The Endgame Revisited - US E-cigarette Summit 2021
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The document presents an analysis of the tobacco endgame focusing on the perspectives of recreational drug use and the impact of harm related to tobacco products. It discusses the decline in smoking rates, the influence of anti-nicotine propaganda, and the irreconcilable conflicts between public health policy and the tobacco industry's interests. Furthermore, it highlights the need for innovation and technology in addressing tobacco-related harm while examining the formidable opposition to these changes.
The Endgame Revisited - US E-cigarette Summit 2021
- 1. The Endgame Revisited US E-cigarette Summit 2021 Clive Bates Counterfactual 26 May 2021 (Virtual)
- 2. The Tobacco Endgame – the official version
- 3. The endgame revisited 1. The recreational drug perspective
- 4. 1. The recreational drug perspective
- 5. 1. The recreational drug perspective “People smoke for the nicotine but die from the tar”. Professor Michael Russell 1932-2009 Russell MJ. Low-tar medium nicotine cigarettes: a new approach to safer smoking. BMJ 1976;1:1430–3
- 6. 1. The recreational drug perspective
- 7. Smokeless tobacco Tobacco based Pure nicotine based Heated aerosol Unheated Items are not shown to scale Oral nicotine products Vaping products Heated tobacco products “Heat-not-burn” 1. The recreational drug perspective: the future technologies
- 8. 1. The recreational drug perspective: the fundamental innovation Battery Energy Density
- 10. The endgame revisited 1. The recreational drug perspective 2. The weirdness of harm
- 11. The weirdness of harm: the lifeblood of tobacco control
- 12. 2. Weirdness of harm: why people quit Gallus S, Muttarak R, Franchi M, et al. Why do smokers quit? Eur J Cancer Prev 2013;22(1):96–101.
- 13. 2. Weirdness of harm: driver of abstinence Gallus S, Muttarak R, Franchi M, et al. Why do smokers quit? Eur J Cancer Prev 2013;22(1):96–101.
- 14. 2. Weirdness of harm: addiction Addiction is marked by a change in behavior caused by the biochemical changes in the brain after continued substance abuse. Substance use becomes the main priority of the addict, regardless of the harm they may cause to themselves or others. Addiction Center A compulsive, chronic, physiological or psychological need for a habit-forming substance, behavior, or activity having harmful physical, psychological, or social effects Meriam Webster Dictionary Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. American Psychiatric Association Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. National Institute on Drug Abuse (NIDA)
- 15. 2. Weirdness of harm: addiction Addiction is marked by a change in behavior caused by the biochemical changes in the brain after continued substance abuse. Substance use becomes the main priority of the addict, regardless of the harm they may cause to themselves or others. Addiction Center A compulsive, chronic, physiological or psychological need for a habit-forming substance, behavior, or activity having harmful physical, psychological, or social effects Meriam Webster Dictionary Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. American Psychiatric Association Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. National Institute on Drug Abuse (NIDA)
- 16. The endgame revisited 1. The recreational drug perspective 2. The weirdness of harm 3. The smoking epidemic is over
- 17. 3. The smoking epidemic is over 20 Doll R, Peto R et aI. Mortality in relation to smoking: 50 Years’ observations on male British doctors. BMJ 2004
- 18. 3. The smoking epidemic is over 21 Doll R, Peto R et aI. Mortality in relation to smoking: 50 Years’ observations on male British doctors. BMJ 2004
- 19. 3. The smoking epidemic is over 22
- 20. 3. The smoking epidemic is over 23
- 21. 0 5 10 15 20 25 30 35 40 45 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 Percent Past-30 day and daily cigarette smoking prevalence (percent) 1975-2019 United States 12th grade students - Source: Monitoring the Future 2016 and 2019 Smoked in last 30 days (pre-2010) Smoked daily (pre-2010) Smoked in last 30 days (post-2010) Smoked daily (post-2010) Daily smoking Any smoking in past 30 days @clive_bates (2020) 3. The smoking epidemic is over 24 Rate of decline post- 2010 is 4 times greater than 1975- 2010 3 times
- 22. 0 5 10 15 20 25 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Norway: daily tobacco use women age 16-24 - per cent 3. The smoking epidemic is over 1 percent 17 percent
- 24. Youth risk behaviors in context – United States 2017 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 E-cigarette Smoking any combusible tobacco Marijuana Alcohol Binge drinking Drink driver riding as passenger Carried a weapon Texting while driving Percentage of high school students Past 30 day prevalence – high school students NYTS and YRBS 2019 2018 2017 2020 Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance — United States, 2017. MMWR Surveill Summ 2018;67(No. SS-8):1–114. * Refers to driver or passengers riding in vehicles where the driver had been drinking.
- 25. The endgame revisited 1. The recreational drug perspective 2. The weirdness of harm 3. The smoking epidemic is over 4. The anti-nicotine propaganda complex
- 26. 4. A formidable opposition: giant coalitions
- 27. 5. A formidable opposition: big money Since 2007, Bloomberg Philanthropies has committed > US$1 billion to tobacco control Since 2008, the Bill and Melinda Gates Foundation has also invested $210m in global tobacco control Source: Framework Convention Alliance : A Global Strategy to Accelerate FCTC Implementation, 2018
- 28. 4. A formidable opposition: a hostile international treaty
- 29. 4. A formidable opposition: interventionist regulators
- 30. 4. Formidable opposition: fighting dirty
- 31. 4. Formidable opposition: weaponising teenagers
- 32. 4. A formidable opposition: anti-nicotine propaganda complex Politics Regulator Funder Academics Press offices Activists Media Journals & peer review Press releases Conferences Societies and networks Power Influence Communications
- 33. The endgame revisited 1. The recreational drug perspective 2. The weirdness of harm 3. The smoking epidemic is over 4. The anti-nicotine propaganda complex 5. The irreconcilable conflict principle
- 34. 5. The irreconcilable conflict principle Principle 1. There is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests. Article 5.3. In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.
- 35. 5. The irreconcilable conflict principle: world’s lowest smoking rate
- 36. 5. The irreconcilable conflict principle: world’s lowest smoking rate Sweden
- 37. 5. The irreconcilable conflict principle: cannibalising cigarette sales Total - steady decline Cigs – rapid decline Heated Tobacco – sharp rise Phillip Morris International Data
- 38. 5. The irreconcilable conflict principle: the problem of wrongness • Oppose harm reduction • Contrived explanations and bad science • Rejecting innovation • Distorted goals • Flawed policymaking • Echo chambers
- 39. 5. The irreconcilable conflict principle: a technology transition
- 40. 5. The irreconcilable conflict principle: a technology transition
- 41. 5. The irreconcilable conflict principle: a final word… “Claims about the promise of new technology are at times greeted with skepticism, vilification or outright opposition—often dominated by slander, innuendo, scare tactics, conspiracy theories and misinformation. “The assumption that new technologies carry unknown risks guides much of the debate. This is often amplified to levels that overshadow the dangers of known risks.” Juma C. Innovation and Its Enemies: Why People Resist New Technologies. Oxford, New York: Oxford University Press; 2016.
Editor's Notes
- #9: Vaping products Top row shows: 1st generation cig-a-likes 2nd generation ego or ‘pen’ type devices 3rd generation tanks / mods type Bottom row shows Large electronic hookah Small shisha pipes Electronic pipe … there are many other configurations Heated tobacco products – sometimes referred to as heat-not-burn to distinguish between combustible products Shows the iQOs, Ploom and Glo products Novel nicotine products - shows Nicoccino – a nicotine containing film Zonnic – a range of nicotine products – lozenges, gum etc Voke – a cold aerosol (approved but not marketed) Niorette – cross-over NRT Smokeless tobacco Snus Moist snuff Tobacco-based lozenge