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Chapters:

0:00 - Intro

0:56 - FDA has announced its plan to ban sales of menthol cigarettes in the USA

2:54 - Bengt Wiberg shares his thoughts on the Swedish experience of snus

14:50 - Many US physicians incorrectly believe all tobacco products are equally harmful

19:33 - Brent Stafford of RegWatch interviews Michelle Minton

41:22 - Closing remarks


Transcription:

Hello and welcome to GFN News on GFN.TV. I’m your host, Joanna Junak.


In today’s news:


The Food and Drug Administration has announced its plan to ban sales of menthol cigarettes in the United States. Will Godfrey, from Filter magazine tells us more.


, snus user and consumer advocate, shares his thoughts on the Swedish experience of snus


More US doctors are recommending vapes to smokers, but as we reported last time, most continue to have misconceptions about e-cigarettes, a study from Rutgers University has revealed. We find out more about the study.


And after the news, Brent Stafford of RegWatch interviews Michelle Minton, a senior fellow at the Competitive Enterprise Institute and GFN22 speaker.


Joanna: At the end of April, the FDA formally issued its rules for a US ban on sales of menthol cigarettes. Let’s cross over to Will Godfrey from Filter magazine for an update. What’s the significance of this development, Will?


Will: This had long been flagged, Joanna. We were discussing it just a few weeks ago, of course, but now it's officially official. After FDA commissioner Robert Caliph presented the plan in congress, as well as mental cigarettes, it would ban flavours in cigars. The process is slow moving. Many observers think the ban won't take effect for a couple of years or even longer if there are legal challenges. And the FDA claims again that only suppliers, not smokers, will be targeted by related enforcement. But intense debate pits those who see the ban as a way to improve public health against human rights organizations that warn of inevitable police interactions increasing and criminalization increasing in black communities which are already disproportionately policed, and where menthols are disproportionately smoked.


Joanna: What’s been some of the most significant opposition?


Will: Dozens of organizations have come out against it, but one of the most notable is the American Civil Liberties Union. On the day of the FDA's announcement, the ACLU released a statement which read in part time and time again, we see encounters with police over minor offenses result in a killing. There are serious concerns that the ban implemented by the Biden administration will eventually foster an underground market that is sure to trigger criminal penalties which will disproportionately impact people of colour and prioritize criminalization over public health and harm reduction.


Joanna: What happens now?


Will: The FDA will now conduct a public comment period where arguments like these will play out. There's a long way to go, but it's certain to be fought every step of the way.


Joanna: Thank you, Will. Snus is now the dominant tobacco product in Sweden, where it has been used for over 200 years. The safer, pasteurised form of snus has been sold in Sweden since the 1980s. The use of snus overtook smoking among Swedish men in 1996. A significant body of evidence shows Swedish snus to be one of the tobacco products that are least harmful to health. Sweden’s men experience the lowest rate of tobacco-related mortality in Europe. Joining us today is Bengt Wiberg, Founder of the international snus consumer movement EUforsnus, with members from one hundred nations. EUforsnus is a member of INNCO and ETHRA. Bengt is also the President and founder of a Sting Free AB, a startup nicotine pouch company. Bengt will tell us about snus and will elaborate more on what is internationally known as "The Swedish Experience".


Joanna: Hi Bengt. Firstly, can you tell us what snus is and how it works?


Bengt: Hey, thank you for inviting me to GFN.TV. I will be there in Warsaw in June. You can trust in that. Snus is a grain tobacco product that contains grain tobacco, water, salt, PH regulating substances and often flavours. It is used by placing the little tea bag under your lip. It doesn't have to be the upper lip, it could be over here or in the down, because it is 100% spit free. The nicotine is absorbed through the oral mucus membranes of the mouth, the inner lip, the chins and so on. And it's used for up to 1 hour. So it's quite economical. It doesn't require any electricity. It's a low tech, but it's a green tech, and each can contain 20 pouches. And it's also the product that has made Sweden almost reaching the WHO goal of a smoke free nation, because in Sweden only 5% of the men are daily smokers. We use Snus in a much higher degree than we do cigarettes. And then we have I also want to show what is called the modern custom of Snus. It's called a nicotine pouch. It's always white and it has the same content as Snus with tobacco, with the big difference that all of the tobacco content has been replaced by flavoured plant fibres from the plant kingdom. But you use it in the same way, place it under your lip and you enjoy the flavours and the nicotine. Snus is also very good in another way because it doesn't bother anybody else. We all know that vaping is perhaps 97%, 98% less harmful than smoking. But there are regulations. There are no smoking, no vaping in restaurants or on public transport or whatever, whereas nobody can even detect that you have a Snus, which means you can enjoy nicotine, stay away from smoking without problems and without bothering anybody else. Snus is used by all categories of people in Sweden. You can probably find a lot of doctors in the operating theatre, in the hospital, enjoying a Snus while performing a surgery or a managing director or a construction worker or whoever. In Sweden, about 24% of all adult men use Snus and the rate is going up for women. Every second woman who tried these tobacco free nicotine pouches is actually a former smoker. So we are seeing smoking rates are dropping in Sweden and being replaced to a high degree by tobacco free nicotine pouches. Snus comes in various strengths: you have Snus from 0% nicotine all the way up to 43 milligram per gram nicotine and the most common strength is ten to twelve milligrams per gram which is equal to that of cigarettes.


Joanna: We’ve heard the phrase ‘the Swedish Experience’. What is this and what are the implications for tobacco harm reduction?


Bengt: The Swedish experience, I'm not sure, but it could be that the expression itself was invented by Professor Brad Rodu of the United States. The Swedish experience is that in Sweden we are consuming just about the same average quantity of tobacco as the other countries in Europe but instead of smoking it, we are much more higher degree using it in the form of safer products, which is Snus. So as I said before, Swedish smoking prevalence among men is now down to 5%. If we look at Swedish young adults from 16 to 24 year olds, smoking is down to 3%, which is fantastic. In Norway it has even gone further, it's down to 1%. But looking at smoking prevalence is one thing, looking at lung cancer, oral cancer, cardiovascular diseases, etc. Sweden has by far much lower prevalence than any other country in Europe very much thanks to Snus and that we are not smoking. There was a huge study actually last year by the Karolinska Institutet that gives the noble price in medicine each year, I think it was about 448,000 construction workers that were followed for about time period about 30 years. And the conclusion was that if you use four cans of Snus or less per week the chance of getting oral cancer is actually 35% less than a person not using Snus at all. There was another great study published in The Lancet in 2017. It's the global burden of the sea study which is the biggest metadata study in the whole world where all published science has been gathered for about 26 years and the conclusion was fantastic when it comes to Snus, the conclusion was that Snus use had no increased risk for any health outcome. So I guess that's why Swedish men are now coming. Swedish women are very low risk for cancer and premature death due to smoking. What else? I mentioned Norway. Well, there has been some scientific studies showing that if European Union males would have the same tobacco habits as Sweden, some 365,000 premature death would be avoided each year. And we all know it comes a lot of costs from smoking related diseases. Snus has not yet killed a single person as far as I know. In 2017 I was invited to United States and I actually had the chance to ask FDA tobacco director Mr. Mitch Seller what he thought about. I asked him about his thoughts about the Swedish experience and Snus and he quoted several times that FDA absolutely understands the Swedish experience of Snus based on nationwide epidemiological evidence. So we have today, I think about 1.3 million Snus or nicotine pouch users and our population is 10 million and I guess about 8 million are above the age limit of 18 year olds.


Joanna: You are a Founder of the international snus consumer movement EUforsnus. Can you tell us more about this campaign?


Bengt: The EUforsnus consumer crowd movement is totally unsponsored. It was founded by me and a German Snus friend. And we started the hashtag EUforSnus. And now we have a great international community of Snus users from 100 nations, including every nation in Europe, where more than 80% of us are former smokers who quit smoking for good, thanks to Snus. It's a great community. You find you for Snus on Facebook, on YouTube, on Twitter, Instagram and even LinkedIn. And people: we have men and women, everybody, of course, above the age of 18, but we have moderators from 18 countries from India to Europe to the United States.


Joanna: Thank you Bengt for sharing your insights. We’re going to return to you with more questions in the next episode of GFN.TV. According to a study from Rutgers University, many US physicians incorrectly believe all tobacco products are equally harmful and thus are less likely to recommend e-cigarettes for people seeking to quit smoking. Doctor Sud Patwardhan, a UK-licensed medical doctor shared some thoughts about this.


Dr Sud: In this paper recently published in Jamai in April 22, it reports on findings from a cross-section survey done amongst more than 2000 physicians in 2018 and 2019 and physicians who were asked about e-cigarettes by their patients endorsed a harm reduction perspective. Or those physicians who had ever smoked were more likely to recommend e-cigarettes to patients in hypothetical clinical scenarios presented to the physicians in the survey. The physicians were more likely to recommend these cigarettes for an older heavy smoker with prior unsuccessful quit attempts and use of pharmacotherapy for a younger light smoker with no prior cessation treatments. And I'm emphasizing on each of these words for a very specific reason. This survey, despite the fact that it's done three or four years ago and the findings presented more recently, highlights a big gap in confidence and knowledge among physicians in the US. Which could be a result of many different things. But the very fact that electronic cigarettes are in that market for the last ten years or plus are regulated to an extent under the FDA's Centre for Tobacco Products. However, when patients seem to be coming to doctors for advice, from what the findings seem to suggest, doctors are advising based on their own personal experience. There is no clear guideline out there, there is no national health body that's giving them that level of clarity, that level of confidence that, hey, you physician. When you have a patient coming to you who is a smoker and presenting with a complaint that may be associated with the smoking or even otherwise, that's an opportunity for the physician to make a difference in the smoker patient's life by advising on putting tools available. The guideline doesn't exist, to my knowledge, in the US. Which says to the physician, offer electronic cigarettes as one of the options out there. So what are the physicians doing based on this survey? They are following their instinct, they're following their own personal experience with the products. And in this case it looks like they are making that choice for the patient. In the case of older heavy smokers and we've tried with everything else and not managed to quit, they say, oh well, we can perhaps then take the risk of giving you cigarettes to these patients or at least say yes, you are fine to try cigarettes, but in the case of younger live smokers, they are not giving that as one of the other options. And this is despite the fact that there are more studies out there increasingly that are showing that e-cigarettes are as good or in some cases even better than existing available nicotine replacement therapy products like gums or patches or other prescription medications for smoking cessation. So the study highlights a big issue here. Doctors are important influences of their smoker patients behaviours. When a patient asks a doctor what should he or she do in terms of their tobacco use and their habit, the doctor should be in a position to give them with confidence the whole range of tools available. How to use them and hold the patient's hand throughout the journey till they become smoke free or in the case of oral tobacco products. Tobacco free and prevent relapse in the long run. And in this case, based on what we are seeing in the data at least, it's fairly evident that doctors are not necessarily confident in doing that with regards to newer products coming in the market. And the reason this is important is there are still millions of people, even in the United States of America who continue smoking and using risky forms of tobacco. And the physicians have a big role to play in helping them quit these risky products for the good of the patient and their families and for the society. And these are massive missed opportunities, potentially because of the lack of their confidence in these new products. How do we change that is a big problem, a big opportunity for education of healthcare practitioners in the US and globally with the right amount of scientific information which is used by the doctors to make informed decisions and help their patients make the right decisions. That's the way forward, but there's a big job to be done and a long way to go.


Joanna: Thank you Sud. And now, we go over to Brent Stafford and his guest Michelle Minton, who specializes in consumer policy, covering regulatory issues, tobacco harm reduction, cannabis legalization, alcohol, and nutrition. In June, Michelle will be joining us at GFN22 on a panel discussing the possible benefits of nicotine. In today’s interview, however, Michelle will discuss the motivations and tactics that lie behind some of the most outrageous efforts to destroy vaping. Over to you, Brent.


Brent: Hello Joanna, thanks for that. And hi everybody, I’m Brent Stafford and welcome to another segment of RegWatch on GFN.tv. Those who do battle against safer nicotine products are deeply entrenched within all levels of government, regulatory agencies, at universities, in foundations and non-profit health groups. They are organized and well-funded. They are a force to be reckoned with. But thankfully there are those who fight on behalf of adult access to safer nicotine products, and few fight more tenaciously than Michelle Minton, senior fellow at the Competitive Enterprise Institute in Washington, D.C. Michelle thanks for joining us again on RegWatch.


Brent: So Michelle you are a researcher and a writer for CEI and have been covering issues around nicotine vapes for some time. Tell us a bit about CEI and its mandate, and the types of regulatory issues you cover.


Michelle: Also the Competitive Enterprise Institute, where I've worked for almost 16 years now. We're really a regulatory think tank, so a shop that focuses on how we can fix the regulatory state to increase people's economic and personal liberties.


Brent: So when it comes to the kind of regulatory issues, could you describe it as the sin issues?


Michelle: Oh, yeah. My particular wheelhouse, my expertise, for whatever reason, has developed around what we would consider the vice issues, which I include food in that as well, since anything that you could put a sin tax on. So that's gambling, food, alcohol substances, including nicotine and cannabis.


Brent: So essentially you tackle government and government's pension to save adults from their own choices.


Michelle: It really whenever the government is trying to come in and do something for your own good, that's where I come in and say, you know, maybe this isn't a great idea for whatever reason.


Brent: So when government tries to keep you safe.


Michelle: When it's trying to save you from yourself. Yeah. And your own choices. That's almost always a bad idea. Pretty much invariably.


Brent: So do you look at these issues mostly then as a liberty issue?


Michelle: Yeah. I try and look at it from a bunch of different perspectives. So I come at it from, you know, I have a degree in nutrition, which is a public health field. So I do look at it from the economic side of things, from the public health side of things as well. But, but mainly from, from an autonomy perspective, this idea that, you know, you can want to help people and do good for them and those intentions can be true and well-meaning. But there's a line that should never be crossed in medicine or I think in life generally, which is when you cross the line into forcing or coercing people into making choices that you think are good for them, even if they think they want to make those choices. Once you cross the line into coercion and force, you are impeding on someone's personal autonomy, which is what makes us human. It's what allows us to live in any sort of free society. And that's that should just be verboten.


Brent: So when it comes to, say, nicotine, vapes and all of the debate and regulatory actions around that have public health and government crossed the line then.


Michelle: It crossed the line a long time ago and I think back in the nineties that it seemed to be justified. Most people were on board, including even smokers, because the science was so clear about how harmful smoking, combustible tobacco is. And a lot of people were dependent on it and didn't want to be. And so there was this broad consensus that everything should be done to make sure that the next generation and the generations after wouldn't fall into those same traps. So there was lots of educational campaigns. Those are great. Those did a lot to really push young people away from smoking, from even experimenting with smoking. And then there were taxes and warning labels and those, you know, they started to creep up, especially with taxes.


That's fairly coercive because if you're if you're a person who's impoverished or you're on the lower end of the economic spectrum sometimes, especially if you're dependent on a substance like nicotine and you think smoking is one of the only ways you can get it, that's a severe form of coercion, where you're forcing people to choose sometimes between food and a pack of cigarettes. And then in the modern era, it's become even worse, even though we have more choices than ever, safer choices than ever for consuming nicotine. This discussion and the action violating people's autonomy, this idea that just because someone has a dependency, mild or severe, they don't have free will or they have a lesser form of free will. It's very disturbing. It's been increasing with public health, saying, well, we're trying to do it for everyone's good, so it's okay. And I think it's inertia. This idea that's carried forward from the nineties, from the tobacco wars, that it's still okay even though it really shouldn't be.


Brent: In a way, do you think that maybe a bargain has been broken, some kind of a deal? Public health and tobacco control was making with smokers as they really laid on heavy the pressure to quit. Now, there's millions of people that did quit through vaping, but they find that public health is on them as hard as they were when they were smokers.


Michelle: Yeah. You know, there was a lot of stigma on smokers. A lot of, you know, you have to go out in the cold if you want to smoke. This should be a thing if you're still going to do it. If you refuse to do it, we tell you have to do it in private, in your home. As long as you don't have kids or live in public housing where we don't have to see you, we can pretend you don't exist. And then a lot of people found vaping or nicotine pouches or safer forms of nicotine consumption. Even the patch in some ways that's still being stigmatized. People are not being hired by certain companies because they're testing positive for nicotine, even though they're wearing a patch or chewing gum. So there's been an escalation in the stigma where it's no longer just smoking because smoking is bad. And we don't as a society, we don't want this to be an acceptable behaviour. Now it's getting down to a level where you're not even hurting society or the people next to you, but we still don't want you to do it. It's a severe form of groupthink and control about people's private behaviours and any kind of justification that people may have raised in the nineties with smoking, second-hand smoke or children see it or cetera. All of that is obliterated when you're talking about nicotine use through non-combustible sources. But yet so there's I think a lot of smokers who've managed to quit via any means that are available to them. They are now faced at a world where they're being re stigmatized. They felt like, you know, I did what you told me to do. I'm not a bad person anymore because a lot of smokers felt and still feel like they are bad people because they choose to smoke or they have a dependency on smoking. Is that I did it. I did the hard work. I switched to something safer. And then all of a sudden, here comes public health again. And the government and all these public health groups who are saying, no, you're still bad, you're still doing a bad thing, even though you're not hurting yourself or anybody around you. So you continue to feel bad. So yeah, it's a real violation of what felt like a deal to a lot of people.


Brent: Yeah. In a way, it seems that tobacco control and public health don't believe that a smoker is really quit if they're still using nicotine in a vaping form.


Michelle: Yeah. And one of the most the most offensive parts of the conversation is that the conversation is always focused on the industry, you know, and there's a specific reason for this. They want to talk about big tobacco and the tobacco industry or big vape or whatever it is. And they do that because it's a very easy villain and they don't want to be they don't want to seem to be victimising or villainizing the people who use nicotine, but that's what they're doing. And they do it even more so when they refuse to acknowledge what they're doing and how that affects the people who use nicotine still, whether they're smokers, vapers, nicotine pouch users, whatever it is.


Brent: Let's turn to the concept of tobacco harm reduction. In your mind, what is it and why is it important?


Michelle: It's really this recognition that you cannot force people to stop using substances. It's the nature of humanity that once a substance is known, its property is discovered. People will always find a way to access that substance in some form or another, and that the effort to force people not to do it usually has really horrible, unintended consequences, both for the individuals and for society. You k now, when you talk about criminalization or illicit markets and then all the crime that goes with illicit markets and cartels, etc., and then the loss of tax revenue, whatever it is. And when you approach the issue, if you say we think this is still a problem, but we're going to approach it through a harm reduction lens. What you're trying to do is say people are going to use these substances even though we don't want them to. So what we're going to do is we're going to try and figure out how to structure our policy and our public health approach so that we are pushing people towards the safest forms of use, less use, whatever it is. So with cannabis, for example, that's legalize it authorized specific dispensaries. So we know that they're only selling to adults, that they're selling products that are safe with nicotine or with tobacco. Harm Reduction It's this idea that human beings have used nicotine for thousands of years. You're not going to get rid of it. But we know that smoking a cigarette, the combustion, the tar fumes, all of the chemicals that are produced is the most deadly way to consume 3 nicotine. Whereas as you move towards non-combustible approaches like FDA approved nicotine therapies or pouches or vaping, you know, there is no combustion, so it's far safer. So policies and our approach should be structured around pushing people away from the most harmful forms of nicotine use towards the safest forms.


Brent: Considering everything that we've seen happen to nicotine vapes over the last couple of years, is it fair to say that there's a war on vaping?


Michelle: Yeah, absolutely. I think there's a war on Vaping and there's a war on nicotine use that's been ramping up the war on vaping. I think really there's always been a bubbling war on nicotine within tobacco control, and that's the movement of public health lawmakers, whatever it is, who want to end smoking. There's always been a wing of that movement that was anti nicotine use, not because it was dangerous, but just because they didn't like it. And with vaping, I think that has really galvanized the tobacco control movement and brought up that wing that was just anti nicotine because a lot of the arguments people used to use for smoking don't apply to vaping, they don't apply to non-combustible sources of nicotine. So now it's just become, well, nicotine is addictive and that's just bad. Even if the addiction doesn't come with anything bad, that's just bad. And we don't want people to be addicted.


Brent: Michelle One of the biggest arguments that has always been made has been, well, utilizing the precautionary principle. So it almost doesn't matter if there is real harm done, if there's a potential harm. And in this case, everything seems to be wrapped around harm to youth at the expense of obviously what adults need. What do you make of the precautionary principle being deployed here and in the context of the so called teen epidemic of teen vaping?


Michelle: Yeah. I think the precautionary principle has really been misapplied. And some of the people who are the greatest champions of this idea of any kind of new technology needs to prove itself to be safe before it can be introduced. I think people like Cass Sunstein have talked about how it has been applied overzealously and too far in that there is no such thing as certainty. Nothing is perfectly safe. Nothing ever will be. You cannot prove something has zero harms because that's proving a negative. What you can say is, you know, we know for a fact that this thing is less harmful than something that already exists, something that we literally cannot get rid of, which is smoking. So are there potential harms to use? Will more TEENS start using nicotine where they wouldn't have? All of those things are real possibilities. The rates of youth experimentation with vaping and what we're talking about is once a month. So that could literally be I was at a party, I tried a friend's jewel or whatever and then never did it again. Those are the numbers that we're looking at. We say, Oh, I got it. It's up to 20%. It's up to 23%. Those numbers have been going down for the last two years. And yes, you know, the pandemic might have something to do with it. But what's interesting is during the pandemic, what hasn't been going down is youth drinking or youth cannabis use. So if you're talking about social sources, youth are still acquiring these other things through social sources. There's something else that has changed. And I think it really if the panic can be initiated so quickly, one would hope that it can be calmed just as fast. But we're not seeing that. We're still seeing people cite number of numbers from 2017, 2018, because they're scary. And that's a rhetorical political device because they want people to continue thinking about this issue as something to panic about.


Brent: Let's make a turn here to the U.S. Centers for Disease Control and 2019 and the moral panic that was created over the evali this so called vaping related long illness. What happened there? And was it actually something that was real?


Michelle: I mean, that was one of the greatest failures that I've witnessed in public health in my lifetime, and it couldn't have come at a worse time with the CDC slow rolling the information. They knew very quickly. And I know they knew because I knew and I knew because I knew the people in the cannabis industry knew that it had nothing to do with e-cigarettes and had everything to do with tainted, illicit THC products that had made it on to the market because some idiots thought they could cut their weed vapes with vitamin E acetate. They quickly learned that they couldn't do this and they quickly changed. But those products were already on the market. And CDC should have made it much clearer, much sooner that that's what it was. But somebody at CDC either because they were afraid. But I think I think the more reasonable assumption is that they wanted to use the outbreak. You know, they wanted to use these tainted products to scare people over e-cigarettes, to scare kids over e-cigarettes. And, you know, honestly, that did work. A lot of kids thought, hey, e-cigarettes are killing people, putting them in the hospital. I better not touch these things for a little while. Meanwhile, they had no idea that the actual risk was THC illicit vapes, and most of them still don't know that. And this came right before COVID. So you had a lot of people looking at CDC, people who have who are still supporters of CDC and FDA, people who dislike e-cigarettes want them banned. But they watched the CDC wilfully withhold very important lifesaving information from the public. And it engendered a lot of distrust right before the CDC needed it the most, which is when the COVID outbreak happened. It was hard to trust CDC to not do things politically after we just witnessed them do something incredibly politically.


Brent: Now in terms of the people and organizations and groups that are leading the anti-Vaping effort out of the US and that do have an impact globally. Obviously, Michael Bloomberg has to be at the top of that list.


Michelle: I mean, he you know, just because he has a lot of money and an incredible amount of money, but also because he's very passionate about health issues and very dedicated to health issues, he has wielded for many years a lot of power in the US and globally when it comes to how governments approach health issues. Tobacco is one of his main gun controls, another one that he cares about, and he's recently gotten into the issue of drugs more broadly, which, you know, that's only in the last couple of years. It'll be interesting to see how that shakes out, because one of the things he's invested his money into is drugs harm reduction at vital strategies, which some of the viewers may recognize vital strategies. It's one of the main one of the main marketing shops that he's employed on his tobacco issue. So now you have this group that has been pushing for bans in India and Indonesia and all over the world when it comes to e-cigarettes and other nicotine products now espousing drugs, harm reduction. So it'll just be kind of fascinating to watch how they square the difference between their approaches on these two topics.


Brent: Yeah. He's dumped a lot of money into vital strategies, has he not?


Michelle: Many millions. Yes.


Brent: Is there a concern over being able to trust vital strategies in their work in this in the tobacco harm reduction area? Like do they have the credibility that's needed in this space?


Michelle: I you know, I don't know how much credibility they have, honestly. I've always thought of them as like a lobby shop. Basically, they're a marketing firm. They're lobbyists. They're very powerful because they have so many people all around the world who work for them. And they, you know, they funnel a lot of money from Bloomberg, as does the Campaign For Tobacco-Free Kids and the Truth initiative. So trusting them, I don't know. It's a question of how much influence do the individuals who work at a place like Vital Strategies have over the approach they take versus excuse me versus someone like Michael Bloomberg? From what I've heard and what I understand, Bloomberg Philanthropies has an extreme amount of control, a almost inappropriate level of control over the groups that they fund, where if you don't if you don't do what Bloomberg Philanthropies wants you to do, you are not going to be funded again. So especially if you're talking about groups in third world countries where money for philanthropy, philanthropic money, money for non-profits is really scarce. That is that's a significant threat.


Brent: Yeah. Michelle, when we last had you on the show about a year ago, you had just come out with an article that was talking about Michael Bloomberg's. How did you frame it? Philanthropy. Colonialism.


Michelle: Well, so, you know, Michael Bloomberg, tons and tons of money gives a lot of money to the World Health Organization, to groups like Vital Strategies and the Campaign For Tobacco-Free Kids. They then go into other countries and find partner groups, which are often local groups. They do workshops, they proselytize, they get them on board and form coalitions, and then they lobby together and they work. Sometimes they give money straight to governments, as they've done in Russia, China, the Philippines. There's been a big scandal in the Philippines with Bloomberg Philanthropies funnelling money to their FDA. And the reason I called it philanthropy colonialism is because I see this as part of a long tradition in global public health, which is this Western perspective on health and how health is controlled through policy and the role that individuals play and communities play in health. It's this idea that Western scientific medical understanding is always correct. It always has to come from that authority, and then it just gets copied and pasted and applied onto other communities, regardless of what their needs are, what their values are, and what their desires are, regardless of the effect that it might have. And we see this, for example, with Bloomberg Philanthropies. Bloomberg is very concerned with vaping because that's the issue in America. Smoking is pretty low. It's still high in a lot of populations. Right. People with mental health issues, people who are poor, people who live in rural communities. Smoking is still a huge problem of indigenous populations as well. Huge. But, you know, over the entire population, maybe 13, 12% is pretty low. But you have the big issue with that, especially suburban parents are concerned about vaping. And so what Bloomberg has done, if you see what their what vital strategies, for example, does in countries like India, where smoking is still 40% of the population in the thirties, maybe higher, depending if you're looking at men or women, they are pushing for bans on e-cigarettes in India where that is not really an issue there is combustible smoking. And so you have a Western organization, a whole mechanism that's operating, trying to copy and paste what they think is valuable in the US onto other communities regardless of what those communities actually need. And so that's why I called it philanthropy, 5 colonialism, because this idea that Western authorities, Western physicians tell you what to do, you're too dumb to know what to do. You shouldn't have the right. And to a degree, the World Health Organization has been doing this for a long time with their tobacco control compacts that they try and get all the countries to sign on to. You know, countries are supposed to be autonomous just like people. They are the ones who are best suited their lawmakers, the people they vote into government. If they have the ability to vote people into government, they're the ones best suited to know what their people need, what their people value. So it's pretty problematic when you have someone like Michael Bloomberg looking at another country like the Philippines and saying, I know what's best for you. Just do as I say.


Brent: Michelle. The Global Forum on Nicotine Conference in Warsaw, Poland, is coming up this June 16 to 18. You're participating on the panel titled Benefits of Nicotine. This is your first time attending in person. Are you excited to go and why is it conference like in 22 important to the tobacco harm reduction effort?


Michelle: I'm so excited. You know, I've attended in the past both as a panellist online and just as a guest. GFN is one of my favourite conferences because of the fact that it's so thoughtfully organized. They really try and bring in a lot of different voices, not just from the scientific academic community, which is important, but also from the consumer advocacy world. And I think those are and I think just one of the reasons a lot of people like GFN is because you get to hear voices that are so often marginalized or ignored in the conversation, but they consumers are important stakeholders in the conversation. So, yes, I'm very excited to be attending in person for the first time and to be on a panel that I think is going to be very enlightening.


Brent: Excellent. All right. And then last one year. Finally, Michelle, if you could give just one piece of advice to HR advocates attending FN this year, what would that be?


Michelle: I would say reach out to somebody who you think doesn't agree with you and just talk to them. You don't have to try and convince them. Just try and share information with them because that is how people, for one, you humanize yourself. They don't just see the industry. You're not just a big tobacco shill or you're not just some nicotine fiend who's trying to defend their addiction. You're a human being who, even if someone disagrees with you, has a right to your opinions and should be heard.


Joanna: That’s all for today. Thanks for watching and see you next time, for more tobacco harm reduction updates and Brent’s forthcoming interview with Doctor Ronald Dworkin, an American anaesthesiologist who writes on medicine, philosophy and society. Goodbye for now!