CASA: Thank you for making time to join us. Kindly introduce yourself to our audience, for those that may not be familiar with you and your work.
Charles A. Gardner: Let me begin with the hope that all of you are safe and healthy during this time of crisis. Best wishes for you, your families and other loved ones. As for me, I currently serve as a Program Officer in the Foundation for a Smoke-Free World. I worked previously as the Health Attaché, US Embassy New Delhi; Senior Advisor on Research Strategy to @WHO, and in 2 other foundations: Associate Director Health Equity, Rockefeller Foundation; and Director of Child Health at the UBS Optimus Foundation. My doctoral training was in the field of developmental neurobiology (I studied how the brain develops). My favorite color is red. I like long hairy dog stories and bad puns.
CASA: Right to our first question. Smoking prevalence worldwide has declined by staggering numbers due to what is termed as disruptive technology. What is disruptive technology?
Charles A. Gardner: First, smoking RATES are declining fast in many countries. In some (e.g., US, UK, Iceland, Norway, Sweden, Japan), it is plausible to argue that the rate of smoking decline has accelerated due to the availability of various tobacco #HarmReduction products. But the overall number of smokers worldwide is not dropping because (1) global population is growing and (2) poor people around the world are becoming less poor (able to afford cigarettes and other combustible tobacco). Disruptive technology: Weaving looms disrupted hand looms. Cars disrupted horse-and-buggy market. Digital cameras disrupted film leading to “Kodak Moment”: Kodak lost massive market share to aggressive digital camera cos. Smart phones now disrupt THEM.
CASA: What role can innovation and technology play in the fight against smoking?
Charles A. Gardner: Literally every financial analyst on the planet sees e-cigarettes as direct product substitutes for cigarettes. Sadly, many in global health still don’t see the disruptive nature of ecigs (in fact see them as a plot to keep people addicted to nicotine). Almost every new tech ever invented brings new harms (e.g., cars & traffic accidents). History shows that incremental innovation (the opposite of disruptive) leads to increasing safety (e.g., cars got safer, so deaths per mile-traveled plummeted).
CASA: What are some of the proven cost effective innovative approaches used to reduce smoking related mortality?
Charles A. Gardner: Smokers need ALL options to quit. Early harm reduction products deliver nicotine (e.g., patches, gum). Relatively low cost. Hard to see #snus as new, since it has been around for centuries, but it works (disrupting smoking in Scandinavian countries).
Snus-like products can be very inexpensive if made locally. Ultra-low nitrosamine levels make them MUCH safer than toxic smokeless tobacco. Even the FDA agrees on that. Snus-like products could be a game changer to end smoking in low-income countries.
Many assume e-cigarettes are too expensive to help the poorest smokers quit. But before India’s complete ban on ecigs, research found ultra-low-cost ecigs help bidi smokers quit. Affordability and accessibility are both key. Innovation can lower cost.
Heat-not-burn tobacco products have a much higher upfront cost. May not reach the poorest. For those who can afford, they seem to be safer than smoking, and effective in helping smokers quit (e.g., 33% drop in cigarette sales in Japan, over just 3 years).
CASA: Moving on. What are e-cigarettes, and what role can they play in fight against smoking?
Charles A. Gardner: Depending on who you ask, they’re either a plot by big tobacco or the most important health innovation since vaccines. Ecigs deliver nicotine w/most of the hand-mouth, oral & visual stimuli smokers want – but vastly lower levels & fewer toxins than smoke.
No smoking cessation product has zero risk. See side-effects on a box of nicotine gum. Ecigs are #HarmReduction options. In countries that don’t ban them, evidence is growing: They are significantly more effective for cessation than any other option.
CASA: What are some of the more affordable risk-reduction innovative solutions for low- and middle-income countries?
Charles A. Gardner: ALL. For smoking cessation, more options are better… Because every smoker is different. LMICs (or any country) that truly wants to end smoking should subsidize and encourage access to affordable nicotine patches, gum, lozenges; e-cigarettes; and #snus.
CASA: Is there any data or case studies to support the effectiveness of safer nicotine technologies in smoking cessation?
Charles A. Gardner: It is possible to argue safer nicotine tech doesn’t help smokers quit… IF you willfully ignore clinical trials, population-level studies, observational data & tens of thousands of testimonials (and assume 2.4 million UK & 5 million US ex-smokers don’t exist).
CASA: Should Governments and health bodies in Africa invest in the development of innovative and effective smoking cessation tools?
Charles A. Gardner: YES! The most effective solutions often come from innovators who are closest to the problems. This is a key aspect of innovation to address issues in low-income countries… often ignored by people who look like me (noting that this sounds smugly “woke”). I would advise govts to adopt risk-proportionate taxes & regulations for safer nicotine delivery products AND invest in the development of new local low-risk innovations for the local market to meet the price point of the poorest – to end smoking for good.
CASA: How safe are some of these innovative approaches to support smoking cessation as compared to traditional cigarettes?
Charles A. Gardner: With snus, we only have 8 decades of epidemiological data… So yah: Vastly safer than smoking. Ecigs, only 14 years of use. Best estimates on risk are based on the number and level of “toxins” in vapor. Most of those are around 1% or less than smoke.
CASA: Are mobile phone apps a reliable cessation tool especially for a continent like Africa where a vast majority have smartphones?
Charles A. Gardner: ALL innovation has a role. I advise EVERYONE who wants to quit to try everything. Find what works for you. Mobile phone apps are cheap (or free). They send text reminders to encourage healthy behaviors (eating, exercise, etc.). If it works it works.
CASA: Finally, can technology and innovation bring an end to smoking?
Charles A. Gardner: I WANT to say “yes.” Innovation CAN help reduce smoking dramatically. And I prefer carrots to sticks. Personal choice vs. stigma, taxes & restrictions. The latter do work, but at a significant cost to human rights. Tying this back to the theme of this thread. We must never lose faith in Enlightenment and humanist values. In Innovation Economics terms: R&D => innovation => increasing productivity => increasing wealth and well-being. This is not a zero-sum-game.
CASA: And with that we come to the end of our twitter chat for today. We would like to sincerely thank Charles A. Gardner for taking time to engage with us and educate us on innovation & cessation. Until next time, keep the conversation going!