Nicotine pouches: solution or smokescreen?

Give something clever this Christmas, treat a loved one to a year of the spectator, in print and online for just £99, and we'll send you a bottle of our very own English sparkling wine with £48, absolutely free. Have a bright and sparkling Christmas with the spectator. Go to spectator.co.uk/christmas Welcome to a special edition podcast from the spectator. My name is Laura Brown. And I'm the spectator commissioning editor. Philip Morris International is one of the world's most interesting and controversial companies that the firm behind Marble's cigarettes, probably their best known brand. In the 21st century, the company has diversified and smoked free products. These include electronic cigarettes, heated tobacco products, and also nicotine pouches like their brands in, with the topic we're going to discuss now. What is motivating PMI? And to what extent is this driven from genuine concern, rather than just future-proofing? Dr Moira Gilchrist, Chief Communications Officer for PMI, joins me now along with MEP Charlie Vimers, who is vice-chair of the European Conservatives and Reformist Group. Now, we should say from the offset that Philip Morris has sponsored this podcast. In return, we can ask any questions we want. So starting with that, Moira, I'm quite interested. Why did you want to sponsor this podcast? Would it be fair to say you're looking to promote Zen or your own product? No, this is absolutely nothing to do with product promotion. I think what this is to do with is misinformation and making sure that we are straightening out the facts about these products, which I believe have an enormous potential to help smokers move away from cigarettes, the most dangerous way that you could possibly consume nicotine. So we see a lot of misinformation floating around, reaching the ears of policymakers, and ultimately potentially ending up with regulation that's not going to help the problems of smoking may actually have the potential of being kind to productive. So that's why I'm here and that's why I'm sponsoring this podcast. I think I find PMI's commitment to a smoke-free future very interesting, because obviously you've done great work, you own Zen, but you also own Marbra, who if I correct me if I wrong, but is still the world's most popular cigarette and you still sell enormous quantities around the world, how does that balance work and why are you so committed to a smoke-free future, despite having tobacco-based products? So I think this is part of a long-term transformation that we've been going through for the last more than a decade, actually, and we created these products, smoke-free alternatives. As we're calling them in the laboratory, we did all sorts of scientific research on them, and then we launched them on the market first in Japan with our heated tobacco product, and then in Milan, and then now in many, many countries around the world. And we went through a decision-making process a few years into that when we realized that consumers were switching to them, so smokers were switching to them. So what do we do with our combustible business was the big question. Now, if you want to actually end smoking, if you want to replace cigarettes with better alternatives, it actually we decided made more sense for us to hold on to our combustible cigarette business, because then we're in control of moving resources from cigarettes to smoke-free alternatives, we're in the position to be able to cannibalize our own product, rather than, for example, selling off the combustible business and putting it in the hands of a competitor, because then we would be competing with somebody who is incentivized to sell more cigarettes, not pure, and what we have actually done is incentivize ourselves to transform our portfolio and sell fewer cigarettes and more smoke-free alternatives, which are ultimately more profitable for us than cigarettes. So that's a rationale for us still, having a portfolio of cigarettes available, but over time, we want to basically reduce that to almost nothing. And we have a goal that by 2030, we will be two-thirds of our net revenues will be coming from smoke-free alternatives and not cigarettes. Do you imagine there's a point in the future we'll cease to sell cigarettes? I think that will come. At some point, I think it will come for all tobacco companies in the future, because we see that smoke-free alternatives are successful in moving people away from cigarettes, and I think that's the long-term future for the entire industry. Then we'll quite mention both your views on pouches as a smoke-free choice. I don't know exactly how many people use pouches currently, but understanding is that vaping is currently the most popular smoke-free choice. What are the benefits of pouches and why is your focus been in the brands in? So we purchased Swedish March, which is the company that invented and created in a couple of years ago, because of the success that we saw, particularly in the United States, that this category was having, and I'll let Charlie speak to the success in Sweden. But we saw as in as a having a real potential to switch smokers away from cigarettes and a real complement to the products that we owe to smoke-free products that we already had in our portfolio. So we started out with heated tobacco, we have also vaping products, but we didn't have at that time a particularly large oral nicotine pouch offering. So we purchased Swedish March in order to make sure that we had a range of offerings that we could bring to adults who smoke all around the world. And Charlie, could you talk a bit about the impact that pouches have had in Sweden? Sweden have embraced pouches while some other countries have approached them with real hostility. So how do you think you've seen pouches change smokers' behaviour in Sweden? Well, it didn't start with pouches in Sweden. It started with the product called snooze, which has a centuries-long tradition long before public health agencies caught up. So already in the 1970s researcher noticed lower smoking rates among snooze users. And over time, people saw the benefits firsthand, friends and relatives who quit cigarettes using snooze instead. nicotine pouches. They were introduced more recently. They gained traction with young adults and women. Public opinion in Sweden, I would say, shifted through transparency. And in many cases, personal experience, it was not slogans or bands that made a difference. I hear in the debate that many legislators are fearing that this snooze or nicotine pouches would act as a gateway, but we've seen quite the opposite. They have acted as a gateway out of smoking. And we have so many studies to back it up from Sweden that people who start with any of these products, they are much less likely to start smoking and far more likely to quit if they already smoke. Well, Sweden is the only EU country where the rise of an alternative nicotine product has coincided with a sharp, sustained decline in smoking, not the other way around. I'm quite interested in the profile of the average pouch user. Would you say that most people who are using the products are former smokers or smoking alongside pouch using and trying to quit? Or do you think that some young people use pouches as a lifestyle product having never smoked without intention to? I think it's a combination. Let's be realistic. But what people don't really take into account is that what would happen if those products did not exist. What we see in any society is that there is always a certain amount of the certain part of the population that wants to use nicotine for recreational purposes. And then we have as legislators, we do not have the option to legislate a perfect utopian society. We have to rely on the information at hand and to offer the least harmful alternatives. And well, yes, then a few young people will choose to use nicotine pouches, but I do know that there is a way to legislate against marketing towards young people. And that's the path that we should choose rather than full-blown bands, I would say. If I may add to that, I think that's something that we absolutely support. I think it's crystal clear there has to be regulation that prevents youth from accessing and being marketed to for any nicotine-containing product. And I include obviously pouches, nicotine pouches in there. But at the same time, there has to be an opportunity for adults who smoke or use other nicotine products to learn about these products and understand the difference with cigarettes. And I think we live in a world where it would be ridiculous to think that nobody is ever going to take up these types of products. I think that's Charlie said, just something that does happen. Adults choose to use these products. And I think it's we're duty-bounding to give them information that help them make better choices. Obviously, it's in the UK where the governments were in tobacco and more in nicotine have become quite merged. We have the tobacco and vape spill, which is going to ban advertising of all nicotine products, which would include sand and all pouches. That wouldn't be just for children, it would be for everybody. What are your thoughts on that legislation? Do you think it's helpful or harmful? Harmful. I mean, I can just use my personal experience. My mother started smoking in the 60s, just like my aunt did who was at the same age. And my mother quit smoking 10, 15 years ago and went over to to nicotine pouches and snooze. And she has had no health effect from, I mean, 40 plus years of smoking, but my aunt never quit smoking. And sadly, she passed away a few years ago from tobacco-related diseases. So this is a life and death decision facing politicians in the UK, in the rest of Europe. And in the EU, we know that if people switched to less harmful products, we could save around 350,000 lives in the UK if only half of the smokers would switch. We're talking about 36,000 premature deaths every year being prevented. So the evidence is quite clear. Harm reduction saves lives. And I don't know why it's so hard for lawmakers to get that memo. I think I would add to that, I think, legislation doesn't allow the marketing or advertising in any way, shape or form of alternatives to the most harmful form of using nicotine, which is cigarettes are bound to be counterproductive, because how can you ever encourage Sunday to make a better choice? And there are millions of people in the UK who today are smoking. And I think it was particularly striking to see the latest Office of National Statistics and Data, which showed that smoking rates among the, for example, 25 to 34 age group are actually in the highest of all the age cohorts. So what about those people? So I'm interested in your thoughts on what is happening here in the UK, but more broadly across Europe. Governments have, I imagine, you both think rightfully launched a war on tobacco, but nicotine has been caught up in this crusade. Why do you think this has happened? Why do the policymakers have an understanding of, you know, the relative harms of tobacco compared to these alternatives? Well, I think it's a widespread ignorance that is being exploited by those who are Puritans. This is a battle between Puritans and pragmatists. And the Puritans will use the lack of knowledge among European lawmakers to try to equate smoking with nicotine, despite nicotine pouches being 95 to 99 percent less harmful. So if I look around here in Brussels, many MEPs would say yes, cigarettes are as dangerous or pouches are as dangerous as cigarettes. And that is an ignorance that kills. And that is why the European Commission has felt that they can launch new taxes, a shocking proposal by the European Commission with a 143 euros per kilo minimum tax, which is seven times Sweden's rate. So they just want to punish a product that the thing should not be on the market. Why not be be honest about it and go forward with a full ban against anything? And well, maybe include alcohol there as well, because that's the kind of mentality that you have. More, can I ask to pay my support, the generational smoking ban that is currently planned in the UK? So I'm not a lawmaker. So I'm not going to comment about any specifics on on the law. What I do think, no, I'm a scientist by by training. And what I do think is that legislation should be based on science. And I think to Charlie's point was a huge amount of misunderstanding about smoke-free alternatives and nicotine itself. That means that lawmakers are being confused or have been confused. And quite often what I think has happened is that the impact and effects of smoking have been conflated with nicotine. So people in people's minds, they think that all of the diseases that smoking causes are actually caused by nicotine. But that's not true. There was a recent study, fairly recent study done in the US where they asked doctors whether nicotine causes cancer. And 80% of them said yes. That's not correct. So there are no nicotine is not designated as a carcinogen by the World Health Organization, by the US Food and Drug Administration, by IR, the Cancer Agency. And Charlie, I'm quite interested in the lawmaker's policymaker's approach to this. Sweden has taken a very pragmatic approach to nicotine solutions. And as you've said, that has seen a rise in use of things like snows and patches and a fall in smoking. But presumably within the same evidence base, France taken the opposite approach and decided to ban patches altogether and ban Zinn. Why do you think that has happened? And what has led policy makers in France to take such trashy different approaches? While Sweden will become the first country in the world, designated as smoke free by the United Nations, France has a smoking rate of around 18%. While at the same time trying to fight smoking, they're banning nicotine pouches. And they are citing fears about youth uptake and unknown long-term risks, which is not science. It's a sort of moral panic. Sweden on the other side, we embraced harm reduction. And now we're under 5% smoking rate, the lowest in Europe. So the big difference here is whether you focus on outcomes rather than ideology. I mean, we, someone said at some point, well, people are tired of experts. I think, you know, who? Well, I think here we need to listen to the experts. If the rest of Europe followed Sweden's model, we could save up to 350,000 lives every year. If I could just add from my perspective of the UK, I think the UK a bit like Sweden was also one of the leading lights of harm reduction. And what worries me about the path that seems to be taken now is that all that progress is going to be lost. So I think, you know, smoking rates are plummeted in the UK because of obviously strict regulations on cigarettes, but also the support of the public health community around vaping and, and e-cigarettes. But I think what we see in the recent data is that the decline in smoking rates has actually stalled. So to me, looking at this from a scientific perspective, that means that probably more alternatives to cigarettes are required, not fewer. Let me just talk about, I would say, a lack of evidence-led policymaking and a number of European countries. More of your e-cigarettes scientists by background, can you talk us through the current evidence base and what it tells us about nicotine alternatives, particularly pouches? So I think the main scientific finding we had actually came many, many years ago, and that was the conclusion from not ours, from the general scientific community, that the problem with smoking comes down to combustion. It's the combustion of tobacco that causes the production of the vast majority of the harmful chemicals that end up causing smoking related diseases. So that sort of realization helped us and others really focus on solutions that eliminate burning that can then provide adults who choose to use it with nicotine, but without the vast majority of those harmful chemicals. So the scientific consensus, I would say, is all around combustion. So eliminate combustion and you have a whole different scientific picture from products such as vaping, heated back or pouches. So the question is how can we get that message across to the people who really need to hear it, which is adults who are currently lighting up cigarettes every single day. They need to learn about these products and they need to understand the difference between them and cigarettes. And is there any difference in the safety of vaping, heated versus heated tobacco versus pouches, or because they've all eliminated that combustion, are they all equally safe? So the way I like to think about it is when you have the vast majority of the the market, the country, people who are using nicotine, if they're using cigarettes, any of the alternatives are much better than the product they're using today. And I think it's too early to be focused on what is likely to be very small differences between all those different categories. But I would say that the evidence and also the the basic technical facts behind the products probably indicate that nicotine pouches are on the very, very low side of all of those less harmful alternatives. They're probably on the on the very edge of the lowest side. So I think very promising from the perspective of how they could reduce risks for people who switched to them and ultimately have an impact on public health as has been seen in Sweden with the this loose products. And time to Sweden, I think Charlie what I'm learning here is as a big public awareness problem about the relative safety of nicotine products over cigarettes. How did public opinion in Sweden evolve to really sort of embrace the value of the pouches of the harm reduction tool, would you say? And what could the rest of the world learn from that? Well, there was a significant shift in the 90s, I would say, where pouches were introduced for the first time. It really made these products much more attractive to a larger part of the population. But something important also happened because historically Sweden embraced the same kind of Puritan approach that you see in France, for instance. So without scientific evidence, there were warnings of cancer on these counts. But what happened in the 90s was that this myth, because it was a myth, was debunked by research. So the strongest warning that you will find on Swedish cans. And I will quote now this tobacco product harms the health and is addictive. The Swedish authorities health public health authorities would love to publish to print something much stronger than that, because there are quite a few Puritans there. They can't because there is no science scientific proof backing any stronger claim. Oh, what do we know about that? I know they're very limited, but what do you know about the harms that nicotine can pose to health? Okay, so this is again, not our science. This is comes from, you know, literature reviews and understanding what the outside scientific community knows about nicotine. So I think it's very clear that youth should not use it because it's addictive and it's not risk-free and therefore not suitable for people who are underage. And I think that's an important law that has to be enacted to make sure that youth are not able to access the products. The second group of people who should not use nicotine in general is pregnant women. So there's evidence that nicotine causes transients or temporary constriction of the blood vessels, which can cause the blood pressure to rise and the heart rate to increase. And if you're pregnant, your heart is already under an awful lot of strain, so it doesn't make sense to add something that might increase that strain, that strain on the heart. Also, there's some evidence that it could impact the growing fetus. So pregnant women should not use nicotine either. And then the last group of people where it's not advisable for them to use nicotine is people with serious pre-existing heart disease. So again, this impact that nicotine has on the blood vessels can precipitate or make more likely that a stroke or a heart attack can happen, but nicotine itself is not causing that cardiovascular or heart disease, but adding it on top of something that may be caused by genetics or other lifestyle factors doesn't make sense in terms of adding a risk. So those are the main groups of people who should not be using nicotine according to the available science that is out there. The rest of the adult population, the normal sort of adult population using nicotine in much less harmful forms than cigarettes does not pose a very significant health risk in the way that smoking does and smoking it's all the other chemicals that are delivered in the smoke, along with the nicotine that causes the problem. And from your knowledge of the industry, what would you say makes an effective smoke-free nicotine alternative, particularly for helping smokers quit? What are the gold standards you look for in a good product? I think the gold standard is any product that does not combust tobacco that helps an individual move away from cigarettes completely, and that could be one product, or it could be a combination of different products. We see that happening now, so people maybe using vapes at certain points in the day and nicotine patches of another point in the day, and if that combination helps people to move away from cigarettes, that's great. I think one of the underrated incentives for people to swap from smoking to other nicotine products that I've seen from my peers is the cost element, a pack of pouches, I think last longer than a pack of cigarettes, and it's about half of the price at the moment. Across a lot of Europe, we're seeing very heavy taxes imposed on things like pouches and vapes that will slowly start to possibly close that gap. What are your views on that sort of policy making? So again, I think what makes sense from a policy perspective is policy that distinguishes the most harmful form of nicotine from less harmful. So taxation is one way of distinguishing between the two. So if you have products that are less expensive than cigarettes, it's more likely that people will choose them than cigarettes. There's a careful balance that needs to be done. You don't want the products to be too cheap such that they're attractive to the unintended audiences and particularly youth. But I think tax debt differentials are one key way of showing adults is more that these products are different. The same is true of packaging and making sure that there's a differential between cigarettes and smoke free alternatives in terms of the warnings, which Charling talked about, plain packaging, etc. If you have everything dressed up in the same way as a cigarette is, how can a consumer know that it's different? So I think thinking about policy from that differentiation perspective will help them school much faster. So it's not that we're asking for no regulation on smoke free alternatives. There has to be regulation. But allow that, make sure that regulation allows consumers to tell the difference between the types of products. And Charling, could you talk about the taxation approach that's been taken towards pouches in Sweden by the government? Yes, the government has taken a harm reduction approach towards nicotine pouches, snooze, and on the one side and cigarettes on the other side. So as lowered taxes on snooze and nicotine pouches and increased taxes on cigarettes, which is the logical thing to do if you follow the science. But here's an interesting fact about Sweden. We do have the cheapest cigarettes in Scandinavia still, but we also have the fewest smokers. I think that completely shatters the idea that high taxes and bans are the only way to cut smoking. What really made the difference in Sweden was was not price even though it's really price-worthy. A can of snooze and nicotine pouches is maybe, I mean, it could be as that's little less two pounds per can. And you can compare that with cigarettes. But it was not the price. It was choice that made the difference. So when people have safer alternatives available for them when they are legal and where the health effects are clearly communicated, well, people switch voluntarily. So that's what we see in my country. And then there's a final question for both of you, but when you're starting with Moira, this is clearly an area dominated by a lot of misinformation. If you could teach policy makers across the globe one thing about nicotine alternatives and smoke for alternatives, what would it be? It would be the science that underpins the promise of these products. I think just a very simple thing like ensuring that they understand that it's combustion that's a problem with cigarettes. And therefore when you have products that don't combust tobacco, you need to think about them very differently because they are the potential part of the solution to smoking. And if policy makers don't understand that it's very difficult for them to make logical decisions about accelerating the decline in cigarettes, smoking. And Charlie? Well, snooze and pouches, they cut smoking risks by 95 to 99%. That should really be the focal point of this debate. It's brilliant. Thank you so much both for speaking to me about smoke for alternatives and pouches. Every interesting conversation, every enjoyed it. So thank you. Thank you. Thanks for having me.