Hello, this is Patricia Kovacevic, general
counsel and chief compliance officer at
Nicopure Labs. Today we're talking with
Professor David Sweanor, a prominent
attorney and lifelong anti-tobacco advocate
who is also a tobacco home reductionist.
David, can you please tell us a few words
about yourself and your work in the area
of tobacco harm reduction over the last
few years?
Sure. Well, I mean I've been involved in
doing things to reduce smoking since
beginning of the eighties. We
were very successful with a lot of those
things which caused me to then do a lot
of international work with the World
Health Organization, World Bank, ecetera
and it became really obvious by the
early nineties that if we didn't deal
with the product itself, if we didn't deal
with the fact that people smoke for the
nicotine but they died from the smoke
we weren't going to get nearly as far as we
should and in terms of reducing the
health burden. So I started writing more
doing more, speaking more on issues of
risk reduction because this is it
essentially this is a really really
simple issue that we've got a tremendous
number people dying not because of the
drug but because the delivery system and
anywhere else we say change the delivery
system. You know there's reasons that
that you know we deal with things like
clean needles or we deal with condoms
or auto safety. We change something
in a way that deals with the underlying
risk without necessarily having to
immediately change the behavior
associated with it. Correct and Canada
indeed has had some successes in
tobacco control. However, as we know
Canada hasn't quite embraced what is
probably the biggest leap forward in
tobacco harm reduction which are
actually vaping products. In fact,
according to Health Canada, you need a
basically premarket authorization as a
drug as soon as you contain nicotine and
yet e-cigarettes are widely available for
purchase in Canada, albeit arguably
illegal under the federal
regulatory regime. What's happening there?
When is that going to change? Well, I
mean in terms of where we are
one of the problems was conceptual
and I've dealt with this all my career.
When you talk about you know getting
restrictions on tobacco advertising and
government bureaucrats and say but we
don't have any laws that do that.
See, that's why you need a law that does it
and that's why I'm here to talk about
law reform. When they were dealing with
nicotine, their view was if it's got
nicotine in it, then under our laws other
tobacco products or pharmaceutical
product. And since vaping isn't a tobacco
product,
well then it must be a pharmaceutical
product. You know, without saying well you
know this is like somebody who's told to
take shapes and divide them into piles
based on whether they're square or
circle, but then you get your shape that's a
triangle and they say well ok it's not a
square so it must be a certain way, it's
not a circle it must be...
oh my gosh what am I going to do? So they
took this position that it must be a
pharmaceutical product because it's not a
tobacco product. Of course it isn't. So
you have bureaucrats who said we're
going to treat this like it's a medical
device or medical product. It clearly
wasn't but them saying that would be
illegal to sell anything with nicotine
in it, we had this proliferation of vape
shops, you know independent companies
that said we're saving lives.
This makes sense. We're going to do it
and they were backed by those of us who
are saying constitutionally, you know, we
have a constitutional right to life and
we've had our Supreme Court defend
things like safe injection sites for IV
drug users because you've got people who
are dealing with dependents and
they're being forced otherwise to deal
with it in a way that is far more hazardous. So
Supreme Court of Canada has ruled on IV
drugs. It's ruled on marijuana that
people are entitled to access to a safer
alternative. So one of the problems is a
bureaucrat saying this is our
interpretation of the law but when
challenged, the vape shops that were on
to this just started saying you're
wrong. You know, for something as you
know is a lawyer you to say I think this
law makes something illegal doesn't make
it illegal. You know, a bureaucrat can say
something but have they interpret
interpreted the law correctly? Is this
the right law to apply and what's the
Constitution say about this?
And as a result, you know, they haven't
been willing to enforce the laws. So, we have
had this proliferation of hundreds of vape
shops, hundreds of thousands of people
are vaping and Health Canada was frozen
trying to figure out how to deal with
this because of course you intervene and
try to show shut these places down and
number one, you don't have enough
inspectors. Number two, even if you
succeed
you've added to the health problem
rather than reduced it. So they've now
said we're going to introduce new law. So
they're going to do some new new
legislation in the next few days that is
supposedly aimed at facilitating people
quitting smoking by moving to vaping
while trying to deal with unintended
consequences like young people taking up
vaping. Do we know if this law is going to
involve any requirement for a premarket
review, anything similar to what in the
US?
We don't know. We would hope me
Canada's generally, I mean this is from
Canadian perspective, we're generally a
lot more sensible to some of the stuff that
happens in the states. The FDA law
has really harmed public health. I feel
for an agency mandated to protect the
health of Americans, they've ended up
with a law that really protects
cigarettes and makes it much harder for
people to be able to move to alternative
products or for the companies to bring
out something. And in a context where we
know that virtually all the harm is the
delivery system, all of the harms is the
smoke
they've made it harder to move to the
smoke free products.
I mean that's just abysmal. I can't
imagine Canada is going to do that badly.
So we'll see what they do and it's that
trade-off between, are we really going to
focus on all those millions of smokers
who want to quit and they need viable
options and total nicotine abstinence,
this whole quit or die thing is wrong
and we can help them move. We can get the
market to work for us. You know, the way
we have historically done on food
regulations and pharmaceutical
regulations, automobile regulations
etc. Because if you don't do that,
you end up perpetuating the harm among
the people who are a great risk but if
they focus too much on things like let's
be absolutely certain that nobody who
doesn't currently smoke could ever use one
of these products. What you're doing is
condemning, you know,
another million Canadians to a
premature death from smoking in the next
25 years. I mean that's what we're going
to get. So, it's that trade-off between
those and they have to deal with those
of us who are making a what I think is a
very logical public health argument
about maximizing health gains and those
who have an absolutist ideology. So more
like the anti-saloon league and alcohol
saying we just have to get everybody to quit
using nicotine in any form. So they they
have to deal with those competing
interests and of course you know as a as
a proud Canadian I'm going to say I
think they're going to be rational.
I thinking about something that's
actually good for public health.
We'll see in a few days and by the
time this goes to air I could be proven
wrong.
Well, we will definitely debrief that
new piece of legislation with our
audience as soon as it comes out. It's
interesting,
Canada is a commonwealth realm country
of course and it shares a queen with the
United Kingdom.
So what are the chances that the
Canadian government, once this new piece
of legislation is adopted, will actually
engage in active communication of
comparative risk of vaping products to
the audience much like the UK through
Public Health England is doing and
through smoking counselors as you well
know in UK, smoking counselors in
fact are now directed to communicate the
potential benefits of vaping to those
smokers who otherwise cannot quit. Do you
think Canada might be looking into
that direction?
I certainly hope so and I think it's
it's quite likely. If you look at
the history of it you know on so many
things Canada's sort of somewhere
between the UK and the US on issues
and the US has this history of being
very absolutist. That you look at alcohol
prohibition, baptists and bootleggers, yes, that's right!
But yes, the war on drugs.The
view on tobacco if you look at the
underlying goal of major US government
agencies, it is reduced death and disease.
It's a tobacco-free America. The way it
was a drug-free America. We've seen how
that works or no sex outside of marriage
sort of things. So you know, I was just in
Charleston. The front page story in
yesterday's newspaper was about
abstinence-only sex education in the
schools. In this day and age, it's a little bit unrealistic, one would say.
Well, I mean from a Canadian perspective
you know, you look at that and you think
am I reading The Onion, right? This is done
as a joke but it's not done as a joke. I
mean, people really believe the only
thing you should tell young people is
don't have sex before you're married.
Let's ignore the fact they're already
having sex. Let's not tell them about
reduce risk. That isn't gonna happen. That
sort of stuff doesn't happen in Canada. I
think we have a much more British
orientation of saying let's be pragmatic.
Let's be reasonable.
Let's meet people where they are. Let's
look at what we can do to actually have
an impact.
I think bodies like the Royal
College of Physicians in the UK which is
probably the most prestigious health
body in the world, medical body in the
world and it's being ignored in the
United States. You have the Centers
for Disease Control here that's got a
mandate to protect the health of
Americans that's actively misleading
Americans about their leading cause of
preventable death.
I don't think that would happen in
Canada. It certainly doesn't happen in
the UK. So I think if we had to choose
between those models, we're much more
likely to go the UK route in part
because we do have people to be pushing the
constitutional angle on this to say you
know, it is just simply not only wrong to
actively mislead people about things that
can result in their deaths,
it's illegal. It's unconstitutional. You
know what, we will challenge you in the
courts. So I think we we have a chance of
getting something done and to the extent
that the vapers themselves start to
speak out because I think it's a matter
of them getting voice on this. It is
really hard for those who are pushing an
absence agenda to deal with that when
the actual people whose lives are on the
line starts speaking out and we saw that
with things like AIDs that once you
started getting the community at risk to
get voice, to speak out,
politicians had to change, even in the
United States politicians changed and I
think that same sort of thing that
happened here. We have enough users that
they're starting to get angry about
this and I'm a great believer in rage.
You know, you want consumers to get
enraged at things that government is
doing and I think in canada we have a
chance for something fairly pragmatic. I
think will develop over time but we're
going through a major transition here and I
don't think even crazed government
policy like what we see in the United
States from the CDC and you know
freedom just I mean, actively misleading
people. I don't think you can stop it
because information is being shared on
the internet, it is being shared through
social media. People are getting truthful
information and they will get angry. They
will get angry at politicians and
so-called health officials who mislead
them. They will get angry about an FDA
law that's protecting the deadly product for
putting huge obstacles in the way of the
less hazardous product. So what you're
saying is basically because of the power
of the internet and communication in
today's world, FDA and the US are
going to become isolated, the outliers?
Everybody will know in fact that the
whole rest of the world or at least some
very meaningful countries, Canada, the UK
and other European countries are seeing
the benefits to public health vaping
products result in and at the same time
the US is sort of digging their heels
and really not not taking action, not
communicating comparative risk. In your
opinion,
bearing in mind that regulatory hurdles
are really very high in the US and
not so high elsewhere, how do you see this
market of vaping products evolving in
the next few years?
Not the ideal scenario but the realistic
scenario. There will be a one evolution the US
for sure and another one overseas.Yeah.
Well I think part of it is things like
your legal challenge against the the FDA
law. Your on very strong grounds
if the courts move on that. you know.
We've defeated this this legislation
that is really harmful to help
so the US is sent back to have to
rethink this and it could force them
into doing something that is consistent
with the long-term history of the US on
these things of actually getting it
right, of facilitating the change to less
hazardous products like we we've seen on
environmental issues, we've seen on
automobiles. We've seen it
with pharmaceuticals. We've seen it on foods. We've
seen it on industrial equipment.
I mean just so many things. So I think
that's quite possible and I think it's
very much to your credit that you've
done the the challenge of that
legislation. It is brilliant.
I don't think FDA can come anywhere
close to answering the concerns that
you have raised because they simply
don't have the grounds for doing it. So
but if for any reason the US manages
to to push forward with this sort of
irrational let's protect cigarettes
approach, I also believe in my
experience in decades of working on
public policy issues is that good
policy is contagious. So when the
Americans start seeing what's happening
to smoking rates in countries that have
been open to alternatives to cigarettes
it's really hard to ignore. To say had we
done that, far fewer people would be
dying now. Had the United States simply
told the truth about smokeless tobacco
not compared to cigarettes.
I mean it is amazing that ninety percent
of Americans don't believe there's any
smokeless tobacco product that is less
hazardous than smoking cigarettes.
The difference is enormous. They've been
fundamentally misled. I think
as that information comes out, there will be
anger about that. That's the sort of thing
that causes the the status quo to
crumble, you know. It causes the
whole abstinence only thing to get to be
shown to be you know immoral, unethical,
illogical. I think it could
trash it but in the absence of that just
seeing what's happening the rest of the
world is really hard to ignore it. And we
really hope that will translate into
grassroots movements here in the US and
in fact, as you know Nicopure
Labs is on the board of the Vapor
Technology Association. One of our
priorities at the Vapor Technology
Association is of course to work with
Congress and Senate to change the
grandfather data, at least to protect
some of the existing products. Products
that were on the market as of August
8th. We believe that to be a very valid
initiative and it will unfold in the
next few months and that probably is the
key to solving part of the problem with
the regulation.
The other thing that we need
is really, David, people like yourself
like Clive Bates, like Chris Russell.
Scientists from all over the world to
really take the time from their busy
schedule, from your busy schedule, as
you're already doing and thank you again
for that I cannot thank you enough, to go
and speak with FDA but more importantly
speak with legislators because FDA seems
already to have taken the approach
that they cannot do much. They're limited
by what the statute requires and
therefore, honestly we have to change the
statute. So it's again very important
that that engaged as much as yes it's
not your country but I do think it's our
planet and more importantly, it's the future of
our children that really have to see
inevitably, a reduction smoking rates if we
care for their well-being. I mean,
it's one of the reasons many of us were
involved, are so involved. This is
actually really simple problem, you know.
That it's the smoke. You get rid of the
smoke, we solve the problem. We're looking
at WHO telling us based on the status
quo, if we continue just doing certain
things we're doing, a billion people are
going to die in the next hundred years
as a direct result of cigarette smoking.
That's the status quo. How can anybody
think that's acceptable because you're
even beyond things like disease
eradication on smallpox or polio, or
what we've done to dramatically reduce
the the risk of death from automobile
accidents, etc. When you deal with
tobacco, when you deal with nicotine, we
know that we could reduce the risk
probably what by well over ninety-eight
percent really really quickly. Through
really simple things like facilitate new
products getting on the market. Tell
consumers the truth about those products.
Have things like differential taxation,
the things I've written about in New
England Journal of Medicine with Frank
Chaloupka, Ken Warner. Differential marketing,
give people an incentive to move to
those less hazardous products. You know,
economic incentives, informational
incentives, incentivize companies to come
up with better products. You know, the
United States is really good at that. If
you look at the 1938 FDA law that
brought forward science-based products
that truly did deal with
issues that the snake oil products,
that patent medicines didn't and within
12 years, like just 12 years
ninety percent of the pharmaceutical
products sold in the United States or
products that didn't exist before that
law. So what if the FDA, instead of saying
we're gonna get in the way of
alternatives to cigarettes said we're
going to facilitate alternatives to
cigarettes like we did in facilitating
the movement of sanitary production of
food products in 1906. Like we did with
science-based pharmaceutical products in
1938, we are going to facilitate these
changes.
Imagine what would happen. Imagine the
release of of human ingenuity that the
capital, the scientists to come
up with ever better products to meet the
needs of evermore smokers. How rapidly?
You know, you take a hundred billion
dollar business in this country of
cigarettes and most of the users are
already saying I don't want to do this.
Give them an alternative.
I mean it's a slam dunk. We just have to
start doing it and globally it's an 800
billion dollar business. Imagine you know
that people can make billions of dollars
creating thousands of good jobs doing
something that solves the biggest
epidemic we're currently facing. And save
lives. Saves lives, meets consumer needs.
You know, if you look at things like,
what was leading cause of cancer death
in America in the 1940s? It was
stomach cancer. You know, why was that?
That was because of diet. It was because
of highly smoked, pickled, salted foods,
foods that went bad.
You know, people continue to eat food
that had been sitting out on a stove for
days. They didn't have refrigerators and
ice boxes didn't work very well and they were
very expensive. You could have had a
campaign to make people feel crappy
about the food they were eating but they
didn't really have a choice, and instead
what we did is we had technology. We had
entrepreneurs. We had business. We had a
market intervene for something called
refrigeration and because we can now
ship food in refrigerated rail cars and
people could keep food in their homes in
refrigerators that they could pay for
and costs less money to having an icebox
and diets changed. In a short period of
time stomach cancer went from being the
leading cause of cancer death
to be mercifully rare and it didn't
require government expenditure. It didn't
require yelling and coercing
consumers. They already wanted to change
their diets. We just had to facilitate it.
And now we're seeing a similar
revolution with vaping.And it's exactly the same thing.
However, it's industry generated and
it has the potential to change the
biggest problem we're facing today.
Exactly, just the way refrigerator was.
The refrigerator was a commercial
response to consumer need to solve the
leading cause of cancer death in those
days. We now have the leading cause of
cancer death being lung cancer because
the cigarette smoking, plus all the other
cancers and all the other diseases caused by
smoking and these people, just like the
people eating bad food in the forties,
are saying I wish I didn't do this.
We can give them an alternative. You
give them an alternative and then one of
the truisms of public health is that
many of our biggest breakthroughs have
come from two really really simple ideas.
One, you give people enough information
to make an informed decision and two, you
give the ability act on that
information. You do that, we have a
revolution and they're really simple. We
can do it now and we would eliminate
smoking in a fairly short period of
time. We just have to have the
imagination to say we're gonna do this.
We have to put into place and this and
recognize the absolute absurdity of
saying we're going to deal with this by
putting huge barriers in the way of the
the less hazardous products. Can you imagine
going back to the 1940s and saying well we
get this idea of refrigeration but we're
not going to allow you to sell a
refrigerator unless you get it approved
by a government agency and any
refrigerator you come up with or any
changes you make to any existing
refrigerator could take two or three
years and cost you millions of dollars
in order to get it approved and we're
certainly going to run campaigns telling
people refrigerators are really really bad
idea.
I mean you know, where would we be? You
know, we would still be dying of stomach cancer.
We were sensible then, you know,
we could be sensible again and if we do
that we solve a huge problem. That's a
very wise thought and surely we hope
this is the direction that FDA will
eventually take when, hopefully they
start listening to what happens in the
UK and
now in Canada. Thank you Professor Sweanor
for your time. It's always a pleasure and
thank you for watching us. Until next
time. Thank you.
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