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Lindsey Stroud: Oh, and here we go. It is that seamless. So, thank you guys for joining us for the Science, Regulation, and Morality panel. My name is Lindsay Stroud. I'm a Director of the Consumer Center and the Taxpayers Protection Alliance, Visiting Fellow with the Independent Women's Forum, Board Member at the American Vapor Manufacturers, and there's a few other things I'm just not going to mention because you're here to see all of these people. We do have Martin Cullip in the room, and he's a big fan. He's a big He's just really good at the Consumer Center at TPA. So again, thank you for joining us. So I'm just gonna start introducing the panel. We've got Dr. Mara McGlover from New Zealand. She's got 25 years of experience in reducing smoking-related harm. She's chair of End Smoking New Zealand and she's published over 100 studies. That's pretty impressive, girl. And she's focused on reducing smoking rates among indigenous peoples and reducing smoking during pregnancy. Next to her is Dr. John Oistin. He's from Canada, my neighbor to the north. He's got degrees in medicine and medical research before training in anesthesiology. He's also a specialist in both the UK and Canada, and he's also worked in Ethiopia, New Zealand, and Rwanda. And he retired in 2019 from the medical practice, and he's been focused on cessation advocacy and knowledge transition on safer nicotine products, as well as publishing numerous editorials in the Canadian medical journals. We got Dr. Arielle Salia from the United States. She's a scientist at Penny Associates, which is also associated with the Consult for Jewel. Her primary focus is on tobacco use behavior among youth and young adults. Prior to Penny, she spent a decade in academia studying adolescent substance use and addiction. She has over 50 publications to her name in behavioral and methodology. And last but not least, and he's not a doctor yet, and from the United States, is Kevin Garcia. He's a graduate student at Colorado State University studying public health and social work with a focus on global health and disparities. He's also a harm reduction fellow at Filter, content strategist for Next Distro, and a research assistant. And we're just gonna start out with an icebreaker given our panel topic. And I'm gonna start with you, Kevin. And it's the same question for all of you guys. What is the most immoral thing you've seen globally in regards to adults both accessing the information on safer products as well as accessing those safer products?
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Kevin Garcia: I guess I feel like my main point is that I wanna make here today is that tobacco harm reduction is harm reduction. And I mean, I've seen a lot of people you know, stigmatize certain types of harm reduction and a proof of some types, but not a proof of other types. And I'll see it a lot with like smoking kits, for example. I hear the notion in the US, you know, Biden's given out smoking kits. This is harmful, but it's not harmful. It's another type of harm reduction tool we could use to reduce harm, just like we do with vaping tools, with non-combustible forms of nicotine. These are all different types of harm reduction, and we shouldn't be stigmatizing either one. We should support all forms of harm reduction, whether or not they're deemed socially acceptable at the time.
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Arielle Selya: So in addition to what Lindsay mentioned, I also help Clive Bates with his literature review every week. So the literature is what I see. I see a lot of bad errors in the literature, but usually I try not to attribute intention behind it necessarily, never attribute to bad intent. You can attribute to ignorance instead. But one thing that I would say was really immoral was the claim out there on Twitter that Cochrane was funded by Big Tobacco or had Big Tobacco connections. Because whether or not that was an honest mistake, if you're going to throw out a claim like that, you have a responsibility to fact check before you do a lot of damage. And the Cochrane review, obviously, is the gold standard for why e-cigarettes are effective. And to throw out a claim like that really undermines the science.
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John Oyston: There are so many things that have me upset, it's kind of hard to choose, but just three at random. The tobacco companies that claim that they're wanting to unsmoke the world and they're wanting to make transformations, but are refusing to produce medically licensed and prescribable vapes. In the vaping industry, I've been recently involved with a company called SpongeBob Vapes that produces a disposable vape based on a TV character aimed at 6 to 11 year olds. They also sell a plush toy, a little teddy bear with a vape inside it. I think that's just disgusting. And then from the regulatory point of view, in Canada we have a Smokers Helpline and they They're sponsored by the Cancer Society. And so I went online there recently and asked them what their advice is about vaping. And they said, well, there's not enough evidence to recommend vaping as a way to quit smoking. And I asked them what they thought about Evali and popcorn lung. And they said these are valid concerns and I should be worried about them. So this is what the Canadian Cancer Society is sponsoring. So there's plenty of problems to go around.
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Marewa Glover: Thank you, and thank you everybody for coming today. I thought about this question and obviously, you know, you could say that what's most moral is tobacco companies continuing to sell a product that kills people, but I see morals as being more at the individual level. And the most immoral thing to me is that I know many people in tobacco control, public health, they know these products save lives and they are blocking access to them. They are facilitating increased rates of disease and premature death among people from 35 years up. I think that this is the most immoral thing that's going on.
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Lindsey Stroud: Well, we're going to go back to you. So if you guys haven't seen them yet, I actually have the best panel of GFN. Every single one of my people did a video, which made me hosting this a lot easier. I knew what they were going to talk about. But if you haven't seen them, please watch them. Every single one of them did a really good job at presenting the information. And I'm going to start with you, Marawa. I'm going to give a little bit of what they kind of did, and she can explain it better. So your video examined historical human development and unification theory with differing spheres, including the social group forming, spiritual rule forming, and these all play a role in everything humans do, from family to governments and regulations. Can you describe your video a little bit more to all of our listeners, and as well, how that applies to tobacco harm reduction? kind of go into how each sphere, while essential on its own, is also determined by the other spheres?
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Marewa Glover: Yes, so it's quite complex, but I guess being Indigenous and having sort of a Western training, but also Indigenous worldview, which tends to be holistic, so more of a systems thinker, and I came across this unification theory by a theologian, and it was polyspheric model. So I thought, oh, this is too complex to present, but I've done my best to break it down. We have one of the biggest questions that keeps getting asked is why? Why are people against these low-risk alternatives to smoking? Why? People are saying, oh, it's a moral disgust. because they see a cloud of vapor and, you know, they have this physical reaction. So the morals, or saying it's about morals, is a key kind of narrative. It's way more than that, and I try to show all of the other underpinning rationales and motivations for the anti-vaping anti-harm reduction actions and narratives that are going on. So I'll just take an example that Roberto talked about yesterday, and that was the ban on vaping outside, let's say outside, on a breezy beach. I could say smoking, but we'll focus on vaping. Now, why would they do that? And he said it's all about denormalization. He's quite correct there. And he said that they don't want children to see anybody vaping. So one of the spheres is the language meaning forming sphere. So when you do something, it is seen as significative. I had to practice that. Significative. Every act you do signals your beliefs. So if you vape, well, people do what they do, their acts, because they think it's a right act. So a person vaping is sending a signal to others that they believe it's right, and therefore other people think, well, they were vaping, so it must be OK. So in the meaning language forming sphere, things are significant. Banning vaping is significant as well of the group forming of the rules the group sets to control their group. So banning signifies wrong. It's wrong. And that's part of the rule forming sphere. and it's also part of forming the group. So our group is, you know, we say tobacco control, they have an idealistic dream for how society will be, public health has a dream for how society will be, nobody will smoke, nobody will drink, nobody will eat unhealthy foods, unhealthy things are labelled unhealthy, so everything that's happening is all bringing about, it's all about controlling the group, forming the rules, keeping people inside of the rules. It's all about control. The difference, the problem is, and I try to explain it, We have different societies and different communities in the world and we don't all agree. So, you know, we end up fighting about it may be religion, it may be capitalism. You know, that's an ideology. And communities make these up. They're made up. I know that it can be offensive to say that a religion and the beliefs of a religion are made up. Everything is made up by the group to control the group. I can sort of say, you can give me anything that they do, and I can say, okay, in this sphere, it's significant of how they're changing the meaning of words, even. It's all about control.
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Lindsey Stroud: And vaping or novel nicotine products, too, because they're a new thing, they feel that they need to control it before anything starts, is what you kind of see with some of the alarmism.
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Marewa Glover: It's against their, you know, they are, I think I called them, fundamentalist.
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Lindsey Stroud: I have that over here it's a how and yeah the fundamentalist which is one of the best way to describe them anti-harm reduction fundamentalist.
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Marewa Glover: Yeah and they're a public health fundamentalist so somebody else who spoke again Roberto said it was about social engineering absolutely it's about social engineering and Yeah, so everything that is said, everything that is done, all of the bands, they have multiple, there are multiple motivations.
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Lindsey Stroud: Absolutely. And that's a good segue into John's video, actually. And your video discussed this deep conflict between capitalism and public health with conflicting value systems, is kind of how you put it. Capitalism prioritizes individual freedom, personal responsibility, while public health promotes overall good of the community versus individual rights. and then the greatest good for the greatest number. Can you, again, explain how those kind of apply to tobacco harm reduction, and also answer the question, can they work in tandem, or are they always going to be in conflict with each other?
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John Oyston: Thank you for the introduction. So one example where the goals of capitalism and public health are matched is PMI and heat not burn products in Japan. And this is a brilliant example of a situation in which the innovation and the productivity and the activity we get from capitalism can actually work with public health. And as people in this room know from the heat not burn products like ICOS have captured something like 30% of the Japanese tobacco market and they've decreased the sale of combustible tobacco by I think it's 74 billion cigarettes a year in Japan. So that's an enormous success but that's I think almost an aberration. I think in other circumstances things have not worked out so well. So if you look at, for example, Pax Systems and Juul, they invented a brilliant product, and a client base said this could have been the most successful smoking cessation aid ever made, but they decided that there was more profit for them in marketing this as a toy for kids or for young teenagers, and they went that route rather than selling it as a smoking cessation aid, and that's proven to be really unfortunate, and that's why we have this whole discussion about the epidemic of teen vaping. So I think there is normally quite a conflict between capitalism and public health. And I think it's also fair to recognize that obviously we think of the tobacco industry as a capitalistic organization that depends on profits and shareholder value. The pharmaceutical companies also do that and they see safer nicotine products as a threat to their nicotine replacement market and to products like Shampix and Bupropion. But then, as we talked about this morning, academic journals are also in some ways capitalist because they're concerned about the impact factor and they're concerned about placating whoever owns the organization. So this whole conflict between profit and innovation that you get from capitalism and the public good extends to almost all spheres of our activities.
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Lindsey Stroud: It goes back into Marwa's point on the different spheres and how they influence what comes out. Ariel, as a researcher, that breaks down, you beat me to it. I know you do all the work with Clive's group, and thank you for all that, and breaking down those studies is fantastic. Your video features how to examine these studies, and specifically, you looked at, because I think you pointed out, like, oh, we can't go through everything with the limited amount of time, but you looked at confirmation bias and spin, and oftentimes, how these are all presented in the abstract and the conclusions of papers, which, I mean, I'm a busy person. That's usually what I read. How can you, can you teach our audience how they can be better researchers by identifying these problems and how they can, you know, read the conclusions better?
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Arielle Selya: Yeah, sure. So I think the first lesson is that you can realize that the abstract doesn't necessarily reflect the underlying results that are presented. And as I say in my video, there's so many problems out there that I could go into that others have really documented well as far as methodological flaws, study design flaws. But what I'm focused on in my talk this year is let's take for granted, let's take for the sake of argument, which granted is a huge leap, that everything presented is correct, that all the analyses are correct, there's no flaws in the study design. Even so, there's still a pretty serious mismatch sometimes between what the results show and how that's spun in the abstract. And usually this takes the form of selective reporting. So one of the things, after week after week of doing this, I'm starting to kind of better detect what might be red flags in the abstract. So one thing that sort of tips me off is if there's qualifiers. So in one of my studies that I cover in the video, for example, the results are presented among smokers who have never vaped. The who have never vaped is a qualifier that describes a particular subset of the sample that they're looking at, and it makes me wonder, well, were other subsets looked at? And in fact, in this paper, there were. The other subsets that were looked at were smokers who currently vape and former smokers who currently vape. And these are also very important populations to look at. And in fact, the results went the complete opposite direction as the first group, smokers who never tried vaping. And the abstract only selectively presents the one group that kind of supports what I assume is an a priori assumption or a policy stance. So, looking for those kinds of qualifiers is a good place to start. And, you know, after a while, you kind of get, unfortunately, you have to put in the time, and part of the problem is that we're all limited with time. So, I, myself, sometimes only read the abstract, but after a while, you can kind of learn some of the signals in the abstract. And, you know, not all qualifiers are bad. Sometimes it's appropriate to look at that, but it's something that makes me want to take a closer look.
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Lindsey Stroud: Yeah, it's all pretty bad. Sorry. Last but not least, Kevin, your video went over misinformation, disinformation, and dishonest science. And all three of these lead to bad drug policy. And yeah, you kind of focus on the drug aspect of it, because I guess nicotine kind of is a drug. But laxness to any harm reduction tools leads to increased harm. You examined how nicotine bans and other drugs bring similar consequences. Also, the ways that the vaping industry seemingly and ironically supports some of the same stigmatization that you're seeing, misinformation and disinformation against these products that you saw in the drug war. Can you explain that more, and how it can be addressed, so we're not working against each other?
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Kevin Garcia: Yeah, so I definitely want to highlight some parallels between these two movements that I've identified. We have the traditional harm reduction movement and we have the tobacco harm reduction movement. And I've been noticing that there's a disconnect between these two communities. If you go to the traditional harm reduction conferences, you go to the tobacco harm reduction conferences, there's different populations. And I feel like this disconnect is leading to a lot of the harms associated with both our movements. Mariah mentioned the nimbyism. I don't want people vaping in my vicinity because I see them. And it's the same argument that people use against harm reduction. I don't want a supervised use site in my neighborhood because they're going to be in my backyard. But if we pay attention to the science, the science says that Supporting harm reduction policies doesn't increase drug use and that extends to all types of drugs and then uh Because this goes back to my point of the standardization as well in the vaping industry I hear a lot of notions that uh, you know vaping is different from vaporization which is different from heat not burn and it matters if we have a Liquid as the starting substance or a solid and I feel like that's all nonsense You know, the important thing that we should focus on is that we're vaping it's vaporization It's a harm reduction tool, and by focusing on that, we could then bring together our communities, bring together the harm reduction and the tobacco harm reduction communities. And why do I identify this as a big issue? I'll give three examples. First one is at public health trainings. I remember working at a syringes exchange, essentially, and somebody came in, a physician, came in to talk about vaping and then talked about how vaping causes a popcorn lung. and it was the cause of EVALI. We know that's not correct. It was due to drug prohibition. If there was no drug prohibition, there probably wouldn't have been EVALI. Second point, city council events. You know, I've gone to, in Denver, I've gone to a city council event on supervised use site, and guess what? There's only like the traditional harm reductionist there. I went to another event on a flavor ban, and there's only the tobacco harm reductionist there. But if both communities were there to support each other, the supervised use site bill probably would have passed, and the flavor ban probably wouldn't have passed. And it didn't because the governor ended up vetoing it, which is good, but we need that support from the beginning. And a third example, like I mentioned, is the conferences. I was just at the National Harm Reduction Conference, and it's probably the biggest harm reduction conference in the US, and I interviewed people about tobacco harm reduction, and the information that people knew about it was extremely limited, and that's such a big missed opportunity for both our communities. We'd only be stronger if we supported each other, and for us to be able to support each other, we need to respect basic science, and by respecting basic science, we need to standardize things, and by standardizing things, we get to points like, Vaping is harm reduction. Tobacco harm reduction is harm reduction. And by supporting connection, I think it would be a better result for both our movements.
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Lindsey Stroud: Fantastic. Well, I expected you guys to talk a lot more on your videos than what you did. So now we're at question time. And you helped segue it into the science. This seems to be the big problem in all of this. It seems that following the science doesn't really seem to work for everyone. How can we better address this? And I'll start with you, Ariel.
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Arielle Selya: Gosh. This is a tough one because the science supporting harm reduction is out there and it's strong. I think we have to, as discouraging as it is, I think we have to keep publishing sometimes. I know it's getting harder and harder, especially for those of us with industry ties, to get stuff published. But it is worth the effort to get stuff out there and be able to cite it and have that stamp of approval as far as a peer-reviewed publication. But I would say the other side of it is that science is just not convincing to some people. We as humans are fundamentally not always rational, and I think it's not the science that's necessarily driving a lot of the opposition. So I think having the consumer voices is really, really valuable. to tell those anecdotes because there's plenty of anecdotes out there that are alarmism about, you know, a valley or youth vaping. But there's also really, really compelling anecdotes. And at the last panel, I watched Lindsay moderate some really compelling stories from people who used to smoke and found great success in vaping, and they credit it with saving their lives. So I think having those personal anecdotes out there is really important.
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Lindsey Stroud: You guys can just pass it along to each other.
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John Oyston: I find it immensely frustrating because I think the science is there and it has been done and a lot of things are, I think, settled science. Vaping is less harmful than cigarette smoking. Vaping helps people to quit smoking. Nicotine does not cause cancer. Nicotine vaping did not cause EVALI. Popcorn lung is not a problem with vaping. These are all settled science. These aren't debatable anymore. And yet we're still debating them, and people are still using these arguments. And I don't know how we get beyond that. And as a physician, I feel I have an obligation to educate other physicians. But I just find that's such a hard thing to do, not least because of the funding issue. I have previously accepted funding from the tobacco and vaping industries. So Health Canada isn't going to hire me to be a spokesperson on this topic. It's just very frustrating how we actually do the knowledge translation. And if anybody has any good ideas, I'd appreciate them.
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Marewa Glover: So I think that I would talk about why are they lying and why are they misrepresenting the science. So I think it's very important to look at the language that they're using. So this is, again, the language sphere. Most publications occur in the event-forming sphere. This is an event where they are... propagating their ideology and their ideal vision and their utopian vision for the world. So it's done through publications, it's done through regulations, and the language they use, so there's a really useful and analytical tool which is called discourse analysis, and that is very, very revealing if you use discourse analysis, Why have they used that word? You know, and it reveals their underlying ideology and utopian vision, which is everyone is to be, you know, no offense, white, skinny, you exercise a certain number of times. You know, it controls, there are rules about absolutely everything. how many times you should be having sex a week, and whether or not you should be wearing, you know, or using barrier methods of control. Absolutely everything, there are rules. What you should eat, what you should do, and I guess most people, it's like being a goldfish in the goldfish bowl, and they're not aware of the water around them. They're not aware of all of the rules about how you should behave and how you should be like, what language you should use. And so the lying and misrepresenting is all part of this multi-sphered, polyspheric action to control the group. What we have is one group who believe you should all be like them, And we have people who are not like them, who just want to be like they are. And the lies are all about that. They don't want us drinking. They don't want us all of those other things, using substances. There's also the religious kind of many religions. So when people of the whole argument about Addiction. This is another huge narrative they're using about addiction. Addiction is bad. Addiction is, then you're not healthy. What they are partly talking about is this person is fallen. In the spiritual sense, they're a fallen person. If they would do something outside of the rules, What else would they do? They're a dangerous person. We don't know what they're going to do next. They're possessed. These are words they use in their narrative. Possessed by nicotine. Brain worms, you know, and all of their imagery they're trying to get across to make people scared. What you need to be scared of is what they will do to you if you disobey and you don't follow the rules they're trying to form in the group.
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Lindsey Stroud: A lifetime addiction to nicotine is one of the things they put out. But I think also what you kind of pointed out in your video, too, I mean, when you start identifying us, there is automatically a them. And especially people who smoke or use safer nicotine products, I mean, they've already been stigmatized for being people who smoke. And to Kevin now, following the science.
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Kevin Garcia: Yeah. A lot of great points made. I feel like it really highlights why we have to understand and remember the fact that harm reduction is a movement for human rights, and it's a movement about the rights of people who use drugs. And by remembering that, we remember that drug use shouldn't be associated with something negative or bad or whatever. It's just drug use just is. In certain contexts, it could be beneficial, it could be harmful. anything else. And I also want to highlight as a person who's been vaping for like 10 years and kind of been entrenched in THR and have seen how, you know, the science seems like it's going backwards. The more time that passes, the more that people believe that nicotine vaping is the culprit of like evaluate. And I feel like this really highlights why the disconnect aspect that I've been talking about is so, so important. You know, we also talked about like language and standardization. And when we talk about tobacco harm reduction, people don't put it in the same, like, you know, same boxes harm reduction. At least in the US right now, we see like, you know, our president, our federal government supporting some harm reduction policies, but tobacco harm reduction is not spoken about in that same vein. And it goes back to, you know, that lack of disconnect and supporting that bad science. How do we combat people from, Supporting this bad science. Well, we need like the consumers. We need the people we need people to rally up We need numbers and with you know with disjointed communities with no standardized definitions for what harm reduction is then we're gonna continue being disjointed communities and And people are going to keep supporting the bad science because there's not like enough people to be like, hey, this science is not good. We should be paying attention to this because, you know, maybe they don't have conflicts of interest or, you know, they have good, you know, good methods, for example. But yeah.
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Marewa Glover: Go on. I was just going to make a point about what you said, John, about public health versus capitalism. You know, universities are now businesses, and they are profit-making ventures and entities. And many people working in public health, it is a capitalist structure. It is about making profit. And many people in public health, it is about the money. Some people maybe have social justice, a commitment to social justice, a commitment to equity. But at the end of the day, you've got to feed your kids, right?
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Lindsey Stroud: Absolutely. Well, OK, this goes into the next question. We have a few Q&As, and I will get to you guys that have been joining us online. Who ultimately is responsible for informing the public of both, you know, on reduced risk products? Is it the manufacturer? Is it the public health community? Is it the consumer? And I'll let Kevin start this off and just go on down.
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Kevin Garcia: Does anybody else have something to add?
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Arielle Selya: Olivia Wachowski recently published a really great paper looking at a version of the ICO's modified risk claim that was recently authorized by FDA. And doctors, by and large, are unaware of ICOS and the harm reduction potential, but that's sort of a separate story. The point of the study was that doctors didn't trust the reduced risk claim unless it was presented as being authorized by FDA or endorsed by FDA. So I think that's really important. I think there is some distrust of government health messaging and some good examples why that might be the case. But I think the fact is that most of the public will trust a claim endorsed by public health agencies more than they would trust an industry claim. So I think it's essential for public health agencies to effectively communicate about reduced risk products and correct some of the misperceptions out there?
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John Oyston: As a physician, I'd like to say that physicians should be at least part of the answer to this question. And people who smoke attend their physicians regularly for smoking-related illnesses. And as part of that discussion, they should be informed about all the options that are available to them. But that conversation can only take place if physicians actually themselves are aware of all the options that are available to them. And at the moment, they're not. So we do end up in a situation in which a lot of the information is coming from the industry. And that can be OK. I mean, we trust when a car advertisement says this car does this many miles per gallon, that that's going to be a true statement. But in Canada, we have an awkward situation. Sorry. We have an awkward situation. in which the people in the industry, the people who run vape shops, are not allowed to tell their potential customers that vaping is safer than cigarette smoking. So we're banning the industry from communicating effectively from consumers at the same time when physicians aren't able and aren't willing to communicate effectively. So it's not surprising that Canadian consumers and probably consumers around the world are very confused and very unaware of their options.
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Marewa Glover: Thank you, John. That, you know, gives me something to say. What you say, what you do, your acts and your words in this competing ideologies world, what you say and what you do are political acts. So we have ideologies, they form, say, a political party, or a religion, or public health, you know, a sector and If you vape, you know, many people who vape, see, they're just doing something personal, it's a personal choice, but in this environment it becomes a political act. It's seen as, by the other ideology, an opposing political act, a protest. The blacklisting, the cancellation, the censorship is about shutting down that other ideology and opposing political party's ideology or opposing religion's ideology and opposing ideology in public health. We don't all agree.
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Lindsey Stroud: Did you want to add? Well, did you want to do the Q&A that was specific to you? Or did you want to do... Well, we'll do Paul Blumer's first. So Paul Blumer asked, do you think that the science presented to the public and the agencies is too complex? I kind of like this. I deal with American lawmakers and they prefer everything in bullet points, as they've told me. As I've joked with them, they'd prefer if it was in crayon. Should we be writing the science in more simple terms for people to understand tobacco harm reduction? Who wants to go with that one?
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Kevin Garcia: So I feel like we're all talking about how do we parse out the good. bad science, whatever that means, and I feel like the next question really goes together with that last one, but somebody put, you know, while the benefits of a unified harm reduction movement will clearly benefit all those involved, from a scientific standpoint, THR vaping is clearly different from marijuana vaping versus dry air vaping versus heat not burn. The risk, liability, particulate matter, toxicology are all widely different. Is it really beneficial to lump all vaping together? And I feel like the answer to that question is yes, especially going back to the last question. Because should it be written in more simple terms so it's understood? And I believe, yes, it should be put as simple as possible. Any sort of vaporization, heat not burned, vaping, whatever, it should all be lumped. Because obviously, we're having an issue where people don't know what the good science and what the bad science is. And it's obviously presented in a way that people don't know about it because it's It's been overly complicated for no reason. And we run into this a lot in science, and that's how people use science to misinform and disinform the community. We need to just break it down and make it simple. Vaping is vaping. It's harm reduction, period. And I feel like that would be beneficial to our movement.
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Marewa Glover: The words good and bad, which we're hearing here, that's where the whole moral thing comes in. So if something's good or bad, that's a moral opinion. But they're all created. What's good or bad in one group may be completely thought of as bad and good in another group. So I believe in terms of the science, it needs to be communicated, Communication 101, in different languages for different audiences. And everybody's opinion is important. It shouldn't be that there are just good science and bad science There obviously is very poor methodologically and flawed science. But everybody's opinion should be on the table and be able to be aired if we're going to get through this.
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John Oyston: I think when you're communicating science, you have to do it at a whole pile of different levels. And some people just want the 140 character to tweet. And you can do it that way. But you also need to back that up. because anybody can make a tweet that says anything. And so you do have to have the things that go into more detail. And I'd like to share a little bit with Kevin, because I agree that there are similarities between all forms of vaporization, but it matters absolutely and critically what the thing is that you're vaping. And if you're vaping vitamin E acetate, you're going to be in big trouble. If you're vaping cannabis, that's another thing. And there is a very real difference between a heat not burn product and a vape. That makes life more complicated. It offers people more choices. But I think you have to explain that those things are different and explain why some people might prefer heat, not burn, and some people might prefer vape.
00:39:01 --> 00:39:04
Lindsey Stroud: You want to respond to that?
00:39:04 --> 00:40:21
Kevin Garcia: Yeah. I mean, sure, they're different. And I feel like getting super nuanced about it, Yeah, it's an issue with the audience. So sure, heat not burn and vaporization, they might have their small differences. But I feel like those differences are better, you know, better for like the researchers, the academics who want to get into the nuance. But for the consumer, all the consumer needs to know is that vaporization is harm reduction. And when you're not smoking, you're vaporizing. It doesn't matter if you're starting from the solid or liquid, you know, you're still vaping. And what the consumer needs to know what policy makers need to know is that it's harm reduction compared to smoking. And I feel like all of these nuanced details, it's not bad to get nuanced, but it unfortunately confuses people. It's led to misinformation because people are taking this info and just not representing it clearly, if that's making sense. So I feel like, yes, we need to have some sort of distinctions especially if we're academics, if we're in a research lab trying to study this, but for the general population, for all things concerned, you know, vaping, heat not burn, and vaporization, I think it's the same thing because it all causes, you know, it's harm reduction, especially when you compare it to smoking. Yeah.
00:40:21 --> 00:40:32
Lindsey Stroud: Do you have anything to add, Ariel? I mean, do you work with the Kleenex of vaping, is what I call it, what I call Juul, but so you know how much the language can matter.
00:40:33 --> 00:41:40
Arielle Selya: Yeah, so I have mixed feelings on this. I think on one hand, it is good, if possible, to get a simple message out there and communicate the scientific results in a clear manner that's accessible to a lay audience. And also to get away from some of the academic esoteric language, which is difficult to parse unless you have a lot of expertise in research. But on the other hand, I think there's a concern that in trying to simplify too much, that stuff can be swept under the rug that's a little bit hard to explain. So, like, for example, it's a clear message to say that there's a lot of youth vaping and that youth vaping might lead to smoking, that the gateway argument, which I've had a lot of papers sort of debunking, but it's a complicated argument to make that. It kind of takes a technical explanation to explain common liability and how the youth that vape have pre-existing risk factors that would have otherwise predisposed them to smoking. It's a very technical argument to make, so I think there is a danger of losing some of that if simplifying the language too much, so I think it's a fine balance.
00:41:44 --> 00:42:23
John Oyston: Yeah, I think, Kevin, you may be guilty of undervaluing the intelligence of the nicotine consumer. And if you look at the amount of time and effort people make into choosing which car to buy, which golf club to buy, which cruise to go on, people are capable, when it's a matter that they take seriously and they're interested in, on evaluating relatively complicated information. I could summarize the difference between heat not burn and vape in one page and I think I could do it at a high school level language. And I think that's the information that should be available to people because I think there is a significant difference between choosing heat not burn and choosing vape.
00:42:23 --> 00:42:31
Lindsey Stroud: Do we have questions? How are we doing Q&A?
00:42:36 --> 00:44:24
Richard Pruen: Excellent, thank you. Richard Pruen from the Safer Nicotine Wiki. Would you be able to talk a little about going by Dr. Glover's kind of model, how do we try and bring those different groups of people closer together so that we can maybe find out what we have in common and use that to actually work towards shared goals. And also if you would be able to talk about how we can bring information to people at the right level for them to understand so that if they want to go digging they can find the technical details if they want them. and also that they receive a summary from somebody who they find trustworthy enough so that if they don't want to go digging into it, they can read a short summary and go, oh yes, well that's harm reduction, for instance. And the third point was, how do, I mean, as I came into vaping, And yes, it saved my life. I see the harm reduction principle there. That actually opened my eyes to harm reduction elsewhere. Why and how have we ended up so siloed that harm reduction isn't harm reduction? It's tobacco harm reduction or drug harm reduction or gambling harm reduction. Thank you very much.
00:44:24 --> 00:44:45
Lindsey Stroud: Thank you, Richard, and so to kind of summarize what you mentioned, talking to the opponent organizations, summarizing the science, and then also how did we get to this misinformation in regards to heart reduction. I think they all kind of work together, and I think that goes along with your video a lot, so Marwa.
00:44:47 --> 00:46:02
Marewa Glover: Yes, so I do want to acknowledge Carl Phillips who helped me write the paper on the model and unfortunately, I mean I think if you accept that there are different societies that have formed over our history as human beings, and that those groups develop different belief systems to control their societies. And in the world, we have very many different societies with different belief systems. We do not all agree, and we're not all going to agree ever. Unfortunately, with the anti-vaping fundamentalists, and fundamentalists in that sense, with the spheres model, all of their spheres align. So then they don't see any need. It serves their purpose to not communicate with us because we are illegitimate in their mind. We are wrong, we are fallen, we are not worth speaking to.
00:46:02 --> 00:46:11
Richard Pruen: How do we actually solve that problem and start to move towards each other? At the moment things are just getting further and further apart.
00:46:11 --> 00:47:56
Marewa Glover: Yeah, we're getting further and further apart because at some level it is a war, although it's a war of ideologies, but wars are a fight and it's a fight to win. We kind of, you know, social justice, people first, regardless of where they are at, so the person at the centre, and we seek to understand their circumstances. And so we are ideologically opposed on a number of spheres and levels. What we need to do is fight. We need to fight. We need to stand up for the human rights of people. We need to stand up, and it is a social justice fight, and we need to expose their ideology and what's the purpose of it. We need to expose the lies. Thank you for doing what you do and what Clive does. We need to do that more. We need to explain why they use that word, Why are they creating this moral panic around a vaping epidemic? Why are they saying to people that vaping harms when there is no evidence at the moment of harm? Zero people who vape have died in 20 years, 23, 20, how many? 20 years so far. So we just need to keep fighting, we need to expose the lies, we need to be analysing the language and communicating to people as well why that doesn't apply in this instance.
00:47:56 --> 00:48:19
Richard Pruen: So one more question, sorry. How do we differentiate between the people that we need to fight then, because we have no choice, as you've just made clear, and the people on the harm reduction side, who should be allies, but we seem to be fighting them as well? Thank you.
00:48:21 --> 00:49:09
Marewa Glover: The inner war, if you're on the other side, then you face costs. Costs of injury, costs of the loss of your career, the loss of your salary. So, you know, everyone's going to consider that it's going to be different for every person, whether they can afford to fight, and not everyone can. In harm reduction, and you can speak to that probably more than me, Kevin, but I do think that there is a fear of getting dragged into this other war. You know, they've had their own sort of war for quite some time, and what we have is a very vicious war going on. Kevin?
00:49:09 --> 00:50:01
Kevin Garcia: Yeah, I mean, like you just mentioned, you know, we know that vaping is safer than smoking, you know, leads to reduced harms. But when I go to harm reduction conferences, I don't see that notion mentioned anywhere. So I feel like a simple answer is, you know, I'd encourage anyone in this room to attend the traditional harm reduction conferences and get to a point where we're more unified. You know, I interviewed people at the, yet again, traditional harm reduction conferences and like, When I ask people about vaping, people are just scratching their head like, I really don't know. But when I ask them about, you know, sterile syringes, it's like, well, of course, sterile syringes is a harm reduction tool. So we're getting to a point where vaping is not considered a harm reduction tool by many, but sterile syringes is, you know, and they're both harm reduction tools. So my call to action for everyone in this room is go to those other harm reduction conferences and collaborate with each other, learn from each other.
00:50:03 --> 00:51:08
John Oyston: I don't know how bad it is in other countries, but you talk about the need for communication and to talk to people on the other side. In Canada now, it is almost impossible for me to do that because I am physically banned. So the big Canadian smoking cessation conference every year in Ottawa, I have been banned from that for the last two years because I attend events like this, because I've written a report on flavors for the Canadian Vaping Association. The people who are involved in tobacco control that I used to get on with when I talked about like raising the age for tobacco to 21, when I talked about getting people to stop smoking for safer surgery, these people were my friends. Now, the majority of them will not reply to my emails. They just ghost me. I gave a talk to physicians on safer nicotine products. I invited one of my colleagues, a guy that I used to work with. He said it would harm my reputation if I attended your event. So he's not prepared to come and listen to me to speak because that was an industry funded event. So I really, I can't talk to people in Canada anymore, it's crazy.
00:51:08 --> 00:51:20
Richard Pruen: Unfortunately I have that problem as well. I seem to have picked a side and now I'm stuck with it even if I change my mind.
00:51:22 --> 00:52:03
John Oyston: And the sad thing is, I love this expression, I never learned anything by talking to people who agree with me. Because when I do get the chance, and it's interesting to understand where these people are coming from and why they think the way they do, but unless I give them the chance to explain to me why they're saying what they're saying, you know, and someone says to me, okay, there is a gateway. And I said, well, look at the graph. Like, where's the graph? Like, smoking is going down, vaping is going up. And he said, oh, well, we haven't seen it yet, but it's going to come. Well, now I know something about where he's coming from. He's not looking at the data as it exists. He's looking at some hypothetical data that may or may not exist in the future. Yeah.
00:52:03 --> 00:52:11
Lindsey Stroud: That's why I tend to get involved in it. Yeah. Well, actually, and Ariel can, and then we also have another question. So if she goes, and then you'll go with your question next.
00:52:11 --> 00:54:29
Arielle Selya: Yeah. Sure, I'll be quick. So starting off on your third question, why is it that tobacco harm reduction seems to be going, or completely disconnected from other types of harm reduction? I think part of the driving force is from academic incentives. And I'll have another brief academic rant. If you haven't seen my first one on peer review and Clive's list, I'll be happy to share it privately. Part of what academics are told is that you have to hyper-specialize in something. So there's separate grants, there's separate agencies, people devote their entire careers to hyper-focusing on something. So if it's the case of e-cigarette use in youth, that's what they spend their entire careers focusing on, and then they lose sight of other things that have been published in the YRBS recently. such as the extremely prevalent binge drinking, alcohol use, mental health challenges, and both of these are both more prevalent and more immediately harmful to youth than vaping. But because academics are not talking to each other, this kind of gets lost. And now, of course, we see a split within the tobacco community research itself, that there's two different factions. And I think one way of addressing that from the literature At the end of my video, I talk about some kind of preventive actions to prevent some of the issues that arise in the literature, starting with good peer review. And I know peer review is a problem, as you talked about this morning, especially for Harm Reduction Journal and others. But peer reviewers have to do a really thorough job, and it's a thankless job. Everybody's swamped, but it does start with peer review. Myself and a couple of colleagues have been able to balance out some of the initially imbalanced manuscripts to provide a more comprehensive perspective. There's also things like post-publication critique. Oftentimes if you write a letter to the journal, sometimes it's censored depending on who's writing the letter. Oftentimes it's not published at all, but there are more and more options nowadays for posting a critical review on PubPeer or Kaos. It doesn't get much visibility and it usually doesn't have an effect, but there have been some important corrections that have led to either retractions of articles or corrections that basically defang a potentially harmful article.
00:54:29 --> 00:54:31
Lindsey Stroud: Fantastic. We have a question over here.
00:54:31 --> 00:58:34
Roberto Sussman: Yeah, now it's two very brief comments. One is that, yeah, it's true that there are differences between the different harm reduction products, like heated tobacco is not the same, but there are also, there are even more things that these products have in common, which is lack of combustion. And this is a way to describe them, because you can cascade later with details But in general, the issue is the lack of combustion. And that you produce an aerosol, whether it is from a liquid or from biomass, or as it is done in diving and different forms of cannabis, from a solid, right? And it is important because it intersects all this usage. Cannabis can also be smoked. and the smoke of cannabis is as toxic as the smoke of cigarettes, right? And those who vape cannabis are also doing harm reduction. And those who have their instruments, it's a plethora of instruments there that you put the stone and then you light it up and you are also generating an aerosol there. So there is more unity in these things and it intersects several substance usage. And this has to be exploited, not separate in compartments, but to emphasize the unity of this. This is one comment. The other is on the fundamentalists, which we have all bumped with one of these, and I bumped with them personally. There was a time, around 2000, it ended in 2019, where you could still talk to them, right? Before happens what you are saying in Canada, but there was a time you could talk to them. And something important we have to understand about these people is that they think they are doing something good for you, right? This is important because You have to distinguish between the scoundrel that wants to beat you up or hit you or whatever, wants to cause you harm, and those who are doing horrible things to you for your own good. These people, they will never repent. In the factory, the foreman who is hitting others, he feels sorry sometimes, he goes to church, confess, but the person who is crusading, it is never going to feel sorry, he's doing the right thing. He will say, or she will say, well, some people die, these are collaterals, whatever, whatever, but the goal is, et cetera, you know? So the model for understanding them, and I understand them because I come from a Spanish-speaking country, is the Spanish Inquisition. The Spanish Inquisition, officially, they said, we don't want dead people. We want repented people, right? And they were honest in that. And this is the type of thing we are facing. They don't want to kill us. They want to convert us, right? And they think they're doing it for our own good. It's important to bear this in mind, right? So these are my comments.
00:58:41 --> 00:59:11
Lindsey Stroud: the harm and combustible cigarettes as combustion and this whole demonization of nicotine, I guess, I mean, we are looking at tobacco harm reduction the next decade. How can we try to like, you know, solve that? And you know, getting, I just remember like a few years, like I remember back in the 90s, you could quit smoking cigarettes and they said like, oh, three days. And then now it's this whole lifetime addiction to nicotine and like, you know, bogeymen are coming after you and your kids. How do we reconcile that?
00:59:11 --> 00:59:24
Kevin Garcia: I just want to say that I'm a big fan of your one comment that said we should, you know, we should focus more on the similarities, which is not combustion. I'll just go with that. Great way to summarize it.
00:59:27 --> 00:59:51
Arielle Selya: I agree. I would say maybe it's appropriate for messaging on different levels. So I do think that, you know, given the cliff of harm reduction, I think it's appropriate to talk about combustibles versus non combustibles, but also maintain like the precision that allows someone to distinguish between like heat, not burn and vapor and that sort of thing. So I think precise language, but also simple would be good.
00:59:52 --> 01:01:10
Marewa Glover: I just wanted to pick up on what you said, Roberto, and, you know, I can attest to the fact that they are believers. It is like a religion, public health religion. They do believe that in their Yeah, and that they are doing what is the best, what is for your good, and what is for the good of the world, the complete world of humanity. And politicians, I think, are a little bit different. Most of the people we're up against are not politicians. They're academics. They're the true fundamentalist believers, the priests. And politicians understand about negotiating. These people don't. They're not willing to negotiate. There were times when I was getting to the end of, or I started to see cracks, the use of brainwashing techniques, because I was trained in psychology, and really blatant brainwashing techniques used at conferences. It is more like dealing with people who belong to a religion.
01:01:10 --> 01:01:17
Lindsey Stroud: And I think we have an audience question or a couple. So you and then you. OK.
01:01:17 --> 01:01:19
Attendee: Well, ladies first.
01:01:19 --> 01:01:21
Lindsey Stroud: Oh, there's a gentleman.
01:01:25 --> 01:02:45
Fiona Patten: Thank you. Fiona Patten, Australia. So again, I'm sorry. But I take up your point because, you know, I've been a harm reduction activist for decades, long before I went into politics. But now when I speak to my colleagues and, you know, we started a supervised injecting room and I speak to the medical director at the supervised injecting room around tobacco harm reduction because, you know, He's saving the lives of many of the clients of that centre, but they're going to die from smoking-related illnesses. They may not die from a heroin overdose. Big tobacco immediately. First thing he says to me. And it is with every... Even at the International Harm Reduction Conference that I went to in Melbourne this year, we were talking... You know, there was concerns about big pharma. So, you know, I know the Canadians, with some of the work that they're doing in distributing cocaine and heroin, Again, the activists were complaining about the influence of Big Pharma in that. But the minute I start talking about tobacco harm reduction to people, again, it's big tobacco. And I don't know how to get around that. And these are harm reduction activists. And I just, I know, John, you've been facing it in the medical profession, but I mean, how do I circumnavigate that?
01:02:45 --> 01:03:53
John Oyston: In my ideal world, we would have three separate commercial sources, maybe four separate commercial sources of nicotine. So I would love to see combustible tobacco, oral nicotine pouches and snus, and vape as three separate businesses and three separate categories. And so everybody would be in their lane and everybody would be competing for the nicotine market. I somewhat regret the fact that Swedish Match has been taken over by PMI because I like the idea of having a company that was an all nicotine pouch product. I kind of regret the fact that Juul has been taken over by Altria because I think it would have been easier and simpler if we had an independent vaping industry that was not bought up by tobacco. Unfortunately, particularly in the States, we've now got a situation where all forms of nicotine, except medical nicotine replacement therapy, are controlled by the tobacco industry. And I think that's unfortunate. It's a step backwards, and it's going to make it more difficult for people to accept tobacco harm reduction.
01:03:56 --> 01:04:04
Lindsey Stroud: Do you wanna go on on that, or do you wanna, we're running out of time, we have another question, so and I wanna kind of follow up with a future question for y'all, so.
01:04:04 --> 01:05:00
Attendee: Hi, first and foremost, full disclosure, I am from the industry, but I have a second professional hat, and that is a military medical professional. And the reason I bring this up is one of the issues I'm encountering in Israel is the fact that the military, on the one hand, acknowledges that vaping is better than smoking. On the flip side of it, we have an epidemic of disposables blowing up, no pun intended, of course, with the military authorities that don't know how to deal with it. And my question is, how do we prevent independent authorities, medical authorities like the Israeli Military Med Corps, from falling into the landmines that, again, no pun intended, that PHMOH, for example, in Israel might put in place to those who are willing to actually listen, learn, and create an independent opinion on a topic like tobacco harm reduction or harm reduction. Thank you.
01:05:02 --> 01:07:09
Marewa Glover: So with both your questions, there are strategies, you might understand coming from the military, there are strategies, war strategies, strategies for controlling. So they create these narratives to control the way that people think about things and now You know, I was picturing this kind of circle. You do, oh, it's bad for children, then you, you know, there's so many, and we use them in tobacco control, so I can recognize, you know, them. The gateway, the, So they're just strategies they roll out, and when we fight back with intelligence and with evidence, and the evidence isn't there for what they're claiming, and that one falls over, they just pull the next one out. It's like, you know, they have an armory of strategies, and they'll just pull one out, one after the other, and the narrative is put out there based on lies, based using very strong communication strategies, brainwashing, manipulating the way people think about things. So on the one hand, yes, look into the evidence of what are the harms of disposables, what could be done about if it is bad for the environment, but look at what the purpose is. So, you know, in Māori we always say, for anything, for any question, He aha te kaupapa? What is the purpose? What is the underlying purpose of this action? So you look at that. The big tobacco thing, you know that, of course we had that when we only had combustibles. And now they've dragged it out again. It's just a strategy, and try to look at the purpose that's underlying it. What's their ideology trying to achieve?
01:07:09 --> 01:07:33
John Oyston: One of my other hobbies is I'm a hiker, and in the hiking community we have a big philosophy. If you can pack it in, you can pack it out. The stuff that you take, you bring back. And I'd have thought in the military it'd be fairly easy. Like if you have room to take a disposable vape onto an exercise into a war or whatever, then you have the room to take it back. And I'm surprised military discipline can't cope with that.
01:07:33 --> 01:08:27
Arielle Selya: I think, again, maybe the solution is to take a step back and look at the wider context. So for disposables in particular, the thing that comes to mind is the work that Harry Tatton Birch does out of the UK. suggesting that among adults, total nicotine use of any product has remained stable, even as disposables are increasing, which suggests that it's taking away from smoking. Might be a slightly different story in adolescents, although much of that is experimental in nature. But again, taking the wider picture of what's happening with other products, again, I think we have to fight this hyper-specialization of focusing on disposables without taking into context the wider picture, because there's a lot of great evidence from population level trends and econometrics showing the strong substitution between tobacco products. So always taking a step back and looking at other products is a good idea.
01:08:27 --> 01:08:43
Lindsey Stroud: Okay, well we're going to be wrapping up. We got another question? Yep, I mean, well, there's Richard, you're good. Okay, sorry. Tom?
01:08:43 --> 01:09:21
Tom Gleeson: Tom? Hello. Tom Gleeson, New Nicotine Alliance, Ireland. I'm going to be devil's advocate. It's not tobacco harm reduction unless you're already addicted to tobacco. If a naive user uses these products, that's a harm in position. So are we left with a situation, specifically to you Maria, what we're facing in New Zealand, where you will have to sunset combustibles for harm reduction to be acceptable to the antis?
01:09:21 --> 01:10:34
Marewa Glover: Oh no, they're going to sunset the whole lot. Oh yeah. Combustibles is the first step, then vaping, they're looking at sugar, not driving cars anymore, the whole world economic forum. plan for the world. One of the strategies is to co-opt every group, to get on the board of the Society for Research on Nicotine and Tobacco, and change the criteria for membership, and change the purpose of it and the policies of it. Get onto the Cancer Society. Get into politics. That's also a strategy that's being used in New Zealand. Get a public health person in there. Our Associate Minister of Health is from the University of Otago, our centre of anti-vaping fundamentalism. So you infiltrate, you know, I mean looking at war strategies is probably very useful in this area.
01:10:34 --> 01:11:04
Arielle Selya: And I'm going to push back on the idea that it can't be harm reduction if it's a naive user because there are predisposing risk factors that precede different kinds of tobacco use and there's strong substitution between them. And exactly what we're seeing, if there's an increase in never users, or never tobacco users that are vaping, that's exactly what we would expect to see as substitution happens on a population level, because it's an alternate initiation pathway.
01:11:04 --> 01:11:28
Lindsey Stroud: Any more questions from the audience? Well, I've got my, Martin, we only have a few minutes left, so I'm gonna do my last question, if you don't mind. What's the next decade of tobacco harm reduction? Is there hope? And if you guys were going to give a message to consumers and policymakers, especially over the next few years of what we should be doing, what would you tell them?
01:11:28 --> 01:12:00
Arielle Selya: I guess I'll go first since I have the mic. Part of me is pessimistic, just seeing the worsening division that I see in the literature. But on the other hand, I think there's There's maybe, even in academic circles, more of an acceptance that e-cigarettes can have a harm reduction potential for adults who smoke. So I think of the saying that a truth is first ridiculed and opposed and then eventually accepted as common sense. And I, knock on wood, I think I'm seeing the first signs of that.
01:12:03 --> 01:13:00
John Oyston: We're going to be optimistic. Although we live in a capitalistic society, governments are prepared occasionally to put their finger on the scales and weigh the balances a little differently. And if we look what's happening in transformation of transportation, the government is prepared to subsidize electric cars. And recently, the government in Canada has given billions of dollars to set up an electric battery manufacturing plant for Volkswagen. So in a logical world, why isn't the government subsidizing Swedish Match or Juul to make vape. That would be a logical thing to happen because this is in the public interest. And I know that's a fantasy world, but if you want an optimistic vision for the future, imagine one in which the government is supporting transformation in tobacco in the same way that they're funding transformation in the fuel industry or in the automobile industry.
01:13:03 --> 01:15:41
Marewa Glover: I'm not so sure. I think if you look at history, there have been countries that were a democracy, and in a very quick time they fall, and they're no longer a democracy. They become something, one of those other political systems, and people lose freedoms. One of my reports, I looked at where all the indigenous people were in the world, what countries, and to understand what had happened there in terms of colonization or the country being taken over. And it was interesting, I think there's like 99 or 120 countries. It's a thick report available online. But you know, it was a really interesting exercise with what I learnt looking from Ottoman Empire to today, that around the world empires form, they expand, and they contract. And this is going on all the time. So we're all part of this, we're all being affected by this. There's a new empire forming, think Star Wars. And we're all being subjected to the thought control and manipulation to get us to accept this new empire. Or it might be more like The Matrix. The Matrix is another good movie. You're either plugged in or you know you're Neo. And I'm going to be part of the resistance. I believe I like that there are lots of different cultures in the world. I like that we have difference. I think that innovation comes from difference. I think that the future of humanity actually relies on us being different and maintaining our cultures. But there is another almost becoming predominant ideology in the world, and certainly trying to, that believes we should all be the same, we should all speak English, we should all believe the same in the same God or religion that we should all, you know, so I would just caution. Don't think that your current democratic system or your current socialist system will be forever. It won't. This is going on all the time. Learn some history and see that it doesn't, things don't last. They do change. It's up to you now.
01:15:41 --> 01:15:41
Richard Pruen: You're going to say anything.
01:15:42 --> 01:16:20
Kevin Garcia: If I have any final words, just yeah, try to go to those other harm reduction conferences. Let's learn from each other. Let's collaborate with each other. Let's get to a point where we all agree on the definition of what vaporization is, what vaping is, what heat not burn is. Let's all get standardized and let's collaborate. you know, we could support harm reduction policies. Because if, you know, tobacco harm reduction policies are supported, so are other harm reduction policies and vice versa. You know, the more we help each other, the more all of these movements will be able to push forward into the mainstream society and, you know, be a thing that we all have the harm reduction tools that we need.
01:16:24 --> 01:16:41
Lindsey Stroud: Well, thank you, everybody, for joining us. And I was so worried we wouldn't have enough to talk about. We made it on time. Again, if you haven't seen their videos, watch all of their videos. They're amazing. If you need like a little summary, you can see my tweets on it, too. And I also have notes. I'll just email them to you. And thank you, panelists, for joining us today.