Earlier this month, at the 2010 CORESTA Congress, Scott Ballin (former chairman of the Coalition on Smoking and Health) and David Ashley (FDA's Director of the Office of Science at the Center for Tobacco Products) spoke about the future of tobacco in light of FDA regulation (see various Michael Siegel posts for back-story).
In the 1990s, Scott Ballin was a Chairman for the Coalition on Smoking and Health. For more than 10 years he served as the American Heart Association's Vice President and Legislative Counsel. Most recently he has served on the Steering Committee of the Alliance for Health Economic and Agriculture Development (AHEAD), an informal organization formed to work towards the enactment of recommendations contained in the Presidential Commission report Tobacco at a Crossroad, that included passage of effective but fair and workable FDA legislation.
I was there to hear his speech and was able to grab a quick interview with him in an Edinburgh bar later that day. His speech had welcomed a new era of co-operation between tobacco control and the tobacco industry to address the issue of harm reduction. This sentiment is, shall we say, far from universal in the anti-smoking movement and I began by asking him about comments he had made about elements of tobacco control drifting towards prohibition.
CS: You said that you've noticed in recent years that the anti-smoking movement is moving towards prohibition. When did you first notice this and how widespread is it?
SB: For many years the tobacco control community always said that they were not out to ban tobacco, but more and more recently, there have been statements made by a lot of people I've known a long time who believe that now that we have regulation we can go that next step and try to introduce prohibition of all tobacco. And there are some people out there who are even talking about prohibition of nicotine as a drug. I don't know how extensive that is, but it is there and people are raising the issue for the first time. Before, no one would ever talk about prohibition, or even suggest it.
CS: And they're still not talking about it explicitly in the media.
SB: Not in the media so much, but privately and on some of the websites people will talk about "we have a chance to get rid of tobacco now." Y'know, the next step is plain packaging. So there's this progression. As one person said, "We should drive the [tobacco] industry into the sea and tobacco will disappear." It's fine but I don't think people really understand what they're talking about.
As I said today, it's not the tobacco that kills you. It's what you do with it. It's how it's produced and cured and treated—what goes into it. And most importantly how it's used. You can burn it but there's a big difference between that and something that's not burned.
It is an agricultural plant and you can do a lot of different things with it, and I think that people have just refused to open their eyes to this whole new discussion about what tobacco is, what we need to be doing from the standpoint of science to make it even lower risk.
CS: So you would be firmly anti-prohibition?
SB: If people look back at my 30 year history and what I've said, I've never been a prohibitionist.
CS: Do you ever see a time when prohibition would be an appropriate response?
SB: I don't think so, no. When you get the risks of a product down... We have risks in society all the time, like in our foods. Maybe our foods will eventually become more risky than using a tobacco-based product, depending on what we do with the tobacco. We've got cholesterol and sodium and fat and the obesity problem.
So these things have to be put into perspective, but part of the problem with any movement is that it takes on a life of its own and it continues, and it continues, and it continues, and you've got to have an enemy in this day and age to be able to continue your fight. And the enemy is changing. This is not the tobacco industry of ten years ago or twenty years ago. They're becoming more pharmaceutical-like and the pharmaceutical companies are becoming more tobacco-like. It's fascinating to watch.
CS: So what would be your final goal in terms of regulation and law-making?
SB: My final goal, as it has been for the last thirty years, is to ensure that the American public is protected from dangerous products, particularly those who are underage, but that we are doing more to provide information to the public about products. That we are developing new products that are lower in risk. The same as we would do with the food industry or any other industry. This is finally happening with respect to tobacco and I would like to see a system by which the consumer—in a regulated system—has the ability to make some very sound decisions about what they do or don't do with a particular product.
If something's really dangerous they're going to move in off the market through either regulation, competition or consumer choice. If you give the consumer something that's 99% lower in risk—that's consumer-acceptable—we should be doing it.
CS: In terms of cigarettes specifically, is it possible that FDA regulation—which lists over 100 toxicants—could lead to making cigarettes that nobody would want to smoke?
SB: Well, it's possible but with the technology we have today... I mean, I'm of the opinion that there is no potentially safe cigarette. If you burn lettuce and smoke it, you're going to be subjected to all kinds of stuff that you normally would not be subjected to if you ate the lettuce. So there's a big difference here. As long as there's combustion and the ability to create all these toxins—whether it's tobacco or anything else—it's going to be much more difficult to try to reduce those toxins.
Whether that's all possible, I don't know. I don't think anybody knows. And that's what remains to be seen. But the need to develop non-combustible products that are consumer-acceptable is, to me, the most important thing today. We do know that there are significant reductions in risk. We do know that all those toxins are not there. And if we have to take out the TSNAs [tobacco specific nitrosamines] or the heavy metals or other things, that's technologically feasible. We can reduce the risks even further, and we should be focusing on that as an alternative.