Latest / The Chuck ToddCast / Interview Only w/ Dr. Brian King - Decades of Anti-Tobacco Wins Are Being Reversed Under Trump

Transcript

Interview Only w/ Dr. Brian King - Decades of Anti-Tobacco Wins Are Being Reversed Under Trump · The Chuck ToddCast

0:00
Speaker 1: This episode of The Chuck Podcast is brought to you
0:02
Speaker 1: by Chapter. Now, almost everything you hear about medicare is
0:06
Speaker 1: somebody quietly trying to steer you somewhere, and you're skeptical
0:12
Speaker 1: of that, as you should be.
0:13
Speaker 2: I get it.
0:14
Speaker 1: I mean, there's a federal lawsuit going on right now
0:17
Speaker 1: over exactly this companies that branded themselves as unbiased while
0:21
Speaker 1: allegedly pointing people toward whatever would pay them the most,
0:25
Speaker 1: as some sort of broker. So if your default is
0:28
Speaker 1: to distrust everyone in this space, honestly, I get it.
0:31
Speaker 1: I'm a bit distrustful these days myself. That's the whole
0:34
Speaker 1: reason I want to tell you about Chapter. They're independent
0:37
Speaker 1: medicare advisors whose entire model is that their advisors are
0:41
Speaker 1: not paid to push any one plan. They're just trying
0:45
Speaker 1: to help. Yes, there's compensation that goes with it, but
0:47
Speaker 1: it's across the board is what they're trying to do.
0:50
Speaker 1: At the end of the day, they're advocating for you.
0:52
Speaker 1: They're not the insurance companies themselves. They're an actual person
0:56
Speaker 1: who actually goes through your doctors, your prescriptions needs, and
1:01
Speaker 1: then compares them to every single plan available to find
1:04
Speaker 1: the best one. That will work for you and hopefully
1:07
Speaker 1: send save you a couple of dollars too. And here's
1:09
Speaker 1: the part that sets Chapter apart. They don't disappear once
1:13
Speaker 1: you've been in a role. They will keep advocating for you.
1:16
Speaker 1: They're kind of like almost like a concierge service. You're
1:19
Speaker 1: just there. I need help. You're like customer service. You
1:22
Speaker 1: know the plan, you know, help me navigate this again.
1:24
Speaker 1: So you ever get hit with a wrongful medical bill,
1:27
Speaker 1: they'll help you fight it. They want to stay an
1:30
Speaker 1: advocate for you even after you've done this.
1:33
Speaker 2: So look, I get it.
1:35
Speaker 1: I think there's all sorts of space. You see a
1:38
Speaker 1: lot of people are throwing themselves in this healthcare space.
1:41
Speaker 1: When I like about these Chapter folks, I've spent time
1:44
Speaker 1: with them. This is a very transparent organization. It is Medicare,
1:49
Speaker 1: and all of its affiliated stuff can be very confusing.
1:53
Speaker 1: The whole point of this is to make this easier
1:56
Speaker 1: and less confusing. Okay, so look, take this cup deicism
2:00
Speaker 1: you already have in all of this, pointed at your
2:02
Speaker 1: own plan for twenty minutes. It's free, there's no pressure,
2:06
Speaker 1: and then call Chapter today at nine eight zero seven
2:09
Speaker 1: three four three.
2:11
Speaker 2: Nine eight five.
2:17
Speaker 1: So for most of my lifetime, fighting tobacco has been
2:20
Speaker 1: one of the great bipartisan public health success stories in America.
2:24
Speaker 1: Think about where we started in nineteen sixty five. More
2:27
Speaker 1: than four and ten Americans smoke cigarettes today fewer than
2:31
Speaker 1: one intended. That's one of the most dramatic improvements in
2:35
Speaker 1: public health this country has ever seen. It didn't happen
2:38
Speaker 1: because one law changed everything. It happened because of decades
2:41
Speaker 1: of policy. Congress required warning labels, States raised cigarette taxes.
2:46
Speaker 1: Smoking disappeared from airplanes, restaurants, office buildings. Tobacco companies were sued.
2:51
Speaker 1: In two thousand and nine, Congress gave the FDA broad
2:54
Speaker 1: authority to regulate tobacco products, including how they're marketed and sold,
2:59
Speaker 1: and government got remarkably good at helping people quit smoking.
3:03
Speaker 1: If you're old enough, you remember the CDC's tips from
3:07
Speaker 1: Former Smoker's campaign. The commercials were not subtle. Sometimes you
3:12
Speaker 1: looked away, people spoke through tracheotomies, cancer survivors talked about
3:16
Speaker 1: what smoking had taken from them. They were incredibly uncomfortable
3:20
Speaker 1: to watch, which was the point, and the results were extraordinary.
3:23
Speaker 1: Research is estimated that the campaign itself generated more than
3:27
Speaker 1: two million additional calls to one eight hundred quit Now
3:32
Speaker 1: the eight hundred number that helped produce over one million
3:35
Speaker 1: successful quits, prevented and estimated one hundred and twenty nine
3:38
Speaker 1: thousand premature deaths and save roughly seven point three billion
3:43
Speaker 1: dollars in healthcare costs. Folks, it's an astonishing return on
3:47
Speaker 1: investment for a government led public health campaign. But here's
3:50
Speaker 1: where the story has changed. Over the past year. Much
3:52
Speaker 1: of the federal tobacco control infrastructure has been quietly dismantled.
3:57
Speaker 1: The CDC's Office on Smoking and Health, the office that
4:00
Speaker 1: coordinated much of this work that I just described, effectively eliminated.
4:04
Speaker 1: The national Tips campaign, has largely disappeared. State quit lines
4:09
Speaker 1: report dramatically fewer calls without the constant national ad campaigns, and,
4:15
Speaker 1: in an irony that almost sounds made up, when adults
4:17
Speaker 1: smoking recently fell below ten percent, that milestone was not
4:22
Speaker 1: even announced or celebrated by the CDCs tobacco experts. It
4:25
Speaker 1: was highlighted through outside research because many of those experts
4:29
Speaker 1: were no longer in government. Now there's one more side
4:32
Speaker 1: of this debate. The administration and many harm reduction advocates
4:35
Speaker 1: have been arguing that the real goal should be moving
4:37
Speaker 1: adult smokers away from combustible cigarettes toward products like e
4:42
Speaker 1: cigarettes or nicotine pouches like zin right, which many researchers
4:47
Speaker 1: believe are substantially less harmful than smoking. They're still kind
4:50
Speaker 1: of harmful. Some of the same advocates actually criticize my
4:54
Speaker 1: guest today when he ran the fbaida's Tobacco Center, arguing
4:58
Speaker 1: he was too restrictive in improving these products. It's an
5:00
Speaker 1: important perspective to keep in mind because here's what has
5:03
Speaker 1: raised eyebrows. Tobacco companies dramatically increase their political giving and
5:08
Speaker 1: gained access to senior administration officials, and they also won
5:12
Speaker 1: a series of significant regulatory victories from the FDA.
5:16
Speaker 2: Now, does one prove the other.
5:19
Speaker 1: No, correlation isn't necessarily causation. But hey, we've all been
5:24
Speaker 1: in this rodeo in Washington before. But the timeline is
5:27
Speaker 1: striking enough that it's worth examining carefully. And that's why
5:30
Speaker 1: I wanted to have this conversation. My guest today's Brian King,
5:33
Speaker 1: who until last year directed the FDA's Center for Tobacco Products,
5:37
Speaker 1: the exact office responsible regulating cigarettes, vaping products, and nicotine patches.
5:43
Speaker 1: For that, he was in senior leadership with the CDC's
5:45
Speaker 1: offices Smoking in Health, So needless to say, he's been
5:48
Speaker 1: on the front lines of this. What was an incredible
5:51
Speaker 1: success story that in the last eighteen months is now
5:55
Speaker 1: getting called into questions. So I want to get it
5:57
Speaker 1: into that. So Brian, welcome to the podcast, and let
6:00
Speaker 1: me just.
6:00
Speaker 2: Start with I wanted to frame the conversation this way.
6:06
Speaker 2: What I leave out now, I think you covered it nicely.
6:09
Speaker 2: We've made considerable progress reducing cigarettes smoking this country, I think,
6:13
Speaker 2: one of the greatest public health achievements of the past century.
6:16
Speaker 2: But in recent months we've seen corporate capture of key
6:20
Speaker 2: regulatory activities by the federal government and also elimination of
6:24
Speaker 2: our boots on the ground doing work to address what
6:26
Speaker 2: remains the nation's leading preventable cause of disease and death.
6:30
Speaker 2: So highly problematic and simply unprecedented.
6:33
Speaker 1: So look, you've been focused on this and you're quite
6:37
Speaker 1: frustrated by it. I think that's why you're trying to
6:40
Speaker 1: sort of sound the alarm here. So walk me through
6:43
Speaker 1: here what happened, right, I mean, let's get into some
6:46
Speaker 1: specifics here. We had the donations, you had White House access,
6:49
Speaker 1: you had mar lago meetings, FDA approvals. This is more
6:56
Speaker 1: than a circumstantial case, right.
6:58
Speaker 2: Yeah, when you look at ultimately what has occurred, most
7:02
Speaker 2: of the activities started in terms of FDA actions and
7:06
Speaker 2: response to some of this industry pressure earlier this year.
7:09
Speaker 2: And so in March of this year, the agency issued
7:12
Speaker 2: a guidance which indicated that they were more responsive to
7:15
Speaker 2: authorizing flavoredy cigarettes. And so, in the past, the agency
7:20
Speaker 2: followed of the strict science and was only willing to
7:22
Speaker 2: authorize flavors if the applicant provided the sufficient a scientific
7:27
Speaker 2: evidence to show that it was better than tobacco flavor,
7:29
Speaker 2: which we know tobacco flavor isn't appealing to kids, and
7:32
Speaker 2: so to document that they've met the scientific bar, you
7:36
Speaker 2: have to show that your product is more effective than
7:38
Speaker 2: tobacco to help an adult smoke or transition completely. And
7:41
Speaker 2: so the agency in March issued a guidance basically saying, Wow,
7:44
Speaker 2: we're going to open the door a little farther and
7:45
Speaker 2: we're going to base our decisions on maybe certain flavors
7:50
Speaker 2: are better than others. And they highlighted mint and spice,
7:56
Speaker 2: and they said that you know, flavors like fruit are
7:59
Speaker 2: still probably about two thirds of kids use those products.
8:02
Speaker 2: And they also said that age gating technology wasn't necessarily
8:05
Speaker 2: a panacea, and so technology they would prevent people from
8:08
Speaker 2: accessing based on age was promising, but there was inconclusive evidence.
8:12
Speaker 2: And so since the release of that guidance, you then
8:15
Speaker 2: saw a matter of a couple weeks later authorization of
8:19
Speaker 2: a brand of e cigarets cult Glass, which is a
8:21
Speaker 2: California company, and they authorized them in fruit flavors, which
8:24
Speaker 2: is the most commonly used flavor among kids, and basically
8:27
Speaker 2: said that agegating was the golden ticket to get that authorization,
8:31
Speaker 2: and so it was a complete pivot from what had transpired.
8:34
Speaker 2: But what occurred only a couple days prior was a
8:37
Speaker 2: meeting out of Florida golf course between the administration, the President,
8:42
Speaker 2: and key executives from several tobacco companies where they basically
8:46
Speaker 2: pressured the administration to do more to be responsive to
8:50
Speaker 2: the tobacco industry's interest. And so only a matter of
8:53
Speaker 2: days later you had the FDA Commissioner resign over this.
8:56
Speaker 2: You had them completely buckle and turn and authorize these
9:00
Speaker 2: these products. And then only a couple of days later.
9:03
Speaker 2: From there, you then had a new guidance that was
9:06
Speaker 2: issued that basically said, they're going to be more lenient
9:08
Speaker 2: to the tobacco industry and if certain companies are far
9:11
Speaker 2: enough in the application review process, they are not going
9:14
Speaker 2: to take any enforcement action against them, and even further,
9:17
Speaker 2: they're going to issue a list to the public saying
9:19
Speaker 2: these are the industry players that were were willing, you know,
9:23
Speaker 2: to allow to be on the market illegally while their
9:26
Speaker 2: applications remain under review. So a lot has transpired, but
9:30
Speaker 2: the bottom line is the dislodged after corporate capture and
9:34
Speaker 2: also a series of donations that have been made by
9:36
Speaker 2: industry over you know, many years, but also to the
9:41
Speaker 2: superpack for the current administration, as well as a five
9:44
Speaker 2: million dollar donation before that meeting that occurred at the
9:47
Speaker 2: golf course in Florida with the President in May.
9:51
Speaker 1: Look, I think the it's you know, what you just
9:55
Speaker 1: outlined is sort of just another day in Washington, right.
9:58
Speaker 1: I Mean, I hate to say that, but it's like
9:59
Speaker 1: this is, you know, I teach a class for a
10:03
Speaker 1: USC in my fourth year teaching it the next the
10:06
Speaker 1: next in the spring semester, which is how Washington works.
10:10
Speaker 2: And you just described one way.
10:11
Speaker 1: Washington works, right, but that is that is you know,
10:15
Speaker 1: I my joke to the kids are like Washington's always
10:18
Speaker 1: working for somebody. You know, My job as a reporter
10:20
Speaker 1: was to figure out for who, right, and your job
10:22
Speaker 1: as a citizen is to try to make.
10:24
Speaker 2: It work for everybody.
10:25
Speaker 1: So that you know, there's nothing about this story that
10:29
Speaker 1: feels like unfamiliar to how the Trump administration acts. So,
10:33
Speaker 1: but let's talk about that the health harm here have
10:41
Speaker 1: it feels as if like we've just there's this conclusion
10:44
Speaker 1: now that it was the smoke itself that was the
10:47
Speaker 1: cause that the health concern, and that if you imbibe
10:52
Speaker 1: tobacco and nicotine in other ways, it's okay, what's the
10:56
Speaker 1: actual health.
10:59
Speaker 2: Data on that topic? So when you look at tobacco products,
11:03
Speaker 2: they exist on a continuum of risk, with cigarettes smoking
11:06
Speaker 2: being the most deadly. So cigarette contains seven thousand chemicals
11:10
Speaker 2: seventy carcinogens, aargably one of the most deadly consumer products
11:14
Speaker 2: known to mankind, still killing.
11:16
Speaker 1: Let's do this can't compare? Why is a cigarette so
11:18
Speaker 1: much more deadly than a cigar?
11:21
Speaker 2: So both are combustible products, so both have risk. And
11:24
Speaker 2: so anytime you inhale toxins into your lungs, which are
11:28
Speaker 2: meant for clean air, there's going to be risked. And
11:30
Speaker 2: so combustible products in general are at the highest end
11:33
Speaker 2: of that continuum, and.
11:34
Speaker 1: That includes cannabis. That includes right, whether it's.
11:37
Speaker 2: Anytime anything exactly the lungs are intended for for clean air. Right.
11:42
Speaker 2: What makes the cigarette worse? Though? What is it the cigarette?
11:46
Speaker 2: Not only is it products of combustion, but the tobacco
11:50
Speaker 2: industry has put other ingredients into those products over many
11:54
Speaker 2: years to make them more deadly and more addictive. And
11:58
Speaker 2: so although nicotine is not the drug in these products
12:02
Speaker 2: that is causing the death and disease directly, it's certainly
12:05
Speaker 2: the highly addictive agent that is causing people to continue
12:08
Speaker 2: to come back for more. And so when it comes
12:11
Speaker 2: to cigarette smoking, seven thousand chemicals seventy carcinogens nearly harms
12:15
Speaker 2: every organ of the body, including twelve types of cancer,
12:19
Speaker 2: and so the risk is very well established. That said,
12:22
Speaker 2: we've seen new products enter the market that are lower risk,
12:25
Speaker 2: but that doesn't mean no risk, and that includes these
12:29
Speaker 2: cigarettes and nicotine pouches and others. And it also doesn't
12:32
Speaker 2: mean that particularly vulnerable populations like kids should be using
12:35
Speaker 2: these products. Kids should not be using any tobacco products,
12:37
Speaker 2: and those who aren't already using them certainly shouldn't start.
12:40
Speaker 2: And when it comes to nicotine, it's a highly addictive drug.
12:43
Speaker 2: It can harm the developing adolescent brain, which continues to
12:46
Speaker 2: develop until about age twenty five, and it can also
12:49
Speaker 2: prime the brain for addiction to other drugs. And so
12:51
Speaker 2: nicotine is not a completely risk free a drug. It's
12:56
Speaker 2: something we use in therapies like nicotine replacement patch and
12:59
Speaker 2: others to get pull off nicotine in the long term,
13:01
Speaker 2: but it's not something that we should be introducing the
13:04
Speaker 2: population to unless it's for the purposes of an FDA
13:08
Speaker 2: approved a therapeutic purpose or FDA authorized Look.
13:12
Speaker 1: When I was a kid, my parents were concerned about
13:14
Speaker 1: too much caffeine consumption when I was ten or eleven,
13:17
Speaker 1: let alone nicotine consumption. What is the level of you know,
13:21
Speaker 1: you know, we're worried about kids with nicotine. What would
13:23
Speaker 1: you say about just caffeine.
13:25
Speaker 2: Yeah, it's not a direct apples to apples comparison when
13:29
Speaker 2: you look at the way that both of those function
13:31
Speaker 2: in the body. There's different safety profiles, there's different pharmacodynamic
13:35
Speaker 2: profiles and ultimately different risk profiles in the long run.
13:39
Speaker 2: And so it's not a direct apples to apples when
13:43
Speaker 2: it comes to nicotine. And we know that there are
13:45
Speaker 2: inherent risks, particularly to kids, and we also know you
13:48
Speaker 2: know that it's you know, something that can increase cardiovascular
13:52
Speaker 2: risk as well, particularly in chronic exposure. So it's not
13:55
Speaker 2: just the addiction and the impact on the developing ls
13:57
Speaker 2: and brain, but also in the long term, even for adults,
14:00
Speaker 2: there's profound cardiovascular risk. And so you know, bottom line
14:04
Speaker 2: is adult smokers, if they transition completely from a cigarette
14:08
Speaker 2: to these products, it would be a benefit to that individual.
14:11
Speaker 2: But the end of goal should be to get off
14:12
Speaker 2: completely and in the meantime that can't come at the
14:14
Speaker 2: expensive kids.
14:15
Speaker 1: Well, you know, and this to me seems to be
14:17
Speaker 1: the conundrum, which is, if you're a chain smoker, vaping
14:22
Speaker 1: and nicotine pouches are an improvement, right, you'd rather have
14:27
Speaker 1: grandma or grandpa pet Can we get you off the winstons?
14:31
Speaker 1: Can we get you you know, using some zen? But
14:35
Speaker 1: it does seem as if we have we passed, you know,
14:39
Speaker 1: when smoking was more of a recent phenomenon that made sense.
14:42
Speaker 1: We're now, arguably, what do we.
14:45
Speaker 2: Are?
14:46
Speaker 1: We twenty five years into the pouch thing and we're
14:51
Speaker 1: about fifteen years of mainstreaming vapes.
14:54
Speaker 2: What would you say? So, yeah, you said it's entered
14:56
Speaker 2: the US market around in two thousand and eight. Okay, So.
15:02
Speaker 1: To me, the concern would be that it now is
15:04
Speaker 1: actually it's been so long, and that it turns into
15:08
Speaker 1: a gateway back to smoking.
15:10
Speaker 2: Is there any evidence of that? So if you look
15:12
Speaker 2: at the preponerance of the science, know that doesn't mean
15:15
Speaker 2: that it's not happening. But when we look at the
15:18
Speaker 2: longitudinal evidence, which is what follows people over time, it
15:21
Speaker 2: does not peer based on the existing literature that it's
15:24
Speaker 2: a transition to smoking. But that still doesn't negate the
15:28
Speaker 2: inherent risk of using the product, particularly among kids, and
15:32
Speaker 2: so you know, ultimately it's important to look at the
15:34
Speaker 2: preponderance of the evidence. But even if it's not leading
15:37
Speaker 2: kids to smoke, they still shouldn't be exposed to nicotine
15:40
Speaker 2: and the adverse effects of these products, and all the
15:43
Speaker 2: more reason why we need a well regulated marketplace to
15:45
Speaker 2: make sure that only those products that are actually going
15:47
Speaker 2: to help adult smokers transition completely are the ones that
15:51
Speaker 2: are authorized on the market, and that's why that FDA
15:53
Speaker 2: review is so critical, and enforcement is also essential to
15:56
Speaker 2: get the products that aren't authorized by FDA off the market.
16:00
Speaker 1: So look, I you know, I remember Trump was was
16:05
Speaker 1: I think it was he was trying because it had
16:08
Speaker 1: been a big sort of there had been some advocates
16:10
Speaker 1: in the sort of megaspace about hey, the flavored vapes
16:14
Speaker 1: and the flavor, you know, please bring it back, bring
16:16
Speaker 1: it back. So this has always felt like there is
16:19
Speaker 1: a constituency in his political base that has been agitating
16:24
Speaker 1: for this for some time.
16:25
Speaker 2: Has it not? Oh yeah, there's certainly been pressure on
16:28
Speaker 2: FDA for for many years. I think you know what's
16:31
Speaker 2: different here is that you actually have the administration acting
16:35
Speaker 2: on it and following you know, very flagrant political donations
16:40
Speaker 2: and pressures. And you know, having served in the US government,
16:43
Speaker 2: I'll say that there was always White House interest and
16:45
Speaker 2: tobacco work. You know, it's the leading cause of preventical
16:48
Speaker 2: disease and depth. You know, I would question if an
16:50
Speaker 2: administration's health insurance services didn't have interest in that. But
16:53
Speaker 2: what we're seeing now isn't just interest, it's interference. And
16:57
Speaker 2: I think that it's also highly ironic because you have
17:00
Speaker 2: a health department that's basically priding itself on being anti
17:03
Speaker 2: corporate capture and championing, you know, efforts to prevent chronic disease,
17:08
Speaker 2: and in this case, you've got both happening with corporate
17:11
Speaker 2: capture and not doing anything to address the leading cause
17:14
Speaker 2: of preventable disease in the country.
17:16
Speaker 1: So I'm trying to put myself in the shoes of
17:19
Speaker 1: Altria here or any of the tobacco companies, and you know,
17:23
Speaker 1: I'm trying to continue to grow my business. I'm just
17:25
Speaker 1: like being very cynical and transactional here. As I'm thinking
17:28
Speaker 1: this through, I would think it's in their interest to,
17:32
Speaker 1: you know, at this point they pivoted their business to
17:36
Speaker 1: I assume, you know, exporting cigarettes internationally and trying to
17:43
Speaker 1: essentially corner the domestic market on the on the nonsmokable
17:46
Speaker 1: tobacco products, right, whether it's the pouches, the vapes, the SIGs,
17:50
Speaker 1: et cetera. So isn't it I could make a case
17:55
Speaker 1: that it's actually in the domestic tobacco company's best interest
17:58
Speaker 1: to continue the anti smoking campaigns, to continue the transition
18:04
Speaker 1: of my two packa day people I want to not
18:08
Speaker 1: only now, I'm fine with them quitting because I can
18:11
Speaker 1: transition them to my growth business over here. So again
18:15
Speaker 1: I'm being cynical transactional business guy here. That's the part
18:20
Speaker 1: that's a head scratcher to me. Why get rid of
18:22
Speaker 1: this ad campaign?
18:24
Speaker 2: Yeah, well, it's contra productive to common sense and also
18:28
Speaker 2: public health. You know, there's certainly been you know, vocal
18:32
Speaker 2: attention from industry indicating that they want to transition people
18:35
Speaker 2: to lower risk alternatives. But in the same breath, many
18:39
Speaker 2: of them are still selling cigarettes, making massive amounts of money.
18:43
Speaker 1: How much of their bottom line is the actual old
18:46
Speaker 1: fashioned cigarette It varies by the company, but for many
18:50
Speaker 1: it's still the majority of their portfolio and in some
18:53
Speaker 1: cases most. And is it more international than domestic these days?
18:57
Speaker 1: I mean, you know, Asia, you see a lot of
19:00
Speaker 1: cigarettes smoking.
19:00
Speaker 2: Yeah, it's certainly you see far more marketing, you know,
19:04
Speaker 2: for cigarettes, you know, internationally, but even in the US
19:06
Speaker 2: you have companies that are heavily promoting It's about a
19:08
Speaker 2: million dollars an hour is still being spent to advertise
19:11
Speaker 2: cigarettes in the United States alone, So it's not going away.
19:14
Speaker 2: And you've also seen adapting to regulations. So you know
19:17
Speaker 2: now that they can't advertise on television and radio. You
19:21
Speaker 2: know now you've seen shift to point of sale at
19:23
Speaker 2: convenience stores, you've seen electronic promotion through the Internet and
19:29
Speaker 2: social media. But all that said, you have this irony
19:32
Speaker 2: because if the goal is really to transition people, you're
19:35
Speaker 2: seeing the industry fight tooth and nail at the federal
19:38
Speaker 2: level and the state and local level to basically prevent
19:40
Speaker 2: policies from going in place they would actually help people
19:43
Speaker 2: stop smoking. So graphic warning labels, the industry has been
19:46
Speaker 2: litigating that for over a decade in this country, when
19:49
Speaker 2: over one hundred countries have already done it. Then there's
19:51
Speaker 2: a strong evidence space pushing back against the menthol role
19:54
Speaker 2: that the Bidenair administration wanted implement all actions that would
19:57
Speaker 2: reduce smoking. And so, if you really want to help
20:00
Speaker 2: people transition away, it's not just creating a product that
20:02
Speaker 2: will make you money, it's also creating an environment with
20:05
Speaker 2: policies that will actually drive people to quit or transition
20:08
Speaker 2: to those lower risk alternatives. And that's where you have that,
20:12
Speaker 2: you know, complete conflict of actual action when it comes
20:15
Speaker 2: to the industry.
20:20
Speaker 1: This episode of the Check Podcast is brought to you
20:22
Speaker 1: by fand OL Baseball fans.
20:24
Speaker 2: Think you know who's.
20:25
Speaker 1: Hitting a homer today, Well, Fandel is giving you a
20:27
Speaker 1: free chance to call your shot with Daily Dingers. Joining
20:31
Speaker 1: the action is easy. You just make your free pick
20:33
Speaker 1: on who's hitting a home run and their game, and
20:35
Speaker 1: if you're right, you'll get a profit boost to use
20:37
Speaker 1: on your next bet for a chance at extra winnings.
20:41
Speaker 1: You've got nothing to lose and you get a lot
20:43
Speaker 1: to gain. And don't forget you can make a free
20:45
Speaker 1: pick every day during the MLB season. It's just another
20:48
Speaker 1: reason why fandel is the home for home runs. So
20:51
Speaker 1: are you ready to play your game today? Join all
20:55
Speaker 1: the action at FanDuel dot com that's fandel dot com
20:58
Speaker 1: to play Daily Dingers and make your free pick on
21:01
Speaker 1: who's hitting a homer. Playball and swing for the fences
21:04
Speaker 1: on fandle, an official partner of the MLB. Twenty one
21:08
Speaker 1: plus in select states for Kansas and affiliation with the
21:11
Speaker 1: Kansas Star Casino. It's eighteen plus in DC, Kentucky, Wyoming.
21:15
Speaker 1: If you have a gambling problem, call one eight hundred
21:18
Speaker 1: Gambler or one eight hundred MI reset or call one
21:22
Speaker 1: eight eight eight seven eight nine seven seven seven seven.
21:26
Speaker 1: You can also visit CCPG dot org slash chat. In Connecticut,
21:30
Speaker 1: you can visit the MD gamblinghelp dot org. In Maryland
21:35
Speaker 1: for help, you can visit gambling Heelplinema dot org. You
21:39
Speaker 1: can call eight hundred three two seven five zero five zero.
21:42
Speaker 1: In Massachusetts, you can call one eight seven seven eight
21:46
Speaker 1: Hope and Why, or you can simply text hope and
21:49
Speaker 1: why New York in order to get some help with
21:53
Speaker 1: any gambling concerns. Finally, you can also call one eight
21:56
Speaker 1: seven seven seven seven zero seven eight six seven you're
22:00
Speaker 1: in Louisiana.
22:06
Speaker 2: They clearly they wanted this ad campaign to end. Well,
22:10
Speaker 2: we can't connect the dots precisely, but I think that
22:15
Speaker 2: the tobacco industry is certainly not perturbed that the campaign
22:20
Speaker 2: is off the airwaves. It was highly effective on the
22:23
Speaker 2: airways for over a decade, has helped over a million
22:25
Speaker 2: Americans quit smoking, and was part of CDC's Office on
22:28
Speaker 2: Smoking Health. It is now has been completely eliminated. Those
22:31
Speaker 2: staff are not brought back. They're currently on administrative leave.
22:34
Speaker 2: They're protected by litigation by the state's attorney general, but Ultimately,
22:38
Speaker 2: that was the office responsible for monitoring youth tobacco use
22:41
Speaker 2: in this country through the National Youth Tobacco Survey. They
22:44
Speaker 2: responsible for the TIPS campaign. They gave grants to all
22:47
Speaker 2: fifty states to do tobacco prevention and control work across
22:50
Speaker 2: the country, and they also did you critical work in
22:54
Speaker 2: terms of just surveillance and science, and so all of
22:56
Speaker 2: that is now not happening, which is certainly a detriment
22:59
Speaker 2: to the public health of this country. And that's the
23:01
Speaker 2: ultimately casualty of this. It's the American people because now
23:05
Speaker 2: you have the office responsible for addressing the leading cause
23:07
Speaker 2: of prevental disease and death that has now been completely
23:10
Speaker 2: sidelined and eliminated.
23:11
Speaker 1: Given that there is an alternative to get your nicotine
23:16
Speaker 1: in a variety of ways, why is the old fashioned
23:20
Speaker 1: cigarette legal?
23:23
Speaker 2: So it all comes back to bipartisan legislation. So if
23:27
Speaker 2: you look at the two thousand and nine Tobacco Control Act,
23:30
Speaker 2: which was bipartisan bi cameral, that was the first time
23:32
Speaker 2: FDA got the authority to regulate tobacco in this country.
23:36
Speaker 2: That law specifically prohibits the FDA from banning any product class,
23:41
Speaker 2: including cigarettes, and it also prohibits the agency from reducing
23:45
Speaker 2: nicotine levels to zero. It doesn't prevent the agency from
23:49
Speaker 2: reducing it to minimally addictive levels, which the last administration
23:52
Speaker 2: in the waning hours, released a proposal for that, which
23:55
Speaker 2: the current administration has now done away with. But you know,
23:58
Speaker 2: if you remove that highlyve agent, that would prevent people
24:01
Speaker 2: from coming back for more. But ultimately it comes down
24:04
Speaker 2: to what is the regulatory structure in the United States,
24:07
Speaker 2: And based on that bipartisan legislation, there was parameters in
24:11
Speaker 2: that law that prevented the agency from out white banning
24:14
Speaker 2: entire product classes, including cigarettes.
24:17
Speaker 1: Well, and this is where I would come in and say,
24:20
Speaker 1: remember how many people in the state of how many
24:24
Speaker 1: elected officials from the states of Kentucky and Virginia in
24:28
Speaker 1: North Carolina three very tobacco three tobacco states who have
24:33
Speaker 1: influence in Congress. So what you just outlined there and
24:37
Speaker 1: those three states, And certainly there was biparties of people,
24:40
Speaker 1: including leadership like Mitch McConnell, So I could picture how
24:43
Speaker 1: they say, well, you can't get we can't you know,
24:46
Speaker 1: totally kill our tobacco farmers and all of this. You
24:51
Speaker 1: know what would happen to tobacco farmers of cigarettes were
24:54
Speaker 1: the old fashioned cigarette was essentially.
24:58
Speaker 2: Banned. Well, what we've seen in other countries and also
25:02
Speaker 2: domestically is over the years, as cigarette smoking has gone down,
25:05
Speaker 2: that you've seen transition into other types of farming. And
25:09
Speaker 2: so people have been able to transition successfully and they've
25:12
Speaker 2: also transitioned into other areas. And you also continue to
25:15
Speaker 2: have a need for nicotine, tobacco derived nicotine for things
25:19
Speaker 2: like nicotine replacement therapy and FDA approved therapeutics with the
25:23
Speaker 2: intent of getting people off. You still need the tobacco
25:26
Speaker 2: leaf for that. Yeah, so more recently you can produce
25:29
Speaker 2: nicotine synthetically, but the vast majority of nicotine out there
25:34
Speaker 2: is extracted directly from the tobacco plant. That's the cheapest
25:37
Speaker 2: way to get it. The price has gone down in
25:40
Speaker 2: recent years to create synthetic in the lab, but it's
25:42
Speaker 2: still pretty pricey, and so most people are still using
25:45
Speaker 2: the old nicotine derived tobacco from the tobacco.
25:48
Speaker 1: You know, I think about our history, right, we're both
25:53
Speaker 1: as a society, we're both libertarian and puritan sort of
26:00
Speaker 1: have these cross currents, and it's it's always been constant, right,
26:03
Speaker 1: our puritan side showed up during prohibition, right or libertarian
26:07
Speaker 1: side shows up in all of these you know, cannabis
26:10
Speaker 1: laws that have been popping up by state and stuff.
26:14
Speaker 1: But when you look, I mean, you know, we have
26:17
Speaker 1: this sided. You know, for instance, hey, there's a level
26:21
Speaker 1: of alcohol you're allowed to sell, right, you know, you
26:26
Speaker 1: can find one fifty one proof stuff and all, but
26:29
Speaker 1: there is a there is we we sort of set
26:33
Speaker 1: some limits here and so, which means essentially we got
26:38
Speaker 1: rid of the worst versions of alcohol that could prove
26:42
Speaker 1: deadly or whatever it is. Is that where we should
26:47
Speaker 1: head with a cigarette? Can you can you get it
26:50
Speaker 1: down to where you even have just less and less
26:53
Speaker 1: and less. You still allow the addictive product.
26:55
Speaker 2: But less of it, well, certainly, And that's where I
26:58
Speaker 2: think the nicotine standard in which you know, folks talk
27:01
Speaker 2: about harm reduction, and I would argue that is the
27:03
Speaker 2: single most effective population based harm reduction policy you could
27:06
Speaker 2: implement for tobacco. If you reduce the addictivation to minimally
27:10
Speaker 2: addictive or non addictive levels, you are going to prevent
27:13
Speaker 2: the primary ingredient that's bringing people back. And so that's
27:16
Speaker 2: going to prevent initiation. It's going to promote cessation and
27:19
Speaker 2: it's going to reduce likelihood of relapse. And so when
27:21
Speaker 2: it comes to cigarettes, no other country has been able
27:24
Speaker 2: to do that. The US would have been the first
27:26
Speaker 2: out of the gate, and that would have been a
27:28
Speaker 2: consequential strategy. And you can also do other things around
27:31
Speaker 2: ingredient regulation as well, and so prohibiting menthol would be
27:34
Speaker 2: a great example. That's the last flavor that was available.
27:38
Speaker 2: All other flavors were banned with that Tobacco Control Act
27:40
Speaker 2: in two thousand and nine except menthol, But that's you know,
27:43
Speaker 2: still being used, and it's particularly prominent among African American
27:47
Speaker 2: populations where you that was.
27:49
Speaker 1: Pressure that was applied to Biden, don't do it because
27:52
Speaker 1: of that.
27:52
Speaker 2: It was part of that.
27:53
Speaker 1: I mean, this is where you've seen bipartisan constituency sort
27:58
Speaker 1: of fears, right, fears of of alienating a specific constituency,
28:02
Speaker 1: whether it's the the manosphere right with the flavored stuff,
28:07
Speaker 1: African American community with menthol. I want to talk about
28:10
Speaker 1: the flavor issue here minute, because I know this is
28:13
Speaker 1: going to sound a little almost shallow, but the fact is,
28:19
Speaker 1: adults I have migrated more to right sugary or fruity
28:28
Speaker 1: standards when it comes to imbibing their caffeine, when it
28:31
Speaker 1: comes to imbibing their alcohol, imbibing the cannabis if you're
28:37
Speaker 1: you know, hemp derived drinks, all this stuff. So there's
28:40
Speaker 1: this whole movement among marketing to adults to market fruit
28:44
Speaker 1: flavors and to market all this. So is it make it?
28:49
Speaker 1: I mean, how if I'm just putting myself in the company, like, hey,
28:54
Speaker 1: there is adult demand for these flavors. Is there another
28:59
Speaker 1: way we can put some sort of safeguard here away
29:04
Speaker 1: from kids? Is there marketing stuff that I'll embrace as
29:08
Speaker 1: a company if you'll let me still market blueberry and
29:11
Speaker 1: mango because I have a customer base that really launts
29:15
Speaker 1: blueberry and mango, and hey, they're in their thirties.
29:19
Speaker 2: Yeah. Well, I think that's where effective regulation comes in place.
29:22
Speaker 2: And I think Congress got it right with the Tobacco
29:24
Speaker 2: Control Act where they basically required FDA to weigh the
29:27
Speaker 2: benefits and the risks of these products on the population
29:31
Speaker 2: of as a whole and making determinations throughout authorization. And
29:34
Speaker 2: that includes benefits of what are the products that will
29:37
Speaker 2: most help an adult smoker transition completely, but also the
29:40
Speaker 2: risks of initiation, particularly among kids, and so in doing that,
29:43
Speaker 2: you have to look at that big picture view. And
29:45
Speaker 2: so when it comes to flavors in the past, the
29:48
Speaker 2: agency said, well, you know, we'll authorize menthol because we
29:51
Speaker 2: know it's lower appeal among kids and that these applicants
29:55
Speaker 2: have shown the product actually helps adult smoker's transition completely
29:59
Speaker 2: because they don't all do do that, they're not all
30:01
Speaker 2: efficient at nicotine delivery. But on balance, they said, but
30:04
Speaker 2: we know that these particular flavors are most appealing among kids,
30:08
Speaker 2: and so we've got to keep those, you know, very
30:12
Speaker 2: stringently regulated and make sure we're not flooding the market
30:15
Speaker 2: with those products and authorizing them. And so you saw
30:18
Speaker 2: a shift. You know, the former FDA commissioner agreed with
30:22
Speaker 2: that purview in terms of, you know, make sure we're
30:24
Speaker 2: not introducing flavors they're going to be particularly problematic to kids.
30:28
Speaker 2: And now you've seen a reversal, and you've also seen
30:31
Speaker 2: i think jumping the gun on of existing science. We
30:36
Speaker 2: don't really know a lot about age gating technology yet,
30:39
Speaker 2: but you had an authorization based on a single application
30:41
Speaker 2: without really understanding you know, is this really a panacea,
30:45
Speaker 2: Is it really going to help prevent kids from using
30:47
Speaker 2: the products when you know, the reality is you have
30:49
Speaker 2: kids who can hack an iPhone and you know less
30:51
Speaker 2: than a minute. And so following the science and doing
30:54
Speaker 2: everything you can to optimize benefit for efficient nicotine delivery products,
30:58
Speaker 2: but not doing so in a way that you're opening
31:00
Speaker 2: the floodgates to increase youth risk.
31:02
Speaker 1: So let me tell you about Mike's hard lemonade. How's
31:06
Speaker 1: that not targeting youth kids?
31:09
Speaker 2: Well, you certainly have promotion across a variety of risk factors.
31:13
Speaker 2: And I'm not going to compare one public health risk
31:15
Speaker 2: factor to another.
31:16
Speaker 1: No, I understand that, But that is I mean to me,
31:18
Speaker 1: you know, oh lemon a right? Like it is like
31:24
Speaker 1: the same argument being made about these tobacco products and
31:27
Speaker 1: the flavors. Well, my goodness, the entire alcohol industry has
31:31
Speaker 1: gone to the fruit side of things.
31:34
Speaker 2: Yeah, and kids shouldn't be using those products either. We
31:36
Speaker 2: have agent sale requirements, we have laws, we have regulation,
31:40
Speaker 2: and when it comes, you know, to tobacco products, that
31:43
Speaker 2: regulation is clear and it's important that we obey the law.
31:46
Speaker 2: You know, we follow the science and we tell the truth.
31:48
Speaker 2: And that's been a central tenants for FDA for many years,
31:51
Speaker 2: and it's critical that that continue.
31:55
Speaker 1: I keep hearing the phrase age gating technology. It sounds fancy.
32:00
Speaker 2: Explain. So age getting technology is basically uh in device
32:09
Speaker 2: technology that would prevent an underage person from accessing the product.
32:13
Speaker 2: And so that can be done with biometrics, it can
32:15
Speaker 2: be done with you know, other entry of information such
32:19
Speaker 2: as you know, scanning of license and others.
32:22
Speaker 1: And to actually open the product, like every time I
32:25
Speaker 1: opened the zin canister I've done.
32:28
Speaker 2: This is for cigarettes. This is specifically cret okay, yeah,
32:31
Speaker 2: and so e cigarettes are you know, electronic products, and
32:34
Speaker 2: so in order to actually trigger the inhalation mechanism, you
32:38
Speaker 2: you know, need to input information or other biometrics that
32:43
Speaker 2: would allow it to function. You know. That's said, this
32:45
Speaker 2: is a relatively new thing, and this first authorization from
32:49
Speaker 2: FDA was based on, you know, a single application that
32:53
Speaker 2: provided evidence of among a small sample of individuals saying,
32:57
Speaker 2: you know, it worked. But there's not really any profound
33:00
Speaker 2: body of scientific literature demonstrating the effectiveness of this in
33:04
Speaker 2: the context of tobacco products. But you know, we do
33:07
Speaker 2: have literature in other areas that shows that it doesn't work.
33:09
Speaker 2: And so it's important that we really, you know, monitor
33:12
Speaker 2: the situation carefully, particularly ways that it could be adulterated,
33:17
Speaker 2: particularly by under age persons and negate the you know,
33:20
Speaker 2: intended purpose of preventing them from using it.
33:22
Speaker 1: What kind of research has been known about essentially pouch usage,
33:27
Speaker 1: z in usage in middle schools and high schools. Look,
33:33
Speaker 1: I mean, you know, you know, when I'm of the
33:36
Speaker 1: age where back then you just snuck outside to have
33:40
Speaker 1: a cigarette if you were you know, in high school,
33:43
Speaker 1: or maybe it was after lunch, but there was you know,
33:45
Speaker 1: we didn't you know, there was maybe a couple of
33:48
Speaker 1: kids that chewt tobacco or had Copenhagen or something like.
33:50
Speaker 2: That, but it wasn't this.
33:53
Speaker 1: So this is you know, this is obviously, you know,
33:56
Speaker 1: something I was concerned about when my kids were in
33:58
Speaker 1: middle school, with the vaping and all this stuff. What
34:01
Speaker 1: is you know, as Zin as a you know, that's
34:04
Speaker 1: a brand name. But is Zen and Zen like products
34:06
Speaker 1: have become more prominent, do we have good data on
34:11
Speaker 1: usage among those under eighteen?
34:14
Speaker 2: So nicotine pouches were added to federal surveys around two
34:18
Speaker 2: thousand and one. When they hit the market in the
34:21
Speaker 2: United States, there was obviously precursors of smokeless products. So
34:24
Speaker 2: we have data for about a half decade, and what
34:26
Speaker 2: we know from that is that use remains relatively low
34:29
Speaker 2: but is slightly upticking. It's actually the only tobacco product
34:32
Speaker 2: where we've seen an increase among our nations.
34:35
Speaker 1: Do we track alcohol usage among under eighteen as well,
34:37
Speaker 1: by the way.
34:38
Speaker 2: Yes, yes we do. It depends on the survey. For tobacco.
34:42
Speaker 2: We typically use the National Youth Tobacco Surveys, so they
34:45
Speaker 2: don't assess other things. But there are other surveys like
34:47
Speaker 2: CDC's a Youth Risk Behavioral Surveillance system that does. But
34:51
Speaker 2: when it comes to tobacco, nicotine pouches is about two percent.
34:55
Speaker 2: It's upticked over the past couple of years, but still
34:59
Speaker 2: relative low. But I will say, you know, it's important
35:02
Speaker 2: to continue to monitor because these cigarette use was relatively
35:05
Speaker 2: low on twenty eleven, and then you know, we saw
35:07
Speaker 2: a meteoric increases from twenty seventeen to twenty nineteen that led,
35:11
Speaker 2: you know, the government to call it an epidemic. Fortunately
35:14
Speaker 2: we've now decreased those levels, but you know, we don't
35:17
Speaker 2: want to be playing a game of public health whackahole
35:18
Speaker 2: where we've got some products going up, others going down
35:20
Speaker 2: among kids they shouldn't be using any tobacco product, and
35:23
Speaker 2: then include empty patches.
35:25
Speaker 1: What is the when you know we had this to
35:28
Speaker 1: that to year uptick? What why do you think it
35:30
Speaker 1: was so easy to stamp it out?
35:33
Speaker 2: Well, you know, I think we still don't know the
35:36
Speaker 2: full effect because the latest data points were before we
35:38
Speaker 2: had authorization of the products by the FDA, and also
35:42
Speaker 2: the recent authorization of a modified risk claim, which basically
35:46
Speaker 2: allows the company to promote that their product is lower
35:49
Speaker 2: risk compared to to a cigarette, And so we haven't
35:51
Speaker 2: fully experienced the full promotion of the products. But I
35:55
Speaker 2: think you've had a lot of social media engagement, particularly
35:59
Speaker 2: among young people. The products are easily concealable, they're available
36:02
Speaker 2: in kid friendly flavors, and so you're starting to see
36:05
Speaker 2: you know, slight interest and optics some of what we've
36:08
Speaker 2: seen for other products, and now more than ever. You know,
36:10
Speaker 2: we've got to make sure that doesn't increase and it
36:13
Speaker 2: reverts and continues, you know, downward, like we've seen for
36:16
Speaker 2: Ease cigarettes. But that said, I think we're kind of
36:18
Speaker 2: in a wait and see. We need to see the
36:20
Speaker 2: data for the next year. But right now the levels
36:25
Speaker 2: are certainly, you know, not meteorically high for nicotine pouches,
36:30
Speaker 2: but they're also not going down significantly, which is what
36:32
Speaker 2: we want to see when it comes to kids' usage.
36:36
Speaker 1: What do we know about what do we twenty six
36:39
Speaker 1: years and that you just said we started, you know,
36:42
Speaker 1: the basically the pouches, these nicotine pouches. You know, chewing
36:46
Speaker 1: tobacco can lead to gum disease.
36:48
Speaker 2: We know that.
36:49
Speaker 1: What do we know about the pouches and what kind
36:51
Speaker 1: of long term I mean, I guess we're I assume
36:54
Speaker 1: we're hitting our first generation of sixties and seventy year
36:57
Speaker 1: olds who've been maybe using pouches for the last fewener
37:00
Speaker 1: twenty years.
37:01
Speaker 2: Yeah, so the nicotine pouch is the current version, our
37:05
Speaker 2: relatively new invention. So that's the past half decade. The
37:08
Speaker 2: probably closest parallel would be Swedish snooze, which is snowze,
37:12
Speaker 2: so I remember that stuff, yeah, which doesn't involve spitting.
37:16
Speaker 2: So it's a little more a glamorous if you will,
37:20
Speaker 2: where you can just you know, remove it from the
37:22
Speaker 2: gum and.
37:23
Speaker 1: The leg and my and my traveling around the world
37:25
Speaker 1: days of covering, you know, having to be up twenty
37:28
Speaker 1: out of twenty four hours. I may or may not
37:30
Speaker 1: have been a snooze user back in the late oughts
37:33
Speaker 1: every now and then. And boy did that stuff wire
37:36
Speaker 1: you in ways. That was that was a little little intense.
37:39
Speaker 2: I'll just be honest. Well, and I think you know,
37:41
Speaker 2: we're seeing a lot of initiation, particularly nicotine pouches among
37:44
Speaker 2: young males. You know, you're seeing flatline among kids, you know,
37:47
Speaker 2: slight uptick, but it's been a two to threefold increase
37:50
Speaker 2: among young adults, particularly males.
37:53
Speaker 1: And what what are have we seen any health spikes
37:57
Speaker 1: or we don't know yet?
37:58
Speaker 2: Is it just so it's too soon to see what
38:00
Speaker 2: the health spikes are. But we do know that there's
38:02
Speaker 2: inherent risks of exposing, particularly for a nicotine naive person,
38:05
Speaker 2: and so you know, you're inoculating the body with a
38:07
Speaker 2: psychoactive substance. Is also highly addictive and can cause adverse
38:11
Speaker 2: effects to the cardiovascular system. And so if you're not
38:13
Speaker 2: already you know, smoking, you should not be starting a
38:16
Speaker 2: nicotine paust. But what we're seeing is a lot of
38:18
Speaker 2: new initiates, particularly young adults, and there's also I think
38:22
Speaker 2: a conflation of you know, understanding of the inherent benefits
38:27
Speaker 2: versus risks. You know, nicotine does have a very acute
38:30
Speaker 2: stimulant effect in terms of honed in attention, but you
38:34
Speaker 2: have to consider the long term effects of addiction and
38:37
Speaker 2: also other risks, and so you can't dismiss a potential
38:40
Speaker 2: acute benefit around attention for you know, the very profound,
38:44
Speaker 2: you know, long risks of exposure and addiction. And many
38:47
Speaker 2: people don't appreciate that, particularly folks that haven't used nicotine before.
38:56
Speaker 1: This episode of the Chuck Podcast is brought to you
38:58
Speaker 1: by Ethos and what Ethos does is it helps you
39:00
Speaker 1: find life insurance. Let me tell you why life insurance
39:03
Speaker 1: bailed me out. My father died when I was sixteen.
39:05
Speaker 1: We didn't have a lot of money when it happened,
39:07
Speaker 1: and we were in a pretty tough financial spot after
39:10
Speaker 1: it happened.
39:11
Speaker 2: I'm an only child.
39:13
Speaker 1: Suddenly my mother's single, single mother. She had a job,
39:16
Speaker 1: suddenly lost a job, looking for another job, and we
39:18
Speaker 1: were struggling. You know, my dad didn't leave us in
39:21
Speaker 1: the best financial situation, but he did make one purchase.
39:24
Speaker 1: He bought a life insurance policy. Wasn't a huge chunk
39:27
Speaker 1: of change, but it was enough when we found it.
39:30
Speaker 1: And when I say we found it, meaning we went
39:32
Speaker 1: through his desk and we found, oh, look at this,
39:33
Speaker 1: let's see if there's anything here. And it helped us
39:36
Speaker 1: out at a time that we really needed it. And
39:38
Speaker 1: that's why I think it's important that if you can,
39:42
Speaker 1: especially if you have young children, if you can get
39:45
Speaker 1: life insurance, you should get it. Life is full of
39:47
Speaker 1: unexpected emergencies, unexpected things happen. It is an extra bit
39:52
Speaker 1: of security, something you can leave and help out at
39:55
Speaker 1: a time when you're you're not there to help. So
39:58
Speaker 1: what does Ethos do well? Ethos makes getting life insurance
40:01
Speaker 1: fast and easy and it's one hundred percent online. You
40:04
Speaker 1: can get a quote in seconds, you can apply in minutes,
40:06
Speaker 1: and you can get same day coverage. They will find
40:08
Speaker 1: you the right fit. There's no medical exam. You just
40:11
Speaker 1: answer a few simple health questions online. You can get
40:13
Speaker 1: up to three million dollars in coverage and some policies
40:16
Speaker 1: are as low as thirty dollars a month, and you'll
40:18
Speaker 1: get your lowest rate from their network of trusted carriers.
40:22
Speaker 1: So take ten minutes to get covered today with Life
40:24
Speaker 1: insurance through Ethos Get your free quote at ethos dot
40:28
Speaker 1: com slash chuck that is, e t hos dot com
40:33
Speaker 1: slash chuck. Application times may vary and rates may vary.
40:43
Speaker 1: How much of this money was, how much of these
40:46
Speaker 1: ad campaigns were supposed to be financed by the big
40:48
Speaker 1: tobacco settlements and are they still? Is that still the
40:52
Speaker 1: money that's behind this in theory.
40:54
Speaker 2: So an answer is no short answer. And so for
40:57
Speaker 2: folks who may not be familiar. In nineteen ninety eight,
40:59
Speaker 2: there was the Master Settlement Agreement, which is what you're
41:01
Speaker 2: talking about, and that was agreement between forty six states
41:04
Speaker 2: attorney general and the tobacco industry which basically requires the
41:07
Speaker 2: tobacco industry, the big companies, to pay in perpetuity to
41:10
Speaker 2: states for the health care costs of smoke it, which
41:14
Speaker 2: you know are over two hundred and thirty billion dollars
41:18
Speaker 2: a year in this country, you know, monumental. That said,
41:21
Speaker 2: vast majority of states are simply not allocating those dollars
41:24
Speaker 2: for that purpose. They're filling in potholes because it's a
41:26
Speaker 2: guaranteed revenue stream. And so when you have guaranteed cash,
41:30
Speaker 2: states are working to divert that to other things instead
41:33
Speaker 2: of public health and certainly not tobacco control. So some
41:36
Speaker 2: states are.
41:37
Speaker 1: I was just going to say, this gets it too,
41:39
Speaker 1: and I'm going to i.
41:42
Speaker 2: It.
41:43
Speaker 1: You know, this is exactly what happened to the lottery. Hey,
41:46
Speaker 1: we're going to use this money for education. Great, we'll
41:48
Speaker 1: replace the money we used to use for education and
41:50
Speaker 1: need set money elsewhere. So these are all we're supposed
41:54
Speaker 1: to be additive financial benefits for the states to be
41:57
Speaker 1: able to do this, and instead entered to the tax cuts.
42:01
Speaker 2: Yeah. Yeah, And in many cases, you know, there are
42:03
Speaker 2: some states that have done well. Oklahoma is a great
42:05
Speaker 2: example of one that actually set up a foundation to
42:09
Speaker 2: allocate the dollars coming in through the MSA, and recently
42:13
Speaker 2: now their legislator is sue legislature is suing to try
42:15
Speaker 2: to make spat they lost by public referendum and now
42:19
Speaker 2: is working through other legislation to try to subvert that.
42:23
Speaker 2: But you know, ultimately, you know, the guaranteed revenue stream
42:26
Speaker 2: is a key opportunity. That's you know, if they're taking advantage.
42:30
Speaker 1: Of what does it say to did the tobacco industry
42:34
Speaker 1: ever really take a hit on this or not?
42:37
Speaker 2: Ultimately, I think there was some hit. I think, you know,
42:40
Speaker 2: it depends on who you ask. Some would argue that
42:42
Speaker 2: the settlement actually was favorable to the industry because if
42:45
Speaker 2: they would allowed individual plaintiffs, they yeah, they could have
42:51
Speaker 2: bankrupted industry because they were doing massive hundred million dollar payoffs,
42:55
Speaker 2: particularly the Angle progeny lawsuits out of Florida, and so
42:57
Speaker 2: if those were allowed to continue, I think industry could
43:00
Speaker 2: have you been potentially bankrupted. But you know, with the settlement,
43:04
Speaker 2: it's still a knock on their cash flow, but it
43:07
Speaker 2: certainly pales in comparison to what's coming in from product sales.
43:12
Speaker 1: So if you were brought back in, how would you
43:15
Speaker 1: you know, what would you restart?
43:17
Speaker 2: There?
43:18
Speaker 1: Is there some things that are unnecessary anymore in the
43:21
Speaker 1: tobacco free campaigns.
43:23
Speaker 2: Now, I think there's always opportunity to identify efficiencies, and
43:26
Speaker 2: I think that you know, coming into the current administration,
43:29
Speaker 2: that public health folks, including those of CDC and FDA,
43:31
Speaker 2: were open to that in terms of you know, identifying efficiencies,
43:36
Speaker 2: making sure that we're tight trading. You know, this is
43:39
Speaker 2: a field that's been around for over a half century.
43:41
Speaker 2: Other respectors are constantly looking to tobacco, like Wow, they
43:43
Speaker 2: did so great at reducing smoking. There's always opportunity for efficiency.
43:47
Speaker 2: But for me, the bottom line is you got to
43:48
Speaker 2: obey the law, you've got to follow the signs, and
43:50
Speaker 2: you've got to tell the truth. And we're starting to
43:52
Speaker 2: see that eroad on multiple fronts, and there's ways, and
43:56
Speaker 2: we've done it in the past across multiple administrations independent
44:00
Speaker 2: of the party, where you can still prioritize working on
44:03
Speaker 2: the leading cause of provencial disease and death without you know,
44:06
Speaker 2: undermining the credibility of both the science and the law.
44:10
Speaker 2: And I think that's where we really have to be
44:11
Speaker 2: cautious in the current environment, is not allowing the corporate
44:14
Speaker 2: capture to take over a meaningful, evidence based public health practice.
44:20
Speaker 1: I want to try to land this plane here. I
44:21
Speaker 1: want to go back to because you know, we're it's
44:25
Speaker 1: frustrating to see watch what's happened in the last fifteen months,
44:27
Speaker 1: but this has been a massive success story. Right when
44:32
Speaker 1: you say, if you actually step back over the last
44:34
Speaker 1: thirty years, right, you know, my mother was a packa
44:36
Speaker 1: day smoker. Back when I was a kid, I had
44:40
Speaker 1: plenty of relatives who were near packa day smokers. When
44:44
Speaker 1: you look at all the things that were done was
44:48
Speaker 1: banning indoor smoking in public places.
44:51
Speaker 2: The most effective, not the most effective, but certainly effective
44:55
Speaker 2: part of the toolkit. The single most effective intervention to
44:58
Speaker 2: reduce consumption of tobacco is increasing price. Taxation based on
45:03
Speaker 2: the science, most effective, but we also know from the
45:05
Speaker 2: science a comprehensive approach is key. So increasing price, smoke
45:09
Speaker 2: free policies, hard hitting mass media campaigns like CDC's tips campaign,
45:13
Speaker 2: cessation resources, and a well regulated marketplace. And that's not
45:17
Speaker 2: to say that you can't have lower risk alternatives on
45:20
Speaker 2: the market, but they have to be well regulated and
45:22
Speaker 2: they have to be part of a broader picture where
45:24
Speaker 2: you also have those policies that are making efforts to
45:27
Speaker 2: prevent initiation, to promote cessation, and to prevent relabs.
45:32
Speaker 1: Now I want to flip here a second, because look,
45:36
Speaker 1: most of this is about trying to prevent this, trying
45:40
Speaker 1: to prevent underage usage. And I think about we're worried
45:45
Speaker 1: about it with alcohol, We're worried about it with cannabis,
45:48
Speaker 1: or worried about it with tobacco. But this is you
45:52
Speaker 1: want to talk about an efficiency. I mean, it feels
45:54
Speaker 1: like there should be one office worried about childhood addictions
45:59
Speaker 1: and should be makeing sure, Hey, let's you know what
46:02
Speaker 1: is if you were to reorganize, should we be should
46:06
Speaker 1: that be the north star? And like all of this
46:07
Speaker 1: fall under one thing, because it I feel like now
46:09
Speaker 1: we're kind of siloed on the federal level. Right alcohol
46:12
Speaker 1: does it in one place, and tobacco's over here, and
46:14
Speaker 1: right now cannabis is just the states that have legalized,
46:17
Speaker 1: and the beds are kind of just now dabbling into it.
46:20
Speaker 1: How much should they you know, you know, rescheduling it
46:25
Speaker 1: and the issue with hamp and all of that stuff.
46:27
Speaker 1: So it feels like, actually, we have a really bad
46:29
Speaker 1: patchwork right now on the federal level. When if you're
46:32
Speaker 1: if the if the if the goal is to you know,
46:37
Speaker 1: keep our kids as healthy as possible before they turn eighteen, right,
46:40
Speaker 1: whether it's you know, limiting access to you know and
46:43
Speaker 1: marketing on tobacco, on cannabis, on alcohol, it feels like
46:49
Speaker 1: we don't have the right structure for that.
46:53
Speaker 2: Well. I think that there's definitely opportunities for streamlining and efficiency,
46:57
Speaker 2: but I also think it's important to consider all the
46:59
Speaker 2: things that have to cur and so when it comes
47:01
Speaker 2: to the federal government. We've always had what I call
47:02
Speaker 2: the trifecta, And so CDC focuses on the people, FDA
47:06
Speaker 2: focuses on the products, and NIH focuses on the science.
47:09
Speaker 2: And all three of those in the context of tobacco
47:12
Speaker 2: have a specific role. So the Office on Smoking Health
47:15
Speaker 2: was doing boots on the ground policy and health comes,
47:17
Speaker 2: FDA is manufacturing, is regulating manufacturing, marketing and sale. And
47:22
Speaker 2: then NIH is funding that extra real research to continue
47:24
Speaker 2: to move the lever forward on those CDC policies, and
47:28
Speaker 2: you know the FDA regulation and so you know, I
47:30
Speaker 2: think there's opportunity for identifying efficiencies, but you also can
47:33
Speaker 2: negate all of the things that are needed to effectively
47:36
Speaker 2: implement public health practice.
47:38
Speaker 1: No, I understand that alcohol is not in the FDA, right,
47:41
Speaker 1: isn't that is that bureau?
47:42
Speaker 2: Is that atf Yes, yes, alcohols, and but CDC had,
47:46
Speaker 2: you know, an alcohol program. So is that a mistake
47:49
Speaker 2: that alcohol?
47:50
Speaker 1: Because I think about what's coming here, right, You've got
47:54
Speaker 1: the the sort of adult beverage industry. You have alcohol
47:58
Speaker 1: being regulated one way, what about these non alcoholic but
48:03
Speaker 1: cannabis based drinks?
48:04
Speaker 2: Like I just think about all of this and.
48:06
Speaker 1: It just feels like we you know, the bureaucracy is
48:09
Speaker 1: it's almost too siloed.
48:11
Speaker 2: Yeah, yeah, no, I absolutely agree. And I think you know,
48:14
Speaker 2: a lot of that is just the function of how
48:15
Speaker 2: you get regulation in this country, and that's through you know,
48:18
Speaker 2: Biden purposing congressional action. And so you know, the FDA
48:22
Speaker 2: tried to regulate tobacco years ago, you know, before congressional authority,
48:25
Speaker 2: and they lost in the Supreme Court you know, sided
48:28
Speaker 2: against the agency, and so they said, yeah, you got
48:30
Speaker 2: to go back to Congress. And when you do that,
48:32
Speaker 2: there's specific parameters that occur, and you also have to
48:35
Speaker 2: remember the very ability and how the products are regulated.
48:37
Speaker 2: And so that's why, like you know, drugs have a
48:39
Speaker 2: safe and effective standard. You know, tobacco can't have a
48:42
Speaker 2: safe and effectives. There's no safe tobacco products. So they
48:44
Speaker 2: got you know, appropriate for protection of public health where
48:47
Speaker 2: you weigh risk benefits. But ultimately it's it's risk factor
48:50
Speaker 2: specific when it comes to regulation, but not in public
48:53
Speaker 2: health practice. And that's why you know CDC you can
48:55
Speaker 2: see that bigger picture umbrella. So you know, alcohol, you know, tobacco,
49:00
Speaker 2: chronic disease work is all under a single umbrella. But
49:02
Speaker 2: when it comes to regulation, that's a different beast and
49:06
Speaker 2: it's largely dependent on congressional authority. Politically.
49:10
Speaker 1: Is the MAHA movement an ally here or an adversary?
49:15
Speaker 2: It's kind of ironic because MAHA hasn't really done anything
49:18
Speaker 2: prominent on tobacco, and it's you know, the irony is
49:22
Speaker 2: palpable because they're anti corporate capture and they're pro preventing
49:26
Speaker 2: chronic disease. And this issue is we're seeing the complete
49:29
Speaker 2: opposite where you've seen complete corporate capture. And I've said
49:32
Speaker 2: in the past, you know, attempting to combat chronic disease
49:36
Speaker 2: without tobacco control is like attempting a triathlon without a bicycle.
49:39
Speaker 2: You are destined for failure before leaving the starting line
49:42
Speaker 2: because you don't even have the equipment. Yes, exactly, you
49:45
Speaker 2: have to involve tobacco in chronic disease prevention. And so
49:48
Speaker 2: I think MAHA has really dropped the ball, and the
49:50
Speaker 2: irony is palpable that they're not addressing the leading cause
49:53
Speaker 2: of preventable disease and death in this country.
49:55
Speaker 1: So ultimately, somebody's going to listen to this interview and saying, well,
50:00
Speaker 1: we need campaign.
50:01
Speaker 2: Financial re form.
50:02
Speaker 1: That's ultimately what happened here is that is that at
50:05
Speaker 1: its core, you can't just look away from the money
50:08
Speaker 1: aspect of this.
50:09
Speaker 2: I think it's multifaceted. You know, you're always going to
50:12
Speaker 2: have a corporate interests, but you need the systems in
50:16
Speaker 2: place in the government to effectively address the issue. And
50:18
Speaker 2: so I think, you know, first and foremost, elimination of
50:21
Speaker 2: CDC's Office on Smoking Health is highly problematic. Congress has
50:24
Speaker 2: allocated the dollars, but the administration.
50:26
Speaker 1: Which is going to say is that it's not legal
50:29
Speaker 1: what they did, because Congress is the one that created
50:32
Speaker 1: the entity.
50:34
Speaker 2: Correct, Yeah, Congress has allocated the dolls for tobacco and
50:36
Speaker 2: right now the administration is not spending it, you know,
50:39
Speaker 2: on the FDA's front. Congress has also reinstated the user fees,
50:43
Speaker 2: as they've continued to done since the establishment of the center.
50:47
Speaker 2: So you know, there's no problem with that cash and
50:49
Speaker 2: the kitty, it's just the administration prioritizing the work, and
50:53
Speaker 2: particularly with CDC, they remain eliminated now a year and
50:56
Speaker 2: a half into the administration, and.
50:58
Speaker 1: Yet what we don't knows what that money has now
51:01
Speaker 1: gone to. It's gone to other stuff.
51:03
Speaker 2: Basically, it's basically not being spent. Some of the money
51:06
Speaker 2: has been dislodged to the state programs, but it's at
51:09
Speaker 2: a trickle and in some cases they've given the states,
51:12
Speaker 2: you know, five months to spend twelve months worth of data,
51:14
Speaker 2: and so it's basically like setting people up for failure.
51:17
Speaker 2: But you know, the key components, like the tips campaign
51:19
Speaker 2: is completely off the air, and you're losing a lot
51:22
Speaker 2: of that technical expertise, particularly at the state level, on
51:26
Speaker 2: you know, key CDC activities.
51:28
Speaker 1: Is there better litigation that should be pursued here that
51:33
Speaker 1: would sort of force an unlocking of this.
51:37
Speaker 2: I think that right now the staff are protected by
51:40
Speaker 2: the state's attorney general. I think the staff far But
51:42
Speaker 2: what about the yeah, yeah, I mean the programs. You know,
51:45
Speaker 2: that's I think it's to be seen. You know, maybe
51:47
Speaker 2: with a new CDC director in place, you know, this week,
51:50
Speaker 2: Well we'll hear on if that potentially occurs. We may
51:53
Speaker 2: see some dislodging. But you know, ultimately I think it's
51:57
Speaker 2: it's it's going to depend on the next couple months
52:01
Speaker 2: and whether they turn things around like they've done at FDA.
52:03
Speaker 2: You know, they did reinstate staff in the tobacco program.
52:07
Speaker 2: But in the meantime there's also litigation that's occurring. My
52:10
Speaker 2: organization and other public health organizations recently sued the FDA
52:14
Speaker 2: for their enforcement guidance that we discussed earlier, and so,
52:17
Speaker 2: you know, I think there are actions to make sure
52:19
Speaker 2: that we are obeying the law and following the science,
52:21
Speaker 2: and there's entities willing to do that.
52:24
Speaker 1: And I will fully understand if you decide you don't
52:26
Speaker 1: want to weigh in on this. But I just spent
52:29
Speaker 1: a good ten minutes in my previous episode about the
52:32
Speaker 1: measles epidemic and the fact that we're in and it's
52:35
Speaker 1: just it does feel as if we've just gutted public
52:39
Speaker 1: health in the last eighteen months. And the question I
52:42
Speaker 1: have is how hard is this going to be to rebuild?
52:45
Speaker 2: Yeah, we're in a public health apocalypse when it comes
52:48
Speaker 2: to infrastructure. As a public health practitioner of nearly twenty
52:51
Speaker 2: five years, I've never seen the level of decimation and
52:54
Speaker 2: flagrant disregard for not only science but also evidence based
52:57
Speaker 2: public health practice. My guest is will take decades to repair.
53:02
Speaker 2: And it's not just getting programs back, but getting repairing
53:07
Speaker 2: the misinformation, the trust view of public health to trust
53:12
Speaker 2: and the next cohort of the public health workforce, you know,
53:15
Speaker 2: following on a pandemic and then all of the misinformation
53:18
Speaker 2: and distrust of public health officials. You know, I really
53:22
Speaker 2: worry about the long term ability to recruit people to
53:24
Speaker 2: this field given the level of vitriol and animosity that
53:28
Speaker 2: they faced. Oh.
53:29
Speaker 1: You know, if you're in any there's a couple of entities.
53:32
Speaker 1: Whether it's in the science arena that government provides the
53:36
Speaker 1: resources for that scientific community, you know, whether it's research
53:41
Speaker 1: on the oceans and the climate with Noah, or it
53:44
Speaker 1: is public health. And if you've got a government that
53:48
Speaker 1: essentially is gutting that that is you know, as somebody
53:54
Speaker 1: who has a daughter with an oceanography degree and a
53:58
Speaker 1: much limited now environment of employable places in the public sector.
54:02
Speaker 1: There's some private sector opportunities, but it's it's minimal compared
54:06
Speaker 1: to what used to be available in the public sector.
54:08
Speaker 1: But this is going to be a loss of a
54:11
Speaker 1: you know, in hindsight, you know, my daughter ten years
54:15
Speaker 1: you know, ten years from now, or somebody that's ten
54:18
Speaker 1: years younger than her that wants to pursue that is
54:20
Speaker 1: now going to say, may I'm want to pursue something else.
54:23
Speaker 2: Yeah, yeah, absolutely, And I will say that we've lost
54:25
Speaker 2: a lot of great institutional knowledge and expertise. In my
54:28
Speaker 2: you know, two decades plus working this, I've worked in academia, advocacy,
54:32
Speaker 2: and government, and I'll say that the civil servants were
54:35
Speaker 2: second to none, and that level of expertise and passion
54:39
Speaker 2: of people willing to do this work not for a paycheck,
54:41
Speaker 2: not for the glory, but because they want to help people.
54:46
Speaker 2: That that view, that drive is something that's simply not
54:49
Speaker 2: replaceable and not available in the public sector, in the
54:52
Speaker 2: private sector, and so I do think, you know, the
54:54
Speaker 2: loss of that is certainly certainly going to have a detriment,
54:58
Speaker 2: and it's going to take us years to rebuild that.
55:00
Speaker 2: I'm still hopeful it's going to happen. But the sooner
55:02
Speaker 2: we can, you know, get the ship upright and sailing
55:06
Speaker 2: into better waters, the better. When it comes to public
55:09
Speaker 2: and I.
55:10
Speaker 1: Assume that if we're collapsing on public health, the rest
55:14
Speaker 1: of the world is not in a better place. No,
55:18
Speaker 1: it certainly has a trickle down effect. Absolutely well, Brian,
55:23
Speaker 1: this is it is in some ways, this story is
55:28
Speaker 1: not surprising, right, it's it's influence, it's a it's as
55:32
Speaker 1: old as sort of Washington itself.
55:33
Speaker 2: But it's.
55:36
Speaker 1: It's hard to get traction, isn't it. It's hard to
55:38
Speaker 1: get people fired up about this. And I guess part
55:40
Speaker 1: of it is, look what we just described. You know,
55:43
Speaker 1: we have a public you call it apocalypse. Forget emergency anymore, right,
55:46
Speaker 1: it's public health apocalypse. And it's like, it's understandable. Where
55:50
Speaker 1: do you begin? You know, what what should be the
55:53
Speaker 1: siren song?
55:53
Speaker 2: Is it?
55:53
Speaker 1: What's happening with our vaccinations? Is what's happening with the FDA?
55:58
Speaker 2: Right? It is just it feels almost overwhelming. Yeah, no,
56:02
Speaker 2: it absolutely is. And I think what we've got going
56:04
Speaker 2: in our favor, though, is there's dedicated people that are
56:07
Speaker 2: working to preserve the integrity of the public health infrastructure.
56:11
Speaker 2: And it may vary by risk factor, but you're seeing
56:13
Speaker 2: coordination on the tobacco front. We certainly see that with
56:16
Speaker 2: public health groups. But ultimately, you know, folks have to
56:20
Speaker 2: make sure that they're you know, leveraging assets and expertise
56:24
Speaker 2: to make sure we're protecting public health because the casualties
56:27
Speaker 2: of this are the American people, and if they haven't
56:29
Speaker 2: felt it already. It's only a matter of time before
56:31
Speaker 2: we're going to see it trickle down from Pennsylvania Avenue
56:33
Speaker 2: to main streets across this country in terms of impact
56:36
Speaker 2: of reduced funding from CDC and other activities.
56:40
Speaker 1: And this is the classic example of we're really not
56:42
Speaker 1: going to realize the impact probably for a decade. Right,
56:46
Speaker 1: it'll be suddenly like everything right, oh boy, that was
56:49
Speaker 1: a mistake, And it's like, yeah, that was a mistake.
56:51
Speaker 2: Yeah, there'll be a case study. But are our kids
56:53
Speaker 2: and grandchildren of what not to do? And I think
56:57
Speaker 2: that we're just kind of on the precipice because things
56:59
Speaker 2: have kind of been holding on. But we're starting to
57:01
Speaker 2: see that deterioration of infrastructure. And you know, if you
57:04
Speaker 2: get a communical disease outbreak, we're already seeing that. But
57:08
Speaker 2: even on the chronic disease realm, we've got thirty million
57:10
Speaker 2: Americans still smoking cigarettes in this country. You know, we
57:13
Speaker 2: can't pull the foot off the accelerator. Now. The time
57:15
Speaker 2: is to pound it and focus on the progress and
57:17
Speaker 2: see more as opposed to pulling back.
57:20
Speaker 1: My fear is that tear down at the infrastructure to
57:22
Speaker 1: some is a feature, not a bug. Absolutely, Ran, appreciate
57:27
Speaker 1: your efforts. Where can people go help? Where can people
57:29
Speaker 1: get involved?
57:30
Speaker 2: Yeah? I then go to our website Tobacco Free Kids DOTRG.
57:33
Speaker 2: We actually just redid a lot of great resources and
57:36
Speaker 2: it's happening at the federal, local, state level, but also
57:38
Speaker 2: the global level in terms of tobacco related advocacy work.
57:44
Speaker 1: Is it the UK that just got rid of right?
57:46
Speaker 1: Is it starting win? You can't buy cigarettes in the UK.
57:48
Speaker 2: Yes, Yeah, they just implemented a generational tobacco product policy.
57:51
Speaker 2: It's not all products, but yeah, you're seeing a lot
57:53
Speaker 2: of good momentum internationally on a lot of areas, but
57:57
Speaker 2: not so much at the national level on tobacco of control.
58:01
Speaker 2: We'll see these days.
58:02
Speaker 1: Well, appreciate the time. Uh and you know, keep fighting
58:06
Speaker 1: the good fight.
58:07
Speaker 2: I appreciate it. Mm hmmm mm hmm