truth when it feels inconvenient, and open your minds and ears to all of the science that is before us. But the same goes for my other community. with whom I agree regarding the evidence-based promise of THR, but which also bears some responsibility for the adversarial nature of the relationship and for not always acknowledging areas of ambiguity or concern, including significant rates of experimentation with vaping by youth. Mind you, this has in the United States, for example, changed quite a bit for the better in the last three years. and youth-oriented marketing by some segments of industry, generally the illicit industry. We won't come together if we don't come together. Well, a lot has happened since I wrote that, some of it very challenging. But my faith in the cause of bridging this divide hasn't wavered because we can't afford to do so. I firmly believe that driven by a lot of hard work, collaboration wherever we can find it, and reaching out honestly with an open hand, we will bridge differences and find more common ground. So to conclude, I want to emphasize that how we choose to approach ending the epidemic of death and diseases caused by smoking is reflective of how we really feel about the people who smoke. If we continue to offer them only the same solutions that have failed them time and again in the past, I think that we imply, whether we intend it or not, that we do not think them worthy of compassion or the potential benefits of innovation. As scientists public health advocates, social justice warriors, and simply as people who care about our neighbors. We must accept when the evidence shows that past solutions are not working well enough. The status quo, again, is not acceptable. And finally, let me just say, those who say it cannot be done should get out of the way of those who are doing it. Thank you again for your privilege, the privilege of your time, and for linking arms in this noble cause.