To begin with, Clive discussed “The Good” – how we would like the world to be: “It requires a deep and changed understanding in the public health community and the world at large on how tobacco harm reduction works. It is not a smoking cessation product; it is a rival value proposition to smoking as a way to consume nicotine – a relatively innocuous consumer lifestyle drug.”
He spoke about how the value placed on potential danger is out of all sense of proportion with reality. “We need much more mindfulness on the perverse consequences of blundering in with clumsy excessive regulation.”
Moving to the second point, Clive said: “We need a new narrative about this in the public. The relentless negativity has to stop. People have to see where the benefits are emerging and listening to the smokers who quit smoking; listen to the stories of harm reduction and start to see the upside.
“We have to stop the tirade of false and misleading science and replace it with a story that is more hopeful and focusses on the benefits.”
Clive added that we need to shift to a more risk-proportionate regulatory regime, that means being tougher on the actual harmful products and adopting a liberal, open-minded approach to the less harmful products such as vaping and snus.
This includes the full gamut of possible approaches, he believes, including tax, advertising, warnings, consumer messaging, control of ingredients and access, age restrictions, permission to use them in public places, “and so on.”
“The reason is,” he continued, “that you have two competing value propositions. You have the smoking value proposition which regulation attempts to degrade, and then the vaping or tobacco harm reduction proposition which regulation should try to enhance – and thereby encourage people to move.”
Finally, Clive says, we need a deep rethink of nicotine. “People are locked up in the wrong understanding of nicotine, not a particularly harmful drug – it’s not even that addictive in most of its forms. It is a popular consumer drug and it can take its place alongside caffeine and moderate alcohol consumption as a legitimate lifestyle drug. It’s legal everywhere, it’s just legal in forms that are harmful.
“So, the question in the long-term is ‘what does the consumer market for nicotine look like?’ And this isn’t necessarily one about tobacco harm reduction, it’s about the future of nicotine consumption. We see the four product categories already emerging: vaping products, heated tobacco products, smokeless tobacco products, and oral nicotine products.”
When moving on to “The Bad”, Clive says that this represents more where things are at the moment rather than where they ought to be.
This includes extremists pushing bad narratives pushing lies about vaping being as risky as tobacco products. “This is completely wrong,” but it’s becoming the dominant narrative.
The regulatory approach appears to favour prohibition, to treat it like a medicine, or to treat it just like smoking. This, Clive says, prevents products coming to market and allows the protection of the traditional tobacco industry.
“The Ugly” covered the way it’s all being done, the development of an anti-tobacco harm reduction complex consisting of funders, researchers, media and political allies all reinforcing each other’s messages. “It’s highly sophisticated and very well-funded by philanthropists like Bloomberg…it’s an insidious operation.”
The scientific review process is failing us all, Clive stated, and it is operating to block the tobacco industry to transition out of being “the merchants of death”.
“There’s an attitude I find despicable, there’s a complete lack of empathy and humility. A lack of connection with the at-risk populations, with the lives of the often vulnerable and disadvantaged people who are smokers.”
There are things to be hopeful about, he concluded, but the situation for tobacco harm reduction is currently bad and getting worse.