In this compelling presentation, Dr. Alex Wodak explores the inevitable and rapid shift from combustible tobacco to safer nicotine alternatives. Moving beyond just the obvious health benefits, Dr. Wodak dives deep into the broader impact of these disruptive technologies and outlines why harm reduction advocates are crucial in shaping future legislation.
Transcription:
00:03 - 02:04
[Fiona Patten]
Thank you, Jess. And welcome, everyone. It's great to see us all back here together. Again, I usually start these proceedings by apologising for being Australian. Please, if there's the one good thing we can do is to show you what not to do. And as I stand here today, Australia is continuing going backwards. But I'm here to introduce the Michael Russell oration that will be by another Australian who probably needs no introduction in this room, Dr. Alex Wodak. Dr. Alex is a retired physician. He was president of the Australian Drug Law Reform Foundation for many years. He's worked full time in drug law reform and tobacco harm reduction as his kind of retirement hobby. But it's far more than a hobby for Alex. And he, as you know, he has been leading this fight, which is why it is so appropriate that he provides the oration today. He's well disguised, our Alex, because he's a radical and he's a lawbreaker and he's sort of like our Clark Kent of harm reduction. He started the first medically supervised injecting centre in Australia before it was legal to do it. He started up providing a needle syringe program, again, before it was legal to do it. And he's had an interest in tobacco harm reduction since 1992. He's been really active in this space, as you all know. He is a friend to tobacco harm reduction. And given the theme of prohibition and public health, I think there was no better person to ask to provide the Michael Russell oration. So please welcome to the stage Dr Alex Wodak.
02:20 - 39:11
[Alex Wodak]
Well good afternoon everybody. And thank you for the introduction, Fiona. Thank you also to the organizers of this conference. It takes a lot of work to put something like this on, and that's much appreciated. As you can see, the title of the talk is Safer Smoke-Free Nicotine Products Will Inevitably and Soon Globally Replace Combustible Cigarettes. And that's really what this talk is all about. And now, as Fiona mentioned, I've been interested in this subject for 34 years now. And the reason for that is that at the third international conference on drug harm reduction, at a time when we were obsessed with the need to control HIV spreading among and from people who inject drugs, I was chair of the program committee of the third international harm reduction conference, which was held in Melbourne in 1992. we decided to invite Professor Michael Russell to come to Melbourne to address the question of whether harm reduction was appropriate for tobacco. So that's how long I've been interested in this question. I'm also interested in the question of why the Global Forum on Nicotine decided to meet in this city, in Warsaw. where the irresistible forces met the immovable mountain of communism. And I think it's such a wonderful symbol for the struggle we're going on with for the last 15 or 20 years, where the irresistible force of harm reduction has met the immovable mountain of prohibition. So I'm going to be talking about and trying to answer eight questions. Is smoking still the world's most important preventable cause of death and disease? Is the minimization of smoking as soon as possible the agreed number one objective? Thirdly, what are the major global trends in smoking in the last 60 years? And fourthly, has the health debate over tobacco harm reduction been resolved? Fifthly, well apologies for this acronym which I'll use repeatedly, Smoke-free nicotine products replace combustible cigarettes. Six, is opposition to tobacco harm reduction a closed thought system? Seven, why is there so much opposition to tobacco harm reduction? And finally, if it's inevitable that safer smoke-free nicotine products will replace cigarettes, why bother intervening? So that's what's on the menu for today. Next please. Now you will be familiar of course with this diagram of per capita tobacco cigarette consumption in the United States from 1900 until 2010. And I want to just draw your attention to two features. Firstly, that peak consumption of cigarettes per capita in the United States was in 1963. So that's 61 years ago it reached its peak, and it's been falling for 61 years since then. Secondly, it's been falling at a rate of around about 2% per annum until around about 2010. Now, this diagram cuts out at 2010, but had the diagram continued up until the present day, what we would see is that the rate of decline has declined from, has increased from about 2% per annum to about 5% per annum. So these are really the remarkable features. Next slide, please. Okay, thank you. So let's tackle the first question. Is smoking still the world's most important preventable cause of death? And the answer to that is yes, but it may not be for much longer because overweight, obesity is struggling to overtake smoking as the world's leading cause of preventable death. Now, in the Second World War, deaths from war were about almost one million per month. But after 1945, deaths from warfare decreased to about a few hundred thousand per year. Still too many, but a great decrease. And that has persisted from about 1945 until now. It's staggering to think that deaths from smoking are 20 to 30 times the number of deaths worldwide from warfare. But those are the facts. Second point I think it's worth making is that much overlooked that smoking greatly exacerbates economic inequality, and it also worsens the outcome for TB and HIV. And this is very, very important for a number of reasons. Firstly, because due to the decisions made by the current president of the United States, HIV will start increasing again worldwide. And that's particularly important in sub-Saharan Africa, where 70% of the world's HIV is in that part of the world. And there's also a lot of tuberculosis in sub-Saharan Africa. So as smoking increases in an area of the world where, which will account for 25% of the world's population by 2050, we're going to see increasing importance of smoking exacerbating TB and HIV in that region and in the rest of the world as well, but particularly important there. So to sum it all up, reducing smoking should be our paramount focus, not reducing tobacco or nicotine. Okay, the second question, is the minimization of smoking as soon as possible the agreed number one objective? Well, it certainly is amongst advocates for tobacco harm reduction. What we want to see is the conventional tobacco control policy supplemented by an encouragement of smokers to switch to smoke-free nicotine products as soon as possible. What do our opponents want? Well, it's not really clear what they want as their paramount objective and it often seems as though eradicating the tobacco industry is their highest priority. What have been the major global trends in smoking in the last 60 years? Well, as you've already seen, the United States has had this rapid decline in per capita consumption over 61 years, but figures from other countries are harder to obtain. And these trends have been masked by population growth in all these countries. And in recent decades, what we've seen is that smoking has been decreasing in the high income countries, but increasing rapidly in low and middle income countries. So the major beneficiary of a rapid transformation from combustible cigarettes to smoke-free nicotine products will in fact be the low and middle income countries where the majority of the world's population lives. A very important event that we should remember and that the British American Tobacco Company is certainly very conscious of is what happened to the Kodak Camera Company. In 1975, that company had some staff who invented the world's first digital camera. The board of Kodak Camera Company decided to keep that discovery quiet. In 1996, Kodak was worth $31 billion, US dollars. Today, that company is worth only $700 million, and maybe not even that amount. And the reason for that is that other companies discovered Kodak how to make digital cameras and we had a rapid transformation from analog film and cameras to digital film and cameras and this was an example of disruptive innovation and the Kodak camera company paid the penalty for this misjudgment by its board. And the traded tobacco companies are well aware of this and other events like this, and they don't want to make the same mistake. They are aware that if they go too slowly in this transformation, they will also be swept away like the Kodak camera company. We have to remember that tobacco companies have been... amongst the best performing industries on stock exchanges for about a century. And this continued even after they were ostracized and forced in 1998 to accept the Tobacco Master Settlement Agreement. Now it's true that their conduct had been beyond reprehensible for a very long time and they had worked hard to be so ostracised and demonised. So decades ago, the traded tobacco companies started realising that the cigarette would soon become obsolete and that they realised, some of them realised that they had to change their products for commercial reasons and perhaps some also wanted to change for humanitarian reasons. I'm less interested in their intention I'm much more interested in the effect, in the impact of these decisions. So Philip Morris International, British American Tobacco, and Altria are probably the three tobacco companies that are transforming fastest from combustible cigarettes and tobacco to smoke-free nicotine products. Some of those traded tobacco companies are only transforming slowly And as far as I know, no state-owned tobacco company has started transforming yet. And we have to remember that the state-owned tobacco companies sell the majority of cigarettes around the world. Tobacco companies switching from cigarettes to smoke-free nicotine products fits most definitions of disruptive innovation. This is a concept that academics studying business formulated just over 30 years ago. And what it means is that disruptive innovations are a new way of doing business to create new markets. They often enter at the bottom of an existing market, and that eventually displaces established market leading firms, products, and alliances. And most disruptive innovations, but not all, succeed. Disruptive innovation started slowly in the smoking world, but then accelerated this century. Swedish snus was the first tobacco harm reduction product, and it's now over 200 years old. It was relatively unknown outside Sweden until recently. Vaping was the next tobacco harm reduction product, and it entered the market in around about 2007. It took a few years before it started becoming popular in the US and UK, and other new tobacco harm reduction products followed. Product improvement in the last 15 years has been extremely impressive. The number of smokers around the world is still around about 1 billion people. the number of people in the world using smoke-free nicotine products increased from almost zero in 2010 to about 180 million these days. So that means that in 15 years, smoke-free nicotine products have captured about 15% of the global market of smokers. And one of the features of disruptive innovations is that they often start slowly until they reach some tipping point, and then after that, growth is exponential. And we're probably seeing that now in the, or about these days, with regard to tobacco harm reduction products, just as we're seeing that now with electric vehicles replacing vehicles powered by internal combustion engines. As more tobacco companies start entering the smoke-free nicotine product market, and these products are rapidly improved, the transformation of the market is likely to accelerate. Now, the consumption of smoke-free nicotine products is probably not just increasing, but accelerating. Philip Morris International began selling smoke-free nicotine products in around about 2014. And in the fourth quarter of last year, smoke-free nicotine products accounted for 42% of PMI's revenue. So the annual growth of smoke-free nicotine products as a proportion of PMI's revenue was almost 4%. The PMI's aim for smoke-free nicotine products is that these will account for two-thirds of their revenue in four years' time. So growth is really increasing rapidly for that company. British American Tobacco, which is the second largest traded tobacco company in the world after PMI, aims for the number of people consuming its smoke-free nicotine products to increase from 34 million as it was last year to 50 million by 2030. They aim for smoke-free nicotine products, which currently account for 18% of BAT's revenue, to account for half of its revenue by 2035. Smoke-free nicotine products have been increasing for about the same time as PMI, but at a slower rate of about 1.5% per year. Now, this is a diagram taken from a financial report of Philip Morris International, and it shows the growth from 2014 to 2025 of the net revenue from smoke-free business, up from zero to 42% in 11 years. The most impressive evidence that I've seen of accelerating growth comes from the compound annual growth rates of different kinds of nicotine products. Is it any wonder that traded tobacco companies want to get out of combustible cigarettes as fast as they can and rapidly transformed to smoke-free nicotine products, given these compound annual growth rates, which I'll show you in a moment. Now, we have to remind ourselves, those of us who don't live in the commercial world, that these transformations involve colossal financial risks. The tobacco companies have to retire products which have made spectacular profits for over a century. that tobacco companies have really been machines for making lots of money. And they have to replace cigarettes with products of unknown profitability that have to be developed at substantial cost. This is a diagram from Goldman Sachs report last year, and it's reporting on the US cigarette market. And on the right-hand side of the slide, as you see it, is the list of the compound annual growth rates of different kinds of nicotine products. And you'll see that in the pale green, which you might be able to see at the very top, just under that black line, you can see that the Heat Not Burn, or for Philip Morris International, that's ICOS, heated tobacco products is another term that's used. This has a compound annual growth rate of 48.3%. Going two down, nicotine pouches in pale blue is increasing at a rate of 21.0%. Vaping is increasing at 9.5%. And then in dark blue, cigarettes are declining at minus 7.9%. These are really staggering figures. And here you can see, as Hamlet would have said, a consummation devoutly to be wished. You can see that Philip Morris International's cigarette shipment volume has decreased from 927 billion units in 2012 to 617 billion units in 2024. These are staggering figures, and here you can see they're being replaced by their shipment of heated tobacco units from only seven billion units in 2016 to 140 billion units in 2024. As one is declining, the other is increasing. We now have seven countries, I believe, where there are more people consuming smoke-free nicotine products than the number of people who are smoking cigarettes. And that includes the United Kingdom, the United States, New Zealand, Sweden, Norway, Iceland, and Japan. And the number of countries where there are more people consuming smoke-free nicotine products than smoking cigarettes is going to continue increasing. So this is all establishing a pattern of, I believe, of inevitability. The best our opponents can hope for is to delay the inevitable. And they're certainly trying to do that. Now, we have to ask ourselves, we've been debating the health aspects of tobacco harm reduction for about 15 years. It reminds me of the introduction to an old coward play, Blythe Spirits, where a couple are having breakfast in their garden, and Charles Condamine says, to his wife, who's reading the Times, anything interesting in the Times? And his wife, Ruth Condivine, says, don't be silly, dear. And that's really what this debate has been like. The debate hasn't been resolved in 15 years, and there's no indication, in my view, that this disagreement over health data is ever going to be resolved. Some of us in this room have been involved in debates about harm reduction over illicit drugs for a long time, and we've been involved in many similar debates in drug harm reduction. And despite copious, incontrovertible evidence supporting drug harm reduction, it made no difference to the implacable opponents of drug harm reduction. What ended each debate was not decisions by health professionals or researchers, but decisions by politicians. And the opponents of drug harm reduction never admitted that they'd got it wrong. And the opponents of tobacco harm reduction have shown that they are much more loyal to their cause than they are to scientific evidence. Will smoke-free nicotine products replace combustible cigarettes? Well, we're going to look at this from the point of view of firstly consumers, secondly producers, and thirdly investors. And it's very clear that consumers are very keen and increasingly keen on switching from deadly cigarettes to smoke-free nicotine products. And people who use drugs generally prefer to use lower-risk drugs if they can, and especially if those drugs are available, attractive, affordable, and accessible. The opponents of tobacco harm reduction try to ensure that smoke-free nicotine products remain illegal, but if they're legal, they want to make them unavailable, unattractive, unaffordable, and inaccessible. But black markets respond to strong consumer demands. As you know, it's 250 years next month since the US Declaration of Independence, and a wonderful document that includes in it a statement that to secure these rights, and it's referring here to the rights to life, liberty, and the pursuit of happiness, governments should derive their just powers and I want to emphasise, from the consent of the governed. And where the governments provide laws that respect the consent of the governments, things go well. But in our country, the laws regarding vaping do not accord with the consent of the governed, and we have a flourishing black market, which was estimated today by the Australian Bureau of Statistics to account for 80% of the demand for tobacco and vaping. Now, so much for the consumers. What about the producers? Well, some major traded tobacco companies are transforming rapidly. But so far, state-owned tobacco companies have shown, as far as I know, little or no interest publicly in tobacco harm reduction. What's driving all of this is the invisible hand of the market, in my view, and here we see that the The Invisible Hand of the Market is a concept that was coined by Adam Smith also 250 years ago, and he wrote of the invisible hand which guided individuals pursuing their own self-interest in a free market, unintentionally promoting the general benefit of society. He proposed that supply-demand and competition acted as invisible forces guiding resources to their most efficient use, often only requiring minimal government intervention. Two hundred and fifty years later, traded tobacco companies rapidly transforming to avoid financial calamity, but producing greatly demanded, much safer ways of taking substances enjoyed by over a billion people in the world. The third group I want to direct your attention to are the investors in tobacco company shares. The share price of tobacco companies which are transforming more rapidly are higher than tobacco companies transforming slowly. And from that we can infer, I think with justification, that investors in tobacco company shares take the rate of transformation into account when investing. And this, again, was a slide that will be familiar to many of you, and you can see that the recommended retail price as a percentage of 2024 sales value on the horizontal axis compared with the... prices versus earnings on the vertical axis, and you can see that that fits pretty well with PMI, the clear leader, followed by BAT and Altria and also the Korean company. Okay, let's look at tobacco control, public health, governments, and international organizations. Now, there's a miscellaneous group closely following what we could call the Bloomberg narrative. Why would they do that? Well, they see people like us as an existential threat for them, and they're right to see it that way. It's a little bit like the Warsaw Pact, which was of course based here in Warsaw, which was a military alliance of the East European communist countries along with the USSR. And Comic-Con, which was based in Moscow, which was an economic alliance of those countries. As Upton Sinclair said, often quoted statement, that it is difficult to get a man to understand something when his salary depends upon his not understanding it. And Michael Bloomberg is supposed to have given $1.6 billion, and Bill Gates has also given a handsome sum to our opponents to try and stall tobacco harm reduction. And a futile expenditure is there for all to see. Should we be cautious about the introduction of new harm reduction interventions because of the risk compensation hypothesis? And the risk compensation hypothesis is that all of us live with our own acceptance of some degree of risk, and then when our lives are made less risky, we compensate in our behavior by changing our risk behaviors. But when we look at actual evidence that this is important, that the risk compensation hypothesis actually matters, it's very hard to find evidence that it does matter. When car seat belts were introduced, drivers did not drive significantly faster or more recklessly When needle syringe programs were introduced, people did not start injecting earlier, more frequently, or for longer durations. But anxiety about the possibility of risk compensation may be a reason that some people oppose harm reduction. Why is there so much opposition to tobacco harm reduction? Well, it's important for all of us to realize that vehement and protracted opposition to every new drug harm reduction intervention for drugs has been a very powerful feature most of us had to deal with. We had tremendous opposition to the introduction of methadone treatment, to needle syringe programs, to drug consumption rooms, to every kind of drug harm reduction. And as I've mentioned, tobacco harm reduction has been an existential threat to people and organizations committed to the tobacco control endgame, which will become obsolete when smoke-free nicotine products have replaced cigarettes. This is all deja vu revisited for me in 1971, my first year working as a doctor in a hospital in Melbourne. There was a new tower block being constructed and I stumbled across the architect who was explaining this to someone and I asked the architect how the beds were going to be allocated in the new tower block. He pointed out to me that the building had been designed before the car seat legislation had been approved but it was being built after the legislation had been approved and already within a few years the demand for hospital beds had declined dramatically thanks to the cast seat belts. So many hospital beds were now available for treating cancer or heart disease or other purposes. And that staggering discussion, that conversation had a huge impact on me and changed my career considerably. But harm reduction is generally extremely effective, extremely safe, and very cost effective. And it's used very widely and without much controversy, unless we're talking about sex or drugs. But even in drug harm reduction, we see that acceptance generally comes happens eventually. Is opposition to tobacco harm reduction a closed thought system? I direct you to Ernest Hemingway's novel, The Sun Also Rises, where Bill and Mike are talking and Bill asks Mike, how did you go bankrupt? And Mike says two ways, gradually and then suddenly. And I mention this because I think what we're going to see is the sudden collapse of opposition to tobacco harm reduction. Our opponents avoid private or public discussions or debates with advocates for tobacco harm. of tobacco harm reduction. Would they avoid these debates if they were confident they could win? Of course they wouldn't. All they can offer now is sophistry and smearing. But this lack of debate has left them with a closed thought system. Just like, for me, this is just like the closed thought system of the USSR and its satellites 40 years ago, like Warsaw Pact, like Comic-Con. In the short term, closed thought systems may provide some advantages, but soon the disadvantages become obvious. And closed thought systems often end by collapsing suddenly, just as we saw with the Warsaw Pact and Comic-Con. And I think we're going to see the collapse of the closed thought system of opposition to tobacco harm reduction in just a little while. But if it's inevitable that smoke-free nicotine products will replace cigarettes, why bother intervening? It's a good question, I think. And there is a good answer to it as well. And it's because the base rate of smoking-related deaths, somewhere between seven and eight million deaths per year, is so astonishingly high. So if efforts can shorten this by only, say, 10%, that still means many lives are being saved. So what we've been doing around the world to support tobacco harm reduction has had some clear benefit in some countries. Unfortunately, Australia, Fiona in my country, is not one of them. Maybe the increased effectiveness could be achieved if we took the advice of Clive Bates, who said we should pay more attention to the Harvard Review of Business and less attention to the New England Journal of Medicine. I agree with Clive on that. So what are the conclusions we can draw from all this? Firstly, smoking is still an extremely important public health issue. Secondly, that reducing smoking and therefore smoking-related deaths as fast as possible should remain our paramount objective. Thirdly, that the advent of a range of safer smoke-free nicotine products is a major advance in public health akin to the introduction of vaccination. Fourthly, consumers, producers and investors support transformation from high risk to low risk nicotine options as soon as possible. Fifthly, that will be accelerated if regulators ensure low risk options are available, attractive, affordable and accessible. Sixth, transformation is now occurring rapidly is probably accelerating and should now be considered inevitable and unstoppable. Seven, the health debate regarding smoking is still unresolved, shows little sign of ever being resolved by financial reports of rapidly replacing higher risk options. Finally, advocates for accelerating the transformation from cigarettes to smoke-free nicotine products has an effect and is worthwhile because the base rate of smoking-related deaths is so astonishingly high.
39:11 - 41:30
[Fiona Patten]
Thank you. Thank you so much, Alex. And I think... In my personal opinion, if Alex is optimistic, then there is great cause for the rest of us to also be optimistic. Now, poor old Ethan Nadelman is not that optimistic. He's suffering from a terrible bronchitis, so he couldn't be with us today. But we are very lucky to have as a responder to Dr. Wodak's oration, Dr. Garrett McGovern, again, a great friend of GFN. Qualified in medicine in 1995, so he's just a young tacker compared to our Dr. Wodak. But has followed in Dr. Wodak's steps and obviously his own path in specialising in the treatment of substance misuse since the implementation of the methadone treatment protocol in 1998 in Ireland. He's a medical director of the Priority Medical Clinic, a private addiction treatment program that's located in Dublin. He was appointed to the Health Committee of the Irish Medical Council in June just last year. Dr. McGovern is also a member of the Irish chapter of the New Nicotine Alliance. It comes as no surprise that he is an ardent advocate of ready access to safer nicotine products as an alternative to smoking, and is one of the first members of the International Doctors for Healthy Drug Policies, which is an international group of medical addiction experts aiming to promote sensible drug policies. Now, some of you may have heard that this morning, I think that Alex and Garrett may have joined forces and are going to combine their significant brains and energy to establish, well, I'm not quite sure what it's going to be, but it is going to be global and it's going to be a doctor's alliance for tobacco harm reduction. So please welcome to the stage Dr. Garrett McGovern.
41:35 - 51:53
[Garrett McGovern]
Thanks Fiona for that really kind introduction. I don't know how I can encapsulate what Alex has said. I've been frantically writing notes to try and get through all of it. And I might finish on some questions, which may be rhetorical, I don't know, in relation to this whole debate. And this debate, let's be straight, has got ugly. There's no question about that. And it's going to get uglier. But I think at the end of the day, the truth will win the day. I mean, Alex opened his talk very confidently, and he said that safer nicotine products will inevitably replace combustible cigarettes. There's absolutely no doubt that will be true, and I have no doubt about it myself. I think there's going to be casualties in the meantime, and the amount of people who smoke at this moment in time who are ambivalent about switching to safer nicotine products will tell you the battle that we have because for every decent article that you will read You'll probably read another 10 others that are junk and are trying to frighten people. The ultimate goal in all of this should be, and will always be, the minimization of smoking. After Fiona mentioned this morning, we had this group, we're trying to set up a doctor's group to try and counter a lot of the stuff in the medical profession, misinformation, disinformation. One of the things that was interesting about that, and I don't know if he's in the audience. He's here, I'm sure. Roberto Sussman made the point that in all the years, I think he's a decade off cigarettes, he doesn't tell people he vapes. He says he doesn't smoke anymore. And I think that's a really key point. When you vape, you don't smoke, because we know that the burden of disease is because of tobacco. It's amazing, really, the gradual reduction in the consumption of cigarettes, as Alex has said, since 1962. I mean, it's only when you put up that graph you realize that this is reducing, it's plummeting. I mean, 2% up to 2010 per annum, and then it's 5%. And say for nicotine products, although the other side won't want to acknowledge this, It's because of the proliferation of safer nicotine products that that reduction is happening. It's the most preventable cause of death smoking. We know that. It absolutely exacerbates health inequalities. Myself, Alex, and many of us in this audience have worked with marginalized groups who have used many, many illicit drugs over the years, live in very, very impoverished conditions, and who unfortunately succumb. And many of the patients I treat, if overdose doesn't kill them, unfortunately tobacco, alcohol is in there, but that's what will kill them. Alex said, and he's absolutely right, that the ultimate goal is the reduction of smoking. We're never going to abolish smoking. That probably isn't going to happen as much as I'd like to see it happen. But it's not the... abolition or the reduction in nicotine use. So this is one of the problems and gets conflated. Nicotine has been terribly demonized by opponents of tobacco harm reduction for decades. The tobacco industry is learning the lessons. I mean, Alex very eloquently talked about other industries. Kodak is a great example. They were slow off the mark, and their market share reduced, and probably is going to continue to reduce, because they didn't think that disruptive technology would end up harming them. They thought, we're Kodak. We're OK. But god, the tobacco industry, they ain't messing about. They're Altria and BAT. and PMI, they're all going into this. They're going large on this because they know where the direction of traffic is going. And as Alex says, the disruptive technology will win at the end of the day. And we know the benefits of safer nicotine products in terms of taking smoke out of it. 200 years old, snooze, it's amazing to think that snooze is that old and that Sweden have kind of largely on their own kind of embraced it. And yet you have countries who will ban snooze and they will try and tell you that snooze causes mouth cancers, which is all nonsense, of course. 15% now of the whole global market, as Alex says, is now utilizing these products. And that's, again, only gonna go in one direction. All the big companies, they've gone large on this. I mean, it's an astounding figure. PMI, 42% global net revenues since 2014. It's just amazing stuff. And the tobacco industry is all about profits. Of course it is. I mean, Alex was talking about is it profits or is it the humanitarian cause that they've got a conscience? I think the conscience part is less interesting to me. I think that if there's safer products out there and they can survive, well, I'm all on for that. Who sells these products, to be honest with you? doesn't really concern me. I don't care who sells them as long as they get out there and we don't have barriers in the way. I mean, again, I mean, Alex Chock full of facts today. I mean, he said that UK, US, New Zealand, Sweden, Norway, Iceland, Japan, safer nicotine products are outshining and outselling cigarette consumption. I mean, that's a major story in itself. It's a huge polarizing debate. I mean, I'm from Ireland and... often think I'm the only doctor in Ireland that actually is interested in safer nicotine products I suspect that are many thousand doctors there are in Ireland I expect there are many thousand doctors in Ireland who probably agree with me but because there's many powerful doctors who are in the year of government have the year of government they don't feel they can talk and one doctor said to me I'd be afraid to talk and get into trouble. And I said, I'm always getting into trouble. So if I can do it, you can do it. I don't know whether it's a thing with the medical profession, but sometimes they're just, maybe it's the training, they're terribly afraid of upsetting their seniors. Politicians and policymakers, they're the guys who, in the end of the day, are going to make decisions. We know this, all of us here who've fought this battle with, you know, safer consumption rooms, OST, methadone, buprenorphine, needle exchange. We fought battles back in the day that looked unwinnable at the time. They weren't unwinnable. They're policy now. And who makes policy? politicians and policymakers so the market for these safer nicotine products is as Alex says it's it's accelerating it's not just increasing accelerating and of course if they want to ban these products we have a black market a thriving black market we know from and again it's a bit like Kodak The governments kind of think when they ban these products, I mean, you've seen the latest legislation in the UK about not allowing anybody after 2009 to smoke. I mean, it sounds brilliant. It sounds wonderful. Win-win all around. I mean, how they're going to police that is beyond me. But there will always be a black market to fill the void, and they'll be rubbing their hands when they see a lot of these products are banned. I think Alex touched on this. I mean, I always feel when governments get involved in something that's working... there's going to be a bad outcome they always make a mess of it and it tends to be a moral panic and hysteria and they usually will cook up the public because the public unfortunately usually ill-informed I don't mean to be unkind but they're usually ill-informed and many of them don't care so that when when they go to ban things they seem to think they take the simplistic view and they don't realize how nuanced this is Bloomberg, yeah, he sees, and WHO see, tobacco harm reduction proponents as an existential threat. The aim is to be less risky, not to have no risk at all. I think they won't debate us, because I think Alex is quite right. They know that they can't win, and they exclude us not because they think we're evil and we're shills. That's a very convenient debate for them. But they know that if we go into a room with them and debate this, we will rinse them, and that's what they don't want. A lot of these people who are in the other corner have egos. I mean, we all have egos. Let's be straight about it. We don't like to be shown up. but they particularly have egos. And that's why a lot of them will go to their graves, doubling down, even though the evidence is overwhelming. And their collapse will be inevitable. I mean, seven to eight million deaths a year, vaping doesn't kill anybody. I mean, Christ, I mean, how revolutionary a technology can you get when something doesn't kill anybody? Somebody asked me once, I did a radio slot in Dublin, And somebody said to me, what if you're wrong about this? I said, wrong about what? They said, well, if vaping turns out to be carcinogenic or cause heart disease. I said, we already have the answer. The burden of disease is from inhaled tobacco, inhaled burning tobacco. This is vapor. We already know that that's safer. We don't have to wait 20 years. And how long do you wait? I mean, I did a talk, I think, here two years ago on the precautionary principle. And they love the precautionary principle in Ireland, which is basically blow it out of the water without even knowing what it is. which reminds me of Margaret Thatcher and the Belgrano, but that's another story. So in conclusion, smoking is a massive, big public health problem, and we should be trying to decrease smokers at all costs. And I don't sort of say to smokers, you need to do it my way, which is vaping. I merely say, whatever. If you stand on the roof in your nip and give up cigarette smoking, I'm with that. Just get away from cigarette smoking, because it will kill people. And I've seen people in my own family And I've seen people who I've treated for many years harrowing stories of what smoking has done to them. Safer nicotine products, opposing that is like being an anti-vaxxer, really. I mean, we know that vaccination programs worldwide have saved people. So I'll just finish and say that this is, we're going to win this debate. I'm going to be optimistic like Alex, and we just have to keep on fighting. Don't put the gloves down, guys.
51:54 - 51:55
[Alex Wodak]
Thank you.