Vaping: The Next Health Crisis or a Lifesaving Cure?

0:00Hazel Cheeseman:Welcome to Catching Up With The Royals, a brand new show with me, Richard Coles. And me, Emily Andrews. Every week we'll be going beyond the headlines, lifting the lid on what life is really like behind the palace walls. Hello sir, good morning. I'm the Sun's new royal correspondent. Oh, he said, look at me up and down. Things are looking up. We'll be diving into the moments everyone's talking about. What does the world owe you if all of a sudden you've handed back your crown? Meghan and Harry can't keep hold of their stuff. We'll reveal the secrets of an organisation usually shrouded in mystery and explore defining moments of royal history to see how the past still shapes the monarchy today.

0:38Now, you actually knew Princess Anne.

0:40Hazel Cheeseman:I think one of the ways she acquired power was through that relationship with the present. But before that interview, no-one had really spoken and been so open. Was that a game-changer? So, join us every week wherever you get your podcasts, on YouTube and on Saturdays on 5, as we catch up with the Royals. Is vaping the next major health crisis? The tobacco industry would lead us to believe that smoking rates are going down and as vaping rates go up, that's a good thing because vaping is healthier for us than smoking. And my philosophy is a step in the right direction is always a good step. So is vaping good for us or is it actually hiding some dark secrets and could it be the next health crisis?

1:29our guest today is hazel cheeseman chief executive of action on smoking and health and someone who has worked in the tobacco control industry for over a decade very exciting stuff i'm interested to hear this podcast because we know smoking is bad but now vaping is the new thing so what's going on can you give us a bit the backstory of what you've done in your career your role and how that fits into the current kind of smoking and vaping debate yeah then thank you for inviting me along so action on smoking health the charity that i run has been around for more than 50 years so we were set up by the royal college of physicians to campaign on the harms of smoking because in the in the 50s and 60s the evidence was emerging that smoking was lethal that it was causing lung cancer and subsequently you know the evidence grew on all these other health conditions that smoking causes and the college wanted their government at the time to take action they weren't taking action so they established ash to kind of drive forward that change and so that's basically what we've been doing for the last 50 years looking at the different ways in which we can reduce smoking in this country and we now we have some of the lowest rates of smoking in Europe, you know, we've really like one of the world leaders, I would say, in this space.

2:51It always amazes me whenever I go back to Europe, how many people still smoke. I'm like, what's going on? Yeah, and we used to be the dirty ashtray of Europe. So, you know, we've done an amazing job in this country of bringing smoking rates down. And as you say, we now have these other nicotine products on the market that you probably couldn't have even dreamt of when ash was established you know how they fit into the the conversation about smoking is something that ash has spent a lot of time working on and thinking about over the last more than 10 years now i mean e-cigarettes arrived on the uk market probably in around 2007 they looked a lot like cigarettes at the time they had these sort of cigar like products you might remember them uh they sort of had sort of fake filters at the top of them to make you know made out of plastic but made to look like a cigarette and they were kind of marketed as something that you could use because the smoking ban had come in in um pubs and clubs you know in all public spaces and so it was like oh you can you can use these in places where you can't smoke and they were they sort of were okay but they didn't um they weren't very good alternatives i would say for people who were who wanted to use something instead of smoking because of their addiction to nicotine um but over time they became much better at delivering nicotine and much more popular and they were to excuse the pun kind of a slow burn they uh took off really behind the scenes with smokers saying to each other oh i've been using this thing it seems to be good at helping me not smoke uh and people would try them and then as they gained in popularity the kind of commercial forces i suppose come into play you know there's a market there the tobacco industry started to get into the game started to produce these products other players and we've seen an absolute explosion in the types of products on the market the businesses that are involved in that industry and uh the flavors the the marketing you know you you you will just experience that being in the world you would have seen the explosion of this market well you see it on basically every high street in the country there's guaranteed to be a little vape shop somewhere on your high street but what what's the data saying because i i don't know i'm 37 now so i don't hang out with 18 year olds but what's the actual data saying of how many people are vaping now in the uk so more it's more or less uh more or less the same proportion of people are vaping as are smoking so around about 10 maybe a little bit more and it does vary a bit by age so it is more common among younger people younger younger adults and less common in the sort of 60 plus category although the the use of vaping products has grown in every age group uh over the last decade uh and quite exponentially uh in pretty much all of those age groups but it continues to be something that was adopted earliest i guess by uh young adults as lots of kind of new technologies are like new products on the market tend to be adopted by people in their 20s because because of the just the way they are in the world yeah um and then you and then you see them you know being taken up by other age groups and concerningly i mean there are i think as i've sort of implied there are sort of perhaps benefits to some of the way that uh vaping products are being used by some people particularly smokers but there's obviously a concern about people under the age of 18 people that have never smoked using these products and we've certainly seen an increase in that perhaps over the last four or five years so so correct me if i'm wrong but about 10 of the uk smoke normal cigarettes yeah 10 roughly now vaping as well so you've got 20 of the population no there's a big overlap there's a big overlap so you know the majority of people that are using these products are using them either to reduce the amount they smoke or to quit.

6:47But let's say it's sort of in the region of 15%. About 15%. Okay, so that makes sense. But then that gets to the point of why they were designed, right, as a tool to essentially transition from smoking into something that gave you a similar experience but was better for your health. Yeah. Now, if they're used in that regard, transitioning away from smoking into vaping and then potentially not at all do you think they're healthy they are definitely healthier than smoking i would be very unwilling to say that vaping products were healthy because anything that you're in your lungs are a very vulnerable organ anything that you're inhaling into your lungs that you need not be inhaling in is probably going to carry some risk yeah but cigarette smoking is so terrible for you you know somewhere between half Often two in three people that smoke will die prematurely from smoking.

7:43There is just no other product like that on the market. They're heavily addictive. It really doesn't take that many cigarettes to addict somebody. And the consequences of that are like a lifetime of addiction and often premature death. So compared to that very high bar of just how terrible cigarette smoking is for you, vaping is much less harmful. okay it is the the evidence that it is um able to help people stop smoking is growing and quite good and exact quantifying exactly how much less harmful they are than cigarette smoking is difficult because people haven't used them for the decades that we've seen cigarette smoking but by any measure they are they're just so many magnitudes less harmful than smoking that if you're a smoker and you're switching healthier for sure it's a step in the right direction right and i think that is an important thing if you're eating you know bags and bags of crisps every day and then you keep eating bags and bags of crisps but switch to baked crisps you're going to get less fried fat and that's going to be healthier for you but is it healthier to actually have the bad crisps well probably not right you're better off without them ultimately so i think that's a similar point but what you're saying i guess then is that the the risk here is if vaping is becoming so attractive and fun and engaging for a younger audience is bringing new smokers into the game that wouldn't have otherwise been smokers yeah absolutely so we sort of talk about naive nicotine users you know the common thing i guess in these products is that they contain nicotine and Nicotine is not kind of inherently at the quantities that obviously you can use it as a poison, like you can use it as an insecticide at high concentrations.

9:33But it's a plant, no? It is a plant. Well, the nicotine comes from the tobacco plant. Yeah. At very high concentrations, nicotine is a poison. But at the levels of concentration that you find even in a cigarette, it's addictive, but it's not the thing that's killing people. But it is the thing that keeps people smoking. it is the the thing that people are getting uh that is giving them a pleasurable experience from a vape or from these other new products on the market that we now have things like nicotine pouches yeah you know so the nicotine is important because it's addictive it's the addictive part but not necessarily the bad part well it depends if you think it's bad yeah fair enough um but yeah i mean for some people uh for lots of people that are are you know dependent on nicotine in some form or another that is a it's just a negative experience like people don't enjoy that the sense of being dependent on something and additionally if you're a cigarette smoker it's also killing you so i think it's it's hard to see the the nicotine is completely neutral but the uh the concern i think is that we have really had insufficient controls on the way that these products are marketed and positioned so the value of them as a way of helping people stop smoking which i think is indisputable um is in danger of being kind of drowned out by the way that they're positioned in shops the bright colors you know the the all the flavors yeah all the marketing that kind of comes around that and the the sense that the public have that this is something that people are like people are taking up and becoming addicted to nicotine for the first time through vaping products so we can unpack that a bit more about whether that's true whether people are you know people who otherwise wouldn't smoke our do you have data on that there is a large group of people under the age of 18 who are trying nicotine for the first time through a vaping product that's obviously concerning but the question that we have when we look at this as kind of public health professionals is well who are those people and would they have used nicotine in a cigarette for the first time if they hadn't tried it through a vaping product the data is growing all the time and our understanding of that is growing all the time at the moment we don't see a growth in the number of people who are smoking underage it's kind of static at the moment it needs to some of the laws that the government is looking to introduce at the moment will hopefully address that um but we probably have seen a bit of a growth in the last couple of years in the overall level of nicotine use in under 18s so that does indicate that some of those kids would probably not have used nicotine at all if it wasn't for the way that the evades were being marketed well and it speaks to logic right and i don't think i've ever really told anyone this publicly but you know when i was 14 i think we went on a school trip to disneyland paris and obviously they just didn't care about age restrictions on smoking or whatever so we like thought it was cool to go pick up some cigarettes from the petrol station and then we had nothing to do it was like 10 o 'clock at night in Disneyland Paris the park was closed we all got cigarettes and smoked for the first time and it was disgusting like it was tasted foul but we did it because we thought it was exciting not allowed you know and cool and whatever and then felt absolutely horrendous the next day and had to get the bus back to England and just it was like the worst bus ride of my life um but that experience very much was like well that's disgusting like why would I do it now if the experience was oh my god this tastes like strawberry laces you yeah and then it doesn't give you the same kind of feeling the next day because perhaps it's not quite as bad then yeah you might uptake smoking right because you're like actually that's not so bad this is quite cool well it's a really like a telling story like it it tells you something about teenagers and something about like the way that addiction can work so like the purpose of teenagers in like you know as you grow up is like teenagers are experimental they're supposed to push boundaries they're supposed to kind of break away from being children and become adults and we see this in all sorts of things that like teenagers do all sorts of dumb things because they are teenagers they you know they put themselves in danger and at risk and and one of the things that they do uh is to try things like smoking and night vaping and for lots of those young people trying cigarettes for the first time so the the evidence was suggested around half of people around half of those kids who tried that those cigarettes with you in disneyland paris would probably have gone on to regularly smoke and about half wouldn't really which is pretty high though that's quite I didn't think it'd be that high.

14:34So, you know, for you, it didn't, you know, maybe it didn't trigger the dopamine responses in the brain that it might have done for somebody else. You know, people respond differently to nicotine depending on their own body chemistry. We don't quite know yet, again, because the data is still growing. What's that transition from vaping? If you try a vape, is it the same sort of likelihood that you will go on to regularly vape? it doesn't look like that's quite true at the moment because trial is quite a bit higher than continued use but honestly as these products become better at delivering nicotine which if we go back to the like they were originally created to kind of help people stop smoking you know you want them to deliver nicotine quite well because that makes better alternatives to smoking but on the flip side if they're better at delivering nicotine they could also be better at like making you addicted making you addicted you know the smokers are already addicted so we kind of don't worry so much about them so i think it is really important that we think about how you know the the argument from industry uh the industry you know the different bits of the of the industry that make and sell these products is that they shouldn't be so heavily regulated because they are not as harmful as cigarettes and i to some extent agree that they shouldn't be regulated in the same way as cigarettes but that's not to say they shouldn't be regulated because they are an addictive product we can see from the way that they you know the uptake has happened in young people that they can appeal to young people that they can um be used by you know be appealing to people that have never smoked before and so we've just we've got to get the balance better in how they're regulated so that we don't lose the opportunity to help the sort of million people that are still smoking whilst protecting you know people who were growing up from being being flogged these products so how old do you have to be to buy a vape today 18 but but indeed yeah okay because you see it yeah kids on the corner of the school hanging out okay they'll get their hands on it somewhere won't they

16:45for parents or you know family members that have a teenager that's vaping ignoring the kind of potentially it's better if they you know it's a good transition from smoking is it really bad for our health like it's order of magnitude is better than smoking but do we know how bad it really is it is a tricky question to answer you know we we don't expect them to be without risk because as I say, there are, you know, there aren't a gazillion chemicals. How bad is vaping? I just can't remember the number of them. There aren't as many of the very harmful chemicals that we see in tobacco smoke in the vapour that you inhale.

17:28But there's not nothing in them. It's unlikely that the nicotine is, you know, beyond addicting you is doing that much harm. But, you know, there are other ingredients in those products. that that could potentially have have a harm well because when you burn stuff it's typically not that good and like you say our lungs are weak and sensitive and there was like the cases in the beginning of like wasn't it the vitamin e oil that was in them that everyone thought was helpful and then actually burning vitamin e oil was like toxic and like so the one thing that vapes are not doing is they're not burning anything so they are heating it into a an aerosol i think would be the technically the scientific thing um uh but the so yeah when you combust something when you set fire to it and inhale it like pretty much whatever's in it it's bad for you yeah um so you don't have that in in these vaping products but the and the uk market is not unregulated so we do you know you can't put vitamins in legal uk products there are other ingredients that are being caused for concern and are prohibited from uk products but if you are accessing products that don't comply with UK regulations or accessing them in other countries then they could have some of these chemicals which are concerning and obviously if you're underage and you're accessing these products there is a bigger risk that they are not legal because unscrupulous people who are prepared to sell to people under 18 are also much more likely to be selling products that are not.

18:59Or you pick them up online or when you're in a holiday in a different country. And there was a particular concern with vitamin E acetate. So in America, they had a whole load of vapes that had THC in them, the sort of active ingredients of cannabis. And they were cut for reasons I don't really understand with this vitamin E acetate. And something to do with the combination of these chemicals was really, really damaging and caused these really acute lung injuries in America. so obviously we don't have the thc i mean you can obviously buy them illegally with thc in them um we don't have the vitamin e acetate and so the legal products in the uk you know they put you at that kind of acute risk but is there a chronic risk from using these products you know for most people don't have an acute reaction to cigarette smoking some people do but like most people the harm from cigarette smoking takes a good a couple of decades to accumulate and then you have the cardiovascular risk the cancer risk the respiratory risk if we take like those in turn so cancer risk from vaping products at the moment we really just don't have any reliable evidence which would suggest that vaping would increase your risk of cancer they've done various studies where they you know look at people's urine and look for biomarkers in the urine you know that we would expect to be like indications that you might have um elevated risk of cancer and we just don't we don't see that a cardiovascular risk so that would be more i think the jury is more out there if you think about the you know nicotine might have a kind of similar response on the body as caffeine in terms of like you know the cardiovascular impact and we all know what that feels like you know what most people have had a lot of coffee and felt their heart rate go so it's plausible maybe that there could be some elevated cardiovascular risk but it's not proven and certainly in the again if we go back to people who are using them as an alternative to smoking the evidence that people when people stop smoking and switch to people with existing cardiovascular conditions in heart conditions you know stroke whatever it might be when they switch to vaping products that the kind of markers of harm around that cardiovascular goes down so it definitely but we already kind of know they're better at smoking respiratory risk and that is probably where the long-term risk if it if it is there from vaping products is likely to emerge because as i say that the lung is a very like vulnerable organ you know we know that being exposed to pollutants in the in our environment is bad for our lungs exactly so inhaling something into your lungs is probably going to have some long-term respiratory risk but we literally we couldn't we can't quantify it well even having a open fire in your house yeah burning wood is not going to be good for your lungs i mean probably that's riskier i would say because you've got those small particulates that we the reason why smoking is banned in public places is because of those small particulates that are produced when you set fire to things and if you have them in enclosed spaces that's obviously really really bad for health so yeah open fires are not good are not good for your lungs but i get it right this is some of the problems in like health and nutrition science around ultra processed foods is is very difficult and it takes maybe 50 years to pinpoint that thing causing that thing right yet we're seeing cancer rates rise in younger kids especially but to tell people what it exactly is is almost an impossible job um which is hard because if vaping's only been around for 10-15 years then how do you prove it yeah and and in a way it is like a there are obviously like precautionary things you can do you can say like there there seems to be like very little downside I think from ensuring that the fewest number of under 18 year olds start vaping you know it most of them are not smoking most of them won't be able to even legally buy cigarettes in the future as the law changes um like we should put regulations in place that reduce the appeal of these products particularly to this age group i feel there's very little downside there regardless of where how much it turns out vaping you know is or isn't bad for you the thing where we've got to be more cautious in how we regulate and how we communicate to the public because most people do now you know more than half of people from the survey work that we do uh and smokers not just the general public think that vaping is as bad or worse for you as smoking which isn't true and perhaps make will then inhibit those people from using them as a way of stopping smoking so as we regulate and as we communicate about these products we do do have to get the balance right because there is a risk that you go all the way down that precautionary road and you like put loads and loads of hairy restrictions on them and you put all these like scaremongering health messages out there and you know maybe you like completely stop any under 18 year old from ever using these products but then the flip side of that is that you also then inhibit or prevent um smokers from switching and like we absolutely know what the health harms are from smoking we can more or less quantify what the benefits are of switching to vaping and so we can kind of see what the problem would be if you if you absolutely stop people from switching.

24:40So it's quite interesting. The public perception is already that vaping is just as bad as smoking. You shouldn't do it, even if that's not true. But that's the perception. Would you say then the latest trend of like nicotine pouches is just the next step along that journey for tobacco companies to say, OK, well, if we can't do vaping, then we'll just go in pouches and we'll sell you nicotine that way and we're going to make our money that way? I mean, tobacco companies are not in the business of public health. Tobacco companies are in the business of selling nicotine to as many people as who buy it from them.

25:11And they were really late entrants into the vaping market. As I said, it was something that came out of China. There were smaller companies around the world who were selling these products. It took a while for tobacco companies to kind of get in on the game with vaping products. They had taken off. They came out of China. Smaller companies picked them up. And it took a while for the tobacco industry to see them as something that was like a disruptor for their market that they needed to get on board with. So they have not they have learned the lesson. So they are not doing that with nicotine pouches.

25:43And every tobacco company has a big nicotine pouch brand. There is while there are restrictions on the way that vapes can be marketed, albeit that I think they're insufficient. There aren't really those restrictions on nicotine pouches currently. and you'll have seen advertising on the tube, on the billboards, bus stops. And also there is no, currently there's no age of sale for nicotine pouches. So you could buy it to a 10-year-old. No offense. Wow. Because nicotine itself isn't regulated. It's the smoking. Yeah, yeah. So at the moment we regulate medicinal nicotine. So if it's a medicine, it's regulated.

26:22If it's in a cigarette, it's regulated. If it's in a vaping product, it's regulated. If it's in any kind of tobacco product, it's regulated. but but not just general you know novel nicotine products are not it will be when the government passes the bill permanently before parliament but as we speak they aren't is that coming soon yes so they're most of the way through it should be it should the government says it will be passed by the spring and then we will at least have an age of sale for nicotine pouches which will be 18 18 as well okay that's good yeah and they're bringing these other restrictions around marketing and stuff but the but the tobacco industry can see this bill coming like they know it's before parliament they know it will pass yeah the amount of money that must be going in to uh getting a jump on this legislation they're in your face at point of sale uh they are as i say you know you see them on the everywhere because i spend a lot of time on my computer looking at things about smoking i get on social media i get everything about jafferts all day long so essentially they know the ban's coming for under 18 so that they're pumping the money and now to get as many people on it as possible and the restrictions on marketing as well they are attempting to be ahead of the game on this one but it's a different like whether nicotine pouches have a role again as an alternative to smoking like probably like you're not inhaling anything you know you're absorbing the nicotine which as i've already said like it's addictive but it's not necessarily lethal you get them in all these crazy really high strengths which is probably a not a very nice consumer experience and and b probably does have some risk yeah again if you're using them to not smoke it's probably better for you could so it could it could be a you know a step on from vaping in a way a healthier step yeah i mean it again like these things are all novel but from first principles you don't inhale anything they are probably going to be less harmful than vaping they're you know they're less kind of in your face than vaping you know one of the things um that we you know you get a kind of confirmation bias don't you you're like you're worried about how many people are vaping and then everywhere you go all you do is like see people that are vaping and then like reinforces your idea that lots and lots of people are vaping i mean lots of people aren't vaping yeah um but you don't visually see the pouch yeah and the same and like in terms of young people's behaviors we know that young people who believe that their peers are using these products are more likely to go and try these products that's such like basic psychology isn't it if you think everybody else around you is doing something you want to try it too yeah whereas again like the pouches are just a less visible product so i think there's lots of virtues probably in that nicotine pouch space but honestly the tobacco industry is all over it they're just going for it already yeah so i wouldn't i would say they are not the friends of public health they it might be that they happen to sell something that could help mitigate the terrible terrible harms that are caused by their their current big uh cash cow you know which has been a very you know which has made them billions and billions for 100 years well it's an interesting thing because again I tried a nicotine pouch because I was curious and I saw a lot of people talking about the level of focus it can give you and how it's really good and I was writing a book last year so I was like well maybe this can help me focus and lock in to just write 5 000 words in like three hours you try anything at that point well yeah I needed some No, but you know, like I tried it and I literally did it, I think twice and felt terrible both times.

29:50And that's the danger, I guess, where you're giving it to like a 14, 15 year old kid. It's like, it was so much stronger on orders of magnitude than a cup of coffee. Oh yeah. That I felt weird for like a couple of hours after. And I did it twice just to think, oh, maybe it was just the first time. tried to talk and I just never touched it again we do need a bit more research in like how to support people to use them as an alternative to smoking but honestly I think the idea that they're gonna be the thing that you need to focus to just bash just get through that last 5 000 words I mean I don't think there's great evidence for that and if you haven't if you don't use nicotine all the time some of these pouches are crazy strong yeah when you inhale a cigarette the nicotine is in your brain in like you know a matter of seconds under 10 seconds it's in your brain it's really fast so you very if you inhale too much you get too much nicotine in your body you know really soon you know you get a head rush you don't feel great you stop yeah and then your body kind of self-regulates you know it kind of calms down and you feel all right relatively quickly with the nicotine pouches at the point that you start to feel the nicotine because you absorb it more solely like through what they call the buccal cavity in your mouth by the time you start to feel it and you take it out your body's still going to be absorbing like a load more

31:10Hazel Cheeseman:nicotine so you just you're terrible you know you get too much nicotine it makes you feel rubbish and but so that what you do the body's response the human body's response to too much nicotine at an acute level is to vomit so you get these stories about people passing out throwing up like that's what the body does to get rid of the i've got too much nicotine in my body they are They could be useful to help people as an alternative to smoking, but we've got to have some good advice to people on how to use them because otherwise they just feel a terrible experience. Or good guardrails and we have to understand it, right?

31:40Because on one hand, I would never, ever smoke, but I have heard that the nicotine itself, other than addictive element, is like not actually that harmful in itself. So I was like, well, let me try it. Let's see if it works. I'm not opposed to trying new things. But when it made me feel that way, I was just like, this isn't right for me. this idea there is a quite a big thing out there that nicotine can help you focus and whatnot i think that the science is i mean it's dubious i mean it's not completely uh complete nonsense but i i think it's quite difficult to disaggregate from what is just withdrawal from nicotine and what is like maybe providing some sort of neurological benefit of some kind because the experience of withdrawing from nicotine is really unpleasant and you're not focused and you can't and you like and then you have the nicotine and you feel better and you can focus like anybody who's a smoker would have had that experience where they're like oh i don't feel like have a cigarette focus i can do it well yeah of course you withdrew from nicotine and then you got some nicotine and then you could focus so i would be really unsure about the idea that you know using nicotine in a pouch or any other kind of way is going to like suddenly magically help you write a book i think it's i think it is likely to addict you and then and then and then you need the nicotine in order to focus because otherwise you're like yeah experiencing unpleasant withdrawal and that's definitely an issue addiction to anything you don't want anything that's really addictive but what's your biggest gripe then with the tobacco industry and what's going on at the moment what would you want to change biggest gripe with the tobacco industry i mean the big my biggest screw up with the tobacco industry is probably less about what they are doing in the uk more about what they are doing around the world so i mean the the tobacco industry is a big global industry dominated by a small number of big companies and they come in here in the uk market they talk us talk about you know we've got these reduced risk products we're part of the smoke-free future la la la la whilst also arguing against lots of regulation that would be highly effective and regulation of the cigarette market, which continues to be very, very profitable for them, despite the fact that we've got declining rates of smoking in the UK.

33:59And then they are off in Zambia and in Pakistan and in Indonesia and Kenya and wherever. These emerging, well, some of them are not so emerging, these markets where there are poorer regulations, where governments have less capacity to regulate the industry, and they are advertising their lethal cigarettes in ways that they would absolutely not be allowed to do here. You know, fighting against, they've been fighting against regulation in Zambia for more than a decade. Basic like advertising restrictions that we have had in place for 20 years, more than 20 years. So no matter what they say from like a nice corporate responsibility line of we want to smoke for its future, actually their actions are doing the complete opposite in other territories where they can get away with it.

34:48Yeah, exactly. They are corporate interests who are always going to act in a way that's going to maximise their profits. And in the UK, the cigarette market is in decline. I mean, it does still make them 900 million a year in the UK. So it's not like small change, but obviously the writing's on the wall. So what are the other products that we can be selling? What can we be making a profit from? And also the UK sets a standard, right? So the UK regulates in a certain way. it kind of gives other countries the ability and the kind of confidence to go and copy that so the uk matters from that in in that way to the tobacco industry but financially you know those markets in africa those markets in asia i mean smoking rates across the african continent are much lower than they are in europe because basically the tobacco industry wasn't marketing in africa wasn't selling cigarettes for 50 years because people didn't have the incomes to buy them So the market was not relevant to them, even though they were growing lots of tobacco there.

35:49But that's become less true. You know, lots of African countries are, you know, more affluent, developing. They are really exciting markets for the tobacco industry, which is obviously really bad news for the people in those countries. That's really sad to hear. But taking it back to the UK in terms of just people's health in general, what's the one thing you would want them to understand about reducing harm? be it smoking vaping pouches the most harmful thing you can do is carry on smoking it's really it is hard to stop people who have become addicted will know you know most people want to stop they'll try lots of times and they'll find themselves back to smoking again so net you know keep trying to to not do the thing that is you know almost certainly going to shorten your life or make your life much harder as you get older you know if you cannot abstain completely from nicotine these other alternatives particularly these non-tobacco alternatives vaping nicotine pouches they are a good option for if you know if you cannot abstain from nicotine altogether but if you don't need to put nicotine in your body just don't it's not a very fun drug like there are other things to do with your time and other things to do with your money one is expensive and it wastes a lot of people's money and it's not good for their health and it's definitely not cool I would never advocate for it.

37:10No I don't think so. Like you say your lungs are sensitive they're a huge part of your body and if you play any kind of sport you know how important your lungs are to that equation and smoking anything whether it be your you know your smoke fire in your house is you know it's not a good idea so let's not smoke people it's terrible. Thank you so much for joining us Hazel that was a real quick whistle stop tour but I had no idea about what they were doing in Africa so that was really interesting and just shows the ethics of some of these big companies but hopefully the podcast and social media can expose some of the light on what they're actually doing and hopefully get these companies to change their ways and hopefully make us all healthier.

37:49I mean I think it's optimistic to think that the companies will change their ways it's governments that have to act you know there's way too much money to be made governments have got to act to make sure that these industries can't behave in the way that they do. One, thank you for doing what you do and trying to push the industry to regulate or the government to regulate the industry better. And I mean, because one thing's for sure, we should definitely not be giving any of this stuff to school kids. I mean, that's just ridiculous that they find these loopholes and then sell pouches to 12 year olds is absolutely horrendous.

38:22But we like to end the podcast on one final question. What does health mean to you, Hazel? Oh, my goodness. What does health mean to me? it means just being able to enjoy the things that you like to enjoy without being inhibited without having to think health is not having to think about your health i mean i just to bring it bring it back to the cigarette smoking the thing that really breaks your heart when you talk to people who've had a lifetime of smoking cigarettes is that they're you know they're reaching their retirement age or just before their retirement age generally and the basic things that they just enjoy in life like playing football or you know going out with their friends have become difficult because they've got copd because they're like dealing with cancer because they've got a cardiovascular condition yeah and i like what a gift it is to not have to think about your health and i and the best you know from a like tobacco control point of view the best way that you can get to later life and not thinking about your health is not to always stick around amazing I mean it shortens everyone's life so that's quite proven so yeah you just want to live your life for as long as you can as healthy as you can so you can enjoy yeah amazing thank you so much for joining us thank you