Tobacco Asia

Tobacco Asia 13 Q&A THE TA At the start, several decades ago, the people in the field of tobacco control were fighting the good fight against smoking-related cancer and heart and lung disease. But that then slowly shifted toward demonizing the industry that produces those products. And then there was a point where they started saying to themselves – almost like a religious mantra – that there is no safe tobacco product. In their minds, a tobacco product is nicotine. But it seems they gave up on [their] efforts to prohibit cigarettes long ago for some reason. Now they prohibit nicotine vapes and nicotine pouches in different countries, having moved to that "nicotine is the culprit" mantra. They say that it doesn't matter if you are switch- ing from a deadly tobacco product to a safer nicotine alternative because you are still "ad- dicted" -- even though the word "addiction" is not even technically correct. The proper word would be "dependent." There's a saying often used among ex-smokers who quit with safer nicotine alternatives: "Why is your concern about my nicotine dependence more important than my concern over not dying from smoking ciga- rettes?" I think that carries a lot of truth in it. TA: So would you say that reduced risk products such as gums, lozenges, inhalers, and of course nicotine pouches and vapes are a smoker's best chance for quitting cigarettes or cigars, or any combustibles? CG: Yes. All of these are in the toolkit for smoking cessation. That's the number one health benefit we're going to see from all of them. I think of these safer nicotine alternatives -- which is everything from nicotine patches and gums to nicotine vapes and nicotine pouches and snus and even heated tobacco products -- as health interventions because they clearly help some people quit smoking. But we also know that every person who smokes is different. So one thing will work for one person, but not for another. So the more variety of safer nicotine alternatives, the better it is because we have somewhere between 1.1 billion people and 1.3 billion people on Earth smoking deadly cigarettes. TA: Millions of ex-smokers worldwide have successfully quit by switching to these alternatives, yet there are governments and regulators who have banned vapes and even heated tobacco products. Does that make sense? CG: Well, first of all, they're doing that at the behest of and on the recommendation of the World Health Organization [WHO]. So that becomes a whole different conversation. Mexico, for example, even has written its prohibition of nicotine vapes into its constitution. So [those governments] are really serious about wanting to get rid of these safer alternatives. But all of these countries are leaving deadly cigarettes legal and available on every street corner. It still baffles me. TA: Is prohibition a folly? CG: Prohibition almost never works. It does not make things magically go away. It drives them underground where they are under the control of criminals who don't care how old the person they're selling to is. They don't have any age checks in illicit markets. So you achieve the exact opposite of what you claimed you were trying to achieve when you prohibited things. But another bad side effect of prohibitions and demonization is that we also end up prohibit- ing research. If you are deliberately focused on finding harms, that is all you are going to find. To a hammer, everything looks like a nail. It's because of that that we did not learn for many, many decades that there are some health benefits from cannabinoids. That only slowly began to change when older people in their 50s and 60s recovering from chemotherapy began to go on record, saying that cannabinoids helped them alleviate pain and nausea. That started a shift. It tilted the needle of public opinion, at least in the United States. TA: Nicotine apparently also does have health benefits. Can you explain some of those, please? CG: Sure. The number one benefit of nicotine is that it can help people quit smoking, of course. We also know with relative certainty that daily nicotine use prevents Parkinson's disease. We've known for decades that people who smoke cigarettes are 40% to 60% less likely to get Parkinson's disease. Snus users also have a 60% lower risk. There [also] is pretty strong evidence that nicotine may either delay the onset of Alzheimer's disease or prevent it to some extent completely. Then, there are dozens and dozens of studies using nicotine patches that show that nicotine reduces symptoms in people who have attention deficit-hyperactivity disorder [ADHD], some forms of autism, bipolar disorder, schizo- phrenia, Tourette's syndrome, and a number of other neurodiversity issues. My assumption is, what people are doing is self-medicating [with nicotine] because it helps them. There are many studies showing that people with ADHD or people with schizophrenia are far more likely to smoke cigarettes than neurotypical people, people without those mental health conditions. The problem is that smoking kills them. Authorities and the public just can't take that mental leap to realize that nicotine might be benefiting people.

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