What drives tobacco control policy—science or ideology?
In this episode of Tobacco Harm Reduction Unfiltered, Harry Shapiro speaks with Professor David Sweanor about prohibition, tobacco harm reduction, vaping, nicotine policy, and the future of public health. They explore why evidence-based regulation matters, the role of innovation in reducing smoking, and whether prohibition can ever achieve its intended goals.
Watch for an in-depth discussion on tobacco control, smoke-free alternatives, public health policy, and harm reduction from GFN26 – Global Forum on Nicotine 2026.
Transcription:
00:03 - 01:01
[Harry Shapiro]
Well, hello everybody. For the last episode of this conference under the title of Tobacco harm reduction unfiltered. This morning I have with me Professor David Sweanor, Professor of Law with years of experience in tobacco control policy. And we're going to be exploring the murky depths of prohibition under the title of What Lies Beneath. Good morning. Good morning, Harry. Good morning. So there were kind of three themes that we kind of worked out, the first of which seems to be, I suppose, for me in some ways, one of the most significant, and it's all to do with morality and purity and sin and all the rest of it. Can you take me through your thinking?
01:02 - 02:48
[David Sweanor]
Sure. I mean, we're doing public health and as part of public health, to do it well, we try to understand people's lived experience and meet them where they are and empower them to make better decisions. And then we start looking at a lot of what happens in this field that doesn't seem to do that, even by people who call themselves public health. There's a lot of stigma, there's a lot of shame. Where does it come from? And I determined very early in my career that Whenever I see seemingly rational people behaving in an apparently irrational way, there's usually a rational explanation. And in this case, to say, why would people push a prohibitionist agenda when all of the evidence would indicate this is a bad idea? And some of that comes down to work various people have done. Jessica Warner has got a great book called... All or Nothing, a short history of prohibition, abstinence. And there's this morality aspect to it, that it's treating things like sin. It's like the residual effect of the religion that shaped many of our societies, that people are doing something bad. And you not only should not do that bad thing yourself, you need to stop other people from doing that bad thing because that's how you show you're a good person. So the morality ends up being people saying, how do I use the power of the state to impose my moral views on the behaviour of others. You know, I not only have to cleanse myself, I need to make these people pure. I need to force them to be cleansed. Right.
02:49 - 03:07
[Harry Shapiro]
Which is quite... probably goes against the basic principles of public health. So these people are, in a sense, flying under the flag of public health in order to pursue their own personal agenda?
03:07 - 04:59
[David Sweanor]
Yeah. Well, I mean, public health, somebody calling themselves a public health activist, I think is like somebody calling themselves an environmental activist. There's no really clear criteria for that. They can just say that's what they are, regardless of what they do. But if you look at some sort of objective criteria, so if I said, you know, Harry, I'm an avowed environmentalist and I spend my time clear cutting the Amazon. I mean, you say, well, that doesn't fit. When somebody says, I do public health, but they violate many of the principles of public health ethics, such as lying to people, not empowering people, that they're not really doing public health. And often what you find in quite a few NGOs and other areas of life, people get involved in something not because they're really keen on that particular topic, but because they see it as a vehicle to achieve some greater purpose in their life. So if you're thinking that you're fighting sin, you're fighting evil, getting involved in fighting cigarette smoking is a good thing to do, even though your goal is really to fight evil, or if you're trying to fight capitalism, or you're trying to get your name in the media, that they've got some other objective, and they're using this as the means to do that. And I think that causes a lot of the harm in this field, because if somebody's view is, you know, I'm doing public health, but what they really mean is I hate capitalism and I'm going to destroy it. And that's why you see them saying they're fighting big tobacco, but what they're really doing is trying to put vape shops out of business. Because they see that as part of capitalism. Or they're trying to fight the upstart companies that threaten big tobacco because they don't like that sort of thing going on. That's interesting.
04:59 - 06:19
[Harry Shapiro]
I had a very interesting conversation with somebody who was one of the less robust members of what used to be called the Framework Convention Alliance. They're called something else now, the global something else. But there was a group of NGOs who were the only group that were allowed to attend the Conference of the Parties, the FCTC. because they basically towed the party line on tobacco control and safer nicotine products and all the rest of it. And I said to this person, I said, a similar sort of question, what lies beneath? What's going on here? And she was quite candid. I mean, she said, there's a lot of, faith-driven feeling running through a lot of the NGOs. And that's across religions. It's not particularly Christian or Muslim or Buddhist or whatever. In different ways, they've all got this idea of the body is sacred and about purity and all of that kind of stuff, which is all well and good until you start applying it. in the sense having either the political or the financial power to actually bring that about at the expense of other people.
06:20 - 10:10
[David Sweanor]
Well, I think also what we find is there's clearly this very religious subtext to what many people are doing. But they're doing it in a context where they themselves have had no theological training. They have never thought through these concepts. So that if you were to try to talk about something being bad with people who are involved in seeking prohibition on things like nicotine, It's very concrete that no, you shouldn't do it at all. Now try having a conversation with a Jesuit about sin and you get great understanding and nuance and trade-offs and understanding things. The same is in law school where you can say to a first-year class, do you think it's okay to smash the window of somebody else's car? And everybody says, no, of course not. What if it's a very hot parking lot and there's a child strapped into a seat in the back of the car? And they'd be, oh, well, then that case. Or, well, what if it's that situation, but there's a policeman nearby and you can take the class through all of these things and you get to the point of, well, it was an empty truck, but it was slipping into gear on top of a hill and there's a children's party at the bottom of the hill. You're now a hero for vandalizing the truck. And if people don't have that sort of training, if they just see black and white, and the sort of work that we've seen in moral psychology, and Professor Lynn Kozlowski and others had a great paper on the moral psychology aspects of the debates about smokeless tobacco in the United States. This was before there was vaping. And people who take a purity standard, you know, that not autonomy, not the I need to give you the information, empower you to make better decisions about your life, but the purity that... Harry, I just, I can't believe that you would think something like that, that, you know, the body is a temple and somebody, I mean, I feel disgusted that you would even think that this would be possible, that somebody could put a drug into their body. Very, very concrete. Very determined. and very wrong if they actually start to think this through, which we've seen historically where it's actually been some people with very fundamentalist religious beliefs who have been on the forefront of making changes on drug policy because they can deal with the nuance that, yes, I think it is a sin for somebody to use a drug, you know, whether it be sticking a needle into their arm or smoking a cigarette. But I think it's a greater sin if they are prevented from doing something that can protect their life or the life of their partner or an unborn child, And I'm responsible for that. I am now creating a greater sin. Therefore, I must do something. Which is why we've seen really advanced harm reduction policies in places like Iran on drugs. And why it was people in the Nixon administration who were fundamentalist Christians who were the ones who came around to saying, we should be talking about clean needles. So if people can think this stuff through, The challenge we have is that so many people in the field who take a prohibitionist approach, as has been discussed here by various people, refuse to talk. People I've worked with for decades who decide that they cannot talk to me because I support harm reduction. I say, well, what about liberalism? What about the principles of enlightenment? Like, you know, what about simply sitting down and having a conversation? They can't do it for whatever personal reasons they have. And that prevents them from thinking it through to say, wait a minute, you know, maybe prohibition isn't such a great idea. Maybe I need to be more pragmatic.
10:10 - 10:21
[Harry Shapiro]
I think there's this sort of sense of being infected by your... Yes. There's a public health dimension to this, that you will pass the virus of tobacco on. Exactly.
10:21 - 10:41
[David Sweanor]
I mean, if we look at this historically, what was the issue with witches and with heretics and with commies? You know, it was all that they will infect other people. That, you know, you may not be a witch or a heretic. But I saw you talking to somebody we're pretty sure is a witch or a heretic. Therefore, you know, to be safe, I have to totally shun you.
10:41 - 11:11
[Harry Shapiro]
Right. Let's talk about the second theme, which is like opposition to innovation. Sure. So where does that kind of fit into it? Because You know, obviously, you know, there's plenty of examples in history of, you know, companies who've resisted change and they've gone bust because they haven't. But that's not what you mean when you talk about... No, no, this is... What...
11:11 - 15:28
[David Sweanor]
Celeste Juma has wonderful stuff on this, and I'm just going to pull it up. He was a Kenyan Harvard professor who was to the leading edge of understanding why is there so much opposition to innovation? You know, things that change the world. that we end up seeing as very good things, but initially they're heavily opposed. Now, he wrote his book before there was vaping. It's called Innovation and Its Enemies. And just to quote from the book, debates over new technology are part of a long history of social discourse over new products. Claims about the promise of new technology are at times greeted with skepticism, vilification, or outright opposition, often dominated by slander, innuendo, scare tactics, conspiracy theories, and misinformation. Now, he goes on from there, but that's exactly what we encounter when we look at alternatives. to cigarettes. It's innovation and there's this strong opposition to it that comes from people with vested interests and the status quo. People are just simply afraid of something. The whole idea of what if? What if something bad happens here? And It gets in the way of progress, but we've seen it historically. You know, the opposition to coffee when coffee came out makes the opposition to vaping now look pretty mild by comparison. I mean, nobody is subjected to the stuff Murad IV did in Istanbul of the first time we find you drinking coffee, you will be whipped. And the second time, you would be sewn into a sack and thrown into the bore for us. And Frederick the Great saying that they've got to prevent people from drinking coffee because if they drink coffee, they'll drink less beer. And that would be a terrible thing for the world. I mean... The opposition was just so strong, but the opposition to farm mechanization, the opposition to refrigeration, the opposition to pure foods, that it's been just this extraordinary history, and that it eventually collapses, but we're living through it again. And so much of what we do, I've always thought of as, it's like watching the same Shakespearean play you've seen 30 times. And somehow thinking there's going to be a different outcome. I think Caesar's going to be okay this time, Harry. So this is just, it's common. It's just, it's the way it works. As a species, we see this happening again and again. And as Alex Wodak said in his oration series, We are going to see the change. It is happening. It's happening quickly. The question is, how do we speed that up? You know, it's like the eradication of smallpox, which is also opposed by a whole lot of people and bureaucratic obstacles, et cetera. But... How do you speed it up? Isn't it great that we got rid of smallpox as rapidly as we did? Wouldn't it have been even greater if we got rid of it sooner? And in this case, to say we still get eight million deaths a year. How do you speed that up? We can see the transition happening. We can see the slope of that curve, and we know, Leighton Christensen says curves, what's gonna happen to that innovation curve? How do you speed it up? And so how do you understand where that opposition comes from in order to be able to head it off? Why is it that the United States in particular has this long history of pushing abstinence, but not just for yourself as a form of purification, but something you need to impose on others and on the rest of the world? You look at John D. Rockefeller and alcohol prohibition. You know, a wealthy American spending a lot of money to try to push an abstinence agenda worldwide. You know, what happened with the United States on drug policy? You know, it's an abstinence-only view, but it wasn't good enough just for yourself or just for your own country. You have to impose it on the world. And then eventually you get the changes. So John Rockefeller Jr., by the time he came along and said, wait a minute, prohibition is a disaster, and changed his view, and that changed history.
15:28 - 15:41
[Harry Shapiro]
Which kind of leads on to the sort of third dimensions of all of this. There are many dimensions, but let's go with the third dimension, which you've identified in lack of imagination. Right.
15:41 - 18:38
[David Sweanor]
Well, for so many areas of policy, the line about, for everything, there's a really straightforward, simple answer that's wrong. And there are more nuanced, complicated things that actually work. And when we look at the easy answers, and in fact, I see it as like, rate out of fast and slow thinking, Daniel Kahneman, that how do you move something from the limbic system to the frontal lobes? How do you go from just being appalled by something and very emotional in your response to it to actually thinking it through? So prohibition is the easiest thing to say. They should just stop that. I'd see people on the street and they're using drugs. They should just stop to saying, let's understand why they're there and what they're doing. and what we can do to intervene that can reduce their risks and eventually get them housed, etc. That's more nuanced. That's frontal lobe stuff. And I found it quite interesting, disturbing that in the tobacco control field, when we had meetings on things like, how do you get to a smoke-free and then became a nicotine-free society? So seeking ways to get rid of cigarettes. And we have this really long history of how we fundamentally changed all sorts of other products, services, behaviors to greatly reduce risk. Good luck finding Lydia Pinkham's vegetable compound on the shelves of any stores now. Good luck finding cities that have contaminated water supplies. You're gonna have real trouble getting cholera in London these days. We've changed those things, but You've got this simple stuff of endgame. We're going to end this, not by doing the things that work, that take some thought, but prohibition. And if you look at the endgame strategies that people came up with, virtually all of them are permutations and prohibition. What if we just remove the nicotine from the products? What if we forced the companies to sell a little less each year until they couldn't sell any at all? And it's quite extraordinary that you get very well-educated people who have backgrounds in the field who I'm sure have studied how we got rid of impure food, unsanitary conditions, contaminated water, the sort of snake oil medicines, the unsafe automobiles. And instead of saying, oh, yeah, it's the same thing again, it's that knee-jerk limbic system fast thinking, we just need to prohibit it.
18:38 - 18:52
[Harry Shapiro]
Because, I mean, I suppose, A, because it links to drugs. which is like, you know, one of the big, big evils. You know, I mean, dodgy brakes in cars, not great. Drugs, wow.
18:53 - 20:03
[David Sweanor]
There were people who argued against auto safety, saying that this is a really bad idea because it would encourage bad behavior. People would drive more recklessly. And what you really needed is a spike on the steering column, right in the middle of the steering column, so drivers would really pay attention because the least... and they're gonna die. And if you make them safer, we'll just get people driving way more recklessly, they're gonna have more accidents, et cetera. Those, they were moralistic arguments, right? The drivers are sinners, they have to repent. And we see this over and over again, essentially saying, even though it's supposed to be an issue of health, public well-being, that people need to repent, they need to do penance, or they face perdition. You've got to feel really bad about what you're doing. You've got to work really hard to overcome it. That's why things like using vaping to quit smoking is like being sent on a pilgrimage but deciding to take a dirt bike instead of crawling on your knees. It's not acceptable. And if you don't quit, if you don't repent in the way they want you to repent, Terrible things will happen to you. You'll lose your soul, or in this case, you'll die of the disease.
20:03 - 21:02
[Harry Shapiro]
From a political point of view, I mean, a lot of the sort of knee-jerk, fast-thinking things, I think, comes from political short-termism in the sense that politicians... we'll be obliged, we'll often make bad decisions about everything in public, whether it's defence, transport, health, finance, you name it. But as long as that decision works politically, we'll go for it, which means pandering to voters and getting some good headlines in the media. And they're not thinking through legacy, which I think is what we discussed. See, even if you do something good... In a few years, a politician could turn around and say, well, we don't like this. We're going to change the law. I mean, look what happened with women's rights on abortion in the States. They must have thought it was a slam dunk until what's been going on there.
21:03 - 22:41
[David Sweanor]
I think this has become much worse because of social media. And there's many people who have written on this that It really is an enragement machine, trying to get that emotional reaction. So if you're saying, kids, kids, did I mention kids? The poor, sweet, innocent things. That's a very emotive thing, as opposed to saying, let's do a risk benefit analysis. Let's understand trade offs. That doesn't play well in social media. That doesn't enrage people. It doesn't get the anger up. It doesn't get the clicks. So we have lost the ability to have good thinking pieces, like the sorts of things that think tanks are still coming up with, but tend not to get nearly as much attention because it doesn't play well on TikTok or X or whatever. But also, we don't have the media we used to. Early in my career, I could work with investigative journalists and say, I know you think such and such, or the editorial position of your paper is such, but I don't think you're right. And I'm willing to pitch a story to you. And then they say, yes, my editors have given me a month to put this together. That doesn't happen anymore, where you can give them papers to read, contacts, here are the people who oppose me, here's their arguments, talk to them, I'll tell you why I disagree with them, they can tell you why they disagree with me. You figure this out, you've got a month. And now it's people saying, David, can you get back to me by three o'clock, because I have to file three stories before four.
22:41 - 22:44
[Harry Shapiro]
It's a 24-7 cycle, isn't it?
22:44 - 23:13
[David Sweanor]
So it certainly disadvantages the seeking of truth, the thinking of reason, the idea of the enlightenment, science, reason, humanity, of liberalism, of challenging ideas to say, I think we're losing a lot of that. We're still winning when we look at the transition away from cigarettes. But it's like we're in a boxing match with one arm tied behind our backs now.
23:13 - 23:31
[Harry Shapiro]
It's interesting what you say about, you know, how can we speed up the transition? In some ways, when you start talking about AI and deep fakes and all the rest of it, you actually want to start putting the brakes on that. You want to start rolling back on some of this stuff. Because it's running away with us, isn't it?
23:31 - 25:15
[David Sweanor]
The fear of innovation, we get the same thing. The opposition to data centres. And in some cases, like opposition saying, because they use so much water. How do you feel about a golf course? They use more. But that again, that's frontal lobe stuff. So I think we can see where the issues are here if we're willing to look, but I think this field needs more cultural anthropologists, probably more than more epidemiologists to understand where this is coming from. And then for the players involved, the people who are coming with the new products, to understand this isn't about science and health, because they keep getting beat up on that. They keep coming up with products and say, look at this, it's massively less hazardous. Consumers like it will save millions of lives. I'm sure the public health people are going to welcome it. And they get hammered because they're not understanding the sociology of this, the politics of it. that it's not hard to commit with products that are massively less hazardous than cigarettes. What's hard is the politics of get the politics right and you can accomplish a great deal here. And we do have a history of people managing to do things like that. How was it that people were able to deal with other problems areas that used to cause moral outrage, like should women have the vote? Should women be able to own property? Should women be able to have a bank account? Should women have access to contraception? What about single women, should they have? And these were huge battles, many of which are only resolved in recent years in many countries. But people fought it, and they understood it was a political battle. You know, it wasn't just about the science. It wasn't to be able to say, no, this birth control is safe and effective. Well, that was the problem for the people who are opposing it.
25:15 - 25:56
[Harry Shapiro]
But, I mean, in this particular space that we work in... I think a good part of the problem is the fact that the products themselves are coming out of big tobacco. They're coming out of the big companies, although in the vaping world it's more like Chinese products rather than big American companies. But that often is the... At least one of the stumbling blocks because look we can't possibly trust these people look at the history of egregiousness I think that's that's that's used as an attack piece.
25:57 - 26:55
[David Sweanor]
Yeah, but you look historically Vaping did not come from big tobacco. Vaping was a threat to big tobacco and As vaping started to take off, the share price of the major tobacco companies fell by about half. They lost 300 billion US dollars of collective value because the world, the investing world said, these companies are no longer looking sustainable. They're looking a lot like Blackberry did when the iPhones came out. So they're still making lots of money, but this might not last very long. And they were rescued by anti-tobacco people who got in the way of the startup companies, got in the way of vaping, and came up with regulations that basically handed much of the business to Big Tobacco. But even if Big Tobacco was doing this, isn't that what you want? You know, if I said, I'm opposed to auto safety because Volkswagen's got into auto safety. Isn't that who you want to be involved in auto safety?
26:55 - 27:07
[Harry Shapiro]
Yeah, it feels like saying, you know, we... We don't want electric cars because they're still being made by Toyota and Nissan and all the rest of it. And they make combustion engines which cause pollution.
27:07 - 27:15
[David Sweanor]
How do you get the discussion up into the frontal lobes? And if we can do that, I think we just speed up the demise of cigarettes.
27:16 - 27:39
[Harry Shapiro]
Which I think is an absolutely wonderful way to end this discussion. Thank you so much. It's been a pleasure. Wonderful talking to you, Eric. Cheers. Thank you. So there you go, folks. That's the last of our unfiltered interviews. Hope you enjoyed it. Go back and have another listen to the other ones as well. And hopefully see you next year.