Shaping Vaping May 15, 2025
(Rough) Transcript
Jim McCarthy:
Good morning. It's Jim McCarthy with American Vapor Manufacturers here for another installment of our Shaping Vaping podcast. Today, I hope promises to be an illuminating and interesting, scintillating and rollicking conversation with two of the most astute thinkers in nicotine policy, our recurring co-host guest, Joe Gitchell, who I'm going to try to loop in right now, and the inimitable, indefatigable Clive Bates, who I've also just sent an invite to join the chat.
There’s a lot to talk about. There’s, again, so much been going on in vape nicotine policy world. The new secretary of HHS just testified in Congress, and there’s been some interesting movement at FDA also.
And there’s also been a lot of work in the, a lot of development in the academic scientific space that I’m hoping to get Joe and Clive’s thoughts on. Joe, I see that you’re a speaker.
Joe Gitchell:
And I can speak.
Jim McCarthy:
Great. Okay. Clive, I see that you’re a speaker. I got you loud and clear. Excellent.
Good. Thank you so much for joining us. Great pleasure.
Uh, why don’t I, um, let you, uh, give a brief introduction if you would. And, um, and we’ll dive right into our chat.
Clive Bates:
Okay. Uh, well, I’ve been an advocate for tobacco harm reduction since about 1998, when I discovered the concept while I was working for Action on Smoking and Health, the main tobacco control organization in the UK, in those days, it was all about snus and NRT. Uh, I went away from the field for several years to work in government.
Um, and, um, you know, I had a very interesting time as a senior civil servant in the UK government working in Tony Blair’s strategy unit, uh, working for, um, the Welsh government, things like that. Uh, and then I left the civil service, came back into, uh, setting up my own sustainability consultancy, and I could see this amazing opportunity to solve or address at least all the problems that we’d been working flat out on when I was director at Ash with these, uh, this amazing range of new products. Um, smokeless tobacco, um, vapes were going live at the time.
So this is around 2012, 2013. So I, I sort of thought, oh, this is going to all take a few years and then it’ll be game over. Everyone will come to their senses.
These things will, you know, basically wipe out the cigarette industry and, you know, millions of lives will be saved. And, uh, you know, essentially everything we’ve all been working on for, you know, 60 years since the Surgeon General and Royal College of Physicians, uh, will all be over in less than a decade. Oddly, it has not turned out that way.
Uh, and in fact, what has amazed me, frustrated me, driven me to the brink of insanity has been the headwinds from the people who should be vested in the results from this, the public health community, the health authorities in government, health ministers, the World Health Organization, FDA, CDC, they’ve all been pushing in the opposite direction, which I found insane at the time and still find insane today.
Uh, so I have been unable to do what I hope to do, which was to, you know, get involved in this for a little while and then go off and do something more, you know, more interesting, um, uh, just because I’m absolutely driven mad by the resistance to what is an unambiguously unquestionably good idea, which is displacing high risk products with low risk. And, you know, as a, as a by-product of that, converting the market players, the industries involved from merchants of death into merchants of nicotine, which would, you know, is what basically people want to use. They don’t want to get cancer, heart disease, um, you know, COPD, they just want to use nicotine and until we come to terms with these underlying realities, we’re not going to be able to fix them.
And I very, you know, horrified to be honest, that we’re still fighting this battle now, and if anything, things are going in the wrong direction. So how’s that for an introduction?
Jim McCarthy:
That’s, uh, uh, bracing and illuminating. And it makes me think about, uh, the work I do in other product categories in which innovation and especially entirely new novel products are almost reflexively greeted with hostility from regulators and entrenched interests. There seems to be, I don’t know, in our human DNA somehow, or maybe it’s in the, in the, in the way that, that, that bureaucratic institutions operate.
There seems to be this kind of knee-jerk opposition. And it’s so interesting that you had been working on this so long, Clive, you, you know, you’ve seen the emergence and, and progress of other kinds of safer nicotine products. And you also witnessed the, you know, the, the birth and dawn of the, of vaping as one of those products.
And I got to tell you, like from my work with the, with the manufacturers, nothing drives me more up a wall. Um, then the lack of recognition that it’s our members that created these products, that innovated them, that are helping people over the shop counter every single day to quit cigarettes. I mean, I’d be grateful just for like, I think they deserve a ticker-tape parade if I had my way, but I’d be grateful just for some basic dialogue.
And instead we’re just routinely vilified.
Clive Bates:
Yeah. I mean, it’s, it’s unbelievable to be honest. Um, the, the, the innovate, you know, nothing gets punished more rapidly than a good deed.
And the, the innovators in this field are treated as if they are, you know, the worst kind of, of, of predator. But I think, I think you’re right about the reflex opposition to innovation here. And I, I tend to think there’s two reasons for that.
Um, firstly, uh, it’s counter-cultural. So if you work in tobacco control, as I, as I did, the, the toolkit is made up of things that are about state intervention and control. UhEnviar mensagem, you know, it basically says that on the tin.
So measures that are punitive like taxes, coercive, like, uh, bans on the use of these products and stigmatizing, which is the warnings and the, you know, the, the grotesque pictures and the campaigns and the, the, you know, the, the sort of narrative that’s been created about this, then you get a solution to this that comes along, which is all about the, uh, autonomy of the users, uh, informed consumer choice, uh, by empowered consumers choosing innovative products from market actors, uh, in a lightly regulated market, uh, expressing their own agency and autonomy, uh, and making changes to their health in their own interests and at their own expense.
Now that is a totally different kind of mindset, uh, that comes with that sort of innovation. So it’s not just an innovation in products, cause these are not just pimped-up NRTs that are given you by the doctor, right? This is something that’s in the private sector and that has triggered a huge amount of sort of resistance.
Second thing I would say is there’s, there’s a gigantic institutional inertia. I mean, we, since the 1960s, when the problem of smoking emerged, we built an enormous institutional machine of, you know, research departments, scientists, activist organizations, foundations, money, people’s careers depended on fighting tobacco and fighting the tobacco industry and that institutional framework doesn’t just say, Oh, well, you know, I think it’s time I wound myself up and did something else. Let’s get to work on, you know, dental health or obesity or something. They’re like, keep going.
We need to redefine the problem. Uh, so that it’s something we can keep fighting. Uh, otherwise what’s the point of us?
So, you know, if you have perfectly safe nicotine products or near-safe nicotine products, you’re suddenly denying the role and agency of tens of thousands of people who have a career, essentially opposing tobaccos, opposing smoking and opposing the industry that produce it. And that isn’t something that just goes away on its own. It’s basically fighting its corner.
Jim McCarthy:
Yeah. And I think, you know, I see that a lot in other spaces too. I’ll put it in the, in the, in the chat, the, uh, former New York Times science columnist, John Tierney has a lot of really good insight on the, the mission creep of these organizations.
And he, he uses the March of Dimes as an example, as an example of that, um, kind of self-perpetuating blinkered, um, sort of thinking, but I worry to Clive that. You know, about something you touched on a moment ago, which is the agency and the, you know, the individual freedom of, of, you know, ordinary people to take, to take charge of their lives. I mean, that’s something that, that I think about a lot that David Abrams talks about how we’re individual people have a right and, you know, to, to find solutions that, that, that work for them.
And I worry that both sides of the debate in America, at least between, let’s say, let’s call it Republicans and Democrats, conservatives and liberals, you know, the polarized divide in our country that, you know, we’re kind of just staggering. Toward, you know, one policy fixed to another. And with that, and there, there seems to be no recognition they’ve lost completely lost sight of the autonomy, um, and the individual human rights that ordinary people smokers to put a fine point on it, you know, have for their own lives.
Clive Bates:
Um, so, so I, I think that, you know, that’s a micro-control world has, you know, a sort of ha-ha gotcha answer to that, which is, which is that these products are quotes addictive and therefore, you know, individual volition is, is compromised. Uh, autonomy is not possible. You’re, you’re sort of in the thrall.
The problem is when you examine that narrative, it takes you from one extreme to another, from, you know, extreme libertarian perspective, which is that people should do whatever they please down to a, well, these people have lost. Uh, all control. They have no longer have any volition, no longer have any autonomy.
It’s, it’s the nicotine speaking, not them. Uh, and, and, and therefore we have as, as good paternalists have to intervene to, you know, protect their welfare against this all-controlling drug. And, uh, you know, the great Carl Phillips used to refer to this as the, the sort of demonic possession theory of, of nicotine use in, in which you would simply kind of lose all control.
And you can, you can see this in the, uh, FDA’s ludicrous real costs, uh, campaigns where they, where they show teenagers sort of wandering around their schools as if they’ve been turned into zombies, uh, in, in some way. And that, that’s a, that’s a nod in that direction. Of course, it’s much more subtle than that.
You know, there is a demand for nicotine for a reason, you know, for some people, it makes them feel better and feel as though they function better. Uh, you know, I’m not recommending it as a therapeutic substance, but there is an explanation why people use these products and why they don’t always try that hard to stop using them, uh, because they’re basically happy with what they’re doing. Now, because you asked them in a survey, um, you know, people will say, yes, of course I want to quit and, you know, that’s very urgent.
I intend to do it in the next three months. But the reality is that that’s people, you know, um, some kind of social acceptance bias, people want to tell the researcher what they think they should be saying, not necessarily what they feel. And therefore, you know, people, you know, people will say, well, I want to lose five kilograms as well, but do they go on a diet?
No, they don’t. You know, so we, we have to, we have to sort of temper the evidence here with the sort of reality of experiences that people actually quite like this experience. Maybe they, maybe they would reverse it if they could have the opportunity to, you know, start again.
But I still think maybe for 25%, 30% of people, they’re probably getting something from it. These benefits that we have in terms of cognitive function, relaxation, uh, control of anxiety and stress, maybe some therapeutic medical benefits that they’re subconsciously self-medicating. And also that it feels right.
I mean, I, I have to go, um, through, you know, sort of third-party accounts here, and I rely on the, you know, consumers and what they say, say about it, because I have never used nicotine. I’ve never willingly consumed even a molecule of nicotine. So I have to go on what others say about this, but people do seem to actually like it, which isn’t really kind of allowed for in the slave-to-nicotine zombie possession, uh, kind of narrative about nicotine addiction.
Jim McCarthy:
Well, uh, I’m enjoying nicotine as we speak and I can, I can confirm what you’re describing. And I want to touch on Clive.
Clive Bates:
You have a terrific, you sound, you sound totally out of control. I don’t know how you can even have a rational conversation.
Joe Gitchell:
Yeah, I was gonna, uh, I’m not sure that Jim’s experience is proof of anything right now, but you know, go on data.
Jim McCarthy:
Anecdota. Well, I want to dive in. This is a good, good pivot to, um, I think a hugely important, um, paper you put out a few days ago, Clive, which is a briefing for policymakers about how to think about, uh, nicotine products and vaping in particular.
And we have it in the thread beneath our, uh, in the, in the chat here. And I, I recommend everyone take a good, good look at that. Um, and what I want to, uh, it’s interesting because for the first time yesterday, the new secretary of health and human services, Mr. Kennedy testified in front of the Senate about his thoughts on it. He was prompted here, um, by, um, a vape opponent, uh, and on the Senate. And I want to play his remarks, which are just a little bit less than a minute and then get your thoughts and yours to Joe. Um, so take a listen to Robert F. Kennedy yesterday, talking about his approach to vaping policy.
Robert F. Kennedy Jr.:
During the Biden administration, the FDA slow-walked the, uh, the approvals for US vaping companies. And the US vaping companies, in my view, are, were acting very responsibly. They were putting chips in their vapes that would make sure that young people could not use them.
Um, they were giving good information about addiction and, uh, and they were, they had very extensive labels. They really went out of their way not to make it attractive to children. Though you were slow-walked.
So they’re off the market. And in order to fill the vacuum, hundreds of Chinese companies came in with these colored, beautifully, you know, attractive, watermelons, all these flavors are targeted to kids. They have video games on the page that lure kids into addiction.
We are going to wipe them out. Thank you. We’re going to get rid of all.
Jim McCarthy:
Thank you for that commitment.
So that was RFK Jr. testifying to the Senate in, in, in colloquy with Senator Ashley Moody, a Republican from Alabama, I believe. Um, I guess my, my quick, my quick take on that is it’s another example, Republican from Florida, Florida, forgive me.
Yes. Good catch Florida. Uh, but it’s another example to me of how we’re just kind of staggering and lurching from, you know, one, you know, kind of janky policy prescription to another in both of their remarks about flavors, for example, or about, you know, video games on the devices or the colors that disposables come in.
I mean, that is all boilerplate that comes right out of the lobbying playbook of, uh, the two biggest contributors to the Trump campaign, RJR and Altria. And I just, you know, there’s some good to be found in there. I mean, I see a little light at the end of the tunnel there.
You know, but it also really troubles me because it’s not principled. It’s just who you talked to 20 minutes ago and, you know, packed in with all the baggage of their, of their own ideological commitments.
Clive Bates:
Yeah. I, I, I mean, that comment was quite interesting from, uh, RFK Junior, uh, you know, I, you know, is that, is that glass half empty or, or half full? Right.
Um, uh, it’s encouraging that he, he, he is able to acknowledge that, uh, FDA is at fault here for slow-rolling the, uh, authorization processes. And frankly, that is the underlying cause of all of this mess. But it’s concerning that he’s been wound up, uh, to, into a kind of youth vaping crisis narrative flavors.
I mean, these video game things, uh, obviously ridiculous, but they will, they will be in use by about 0.000001% of the, of the vaping public. So they are a, a symbolic, uh, optics problem rather than a public health problem, but, uh, we had, uh, Joe and I are at, uh, the FDLI conference in Washington at the moment. And, uh, uh, Dr. Makari, am I pronouncing that right?
Makari. Uh, um, uh, he returned to exactly that narrative. He brought up the, the video games.
He brought up the flavors. He brought up the Chinese thing. Let’s be absolutely clear here.
Uh, and I know this is going to be unpopular, but the Chinese make absolutely excellent products that thousands of millions of people want to buy, um, you know, there’s 20 million vapers in, in the US and most of them are using products that are not authorized and therefore mostly made in, uh, in China, uh, and are available illicitly. And that’s because the Chinese have a massive innovation advantage over the American companies. It’s not, it’s not just, uh, the fact that these applications take so long.
If you, if you take, you know, the, uh, Juul product, which still hasn’t got its authorization, it was placed on the market in 2015. So it’s a 10-year-old product. Now, if you’re a Chinese company shipping into the illicit market in the United States, you could have had something freshly minted in Shenzhen, uh, six months ago, ship it, you know, by the container load into the United States.
And lo and behold, the customers love it because the customers like innovative new products and the Chinese are very responsive to what the consumer wants, because that’s how you run a fast-moving consumer goods market. You respond to changing communities. So the FDA, the FDA shafts, the American companies in like multiple ways.
First of all, the cost. Secondly, the incredibly narrow aperture through which they are forced to, um, pass thirdly, the huge delays. And then fourthly, the innovation disadvantage and all of the problems that are associated with the US market.
The fact that 90%, 90, 90-plus percent of the market is unauthorized and effectively unregulated. The products are misbranded and adulterated in legal terms is down to the FDA, not having a fit-for-purpose process that will authorize the products that people want. And if the people want flavors, if the people want big, large-scale, 10-milliliter tanks, if the people want brightly colored stuff, that’s what they’re going to get.
They’re either going to get it illegally through that market, or they’re going to get it lawfully, hopefully from a greatly expanded lawful market with far more authorized products.
Jim McCarthy:
Yeah, I think that’s, I think that’s spot on. And I, you know, my, my view and I think AVM’s, you know, uh, board is with a level playing field, American companies can, you know, out-innovate anybody, and if we have a fair chance to do that in a market, that’s, that’s, that’s open and level, you know, bring it on, we’ll take on all comers. And I think a lot of American customers would prefer to use products made by people they know who work and live in their communities and, you know, for all sorts of reasons, and yet you’re right, we’re being restricted from it.
But I mean, Joe, I want to, I want to get you in, in this convo, uh, and hear your thoughts on glass half full or glass half empty about RFK’s first. And so far only remarks about vape policy.
Joe Gitchell:
I actually want to go back to a point that Clive made in putting the onus of the situation on FDA. And I certainly agree that FDA is the proximal agent for, uh, trying to shape this marketplace, but I actually think looking to them to solve it and only to them is not a reasonable expectation, I think. And being at, uh, FDLI is a great forum to highlight that the various centers, uh, that make up FDA, there are strident debates across drugs, across medical devices, across food.
Um, but the tenor, the challenge facing the center for tobacco products is very different, I would submit in that the leading non-conflicted civil society voices that express themselves around tobacco, their formal position is we don’t want any of these things and that creates a real conundrum for an FDA, which is limited in its ability to, uh, extend beyond the license that society has granted it, I don’t believe society as a whole has granted the center for tobacco products, the license to actually execute on the statutory authorities that it has and the emerging evidence with which it’s evaluating.
And I think that’s the root cause of why we have this ossified, depressing marketplace that is riven by illegal products. Um, there is an irony that because of a host of reasons, lots of people who smoke are able to find products that they find acceptable and switch to them. But it’s not, uh, products that have been reviewed, evaluated, and validated by FDA.
So I think that’s the root cause.
Clive Bates:
Can I, can I just, uh, like totally disagree with that? Um, I, I think this works in a different way to the, to the way Joe was saying. If you, if you go back to say 2017, you’d have the Campaign for Tobacco-Free Kids was campaigning against, um, and you know, an FDA too against youth-orientated vapes and the, the, the things that they used to mention there was like gummy, gummy bear or, um, cotton candy or things like that.
So they, they, they were, they were vapes that had a, you know, a plausible, uh, sort of youth orientation to them. Okay. Now what happened after that was that the Juul products came along, and they didn’t have any of that sort of nonsense.
So they were like mango, apple, mint, whatever. Juul was particularly popular. Um, so Campaign for Tobacco-Free Kids and the Alliance redefined youth-orientated products as anything bought by a youth.
Okay. And FDA went with them with that. So I, I actually think the direction of causation is, is the other way.
FDA has been constantly accommodating ever more radical and insane positions from the tobacco control organizations. And at every point they have said, okay, we’ll bank your acquiescence in our madness, and we will move to a newly mad position that goes beyond that. Uh, and we will keep pushing and we’ll keep pushing until you meet our, you know, our goal, which is a de facto prohibition, which is what the Bloomberg groups have always been about.
And outside the US where the, where they get even less scrutiny, um, they are pushing explicit prohibition of these products in every country that they can. You know, they let contracts for, you know, um, prohibition of vapes in Brazil and Mexico. Uh, they were all celebrating like mad when Vietnam banned heated tobacco products and vapes.
And they were deeply involved in that. They’re all pushing a prohibition narrative with, uh, WHO. So the extent to which they’re not doing that in the United States is modulated only by the pushback that they get.
And they get some pushback from that by, you know, residual credible people in the FDA who say, well, not, you know, that’s not what our law allows. So I think FDA has encouraged this movement in the activist community by acquiescing and giving into it far too much.
Joe Gitchell:
Well, uh, that’s a lucid and fair, uh, commentary on my proposal. And I think there’s evidence if we look back to the deeming rule, um, in 2016, when it was very clear that what FDA as, as an agency wanted in that rule was different than what they were allowed to put into force. And if people recall that flavors were the, uh, strike point on that matter, where it was clear that what FDA wanted was not what made it out the other side of the regulatory review process as FDA wanted all not if memory serves all tobacco and menthol, anything that wasn’t tobacco or menthol to be withdrawn from the market and only be allowed back on after receiving an authorization of a PMTA that was not allowed to put into effect, but that was what FDA’s position was, so that certainly would be evidence consistent with Clive’s assertion.
Jim McCarthy:
But let me, let me add a, a, a, a sort of, you know, negative image, converse thought here, Joe, which is all through all these years, all the leaders at FDA that we’re alluding to here, and they’re, you know, the grappling you’re describing and the limits of their authority and so forth, and the various pressures they’re under, you never hear them say anything about the trade-offs and the downsides and the harms that are being caused by the existing policy.
Oh, they’ll weigh in on all sorts of other things like, oh, vaping might make you demonically possessed. I mean, they make all kinds of subjective judgments. We must have authority over synthetic nicotine, don’t you know?
But you never hear any moral qualms, never any concern about, you know, the harms that are being done by the current policy trajectory, and let me just contrast that with what a quote Clive had up a few days ago, he flagged on Twitter from the Royal College of Physicians talking about the policy approach. They said, quote, if a precautionary approach also makes e-cigarettes less easily accessible, less palatable or acceptable, more expensive, less consumer-friendly, or pharmacologically less effective, or inhibits innovation and development of new and improved products, then it causes harm by perpetuating smoking, getting this balance right is difficult. Now there’s a candid, straightforward, honest, relatable assertion that you never hear from FDA leadership, which I think betrays their indifference to it.
Clive Bates:
I couldn’t agree more, Jim. My sort of acid test for whether, you know, anybody is like serious about vaping policy, or, you know, any tobacco harm reduction policy, is whether they are capable of discussing, firstly, trade-offs, and secondly, unintended consequences. And, you know, there are trade-offs, there are, you know, trade-offs between, you know, young people and adults, there might be trade-offs between young people who would otherwise smoke and young people who would never smoke, or ever use nicotine.
There might be trade-offs, you know, between different types of adults, adults that, you know, adults that are about to quit smoking by some other method, and so on. If you can’t discuss those, and you can’t base your regulatory philosophy around those, you’re not taking the issue seriously. And then secondly, unintended consequences.
We have products that are, you know, one to two orders of magnitude less risky than the dominant product in the marketplace. It’s obvious that if you over-regulate, or excessively regulate, or exclude or prohibit those processes, you are going to be vulnerable to unintended consequences in three forms. More smoking, more illicit trade, and more workarounds.
Each of those comes with risks and harms. And if you’re not processing that in making regulatory determinations, or applying regulatory policy, then again, you’re not taking it seriously. And I can guarantee you can go to, you know, the mightiest organizations in America who work in this field, you know, American Cancer Society, American Heart, Campaign for Tobacco-Free Kids, Vital Strategies, Bloomberg Philanthropies, you will never find any reference to a trade-off or an unintended consequence.
I can, I don’t even have to look at their websites to know that. Because I know that if they did, the whole intellectual edifice with which they are operating, which is made of the thinnest possible glass, would shatter and collapse around them. Right.
Joe, your thoughts?
Joe Gitchell:
I think that this points to, and I'm a broken record on this, but I do think this highlights the consequences of the toxic polarization and groupthink that this field has succumbed to. And I think that the more that we can do to try to break down those barriers, and we may have different ways of accomplishing that goal, but the more that we have people getting more comfortable with being uncomfortable with having their beliefs and assertions challenged, that's really the only path forward. And it starts with a discussion of what are the goals that we're trying to accomplish with any policy framework?
And then what trade-offs are we prepared to accept? And I completely agree with Clive that a real harm and deficit is the apparent, I'll stick with unwillingness, though I think there are lots of things that go into it. I don't want to accept unwillingness, but the enormous discomfort of confronting trade-offs to be able to move to end of smoking, to have it be much closer than it even is now.
Jim McCarthy:
Well, Joe, I promised you I'd try to find some common ground in this conversation. So let me see if I can steer us on to a little patch of it. I've been very encouraged in the last few weeks by the new head of FDA, Dr. McAree, I believe. McAree, Dr. McAree, Commissioner McAree. Commissioner McAree, who has been saying loudly and repeatedly on many different platforms that he wishes to be more engaged with ordinary Americans and with the businesses that are being regulated and with various other stakeholders. And he's done some candid conversations in a whole variety of forums.
There are even now on his Twitter feed, he's talking about giving Americans a front row seat to conversation with him on a regular basis. A new program he's doing called FDA Direct. And he specifically has pointed out that this has been a failing of the agency in the past.
And, you know, I'm reminded of the sessions that Dr. Califf, his predecessor, used to hold, which were, you know, invite only in front of the gentlest softball audience, pre-screened questions, including ones about, you know, comparing him to the Apollo moon astronauts. And it just to me, again, the proof will be in the pudding, but that seems a very bold step in the right direction. So I don't know.
There's an example of me being optimistic about the kind of open, robust dialogue that the three of us seem to be urging.
Clive Bates:
I hope that he does go down that route and he does listen. He was presenting or in conversation at FDLI this morning and he was only asked one question. So it's a bit unfair as a way of capturing his whole view.
But it was all, we've got to get tough with Chinese vapes and all these flavors. And, you know, he was asked, what would you do about the sort of illegal market? And of course, you know, nobody says, well, illegal market, you know, bring it on.
It's great. It's helping Americans stay off cigarettes. There was nothing, though, that was other than enforcement.
It was, you know, that as I think we all agree, probably is. Enforcement is a secondary issue once you've solved the fundamental issue, which is to roll back or push back the illicit market by having far more authorized, regulated, well-manufactured products that meet the demand that Americans actually have for vaping products, not the demand that they might have had 10 years ago or, you know, until they embrace that. And let's see if there's enough people in in his ear telling him this message and telling him that it's the authorization process that is the underlying problem, then I don't think I don't think we know.
I don't think we're in a position to be either optimistic or pessimistic.
Jim McCarthy:
Yeah, I agree. And there's also in addition to the sort of the philosophical questions you're raising, the principal questions and tradeoffs you're raising, there's also the question of the scientific literature. And, you know, the playing field there has been sharply tilted for many years, thanks in large part to FDA.
And here's another example of common ground that we can use as an example. In just the last few days, both you and Clive and you, Joe, have tweeted about a meta analysis from tobacco control scientist Stanton Glantz that was deeply flawed and is getting, you know, lit up with slings and arrows from all corners of the nicotine science world. We'll put some of those in the thread.
I believe, Joe, your colleague Arielle Selye, who I can see as a listener here, has put out a good analysis of that, for example.
Arielle Selye:
Yes.
Jim McCarthy:
And I just I don't know, Clive, maybe maybe this is too. This is too speculative also. But, you know, a lot of this a lot of this rigged bias science needs to be called out or thrown in the parrot cage or, you know, I don't know, looked at with a little bit more of a skeptical eye.
And I just don't know whether I should have any confidence that's going to happen.
Clive Bates:
I don't think you should have much confidence in that. I think that the problem is that in the tobacco control academic field, it's better to think of it as a kind of market. You know, people are funded.
People are funded to provide research that answers questions in the way that the funder wishes them to be answered. So in the case of regulatory science, it's usually about finding a reason to regulate, finding a problem to address, giving legitimacy to an institution like a regulator by presenting them with problems for which they should intervene. I mean, I've lost count of the number of ridiculous social media studies in which the conclusion is always that FDA should be regulating Instagram or something like that.
And I think that is never going to happen, you crazy person. But, you know, you have justified your research on the back of finding a locus for a regulator to be involved. Now, the market's incredibly lucrative.
You know, these people are providers. They get paid by grants and there's a willing market for their ideas. So at a stunting glance, that meta-analysis is appalling.
You know, anyone with some basic understanding of science can see right through it. You know, it's using cross-sectional data to make, you know, make causal claims. It's not taking account of history of smoking in all these studies and everything.
I mean, there's a litany of things that you could recite that would, you know, at one level would just blow that paper out of the water. And I'm pretty sure it ended up at that journal, having been rejected at other places because of the simple and obvious evident failings in it. Yet the scientific public publication system and science in general in this field is not self-correcting in the way that it should be.
And it's a massive weakness. And it's not like, well, we're not self-correcting in the same way, you know, in the way that, you know, I don't know, the physics of black holes is. I mean, nobody dies as a result, as a result of bad science on the physics of black holes or string theory.
But people do die when the, you know, the science of tobacco harm reduction, the science of public health is sort of systematically distorted by, you know, these funding priorities and by the sort of institutional inertia that the people conducting the science have. You very rarely see a science paper that ends with nothing to see here. Best not to do any more work in this area.
It's always, you know, we are onto a problem and more research will eventually find it. And then, you know, a regulatory agency will be able to do something about it. And then we are not going to escape from that.
But we could confront it more effectively. We could confront it in a more timely way. I mean, we've had to wait, I don't know how long it is now, but it's many months between these responses, between the publication of Glantz's meta-analysis sometime in 2024.
I think it was like October 24. And these things coming out only just now. And if we could do things faster and if the journal editors could be encouraged to retract, correct, publish statements of concern, there's a range of things in that arsenal that they could do that would flag up problems with a paper.
Sometimes you could publish comments alongside it. I did one recently on a JAMA, I can't remember, it was a JAMA open paper. Yeah.
It was completely insane. But it was written in such a way that if you couldn't sort of follow what was going on in the paper, you would think that, you know, vapes had caused no effect on smoking whatsoever between three waves of the PATH survey. But it didn't say that at all.
I don't want to go into what it actually did say. So I published, I wrote a response in sort of fairly plain English and they were kind enough to publish it. Then the authors were given the right to come back and they produced some garbled nonsense.
But at least it was an opportunity to put something in the record about that paper, about its obvious deficiencies, so that anyone who wanted to could look. But I think the problem is the demand. There is a demand for papers that tell you, when you're writing your introduction to the next big study, that you want to go through and say, oh, well, vaping causes cardiovascular disease, respiratory illness, dental problems, cancer and so on.
You want to put that in because that's the setup to why your paper adds to the body of literature on how damaging and harmful these things are and why, you know, when you do perception surveys, it's right for the respondents to say that these are no less dangerous than, you know, smoking products, which is increasingly the trend now. And that's because there's a demand there. People want these papers.
They want that Glantz meta analysis because it answers a need that they have to problematize these products, which justifies their work, their involvement and their entire career.
Jim McCarthy:
Yes. And you touched on something important earlier, too, about the demand of the journals, because I think that, you know, there's an additional need that's being served, which is in my field, publicity and public relations and mass communication. You know, the major entities that you talked about before take these studies and publicize them.
I mean, you know, despite the many examples of Glantz's work being, you know, shredded like confetti in the comment threads of JAMA or on PubPeer or in other academic circles, I mean, it's left in shreds. And yet I'm looking just now at some of the recent times when Dr. Glantz has been credulously quoted as a leading thinker. And it's like, you know, Time magazine, NPR, San Francisco Chronicle, USA Today, CNN.
I mean, The Guardian, on and on. He's taken seriously as a as a preeminent thinker in this space. And that's why I think the, you know, the focus that AVM and my work with them on media criticism is so crucial, because that's got to be called out.
And news organizations that present him to readers as a reliable, you know, upstanding source of information need to be confronted. And I just, you know, here's where I part ways with Joe a little bit is that, you know, those conversations, you know, approaching those with, you know, a gentle hat in hand, you know, I think, dear editor, you may be mistaken. I mean, if you've ever met a journalist or try to tell them their work is wrong, let me just tell you from experience, that's not a gentle conversation.
You've got to grab them by the lapels and give them a Glasgow kiss right in the mouth. So I don't know, Joe, I'd welcome your thoughts. Maybe steer me back toward the toward the light of the light of harmony, because, you know, that that work, I think, needs to be called out in vigorous terms.
Joe Gitchell:
I'm sorry, I'm still kind of fixated on the Glasgow kiss remark as my college golf coach was a Glaswegian, and the thought of smooching him is definitely a bit distracting. I do think that is this window of opportunity to improve the ability of the scientific knowledge generation approach to become more reliable. And these are not new things.
They don't need to be unique to our field. But we are not on a right path of science in this arena producing reliable knowledge. And until we are prepared to embrace the notions that I think are so well laid out in Jonathan Rauch's 2021, the Constitution of Knowledge and Defense of Truth, and the fundamental notion of everything is subject to disconfirmation, no appeals to authority, if we could apply those principles to this field, I think we could start to see the self-correcting mechanism actually come into play, as opposed to just a tool to frustrate Clive.
Clive Bates:
Yeah, well, let me just quick comment on this, because I think, again, it's worth thinking about information here as a marketplace. You know, the best way to understand, Joe, I mean, I know you're the expert on this, but I'm going to say it anyway. The way to think about journalists these days is about their incentive structure.
They're all online. There are, you know, real-time metrics on engagement, on clicks, on lingering time, on the extent to which people stay within the site and everything. That is very different from even how it was, say, 10 or 15 years ago, when basically they handed over their article to the sub-editor who put a nice headline on it, and then nobody knew if anyone read it.
So they have these extremely strong incentives to publish stories that have high engagement. And of course, the press offices know this, so then they're publishing, they're taking the research, which is usually very biased to start with, and they're adding a further top spin on that to make it more engagement-worthy. And the journalists pick it up, and boom, that's how you go.
I actually think the problem here, well, I mean, there's a larger problem with journalism, and it's sort of general decline into clickbait. But I think the larger problem here, sorry, the problem is really happening upstream. This is really about irresponsible science and irresponsible scientists, like the people who are producing these studies that tell you that vaping causes heart attacks, and vaping causes COPD, they're completely ludicrous.
But they are the origin of the problem here. And the problem is that the discipline within which they operate doesn't have self-corrective pressures that would push those people to the margins and put them on the timeout cranks bench that says, well, I'm sorry, you don't play in this field anymore because you're producing science that is clickbait for clickbait only. It's not actual science as we know it.
And my experience is there are a lot of people, really gifted scientists, really credible, really thoughtful, who do not know how to tackle their colleagues or their notional colleagues on this stuff and get them back into the box or exclude them or put them on the margins. And in fact, those scientists, the ones that are producing the junk science, have lots of strong supportive structures around them that stop that kind of challenge by arguing it's industry talking points or arguing that you're not taking a radical position or you're not seeing the truth or whatever.
Jim McCarthy:
Well, yes. I mean, as you might expect, I lay a lot more blame at the feet of the journalists. I mean, these are not simply gullible dupes.
These are highly intelligent people who know this space intimately and have read the literature, know the different arguments. I mean, you know, I think of reporters on the beat like Christina Jewett at The New York Times or Jennifer Maloney at The Wall Street Journal or Nick Florco, who's now at The Atlantic. You know, they know better.
They know better. And they have an ideological sympathy with those groups. And they have an antipathy for nicotine.
And they slant their coverage. And it's not because they're mistaken or because they're deluded by groupthink. These are willful decisions.
And they need to be held responsible for it. You know, we do that by speaking to the readers and saying, behold, they won't indulge other voices. They are willfully obscuring key aspects of this to you.
And you, dear reader, come to your own conclusion about whether their writing is reliable or not. I mean, what they're selling is their credibility. And I think that's the pressure point.
When you show the public, this is not believable. This is agenda-driven, designed to produce a regulatory outcome, drive hostility toward disfavored industries. And, you know, that's the pressure, I think.
Clive Bates:
Yeah. But how's that going? I mean, you know, each of the people that you mentioned are doing pretty well in their careers.
You know, so whatever they are doing, at least, whatever they are doing from their point of view, from the set of incentives that they face, which may not be, you know, telling hard truths to the American public about things that they're having a moral panic about, they are doing quite well. And so I think it's important to understand their incentive structure and why they do what they do. And I agree that there's probably ideological alignment.
That will be, you know, to some extent, you know, the feel of the publication that they're working for will be, well, you know, everyone around here thinks this is terrible. So they're all, you know, absorbing the kind of moral crisis that there is around these products, and then turning it into, you know, I feel like compelling journalism. They're giving shape to instinctive fears and instinctual reflexive reactions to something.
They're professionalizing that into a sort of counter-narrative. And that's working for them.
Jim McCarthy:
Well, let me offer maybe an optimistic look on that. Go ahead, Joe.
Joe Gitchell:
No, and this is a great discussion. I can't resist highlighting the fact that everyone in public knowledge generation and curation bemoans the fact that the public doesn't trust them anymore. And I have to believe that it, I mean, I'm sticking to my groupthink theory.
I think this is fundamentally, we're social, ultra social primates. We love hanging out with people who agree with us. And there's lots of people who agree with them.
Literally, they will never go to a cocktail party and find someone who doesn't agree with them on these topics. But they are perfect.
Jim McCarthy:
Sorry to interrupt, Joe, but notice that each of those three reporters that I cited, you know, if you look back in time four years ago, were hardliners who would never grant any kind of concession to THR or vaping. And now each of them have been obliged, I think, by a lot of the pressure from us and others, have been obliged to include, often as a, you know, afterthought buried down low in the articles, but the candid admission that vaping is effective in helping people quit cigarettes. And that's, I think, a snapshot example of how that pressure works.
And another Clive I'd suggest is, although those reporters themselves may be, you know, benefiting by towing the party line, there are columnists and thinkers at a higher level in journalism than them. People like Seth Mnookin at the Boston Globe or John Tierney, who's a, you know, emeritus science writer. Or, I mean, we've got a good thread I'll put in the chat about this.
And those people have all looked at our debates with journalists and concluded it's the vape advocates that have the moral high ground here.
Clive Bates:
Yeah, I like where you're heading with that, Jim, to be honest. I think there's a lot of interest in looking at this issue from a different perspective. So we, you know, tobacco just tends to get booted into the health correspondence or the public health writer or whatever.
But, you know, it's not that though. It's a story about innovation. And there are scientists, not scientists, but academics of innovation, diffusion of innovation theory.
There are experts on, you know, the transformation of markets and, you know, what that does to the commercial actors involved. What is it that drives these things? There are people who look at these issues from an economic perspective.
And so, you know, some of the most interesting work that's being done in the tobacco science space is being done by, in fact, almost all of the most interesting work is being done by economists. So, you know, people like Abby Friedman and Mike Pesco, who are looking at what effects do, you know, taxes have, vaping taxes have. What effect do flavour bans have?
You know, what happens when you do these policies where you've got natural experiments that you can do to work out the effects? Absolutely fascinating. Now, if there's not a market for that and their work is brilliant, but it's received far less acclaim and interest because it tells a more complicated story than the sort of mainstream moral panic narrative.
But that's to me where we should be finding people to be interested in the work. Economists, experts in innovation, market transformation. You know, as I usually say, Harvard Business Review, not the New England Journal of Medicine.
Jim McCarthy:
Yeah. Yeah. Well, I mean, you know, you're making me think of a tweet I wanted to cite that you put up the other day about how Vital Strategies Group, we mentioned a moment ago, you know, Bloomberg funded one of the deepest pocket opponents of vaping.
They are hosting event on putting, it's called, headlined, Putting the Public in Public Health at the World Health Assembly. This event will explore how honest, empathetic communication can restore faith in our public health systems. And it, I mean, I don't know.
I'm so appalled by that I'm at a loss for words almost. So I'll quote what you said about it. You called it a defeat for irony.
The abstinence only billionaire funded propaganda operation Vital Strategies is trying to lecture us on empathy and honesty. And again, I think, you know, they know better. You know, these are smart people.
These are not, you know, these folks are not just, you know, misled or gullible. I mean, that's, you know.
Clive Bates:
Well, well, Jim, the particularly egregious aspect of Vital Strategies is that in other areas of public health policy, they're very pro-harm reduction.
Jim McCarthy:
Right. That's incredible.
Clive Bates:
They have internalized the idea of harm reduction for drugs. But I have to say, but that's because that's where their funders want to go. The, you know, the patrician funder Michael Bloomberg has a very different view on harm reduction for tobacco.
So oddly, to no one's surprise, they're oppositional to tobacco harm reduction. So these, as I say, the more you think about this as a marketplace in which people are responding to incentives and not necessarily follow money because it's, you know, it's about institutions. It's about culture as well.
It's more than just money, but people are in a marketplace and are driven by incentives that are not always about reducing serious disease as rapidly and deeply as possible, which is where I think we in public health are kind of grounded. And if you are grounded in that and that's the anchor for what you're trying to do, you cannot be other than genuinely strongly committed to tobacco harm reduction and changing the market for nicotine, which is going away no time soon from high risk to low risk products.
Jim McCarthy:
End of story. Well, Joe, let me Joe, let me offer a little common ground here and see if you'll roll with me on this. You know, Clive has written, I think, very persuasively about why ordinary vapers and and, you know, ordinary smokers and vapers who are affected by these policies have so much anger about the way institutions and regulators are, you know, going about the policy and that it's, you know, both righteous and necessary and understandable and that public health really ought to think about that.
But what if I were to suggest, you know, an idea I'll crib from President Obama, which is he used to point out to businesses, look, there's a lot of people protesting in the streets. They're in front of your headquarters at the shareholder conference. They're angry as hell with pitchforks and the torches.
But I'm a reasonable person. I want to have dialogue with you. The only thing standing between you and those folks is me.
So let's have a conversation. What if we thought about it that way, that, you know, ordinary rank and file vapers and ordinary folks and their, you know, their wild eyed Irish PR flacks like yours truly are going to raise our voice and raise a little hell or good trouble as Democratic icon John Lewis used to call it. And it's folks like.
Cliff Douglas, to name one or yourself to name another who can go to these folks and say, hey, Vital Strategies, I want to take you up on that conversation about honesty and empathy, because I'm the one standing between you and the and the pitchforks.
Joe Gitchell:
I would. I'm fired up and ready to go. Betraying my political origins there.
Love it. Did you catch that?
Jim McCarthy:
OK, well, maybe that's maybe that's a good place to end it. I feel like that hour just zipped by. So here's hoping we can make the conversation to be continued in a future episode.
Clive, I, you know, feel like we could chat with you all afternoon. So I appreciate your time.
Clive Bates:
Well, I'd love that. And I hope shaping vaping goes from strength to strength. I've tried to listen to every episode so far.
They are brilliant conversations. And I love the two different perspectives on every problem coming at it with the same overall objective in mind. I just think it's a really, really interesting, really worthwhile format.
And I hope you develop it, Jim and Joe.
Jim McCarthy:
Yes. Well, we're going to try to make some improvements where we've been putting up full transcripts in the last couple of weeks, which we shall do again here. And Joe, Joe will be pleased to know that just before this episode, I went to Holy Mass with my little young daughter, where I was reminded that God's not finished with me yet.
And so I will. So that's the spirit I came into this chat with.
Joe Gitchell:
Amen. Amen.
Jim McCarthy:
And Joe, thank you as well. It's your, I think it is, Clive's touching on something that I really like about these chats too, which is, which is how we come at this from, we're looking at the same light through different parts of a stained glass window. And so I appreciate you.
Joe Gitchell:
It's a delight, Jim. Thank you.
Jim McCarthy:
All right. Thanks everybody for joining us. We'll be back next Thursday.
We've got some more exciting guests coming up. And so we'll flag some of those in the, in the chat. And in the meantime, thank you for joining us.
We'll see you next week. Thanks, Clive. And thanks, Joe.
Clive Bates:
Thanks. See ya.
Jim McCarthy:
Thank you. Bye.