An examination of the nature of the THR debate, including different factions' objectives and the tactics being used, such as misinformation, emotive appeals and personal attacks. Panellists will share their own experiences, discuss why the debate is being conducted as it is, and ask how we should best operate in a challenging and often hostile environment.
GFN 2024 Panel Discussion #4 - hosted by Will Godfrey with panellists: Marewa Glover, Rohan Sequeira, Maria Papaioannoy-Duic, Christopher Snowdon
Transcription:
00:06
Will Godfrey: Hello, everyone. Hello there. I'm Will Godfrey of Filter, and I'm very honored to be hosting this final panel session of GFN 2024. We'll be easing our way gently through to the end of the conference with the calming and unifying topic of a global culture war. Accordingly, we've rounded up four of the world's most belligerent and, indeed, brilliant THR advocates. We have Dr. Maria Wiglaba from New Zealand. We have Maria P., as she's very kindly suggested I call her, from Canada. We have Dr. Rohan Sekera from India. And we have Chris Snowden from good old Blighty. So what are we talking about exactly? What is a culture war? Well, I'll throw out a working definition which we can argue about if we wish. A conflict or struggle for dominance within or between societies based on groups' differing beliefs. I think that that rings a bell for most of us. We're going to talk about how it's being conducted and how to conduct ourselves through it. But first, just to kind of pin down a bit more what we're talking about, I'll turn to Mirewa. Marewa, would you say that this struggle over THR is primarily between groups with fundamentally different objectives or rather between groups that share basic objectives but just completely disagree on how to get there?
01:45
Marewa Glover: Fundamentally different objectives. And so if I can say that my insights into culture wars comes from my training in psychology. The psychology profession has contributed a lot to the ideas of you know, culture wars. And my personal experience of violence and bullying at work and power and control. So a deep understanding of power and control. Being cancelled was part of that. And my indigenous understanding of colonisation and the strategies that are used to eradicate a unique culture. So I'm Māori, I'm indigenous from New Zealand, and it's been interesting to watch what is happening globally sort of, I don't want to say amusing, as an indigenous person. It's not amusing. It's very frightening what is happening. But I'm seeing the very same strategies that colonists use to take over New Zealand, Australia, Canada. You know, there's 90 million, there's 90 different indigenous countries where indigenous people live. millions of indigenous people have been through this experience. And it's kind of like you're all being colonised now. And we sort of look back and go, mm-hmm. So, yeah. I looked up culture wars just on Wikipedia.
03:33
Will Godfrey: Me too.
03:34
Marewa Glover: Yeah, very similar to what you said, but it said that in political science, a culture war is a type of cultural conflict between different social groups who struggle to politically impose their own ideology, beliefs, virtues, and practices upon their society. And I thought, yeah, that pretty much sums it up.
03:57
Will Godfrey: Thank you for that, and we'll return to some of those important thoughts about cultural differences and the colonization aspect later, I hope. But first, just to kind of take a show of hands, I mean, Moriwa's answer to my initial question, is it between groups with fundamentally different objectives or groups that share objectives but completely disagree on how to get there, Moriwa said fundamentally different objectives. Would any of the three of you disagree with that or see it slightly differently? Maria.
04:35
Maria Papaioannoy: I see it slightly differently, maybe because of my perspective and what I know versus what you know. And, I mean... who we're fighting the cultural war with in Canada is NGOs. And this is tobacco control. I mean, the word control makes me very uncomfortable. But they want people to stop smoking. I want people to stop smoking. So fundamentally, if that is what they want and if that is what I want, we have the same goal. I think their problem is the word control that they've had for the last like 50 years. Some of these people have been in it for so long that they haven't been able to move with the times. They haven't been able to evolve. You have to ebb and flow, especially when it's human beings. I was just thinking the other day, this is the first, vaping is the first disruptive technology in the 21st century. Like it's the first one that came out and it disrupted a lot of things. And I think the biggest one is disrupted for NGOs is what they've always believed in. There's only one way to quit smoking.
05:56
Will Godfrey: Okay, so you, I'm taking from that, you wouldn't concur with, we've had some prominent speakers this week who've urged us to consider ourselves part of tobacco control, just a different branch of it.
06:07
Maria Papaioannoy: I don't like to use the word control. I think it's negative.
06:11
Will Godfrey: Okay, well, promising that we've had some early different perspectives, let's see if we can sow some more division now by turning directly to A lot of the divisions in our different societies around the world are formed neatly along left-right political lines, don't they? But with THR, I think it's a bit more complicated. I mean, for example, I've spoken with many people this week who identify as libertarians. I think I'm sitting next to one. I've also spoken with many people who would say that they're very left-wing. and and that's um it's an interesting mix and it stands in contrast for me with it with a couple of other um situations one is in in sort of drug harm reduction circles where where i i found in my experience there that the um that the balance is is much more firmly left-wing um but also at the political level um where certainly in the united states where i live but also in other places At the level of elected politicians, it's often those politicians on the right who are somewhat more open to THR than those on the left. We'll turn to Chris to address this. How do you assess these relationships between people's politics and their stances on THR at different levels, at grassroots and at elected levels? where you operate. How do you see it?
07:46
Chris Snowdon: Well, I think it comes down to the division within THR, actually, which is probably as profound as the difference between people who are pro-harm reduction and people who are totally against it. Because you can support things like vaping from two different angles. You can either just say, we want to stop people smoking, like you just said. I want to stop people smoking, and this is a great way to get them off cigarettes. Or you can just say that the only reason, the only justification e-cigarettes need is that people like them. The only justification for their existence in the continuing sale is people enjoy doing them. I am obviously on the libertarian side of that and I think it's a shame looking back now that we've made so much of the case for e-cigarettes based on the public health argument buying into the premise that stopping people smoking is just obviously something that the government should be doing. I had a kind of epiphany actually yesterday during Clive Bates' very good afternoon panel discussion. I don't think Clive's here. Is he in a moment? I'd say this to his face though. The epiphany was Actually, it's all your fault, Clive. Not just him, but all the anti-smoking people. Because there's an alternative history to the whole smoking story in which, you know, 1880s, commercial cigarettes are made available. Lots of people start smoking them. In the 1950s, we found out they're really bad for your health and they cause lung cancer. And in the 1960s, we put a health warning on them. And that was the end of the story. Adult consumers were then free to decide whether they wanted to use this product or not. And the anti-smoking movement, such as it was, packed up its tent, went home, packed itself on the back for a job well done. And after that, for decades, it was understood that smoking was really bad for you, but it was none of the government's business. A few decades later, Honolulu convinced the e-cigarette. Word gets around that this is a much safer way of taking nicotine. And millions of smokers just migrate to it. And governments never for a second considered banning it or over-regulating it because that's just not what you do. We didn't do it with cigarettes. We're not going to do it with e-cigarettes. So in a sense, it is all... their fault that we're in this situation because we've accepted the idea that something that is bad for your health just should be banned. And advertising bans and plain packaging and syntax is just the natural thing to do with anything that poses risk. And the situation we're in in practice is that we've got something that, you know, 95% safe or whatever. It's still not risk-free. So let's ban flavors and the advertising and indeed the product itself in many parts of the world, such as India. So look, what I'm saying is, gone on too long already, but there are two approaches to this issue. One is a liberty-based approach. One is a public health-based approach. The public health-based approach will always end up being at least semi-prohibitionist because that's just the way it is. If you're going to prioritize health over everything else and decide that government's role is to make people live a risk-free life, you can't complain when they start regulating and killing off e-cigarettes.
10:57
Will Godfrey: Thanks, Chris. So yeah, Rowan, I mean, Chris lays his political cards on the table. I mean, I've often thought just from experiences of listening to people in this space, and refreshingly, I have no idea at all what your politics are. But it's possible to construct a really compelling left-leaning argument for THR based on concepts like social justice, health equity, bodily autonomy, and it's possible to construct a compelling right-leaning argument based on constructs like personal responsibility, freedom of choice, and market-driven public health victories. And I would suggest that, I mean, Chris regards those as incompatible. Are they incompatible? I would suggest that they're not necessarily mutually exclusive. How do you see it?
11:54
Rohan Sequeira: So talking about politics, even I have no idea how the politics work, but coming as a medical point of view, I am a doctor. We see patients every day. One of the reasons why we face such a big issue in India is because a lot of taxation and a lot of income comes from agriculture resources. And elections are won on that. And there's a very big geopolitical situation over there. The entire wave band which happened was targeted towards the youth not getting access to these products. But what we saw was a paradigm shift. The moment the wave band came into place, there was a sudden surge in the usage of devices among the youth, which basically did the exact opposite of what it was supposed to have done. There should have been a regulation. There should have been a political discussion on this. There should have been an open-ended forum where things would have been discussed. But that didn't happen. It just came in right out of the blue. So that was something which was surprising for all of us. And what happened was, whenever you have any kind of prohibition, whether it's drugs, you have alcohol, anything, you just drive the whole thing underground. And then you see this booming black market. You don't have any regulatory control over that. You don't get any taxes out of that. You're getting products which have no quality control, no quality analysis, you don't know what those contains are. You get a whole range of problems and that makes the entire matter worse because now people are falling sick because of inferior quality products.
13:24
Will Godfrey: Yeah, certainly we've heard plenty about India's ban, which is one of the most notorious in the world. I always imagine that you must be subject to something of a double whammy, both living in India and being a member of the medical profession, which we know has been shown that misperceptions about nicotine there are basically the norm. What's it like for you, just on a personal level, operating in that space? What kind of pushback or reception have you received from your medical colleagues?
14:00
Rohan Sequeira: I think that the medical profession is ideally suited to do THR. And the issue is that 95% to 99% of doctors in India have no clue what THR is. And everything about THR is all based on perceptions and miscommunication, misrepresentation, and false messaging that all THR is only e-cigarettes or liquids. There's no talk of, India is a very big country. Most of the LMIC, the low middle income countries in that area, you have Bangladesh, you have India, you've got Pakistan, you've got Sri Lanka. 70% of oral cancers is because of using the oral tobacco. And there's no one addressing that elephant in the room. And THR should also include oral tobacco, and that is where there is a huge, huge opportunity to use products like the pouches, which has got a tremendous impact in reducing the impact of oral cancer.
14:56
Will Godfrey: But when you try to, I think we all agree with that, but when you talk to doctors,
15:01
Rohan Sequeira: It's very difficult because they come back with a perception that this is bad. There's no way you can convince them. And you have to just remove tobacco out of the topic and just talk about harm reduction. I have seen this pushback happening at every conference, every place. When you go there and you start talking about THR, it's a closed door. They just don't want to listen. Because the misinformation is so strong And that information needs to be challenged. I was just speaking to someone here, and they have this nicotine literacy program. I think a literacy program for nicotine should be also targeting medical professionals. See, because the people who really need THR are patients. they've reached a point of a disease because they've been using a product that causes harm. And when they go to a doctor and they ask a doctor, what do I do? They're actually receptive. So there is a unique opportunity to educate medical professionals with THR so that these pushbacks are much less. And that's the war we're fighting.
15:59
Will Godfrey: Sure, and returning briefly to cultural differences, I'm aware that you rather enviably split your year between India and Portugal. Just briefly, do you experience different receptions for THR in those two countries?
16:13
Rohan Sequeira: Two different countries altogether, totally different perceptions. Portugal is more Western. They have an open-ended discussion. THR is already well-known over there. People know about THR, or at least they have a brief idea that this is THR, harm reduction. Whereas when you look at countries like India, Pakistan, Bangladesh, I was just in Bangladesh about three weeks back to advise the government there. on how to implement THR policy. Bangladesh just decided, the Prime Minister just declared that she wants Bangladesh to be tobacco-free by 2040. Now, for that, they had called a few THR experts to come and advise the government, but they were clearly about finance. This is how much taxation we get from tobacco products. How are we going to avoid that? So that's another cultural war that you're having over there.
16:57
Will Godfrey: Okay. Let's skip over to Canada. Maria, who is opposing THR in Canada, I suppose what I'm getting at is whether it's their sort of political affiliations or whether there are other sort of philosophical or life approach commonalities that you can identify in that opposition that you deal with every day.
17:20
Maria Papaioannoy: I think this is the one topic, vaping, tobacco harm reduction, that every single politician is on the same side publicly. They ignore Health Canada, so the governing body that is there to support our politicians and give them the accurate information, they don't use those resources. We have a Liberal NDP, Bloc Quebecois, the Conservatives, all of them can't touch this it's the children because our NGOs have done such an incredible job we are the first country to have messages on individual cigarettes that tell people not ways of quitting smoking but they'll be impotent And that was considered a big win. We are in a country that shaming people is a positive way to quit smoking. And I think we're in a world where we have allowed ourselves to use shame for this addiction. We're also in a world where people don't totally understand what harm reduction is. Because people say, well, when are you going to quit the vape? If harm reduction... If we're going to say that vaping is harm reduction, I am never going to quit the vape. Because harm reduction is about being part of something, doing an action that is safer. And it's up to me what I'm going to do. It's none of the government's business when or how I'm going to stop. So they all agree on it. And there is no left and right. And the people who support vaping, there are no political alignments. It's people who have seen success or people who have seen family success. I've gone to a libertarian conference, had my little booth there for rights for vapers. Oh my goodness, they were so shocked I was there. Why would I be there? You know, the media. No one will touch it up until recently. We have one paper, one non-mainstream outlet that has been picking up our stories. And that's because five people vaped there. So I don't believe that THR is a political thing. It's like you can't... It's a... It's not a political side thing in my country. It is a political opportunity.
19:43
Will Godfrey: Yes. But to turn it around then, I mean, obviously people who vape or use tobacco harm reduction products themselves, not at the politician's level now, but at a grassroots advocacy level, that's one way you have an obvious connection is people who are using the products. But are there any other... ins that you find with people, whether they're familiar and on board with harm reduction in other realms or...
20:09
Maria Papaioannoy: I think with bureaucrats is who vapes in their family, how close they are to vaping, that we get that. And people who truly understand harm reduction. If someone understands harm reduction and believes in the principles of compassion meeting us where we're at, you will find an open door and you will find, and I like to call them amplifiers. So they will amplify the message within that system. But it's really about life experience and the belief of harm reduction. So honestly, a lot of people in politics are harm reduction, harm reduction. They truly don't understand it because they actually think it's a quitting duel. And it's the ones that understand it that allow THR to be part of the spectrum.
20:56
Will Godfrey: Okay, thank you. We are going to invite all of you to participate in this culture war soon, so please be ready with your inflammatory interventions. But first we're going to turn to Mireille. We've identified some of the protagonists and some of the sort of battlefields among many. And I did check with you beforehand that you were okay to speak about this, because I know that you, we'll tend to turn to how it's being waged now. And I know that you, among other people in this room, have been subject to some really vicious ad hominem attacks, and I wondered if you could describe that to us, but also other unacceptable tactics that you've seen and how you and others have responded to them.
21:44
Marewa Glover: Thank you. So one of the strategies of culture wars is to create polarisation. So split people, and this is a political strategy as well, split people, facilitate doubt, create fear, so fear-mongering, and encourage people to feel anger towards those people who have a different point of view, the other point of view. So I don't see what is happening, all of this anti-vaping as just about vaping. As a professor of public health, I'm concerned about lots of threats to public health, not just smoking. And, you know, so these strategies are being used across the board. They're being used across many issues, many culture wars that are going on. There's one like the culture war over identity that many of you will be hearing a lot about. And there's a very good book here. Frank Faridi writes about culture wars. So the strategies are the same. Vaping is a battlefield that they're using. And it doesn't really matter whether it's... You know, it's just another battlefield where they can play this out. And there's many topics. They can use any topics. Vaccinations... whether you're pro-mandated vaccination or anti. Putting fluoride in the water, that creates division over sexuality, Russia versus Ukraine, Israel versus Hamas, climate change. All of these are fields, battlefields, where the same strategies are being used, and that includes cancelling people, threatening people who will not fall in line with in terms of public health, what they want.
23:55
Will Godfrey: Including you? Yep. And what specific forms has that taken, if you don't mind?
24:04
Marewa Glover: So I was, I guess, subjected to a mobbing at work and pushed out long before I got a grant from the Foundation for a Smoke-Free World. When I started to say, no, that's enough tax, the tax in New Zealand on tobacco is the highest in the world relative to income, and I was beginning to see the unintended consequences of that among Māori and low-income people, you know, not buying food because... they didn't have enough money left after buying tobacco and many other unintended consequences. As soon as I began to question, you know, the line, it was time to get rid of me. And then, of course, I began to promote. I was advocating for snus. I was then advocating for vaping. And I'm completely exiled in New Zealand. I recently had a colleague die. She didn't die. I recently found out that she died. And apparently she died two years ago. I've known all of these people, hundreds of people in New Zealand that I've trained. Not one person thought to tell me. I wonder if Marewa has heard that she has died. Two years later, someone says, I heard. You know, she died, and I Googled and found on her husband's Facebook page that she died a long time ago. I could not believe that no one would even tell me. And I thought about how many people from that sector that I've worked in, I've been in this field for 31 years, how many people I know, and how many people will still talk to me secretly, you know, eight. eight people and she was one of them and she's gone, you know. So that was very upsetting and really sort of drove home the extent of the exile that they managed to get the Ministry of Health to put out a letter to all government-funded agencies that they were not to have anything to do with me, not to talk with me, my advice is not needed, you know, leading indigenous tobacco control researcher in the world They can get their advice elsewhere, not to read my research. And nobody is allowed to talk to me. Or somebody phrased the term, you will get marred. So it has a chilling effect on everybody else. It's about creating fear, threat and control.
26:44
Will Godfrey: And this, of course, is happening in a country that should be regarded as one of the world's big tobacco harm reduction success stories, all the more so since your excellent report that I read this week. Another country that has been put in that... Chris, is our country. I don't live there anymore, but American advocates are always looking enviously over there. Things have changed a bit though recently, haven't they? And I just wonder, accompanying that, have there been similar, you know, what have you seen in terms of outcry, in terms of examples maybe of shunning, such as Mirewa mentioned? Has the climate really dramatically changed for you?
27:33
Chris Snowdon: Nothing like what... what has been going on in New Zealand, the political climate has changed, primarily because there's been a problem with underage vaping of disposable vapes, basically. Everything was going swimmingly until Geek Bar and Elf Bar emerged, and there's no getting around the fact that a lot of school children have been using them. We're not enforcing the law. It's illegal to sell vapes to kids, has been since 2015. A lot of the vapes themselves are illegal. But rather than enforce the laws that already exist, the government has decided to introduce new laws banning disposable vapes. restricting flavors. None of this has happened yet because Rishi Sunak for some mad reason decided to call an election when he was at the nadir of his popularity. But it will happen in the next government without a shadow of a doubt. It's been very unfortunate, but it kind of shows how shallow the pool of support for THR is in the UK. It was pretty much on a knife edge 10 years ago whether the UK would go down the kind of medical route of effectively prohibition or encourage the category. In the end, more or less than the toss of a coin, David Cameron decided we're going to leave this alone. And it worked really well, clearly. The public health people have never been that keen on vaping. Obviously, they take a public health approach, not a libertarian approach. And that means that these things are only there for smokers to get off smoking. And if anyone else uses them, that's a big problem. And if kids use them, that's a really big problem. I agree. I don't want kids vaping at all. I've got a 12-year-old daughter. Half of her friends are vaping. I don't think it's a good thing. I don't think shops should be selling vapes to kids. I would like the government to actually enforce the law. But they don't, and we see this in Australia. We see it in America. The entire category is basically banned in these countries, and yet they're as freely available as they ever were because nobody can be really bothered to enforce the law. But it's still a big problem for people, and it leads to... more dangerous products potentially out there in a huge criminal network and tobacconists being firebombed on a weekly basis now in Australia and the Australians just go, yeah, well, that's just the way things are, I guess. That's just what happens to tobacconists these days for some reason. It's insane.
29:57
Will Godfrey: Rowan, Chris talked about youth use and some of the limits of libertarianism when it comes to that. I mean, it's often framed, isn't it, with the youth thing as a kind of zero-sum game pitting the needs of youth against the needs of adults who smoke. I mean, do you buy that framing and why?
30:18
Rohan Sequeira: Absolutely. I mean, I completely agree with Chris. Kids should be kept away from products which can do harm for them, whether it's less harm or more harm, kids should be kept away. This is going to be a very cash 22 situation because we want to provide harm reduced alternatives to people who really need them. But on the other side, there's a very high potential for people who don't, for young kids and teenagers who should not be using these products but eventually do get access to these products. Now one of the proposals that we had suggested to our local area governments was you have an extensive network of pharmacy shops. Now, I'm not talking about the prescription model. I'm talking about the over-the-counter, right? It's going to be a much better solution where you are restricting the sales, because you can't just walk into a pharmacy and buy medication, right? Because there's a pharmacist and there are people, and they are legally allowed to check your license. They are allowed to check your age. So it brings that problem down significantly, these products into a semi-regulated kind of a situation.
31:24
Will Godfrey: Whereas India's ban has done what to youth vetting?
31:26
Rohan Sequeira: It's just taken the whole thing and blown it up in a very, very big underground market. I have, just outside my clinic where I practice medicine, just outside my clinic, I have six shops selling all these products. And even though there's a big ban, it's illegal to even possess a vape. It's illegal to possess pouches. There are websites all over the place. You can just sit here and Google it. You'll find shops all over India online supplying it to your doorstep. So what's the point of the ban? It didn't make a sense. I mean, it's just a smockery. So let it be regulated. Let it be brought under the purview of control. I mean, I know you don't like control, but at least regulation, right?
32:06
Will Godfrey: Yeah. So, Maria, we're going to invite audience questions and thoughts right after this. But, Maria, I was going to put a sort of similar question to you as I asked Maraiwa about the sort of the attacks, the tactics that you've seen from the anti-THR lobby in Canada. I also wanted to extend it to ask the question of whether, looking at ourselves, are there sometimes behaviors and certain messages from us that are inappropriate or counterproductive? I mean, Just to, you know, Skip Murray, a well-known American advocate, wrote a piece for us recently calling for a sort of a kinder THR debate in which she emphasized the really egregious behaviors of the opposition, but also turned a bit of a mirror on ourselves and asked whether some of our behaviors are actually likely to persuade people who disagree with us as opposed to antagonizing them. And so it was a thought-provoking piece. And I will say that a very small minority of responses from within our community were sadly. abusive to that. So kind of looking at both the tactics used on both sides, first the opposition, but also do we need to check ourselves sometimes?
33:34
Maria Papaioannoy: I can't speak for other people, but I can speak for myself. I'm perfect. No. Sorry, that was my joke. Yeah, I'm mean sometimes. I own it. I own it. Some of the things I say, I call people out for being old and tobacco control, and I'm like in my 50s, so I need to check myself on that. So I've been pausing on that. No one's perfect. Does it hurt my feelings? or does it hurt my ego is where I start thinking to myself. So when, I call them the classic five, again, another dig on how long they've been in business for in Canada. When they go to the CBC, our state paper, and they do this entire interview about me, and it affects my mental health. And it's really hard to try and put myself in that position of, oh my god, these people are criticizing me for having a website that I'm not sharing my address on. And the reason for that is because someone drove for four days to come and tell me what I'm doing is wrong. So I'm not going to make myself available to some crazy person. But they don't care about the reasons. They care about what they see. I'm getting to this. So I get attacked. And you can take so much, and you can take so much, and you can take so much. And unfortunately, there have been times where I've turned around and just slammed the wrong person, not the person that has said anything to me. I'm now finding other ways of kind of manipulating, manipulating, changing the conversation over. I look at it positive. We have had a flavor ban, and I'll use this as the negative, like the negative attacks. We had a flavour ban resurgence happen recently because of our Minister of Health, who has a long history with heart and stroke. And he's been quoted as saying that his job at heart and stroke gave him his life back. So he is indebted to these people. His speaking notes are life and stroke. He lies. He says people have died in Canada from vaping. Heart and stroke said this, not Health Canada. So we've done a campaign, we've gone out there, and we've been very open and honest about it, where we've reached out to vape businesses and said, this is our plan, this is how much money it's going to cost, can you support us? But you can't tell us what to do. It was all in agreement. We've been very public and open. So ASH Canada, Physicians for a Smoke-Free Canada, and Coalition to Tobacco decided to take out a press release. and attack us, and attack what we did, trying to tell everybody that we're hiding the fact that industry paid for it, which we didn't. So you are as honest as possible, because you're going to get attacked even if you're honest. And they put together this entire... I think the press release must have cost $7,000, a link to everything we did, which to me was like a love note. It was a scrapbook of all my efforts and our efforts at, and history just staying there in this beautiful $7,000 press release. So I thanked them for that. One of the advocates that was attacked, who was Marion Burt, picked up the phone and called them. They answered the phone. Cynthia Collard answered the phone. And those of you that are in, you might or might not know who Cynthia Collard is, but she's a very mean person in Canada, and we don't have many of them. And... Marian called her and said, how dare you put my name in your mouth? You are not to speak about me again. And this is Marian Burton. If you guys don't know her, follow her on Facebook. But she's a 75-year-old retired librarian who has quit smoking through vaping and loves it. And Cynthia and her came to some sort of agreement, but the biggest lesson that we took out of this was Cynthia, and Marian said I can say this, Cynthia told Marian, don't worry, you're still going to be able to get your vaping in the black market. This is the person that is fighting to remove vaping, and they are very well aware that there will be a black market and that we're going to be able to access it. Yes, both sides are mean. We kind of deserve it from each other because we're mean to one another, but the best that you can do is try and frame it in a positive perspective. I could have taken that press release and gone down a downward spiral, but I looked at it as a love note. Someone took a lot of time to track everything that we did. And damn it, I'm proud of it. So I'll send out that release and show you guys everything we did to put a stop to this flavor ban. And the more they yell at us and the more they talk about us negatively, I believe the more we win.
38:28
Will Godfrey: That's a lovely bit of reframing, thank you. So yeah, we'll invite anybody like to, I will come back to you guys certainly. We'll leave time to talk about the end game, the way out of this. But I would love thoughts, comments from anyone in the room, whether to a specific panelist or to open. Yes, over here.
39:00
so Mark Dickinson: Okay, so Mark Dickinson from the UK. It strikes me, and you touched on it, Chris, just in your previous comments, the big vehicle in this culture war that's being used, the biggest weapon that's being used, is this save the kids sort of message. And I think we should be stronger in challenging that. Because I think if you look at the UK situation... you've got in the order of 9 million adults who are either smoking or vaping or both, and they don't get any attention at all. And then you've got some kids who are experimenting, and you're right, Chris, there are plenty in the school playgrounds. But then if you look at them, there's maybe 20-odd percent of kids who are experimenting with vaping. Are they the ones that we're really worried about? Or are we worried about the 3.7% of kids who are vaping on more than a weekly basis? But most of those, the vast majority of those, are also smoking. So if we take vaping away from them, it's pretty obvious what they're going to do as a result. They're going to smoke more. So are we worried about the 0.8% or 44,000 kids in the UK who have never smoked and are vaping on a regular basis? including a couple of my teenagers, by the way. And the differential between the adults then and those 44,000 kids is 200 times more. So for every one of those kids, there's 200 adults that we're ignoring. If we're focused on them, the reality is that it's a much smaller number than those 44,000 kids because a large proportion of those And I'm absolutely certain of my teenage kids, if they weren't vaping, 20 years ago, absolutely they would be smoking. Both have been diagnosed with ADHD. I'm sure they're self-medicating for something. And all of this gets ignored, and we just get sucked into this, yeah, save the kids thing. And the ratios between the people who are truly at risk and the adults who were completely ignoring. There's an enormous disparity between it, and I just think we just accept this argument too freely, and I feel personally we should be pushing that argument a lot more strongly.
41:33
Will Godfrey: Thank you for that. Would you like to respond briefly to that, Chris?
41:35
Chris Snowdon: Yeah, well, I mean, I agree to a large extent. You're never going to extinguish underage use of anything, and the decline in... underage smoking in Britain is incredible. And now the average age at which people have their first cigarette, if they smoke, is now 18 or more, which is extraordinary. You can't say that about anything else. You can't say that about alcohol or watching 18-certificate films or looking at porn or anything like that. It's a miracle that we've done that. Except it's not really a miracle. This has come from enforcing the law, primarily. It's almost impossible for somebody under the age of 18 to buy cigarettes in the shop. It's extremely difficult for them to buy a bottle of vodka. And I don't see why it shouldn't be equally difficult for them to buy a vape. They're obviously, you know, kids are gonna get them from older siblings or friends or parents or whatever, like, you know, kids have always done. with cigarettes. But you can say, well, we should make the argument that it's a good thing that kids are vaping rather than smoking, but bloody good luck with that, with the general public, you know? It's not going to work. There's been, I don't like to use the word moral panic about things like this, because sometimes it's kind of justifiable to some extent, right? There's been a massive upsurge in the number of kids, and I don't mean 17-year-olds, I mean 10 and 11-year-olds, vaping. And I personally, call me a fascist libertarian if you want, I don't think that's a good thing. I'm very libertarian when it comes to adults, but I believe that you have to be fairly rational and fairly well-informed, and I don't think 11-year-olds are. So I'm not gonna defend shops selling vapes to children. We could be doing a lot more about it, but rather than doing something about it, we're bringing in all these other policies which are having an effect on adults. And let's face it, that's actually the plan all along. The think of the children argument is nearly always used as an excuse to clamp down on adults doing things. But having said that, that argument wasn't being used in Britain until about two or three years ago. It's not just an excuse in this instance. There are legitimate concerns that parents and teachers have had for quite a few years. I saw this bubbling up way before they made it into the papers because my nephews were vaping or their friends were vaping. And I could see this... train rolling towards us, and I kept telling people, someone needs to do something about this, because this is going to blow up. And it has now. And I see, actually, the same thing is going to happen with nicotine pouches. Hasn't happened yet, but nicotine pouches in the UK are totally unregulated. You can have as much nicotine in them as you want. You can legally sell them to kids. The government has done nothing about trying to stop this emerging hysteria. I think it will happen because what will happen is some toddler will eat a whole load of them and have to have their stomach pumped. You're going to have kids passing out in school because some company has come in with like a 100 milligram version of nicotine pouches. And... the response will be the same. It will be an overreaction, and they'll just ban the category or restrict it really, really heavily. You know, you can't totally ignore people's genuine concerns about things, and I know I don't sound very libertarian in saying this, but actually these things need to be regulated.
44:44
Will Godfrey: Okay, just to play devil's advocate, I mean, for a moment, on what basis would you draw a regulatory distinction between this and the cup of coffee that Dave Sweenor mentioned yesterday?
44:58
Chris Snowdon: Um, well, I think that nicotine is a lot more addictive than caffeine for staff. I know some people say they're really addicted to caffeine, but, you know. I don't believe them. And yeah, it's potentially toxic, which caffeine is. You could actually have a child eat a whole load of these. You don't need to have that much nicotine as a child to have a bad reaction to things. Yeah, I don't know. Am I in a minority here and thinking that kids shouldn't be sold nicotine?
45:29
Will Godfrey: Well, I think both Marewa and Maria Whittle. Oh, no.
45:34
Marewa Glover: Just back to the topic of culture wars. A key strategy of any culture war in all of the different battlefields is to use children. One of the objectives is to create fear among the parents. All culture war is about creating division, which you do by fear. And Noam Chomsky's book, Manufacturing Consent, is a very important book to read to understand how this is done. So children are not only, and having been in tobacco control public health, which I see tobacco control as part of public health, public health are doing this across a number of topics. Tobacco control, and I've never liked it, have always used children and they exploit children and they teach children the anti, you know, all of the messages. And at conferences, world conferences on tobacco control, they always had a youth, you know, they would bring youth from around the world and they would teach them All cultural wars do this. They target children. And in some other areas, you're seeing this, the identity wars, they are targeting children. They're putting it through schools. And they bring the children out and do, like, street protests. They drag the children to select committee hearings and have the children say the messages. And I have even, you know... worked with youth and they don't like it. They know they're being used.
47:16
Will Godfrey: Certainly stark parallels with the war on drugs among other examples there. Okay, let's bring some more people in. Would anyone like to share experiences or thoughts or put a question? Yes, Norbert.
47:34
Norbert Zillatron-Schmidt: Well, I have to say, nicotine and caffeine are pretty similar. I have overdose on both a little bit. And the effects are very similar. Cold sweat, palpitations. nausea, yes, both from nicotine and from caffeine, and it took a little bit longer from caffeine for the symptoms to abate, but there is no very strong difference. And once I switched to vaping, the addiction factor, the cravings were very were strongly reduced compared to cigarette smoking. It was on the level of my addiction to caffeine in the form of green tea. Yeah, I could stand four hours without nicotine and had just about as much cravings as I had about for the tea.
48:52
Will Godfrey: Okay, thank you. That's a debate that can definitely rage on afterwards. But let's, you know, to broaden it out, I mean, one thing, one big elephant in the room we haven't mentioned is the role of industry in the culture war as a specter, as a... as a factor, as an ally, and I don't know if anybody would like to speak to that or other elements.
49:15
Maria Papaioannoy: Maria, yeah. Okay, since we have all these scientists here, and science people, and I'm not, what is a youth? Because we get these studies about youths ages 40 and under, Now, I mean, I'm 52. I would love to be considered a youth, but that's not going to happen. Like, what's the cutoff age? Because I'm starting to worry about the way these numbers are being projected of, oh, you know what? A 25% increase of Canadian youth who vape. And the number is 39 and under. So what is a youth? Can someone tell me what, like, is there a gold standard? Yes, you over there. That youthful Ariel. I just want to know.
50:06
Arielle Selya: It's on? Okay. Arielle Selya, Penny Associates, Consult for Jewel. That's a great point. I think there's an expanding definition of youth. It used to be under the purchasing age, which used to be 18. Now in the US it's 21. But beyond that, there is more of a trend in recent research towards the 18 to 24, 18 to 25 age group. And even in the US, half of these are legally able to purchase product, nicotine product. So I think there's a bit of a mission creep going into young adults. And as you mentioned, it can go up to 35, 39. I think anecdotally, and I don't have hard evidence for this, but I think they've been looking for a gateway. They've been looking for evidence for a gateway in the youth numbers for smoking. And since they're not finding that, I think they're waiting to see something happen in the young adult age group. So I think that explains some of the expanded focus.
51:02
Maria Papaioannoy: Okay, thank you.
51:03
Will Godfrey: Yeah, it used to intensely annoy me to be asked for ID when buying alcohol in the United States, but as the years have gone by, I feel increasingly flattered whenever it happens. But yeah, I mean, to move on to sort of, I'll throw this out there and then I'll come to you, Roberto, but to sort of move on to the towards the end game concept. I mean, we've heard differing perspectives this week. We've heard some powerful and influential voices call for building bridges, for reaching common ground with mainstream tobacco control, to compromise where necessary, and to listen to the other side. We also hear powerful advocacy voices saying that there can be no compromise when it comes to the truth. and that the people who are doing this must be held accountable, must be called out. Are those two visions compatible? And if they're not, where do you fall along the spectrum? I'll ask that to any of you.
52:12
Rohan Sequeira: So, Will, I'll just answer that question with a small observation that I think. I see a lot of similarity between the way they have been able to regulate alcohol, and like you rightly said, you can't have a kid go up there and just buy alcohol, can you? You need an ID card, you need some form of identification, because if they do sell alcohol to a kid, then they can get into a lot of trouble. Now, if we have an infrastructure which is already existing, now understand me properly here, both alcohol and tobacco harm reduction products have the ability to create good and harm. When you take alcohol, it gives you a little bit of relaxation. In small doses, alcohol, by the way, is a drug. In small doses, it works as a mood elevator. In larger doses, it works as a depressant. But even if you look at alternative tobacco products or nicotine pouches, you look at electronic cigarettes, they have the potential to cause both harm and good. Good in the people who are on combustible tobacco and all the other forms of oral tobacco. Harmful for people who have never used these products and are initiated, and somebody mentioned Gateway. So if we have the infrastructure, rather than going for a ban and sitting and having all the hoo-hahs and all the arguments, why isn't there any government that is willing to take that route, go through either the pharmacy or go through channels which are selling alcohol so that you have a barrier to prevent people who shouldn't be taking it from buying it and allowing people who are enabled to take it from taking it. I'll give you some really interesting medical statistics, and that's what I do, I love medical statistics. 2018, there was a survey which was conducted in India. 20 million kids in the age group of 10 to 14 have smoked at least 5 to 10 cigarettes a year. 20 million. That's more than the population of some countries. And on a daily basis, on a daily basis in the last 24 hours, 650,000 kids in India have smoked a cigarette every day. What gateway are we talking about?
54:21
Will Godfrey: Okay, thank you. Marewa?
54:23
Marewa Glover: Yeah. The infantilization of people. So, you know, in public health, after many years, 40 decades or, you know, four decades or whatever it's been, they, you know, they truly believe that the public are dumb. and they're not going to do what is being suggested. So there is an infantilization going on of adults, this is why the mission creep with the age, to justify the public health gods, the professors, are going to save us all because we can't save ourselves. So that's a fundamental kind of belief. And it all goes to, you know, like in New Zealand, the legislation, we got up to the end game, you know, legislation being passed. But prior to that, there were a couple more, three more sort of small amendments. So they now break up amendments to the law into a small piece. And a friend in Australia, I'm like, why isn't anyone saying anything? And they're like, oh, this is, you know, it's like death by paper cut. a small piece of change is proposed, and it's too small for people to go to the whole effort of, oh, you know, well, it's just accepted that this is just going to go on and on and on, whether it's, you know, banning you having cats, First, it's you can't have a cat go outside at night. The European Union with the you can't have a straight banana. There's all sorts of very small changes and laws that are made. One purpose is to make people wrong. They're doing something illegal, and then that encourages people to moral outrage about themselves.
56:22
Will Godfrey: paternalism and control. And I've often heard expressed, Chris, the envy or frustration of public health that THR isn't a solution that came from them. Presumably you would concur.
56:39
Chris Snowdon: Yeah, that's part of it, I guess. I mean, I still don't really know what a culture war is, to be honest with you. But insofar as it involves imposing norms, massively changing norms, making bold assertions and then accusing other people of starting a culture war when they disagree with it, it's kind of going on. I mean, the kind of assertion you could include would be something like, vaping is more dangerous than smoking. And now the majority of people in most countries think that vaping is at least as dangerous as smoking. If that's part of the cultural war, then yeah, we are fighting a cultural war, we are losing, and we shall go on losing unless we find a billionaire like Mike Bloomberg who happens to be in favor of THR and is going to pump a huge amount of money into it. It is just a war. It's a war of attrition. The other side have a huge amount of money and lots of very prolific academics who keep pumping out basically the same kind of two or three studies on a regular basis, looking at zebrafish or talking about the gateway effects. The media love it, because the media doesn't like good news, it likes bad news, fair enough. And over time, people have just been ground down. And it doesn't help that we also live in an increasingly mean-spirited and small-minded society. Western civilization, in my opinion, is rapidly running away from the enlightenment. And we're becoming a very intolerant and bigoted place where everybody's looking for something to ban. And it becomes a circular firing squad in which everyone's liberties are eroded and no one seems to be able to do anything about it. So what can be done? Well, like I say, we need a huge amount of money pumped into it. We need lots of active people. But quite understandably, people are exhausted doing it. And I take my hat off to people like Clive who just keep on going on about this. I mean, I kind of speak about other areas, so at least I get a sort of break from it every now and again. But it's very, very depressing. We know we're right about this, right? On the basics, we know we're basically in the right, we're on the side of the angels. But we're outgunned, outnumbered. My only hope actually is a black market and I really take inspiration from looking at what's going on in the USA and Australia and these other countries and India for that matter, you know, because it actually doesn't really matter what the regulation is anymore. People are clearly just doing whatever they want to do. They're going out there saving their own lives and there's nothing the government seems to be able to do about it. So yeah, bring on the smugglers.
59:03
Will Godfrey: This notion borne out by over 120 million people worldwide that tobacco harm reduction is happening, will happen. It's just a question of whether governments will control it or somebody else. Roberto, I promised about 25 minutes ago to come back to you. I haven't forgotten.
59:22
Roberto Sussman: Five years ago, in a video interview by GFN, I mentioned this idea. What happens when the angels are lying and the devil is telling the truth? I think this is important. It understands how the cultural war and the actual usage of THR products occurs in developed countries and underdeveloped countries. Like in developed countries, public health is trusted. I know that COVID and distrust is decreasing, but still most people trust public health because public health has delivered in previous decades against communicable diseases, et cetera. So here you have angels that are lying. And on the other hand, on countries like India and Mexico, we don't have these angels. We do not trust government institutions, right? So we don't have angels that are lying. And so this means that there is an increasing... See, when you say black market in the context of England or in the context of Sweden or even the U.S., It is an adventurous issue, right? Because the law is enforced. But for us in the lower and middle income countries, it's normal. I just wanted to bring this point.
01:01:10
Will Godfrey: So you're expressing some optimism in the power of the illicit market in lower and middle income countries specifically?
01:01:17
Roberto Sussman: Yeah, we see it. We see it in India and Mexico, Brazil. Yeah. You see the so-called that would be angels in the developed world. They're banging their chest and protecting children and the WHO and public health, et cetera, et cetera. But then in our countries, these people are naturally not trusted. Yes. Right? Thank you. And so it is easier for us. There is much less barriers to go to the black market. And then the black market itself is very diverse. When you say black market, you imagine I have to go to an alley with a machine gun and face some and cartels and so on. No, it's not like that. The black market has a large section of informal. They are illegal because they are not registered and so on. And so there is a broad, I don't know if in India it's the same. It's a broad sector because the law is not strictly enforced. Look, I am not celebrating that the law in my country or in India or Brazil is not enforced because in other issues it has very bad implications. But at least in this particular issue where angels lie in the developed countries, it is a good issue.
01:02:38
Will Godfrey: Thank you, thank you, thank you very much. We are, okay, if you want to come in very quickly on that, Rohan, we are reaching the end.
01:02:46
Rohan Sequeira: Robert, so I just want to agree with you on what you said, but the only thing is, you call it the black market all over the world, but in India it's not called the black market. It's officially called the grey market. Because, yeah, it's called the grey market because it's not black, it's still visible. Yeah, so you have all of these products available online. So it's the gray market, I completely agree with you.
01:03:09
Maria Papaioannoy: I think what we're forgetting, or what has been forgotten by public health, and someone touched on this, are public health officials jealous that they didn't find vaping? And I'm gonna say yes, because what's happened is their role, when I look at public health officials, when I look at the public health unit in my community, they're here, they're my teacher, they're my nurturer. I've switched the role on them. That makes them uncomfortable. And let us all remember that vaping was created by people who vape for people who vape. It wasn't created by big tobacco. They came in after regulations. It was created by people who wanted a solution for themselves and it grew because of that. And I think that makes people very uncomfortable because we were the patients, not the doctors.
01:04:03
Will Godfrey: Yes. And we are running very low on time. And I did want to just get to this crucial question of, you know, we're in a culture war. How do we realistically get out of it? I mean, obviously, trying to win. But how does it realistically happen that this sort of global schisms come to an end? I'm just going to give you about one minute each at most. Yeah.
01:04:28
Marewa Glover: Resist. Resist and don't submit. That's what they want. And I just want to warn you about the Framework Convention on Tobacco Control and the World Health Organization. So with all these little death-by-paper-cut pieces of legislation, in New Zealand, the endgame legislation included writing in submission to the World Health Organization Framework Convention on Tobacco Control. So they are now trying to get, and this was not what the framework treaty was about, it was guidelines and protocols, they're now trying to get governments to insert into local law obedience to the World Health Organization. They have to implement whatever dictates come down from the World Health Organization. This is a globalization goal.
01:05:22
Will Godfrey: Thank you, Mario. Chris, would you like to speak very briefly to that? What's the realistic way?
01:05:28
Chris Snowdon: It will be brief because I don't think there's a solution. I think things are going to get a lot worse before they get any better. We've got a great story to tell. These guys can come up with... much junk science as they like, but we've got real world evidence. Sweden obviously has been a great example for many years, but now you've got the comparison between New Zealand and Australia. It's just staring you in the face that this is not working, this approach is not working. And like I said before, I think kind of support and opposition amongst the general public to THR is extremely shallow and fairly superficial and not very well informed, which means that you can take people either way. Most people aren't that bothered about this issue at all. They're quite happy to live and let live. That's something we used to say all the time, live and let live. We used to say it's a free country. We don't say these things anymore. Yeah. anywhere, which is kind of worrying, isn't it? That's a broader battle to fight.
01:06:20
Will Godfrey: Okay, so we've got resist. We've got not much hope if they look at the evidence staring in the face and don't follow it. Rowan, hope in India. I have heard some of your fellow Indian advocates express some mild midterm optimism. Do you see that too? Sorry? Do you feel the cause for mild mid-term optimism in India?
01:06:40
Rohan Sequeira: Yes. Of recent, I think within the last six months to one year, there has been a little bit of thawing. And in fact, just in the next week itself, I will be talking to about 4,000 doctors on the concept of THR, which is organized by one of the largest newspapers in India. It has got the maximum amount of circulation, and I feel that that is a break in the cloud. And if THR is actually brought to the street level, people will start looking at it differently and will approach the politicians to look at it in their favor.
01:07:14
Will Godfrey: Thank you. Yeah, that newspaper involvement fascinates me when I've been hearing a lot about the effective censorship of THR in the Indian media. And finally, Maria, if we're to get out of this, how can it realistically happen in a good way?
01:07:29
Maria Papaioannoy: If we're gonna get death by a thousand paper cuts, we're gonna give them death by a thousand paper cuts. Every time an NGO writes something that is negative, inaccurate, go to their website, see who funds them. If your government funds them, write a letter to the funding agency to get their logo off of there because your government is not paying them to lie. And it has worked effectively in Canada and email the rest of their funders. Why are you funding someone who lies? Explain what you will do. And just, and that's my big thing is fight back and fight back where it hurts in their pocketbooks.
01:08:08
Will Godfrey: Okay, so folks, that just about brings us to the end before I hand over to Jess, I believe. We are, as we've heard, in a culture war. Some of us may relish it, some of us may be exhausted by it, some of us may yearn and work for reconciliation, but I think all of us for this cause can take a little bit of pride. in our battle scars. It just remains for me to thank very much Chris, Rowan, Maria, Marewa, and please show them your appreciation. Thank you.