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0:00 - Intro
0:59 - Bengt Wiberg on the potential of snus and challenges faced by users outside Sweden
9:04 - Martin Cullip on confused messages about vaping from the Canadian authorities
13:08 - The Government of Kenya has revealed plans to raise excise tax on nicotine products
15:08 - Will Godfrey tells us about what happened at the E-Cigarette Summit
17:52 - Brent Stafford of RegWatch interviews Ronald Dworkin
41:27 - Closing remarks


Hello and welcome, I’m Joanna Junak and this is the next GFN News on GFN.TV. In today’s news:

Bengt Wiberg, snus user and consumer advocate, will join us for the second part of our interview about snus.

Martin Cullip, International Fellow at the Taxpayers Protection Alliance Consumer Center, on confused messages about vaping from the Canadian authorities

The Treasury Secretary of Kenya has revealed plans to raise excise tax on nicotine products. Joseph Magero, the chairman of the Consumer Advocates for Smoke-free Alternatives Association will tell us more.

And after the news, Brent Stafford of RegWatch interviews Doctor Ronald Dworkin, an American anaesthesiologist and political scientist.

In the last episode, Bengt explained why snus is so popular in Sweden and explored what is internationally known as "The Swedish Experience". In today’s episode, we will hear more from Bengt on the product’s potential and the challenges snus users outside of Sweden face.

Joanna: Thank you, Bengt, for joining us again. Snus has been beneficial in reducing smoking rates in Sweden. So why is it banned in the European Union?

Bengt: That's a very good question. Basically, I would say it's due to politics. I asked Dr Karl Fagerstrom: why, how come it is so difficult to accept news in the European Union? And Karl Fagerstrom replied to me it's much more difficult to admit that you have been wrong. And that is probably why. It started in the end of the 80s, there was a very aggressive marketing for a brand called Coal Bandits in the UK. So UK actually proposed to the European Union to ban Snus. So as of today, Snus or smokeless tobacco that is used for sucking, that's the quote from European Union is banned, while products such as Chewbaccs, which looks identical to Snus, but it has cut tobacco instead of grain tobacco that is allowed. You have very dangerous forms of smokeless tobacco coming from Africa and Asia, which can be bought in any European Union country. So the only product, the product that has made Sweden more or less smoke free is still banned in the European Union. And I was there in the Snus trial hearing, together with the New Nicotine Alliance in January 2018, and to hear the EU lawyers saying that the reason why Swedish males have stopped smoking is due to paternity leave or the healthy living style of Swedish men. And of course this is 100% fake facts. There is no such evidence whatsoever. However, we do use Snus in a much higher degree than we are smoking. You can find Snus very much in Sweden, of course. Norway, Canada, United States, Japan, Korea and other countries. As for myself, I think Snus should be available in any country in the world where there are still a lot of people smoking.

Joanna: How did Sweden manage to escape the Europe-wide ban?

Bengt: I would say it's quite simple because we have such high rate and long 200 year tradition of Snus use in Sweden. So when Sweden was joining the European Union, The Swedish government said that we will not join the European Union unless we can continue using our Snus. So Sweden got an exception, which is permanent in the European Union. And the only reason to, how do you say, to ban news use in Sweden, is that if every European Union country is banning it, including Sweden, and that will never happen because, like I said, over 20% of Swedish males are using Snus, and close to 10% or maybe 8% of the women are using Snus. And looking at science, I think it's about 80% of those using Snus are former smoker that had quit smoking for good. So that will never change. And the reason why you can find Snus or moist Snuff products in America is that Swedish immigrants in the 1800s, they brought along with them Snus. So it sort of continued over in North America. In 2019, eight brands of Snus was the first modified risk tobacco product in FDA history. MRTP, which means, actually, that you can market it, and it is, according to FDA, appropriate for public health.

Joanna: A recent study from Finland has shown that snus is becoming increasingly popular among younger adults. Why do you believe they choose this kind of smokeless tobacco product?

Bengt: I can only quote Finnish newspapers and Finnish TV on these days. It seems like smoking is uncool and Snus is cool in Finland. Mind you, as we mentioned before, the sale of Snus is forbidden in the European Union, with the exception of Sweden. But there is no restrictions as to the use of Snus. For example, Sweden and Finland are neighbouring countries, and you are allowed to bring in 1000 grams, which is one kilo of Snus for personal use without any problems at all. And in Finland, there is a lot of border crossings and border sales. In Finland, nicotine pouches without tobacco are allowed, but they have a limit of four milligrams per gram per pouch. But it's funny when something is forbidden to sell in a country. And what we see in Finland, my guess is there are about 200,000 Snus users or nicotine pouch users in Finland, and what we see there without any, how do you say, promotion from the Finnish government. The smoking rates among young adults in Finland has dropped dramatically and being replaced in a high degree by the use of Snus. The Finnish TV, if I remember correct, estimates that the sale of Snus on the black market in Finland is worth some €50 million.

Joanna: Thank you, Bengt, for sharing your expertise with us. A consultation on the Legislative Review of the Tobacco and Vaping Products Act in Canada closed on April 27 this year. The review of the Act focused primarily on vaping provisions and protecting young people from vaping initiation. However, the consultation on vaping seems to be confusing both health policy makers and the public. Joining us today is Martin Cullip International Fellow at the Taxpayers Protection Alliance Consumer Center in Washington DC. Martin will tell us more about the situation in Canada.

Joanna: Martin, thank you for joining us. Can you tell us more about this consultation?

Martin: Yeah, there's been a series of consultations in Canada. I think the first one was on advertising regulations. There was one on raising the nicotine of it or a nicotine cap, sorry, for a 20 mill. And then there was one which finished in September last year, which was a possible ban on flavoured Vaping products. Now they're having another consultation which is ongoing and it seems to be heading in the same direction. But this current consultation has only focused on negative focus, on any positives at all. It said about raising the awareness of health hazards, about the threats to use of Vaping, but there's nothing there to actually accurately educate the public as to what these products can do. And therefore it's come about that only 4.3% of the Canadian public are aware that Vaping products are very much less harmful than cigarettes.

Joanna: Have consumer advocacy organisations been actively involved in the consultation?

Martin: Well, Canada's got a consumer association for rights for vapours. They're working very hard. They had a webinar a few months ago which was in conjunction with healthcare, and then so they are engaging with Health Canada. But Health Canada are very cautious about Vaping products and even the webinar was very strictly controlled as to who could ask questions and who couldn't. But at least they are engagement Health Canada. But how far that will take them, who knows?

Joanna: What do you think Canadian vapers make of the situation?

Martin: Well, I think they're probably as mystified as the rest of us about what's happening in Canada. Canada was at one point probably the most progressive, maybe with the exception of the UK, one of the most progressive countries towards Vaping especially. But then something seems to have happened in the corridors of power somewhere and they've gone completely other way. They used to have ideas of ground-breaking ideas like having risk proportionate messaging on Vaping products, such as this product may cause a dependent on nicotine, but it's far better for you than smoking messages like that, positive messages. But those are vanished now and they're now seeming to go the other way into a more prohibitionist approach. And we don't know if that's come about because it's been swayed by what's happening in America or because maybe some funding has come in. But it's such a shame because the same division in Canada that deals with harm reduction in drugs and has very progressive policies towards drugs are doing the complete opposite when it comes to harm reduction for tobacco.

Joanna: And what do you think will happen in Canada over the next few months?

Martin: Well, it seems to be, at the moment direction to travel in the wrong way, but hopefully working hard. As I said, my organization put in a concentration response. I know some very prominent advocates for harm reduction have done the same and it would be nice if those responses were read and some of the ideas were taken on board. And whoever is pulling the strings there and whoever has changed the progress from harm reduction to against it, hopefully they'll have a rethink and we can see something more positive, but who knows?

Joanna: Thank you, Martin. The Kenyan Treasury Cabinet Secretary has recently announced proposals to change the excise tax on nicotine e-liquid with the aim of reducing accessibility for users including school children and young people . But these new proposals could ensure smokers who are looking for safer alternative products keep smoking, or help the black market in unregulated vaping products to flourish. We asked Joseph Magero, CAASA chairman, a few questions. Joseph, can you tell us who has proposed a higher tax on e-cigarettes and why?

Joseph: Thank you for the question. So, in the finance bill, the Cabinet Secretary revealed plans to more than double the excise on tobacco free products. The average tax increase for excitable goods was 10%, with nicotine products being the only ones hit with the 108% increase. So this was the Cabinet Secretary for the government, for Finance.

Joanna: What would be the impact on smokers in Kenya and in Africa more widely if the bill comes into effect?

Joseph: So prohibitive taxes on negative pouches and electronic cigarettes are putting these safer options out of breach. For millions of smokers who are desperate to quit, this increase is aggressive in so many ways, as well as making people alternative affordable. The tax sentence, the message that they get a town full of traditional cigarettes even though they're helping to reduce tobacco store in more progressive countries across the world. Now, what do we expect with the increase in taxes? This will deter smokers from using tobacco because it will cause lives of results.

Joanna: Now we will cross over to Will Godfrey, who attended the annual e-cigarettes summit last week. Hi, Will.

Will: Hi, Joanna.

Joanna: What were some of the most significant things to come out of it?

Will: So the Ecig summit hosts talks and discussions with many scientists, policy experts and consumers. But it's particularly notable as a rare forum for FDA tobacco control officials to be publicly questioned. As you can imagine, with many THR proponents angry about the agency's failure so far to authorize more than a handful of Nonflavoured vaping products, there was plenty of tension in that room, and some of the sharpest exchanges concerned misinformation. Kathleen Crosby of the FDA's Center for Tobacco Products delivered a presentation in which she patted her agency on the back for its youth prevention campaigns, which, as you know, have been widely criticized for bias and fear mongering. In particular, she lauded what she described as the effectiveness of linking nicotine withdrawal to anxiety and depression in mental health messaging to youth.

Joanna: How did delegates respond?

Will: Quite angrily. Dr. Jaschet Aliwalia of Brown University asked whether in the wake of the Truth initiatives notorious depression stick campaign, it wasn't inevitable that the wider public in a country, remember, where most doctors wrongly believe that nicotine causes cancer. Whether the FDA's messaging doesn't make it inevitable that the public will see nicotine as blamed directly for depression. He accused the FDA, as many others have, of spreading misinformation and THR advocate, Clive Bates was applauded when he asked, is it ever right to exaggerate risks to get the behaviour change you want? Is it okay to imply by a mission or commission that vaping is as harmful as smoking just because you want to deter young people from using these products? What's the ethics of doing that, misleading people to get behaviour change?

Joanna: And how did the FDA officials respond?

Will: Well, Matthew Holman, another senior figure at the FDA Centre for Tobacco Products, was involved in a turt exchange on one panel with advocates like vape shop owner Mark Slys. There are a lot of restrictions on what we can say, how we can say it, the process we have to go through in order to say it publicly that are really challenging, Holman said. And despite what people like you think, we do try our best to communicate that stuff. No, Bates retorted, I do think you try your best.

Joanna: Thank you, Will. And now, we go over to Brent Stafford and his guest, Doctor Ronald Dworkin, who delivered the Michael Russell Oration to the Global Forum on Nicotine in 2019. Doctor Dworkin is an anaesthesiologist and political scientist who writes on medicine, philosophy and society. In today’s interview he will tell us more about how the medical profession reacts to tobacco harm reduction and attitudes towards e-cigarettes. 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 The struggle to secure nicotine vaping products as a viable alternative to smoking grows more frustrating by the day. While the science on vaping continues to show it can be a successful tool to quit smoking, possibly saving tens of millions of lives, the attacks against vaping grow more virulent. Why is that? Vaping supporters are simply asking public health, politicians, and regulators to embrace the common sense of harm reduction, but is this request a bridge too far? Joining us today to discuss this question is Dr Ronald Dworkin. Dr Dworkin is an anaesthesiologist, political scientist, and author of four books and numerous magazine essays. He’s a lecturer at George Washington University Honours program and previously served as the Dir. of Medicine, Society, and Culture program at the Hudson Institute. Dr Dworkin thanks for coming on the show.

Ron: Thanks for having me.

Brent: You have an article published on Quillette titled “The Ideological Aversion to Harm Reduction” which you start off with an analogy between putting a patient under general anaesthesia and how the medical profession perceives harm reduction. Please explain that for our viewers.

Ron: Well, I started the essay by saying how anaesthesiologists are unusual among doctors and that they like combative patients, at least when patients are waking up from anaesthesia. It means that the patients have the spirit to overcome the anaesthetic and fight the breathing tube in their windpipe and return to life. And if the patient doesn't fight back, it usually means there's a complication of some kind. Now, most doctors, of course, don't like this. They prefer passive patients, patients who take orders from their doctors and do what they're told to do. And it is a reason I said why I thought a doctors think harm reduction is sort of strange. The idea of letting patients fight back, ignore the ideas of good health, ignore doctor recommendations, engage in activities that are a little bit harmful and maybe less harmful than the extreme activities, but still somewhat harmful. For example, using clean needles for illicit drug use rather than dirty needles, or using e-cigarettes rather than tobacco to get set to get nicotine. All this seems rather odd to physicians, and for this reason, doctors have not been leaders in any of the major harm reduction movements, whether in e-cigarettes and smoking or needle exchange programs and opiate abuse or birth control and safe sex. Safe sex technologies and the sexual revolution or the designated driver movement and alcohol abuse. Doctors have come around on these issues, but they were never leaders on them. That was the reason.

Brent: Smoking provides some unique complications around surgery, does it not?

Ron: It does. Anaesthesiologists are always concerned that smokers will have poor blood circulation. They have respiratory complications, more complications after anaesthesia. So we always ask for a smoking history before an operation because you can have serious problems if you have a history, long history of smoking.

Brent: So what then brought you around to the concept of harm reduction and specifically tobacco harm reduction?

Ron: Well, I got interested in the subject of harm reduction while working on a larger piece about the public health establishment in the US. How I thought I had grown a bit arrogant and gone beyond the traditional aspects of public health, for example, infectious disease control and quarantine, and had ventured into other areas for example taxes, domestic violence, foreign policy, race relations and so on. Armed with a scientific method and using a little bit of a philosophical sleight of hand, public health, I thought had basically turned every human malady into a potential public health problem, giving them the right, they think, to have a seat at the table and make policy on it. And included in this new list of activities that public health had arrogated for itself was people's everyday behaviour and that includes smoking and the fight against smoking. I will say right out was an important accomplishment of public health. But the problem is that the excitement of public health experience in taking over all these new projects, including everyday human behaviour, is that they brought the scientific method to bear and a certain arrogant idealism to bear ideology. I call it on everyday life problems and as a result I began to ignore reality. They began to ignore human nature. The fact that some people will want to stupefied themselves with alcohol or nicotine, for example, the old sane man and women were pharmacologists before they were farmers because they like to stupefied themselves. And so rather than make the world perfect where people would not smoke, for example, public health was trying to ban the intermediate or the compromise position where you could use nicotine, maybe not in the form of smoking, but safely in the form of electronic cigarettes. And I thought their opposition to this compromise position, motivated by this extreme ideology, this idea of perfecting human beings, was unreasonable and too idealistic and, as I said, arrogant.

Brent: Do e-cigarettes work? Do they do the job that's promised by advocates?

Ron: Yes. I think they I think they do. E-cigarettes are a compromised way of receiving nicotine. Safer than using tobacco. There is no carbon monoxide. There's not the problem of tar and other carcinogens. It is a safer method of taking in nicotine than using tobacco. So I think it serves that purpose well.

Brent: So, Ron, when it comes to tobacco harm reduction, does it save lives? And I guess, you know, is it a valid strategy, you know, compared to say, you know, something for hard drugs?

Ron: Okay. I do think tobacco harm reduction saves lives. The best thing would be if people didn't smoke at all, but it's difficult for them to stop smoking. As I just said, people do like to stupefied themselves with different chemical agents. If you look at the United States, 60 million Americans use a sleep aid at night. 30 million Americans are on antidepressants. 15 million Americans are on anti-anxiety agents. 15 million Americans abuse alcohol. 65 million Americans are binge drinking at least once a month. 2 million Americans use opioids. So people are not going to stop supervising themselves with agents. And so if they're going to use nicotine as their stupefying agent of choice that I prefer, and I think it's reasonable to infer that it's safer to do so with electronic cigarettes through vaping, without the tar and the other carcinogens, carcinogens and without the carbon monoxide found in tobacco. These things cause cancer and other conditions, so it's better to use e-cigarettes than tobacco. Is it even better to use nicotine patches and chewing gum instead of electronic cigarettes? Perhaps. But some people like the experience of inhaling. And if that's the case, and as the choice between the using tobacco or not using the nicotine patches, then it's better for us to have an intermediate position, which is the electronic cigarettes or the vaping. We don't want to have the perfect become the enemy of the good.

Brent: You know, Dr Dworkin, I like that term stupefying agent. In a way, it seems that public health, you know, does just simply does not want the stupefying of nicotine to whatever extent that is to be allowed. Whereas say like a nicotine patch provides no stupefying.

Ron: Yes, I think that's true. When I mentioned that public health is taking for itself increases its portfolio to include many other aspects of life, including everyday life and the fact that many people like to stupefied themselves with substances and have done so for thousands of years. It's as if the fact that they do so is a public health malady and has to be fixed. But the problem can't be fixed. It can be controlled for in some ways made safer for both people who use these agents and for society at large. But you'll never rid society of it. And so I think it's better and more sensible to accept that fact than to try to police all kinds of superinfection and get rid of it altogether, which is impossible. It can't be done.

Brent: Is nicotine, the demon that Vaping opponents have made it out to be.

Ron: I think no, not relatively speaking. I mean, compared to the other highly addictive, stupefying agents. Cocaine, alcohol, heroin. Nicotine is much safer. At the very least, it's not mood modifying or impairing like the other substances I just mentioned are. Nicotine is not perfectly harmless. Harmless. It is a drug. Sugar and oxygen, for example. They seem perfectly harmless, but they are also are drugs. And if using correctly, they can cause problems. And so in the case of nicotine, if it is a drug and not perfectly harmless, then doctors think, why risk any problems by taking nicotine at all? Just don't take any nicotine. That's the health ideal. And so a policy like harm reduction where you're going to accept a little unhealthy activity as something acceptable as a baseline. That does seem strange to doctors.

Brent: So what's blocking then? Progress in the medical? What's blocking progress then with the medical profession in terms of accepting harm reduction.

Ron: As the point. I just as I just mentioned, the philosophy behind harm reduction does seem strange to doctors. That's part of it. Also, I should note that doctors, like all people, are creatures of habit and they like new things and new approaches. But sometimes it's just easier to practice, as one has always practiced and not do the new thing, which comes with a learning curve. And so inertia may be another reason why doctors are not interested in harm reduction.

Brent: And how much do you think that the Evali scare might have played a role in setting back?

Ron: Oh, I think it did play a role and unfairly, I believe the problem with the Valley Square where people got these serious lung infections and some of them died. It wasn't the e-cigarettes, electronic cigarettes. It was many of the users. Users had laced their electronic cigarettes, their vaping devices with cannabis oils, and they had tampered with the devices and sometimes they had purchased them from informal sources. So the problem wasn't the electronic cigarettes. Indeed, cannabis is more of the problem, but doctors grew scared like other people did, especially when they're already predisposed against e-cigarettes in the first place. And that really hurt the vaping cause.

Brent: It occurs to me that the problem with the Valley was a real problem with public health. Because it was such a powerful tool for them.

Ron: Yeah. There's no question that Evali scare was leverage to lead to both on the state and federal level aggressive policing of Vaping and more regulation Vaping and making Vaping almost getting rid of Vaping in certain states. It was the occasion. It was the the useful method, the crisis waiting, the opportunity that had waited for the crisis. And that was the crisis. And the people who did not like Vaping, they use it as the opportunity to get rid of Vaping. So that's what it was. It was a useful political tool to go against Vaping.

Brent: In your recent article in Colette, you make a point that surprised me, that two thirds of doctors as of 2018 actually, you know, are pro, to a certain extent, ends products for use for people who are smoking. But I mean, that stuns me because generally the medical profession seems to be the biggest problem.

Ron: Yeah. There has definitely been a sea change among doctors on the question of vaping and electronic cigarettes. They're more accepting of electronic cigarettes than before. But as I noted in that essay, the medical profession coming around in our new health care issue isn't usually enough to push it forward. What is usually needed to advance things is a more broad based ideology that resonates with larger public and happens in the case of other movements. That doctors were not particularly advancing or involved in usually was not the medical profession that pushed things forward. It was an ideology and non-doctors who did so. So for example, as I mentioned the essay, the fitness and diet craze that was pushed forward not by doctors but by public health people, for example, or corporations that were worried about the productivity of their workers. And they had an ideology behind it with its own code word. The word is lifestyle, the same as the case of chronic disease. It was a problem, but doctors pretty much ignored it. They were much more interested in acute disease and even as late as the 1970s. But it was pushed by public health people in this case and others, and the ideology had its own catchword again. And that catchword was wellness or sometimes healthy aging. And even in the other cases of harm reduction, again, doctors were not pushing this. They came around eventually, but they didn't push it. They didn't move it forward past the goal post. In the case of birth control that was pushed by non-doctors and the ideology, there was usually feminism, my body, my choice and the case of alcohol harm reduction. It was the designated driver concept or slogan and that was pushed by public health people and the Hollywood people actually. So doctors, they come around eventually, but they don't lead. You should. They don't lead. And if they do lead, it's not enough.

Brent: Now in the article you also mentioned that non physicians drunk on ideology are responsible. So are these the people and the kind of ideological thinking you're talking about?

Ron: Yes. When I talk about an ideology, I'm referring to a doctrine or a set of principles that resonates with part of the public, and it has an element of hope and aspiration in it. Not just the drive to make the world better, but also to create a kind of utopia. And what's holding back Harm Reduction now in the area of tobacco and opioid abuse. It's not the practical people. It's not, say, the doctors. They've come around, but it's the non-doctors who are filled with ideology and who imagine a more perfect social order, a more perfect human being, where no stupefied agents of any kind are use, and where people search for happiness only with prescribed and healthy groups. And one finds ideology at work among the public health people, among politicians, among laypeople with no medical background, but who, for example, may be acting as counsellors. They are the main reason that harm reduction is being held back, not the doctors.

Brent: So which side within the political spectrum, you know, is this more applicable to? Is it a left or right issue or both?

Ron: Well, the ideology against Vaping is mostly found on the political left, including the public health establishment is less on the political right. One of the reasons is that most smokers come from are mostly low income working people or what might be called lower middle class. They like vaping and they need vaping to get off cigarettes, get off tobacco. These people tend to vote Republican. And so the conservatives or the right tries not to antagonize them and not try to tries not to push the vape anti vaping issue. Also, the public health establishment tends to swing left and one of the public health's great achievements is exposing the dangers of smoking and anything that suggests backtracking any way on smoking. In the case of e-cigarettes, the idea of any kind of nicotine delivery device is opposed reflexively, reflexively. That's why anti vaping is largely on the left and not the right.

Brent: Would you say? Or is it true that anti Vaping ideology has become hygienic?

Ron: Well, it is in the sense that without an opposing ideology to fight the anti-Vaping ideology, the Vaping course was not going to advance, I'm afraid. The problem is the problem for the pro Vaping people is not the lack of good science or not having the ear regulators. That's not the problem. The problem is more of an ideological one. It's more a problem of public opinion. Or you might even say public relations. Unless the Vape movement understands that, it will continue to face these huge obstacles.

Brent: I know that many people who are vaping advocates are frustrated by the lack of common sense going on within the debate.

Ron: Yes. Because I think this is the problem with ideology. When ideology is involved, common sense often goes out the window because people have such visions of perfection that they envision that they sidestep common sense. They look at common sense not as wisdom, but as an obstacle, and they find it troublesome. And it's actually interferes with their ability to get to the utopia they want to achieve. So that's a problem. Harm reduction is a very sensible, level-headed, moderate approach to human life, and utopians idealists often don't like that.

Brent: In a way, has Vaping got in the way of their plan for building a better generation of kids?

Ron: Yes, it has. It's kind of the same kind of a peculiar thinking here. The idea that human beings could be made something sort of a strait and follow along a certain groove, prescribe group of safe activity, a reasonable activity without any kind of irrationalities. That's not possible. Teenagers. Teenagers vape or smoke cigarettes. If they didn't do that, they would find some other vice.

Brent: Now let's turn to the right, because on the right, is there not a utopia as well that's in the way for vaping or at least tobacco harm reduction?

Ron: So the issue of Vaping on the right, on the right, included on the right, the political coalition is the religious right to the degree they still exist. And religion has traditional looks with suspicion on all sorts of stupefied agents, because these agents interfere with people's God given free will. And so they don't like him for that reason. But politics overrides this concern of suspicion on the right, I think, because they know that their coalition includes people who like Vaping. So I don't see there's no real antagonism toward Vaping on the right. There is antagonism towards opiate harm, reduction on the right because there is a suspicion towards all agents that produce a kind of euphoria so that there is opposition on the right to cannabis legalization or all kinds of drug legalization, although one finds on the libertarian right there's more sympathy towards that. There's also a law and order aspect of the political right, and they see the crackdown on opiate abuse as another way of enforcing law and order. So it's a little bit complicated, political, right. But in general, I would say that the right is more sympathetic to Vaping, more opposed to opiate harm reduction.

Brent: So what hope is there then? If the right has an aversion to air because of their historical position on hard drugs and the left doesn't believe tobacco harm reduction is a valid application of the harm reduction principle.

Ron: Well, there is hope. But in the case of tobacco harm reduction, you have to change your strategy so that right now the vaping cause it seems dead. But if cannabis could come back from the dead, it was hated and despised in the 1980s. And now it's come back from the dead and it's almost on the verge of legalization of vaping can too. But rather than focus on the science of vaping and working quietly with regulators in the FDA to further the cause of vaping, you have to work more in the realm of public opinion and ideology. As I said in one venue. And the United States government is not sovereign. Public opinion is sovereign, and public opinion moves very slowly. But when it does move, it's decisive. So right now, public opinion, especially the most important aspect of public opinion, which is upper middle class opinion, is opposed to vaping. And so you'll have to turn this around and there are a few things you can do. So first you have to stabilize public opinion. You have to work to decrease people's fear about fears about the teenagers vaping. Some of those fears are overblown. I've cited in that essay Brad Rowe, whose work Brad Rodda is a professor of labour somewhere in Kentucky, who said that rather than 3 million new vapers among teenagers, there's really only 90,000. The numbers are overblown because they included 1819 year olds who are adults, and they also included people who are already smoking. But it scared a lot of people, particularly upper middle class people. So you're going to have to try to make sure you have a way to allay the concerns of those people by not, say, pushing flavours that might be liked by teenagers. And you also might at this stage try to show the medical benefits of nicotine the way cannabis did. Cannabis tried to show its medical benefits in the case of, say, helping cancer pain or nausea. So that's the first stage. And once you've stabilize public opinion, then I think it's important to pursue two tracks. There's vaping for harm reduction, and there's vaping as a consumer product because nicotine, unlike the other stupefying agents, is not that mood modifying. I don't mean a product that is easy to get. I don't mind at this stage, even if nicotine was for by prescription. But I want it to get established that nicotine or vaping products is for harm reduction, but is also a stupefying product that can be used for everyday and happiness anxiety if upper middle class people can use their Prozac and there's no reason to others that cannot either user e-cigarettes if they're feeling down now after that established. The third thing you have to do is you have to have an ideology that is developed to rival the other ideologies along the two tracks. So in the case of harm reduction, you have to have an ideology that acknowledges people are the way they are. They like to stupid by themselves. So we have to let's get real about them. We have to have reality here. The second track is an ideology that declares there is an area, a safe space off limits from the public health establishment and the government in general, where people can live the way they want and vape if they want when they come home from a hard day's work. And this ideology might be an ideology of freedom. And then the fourth phase, tobacco harm reduction would then, I hope, move alongside the other harm reductions, reduction efforts in public health in the portfolio. I mean, there's already safe sex products, designated driver concepts, opiate abuse, harm reduction. I hope the day when tobacco harm reduction goes into the public health portfolio and becomes legitimate at the same time, I'd like for vaping then to become also a legitimate consumer product without prescription needs, something to be enjoyed in the realm of freedom and private life.

Brent: So, Dr Dworkin, the Global Forum on Nicotine Conference in Warsaw, Poland, is coming up this June 16 to 18. I know that you delivered the Michael Russell Oration at FN in 2019. I'd like to ask you, why is a conference like GFA 22 important to the tobacco harm reduction effort?

Ron: Because this is where the ideas for moving beyond the science get hatched, going to other areas such as mobilizing public opinion, improving public relations and so on. To do this, it's not. It's not the kind of thing that is developed in a lab or by combing through statistics alone. This requires dialogue from all the different groups interested in nicotine. And this is why the form is so important. It's one of the few opportunities for all people to get together and for this kind of idea hatching to occur.

Brent: And you think it's a fight that's winnable?

Ron: Definitely. But it'll take time. You'll have to play the long game. Don't forget, it took 20 years. 30 years for cannabis to go from dead to something that's on the verge of legalization. This will take time, too, so you'll have to

persevere. It won't be tomorrow or next year. It'll be ten, 20 years. And eventually I think vaping will be both an important part of harm reduction and will become a consumer product. A legitimate consumer product. But it will take time.

Joanna: Thank you Brent and Ronald for an interesting discussion. 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 another GFN22 speaker, Fiona Patten, Member for the Northern Metropolitan Region in the Victorian Parliament’s Legislative Council. Thank you and goodbye.