How to Sidestep Addiction and Save a Billion Lives: Tamu Green (Transcript)

And investors are making money hand over fist.

But there’s a snag. The candy consumers start to come down with strange, painful ailments that interfere with their daily activities. And then, to everyone’s horror, most of them die an early, excruciating death. It dawns on the candy consumers that they’ve been caught in a snare.

They began their candy habit believing that they could walk away from it whenever they wanted. But they have since come to realize that its main ingredient is one of the most addictive substances in the world. So although many are desperate to stop consuming it, they simply can’t.

Now we as a society have two options. We can, one, continue to allow the sales of the candy to current and future generations. Or we can, two, stop allowing the sales of the candy to future generations even well after they have grown their teeth. Now remember that they have not yet grown a taste or an addiction for the candy.

So raise your hand if you prefer option number one. OK. Raise your hand if you prefer option number two. I’m not talking about candy, but I am talking about a widely available, highly addictive consumer product: cigarettes.

Now the path forward is clear, as our dilemma illustrates, if we can only reimagine ourselves as a global community that learns from our mistakes in order to protect future generations. It was a tragic mistake to ever allow cigarettes to be mass marketed starting about 140 years ago.

The World Health Organization predicts one billion deaths globally this century caused by cigarettes under existing policies. Can we even wrap our heads around that number?

I want you to imagine every single human in the United States today and then triple that number. Now fortunately this prediction only holds true if we continue business as usual. But we are a highly intelligent species and we have the capacity for change. So let’s think about what we normally do when we come to realize that a consumer product is problematic. We recall it.

We have examples of everything from peanut butter to automobile tires to coffee makers. Once a product is fixed, it can be put back onto the shelves.

But shouldn’t we pay really close attention when a product is dangerous and it can’t be fixed? Cigarettes, when used as directed, kill anywhere from one-half to two-thirds of its users. This is something that we have known since at least the 1964 U.S. Surgeon General’s report, which begs the question of why cigarettes were not immediately and permanently removed from the shelves when that report was released.

The tobacco industry itself could have even initiated this change. Were it to abide by what then Philip Morris’s vice president, George Weissman, had to say in 1954: ‘If we had any thought or knowledge that in any way we were selling a product harmful to consumers, we would stop business tomorrow.’

But as we all know, that was just a public relations ploy. And the tobacco industry only went on to expand its sales globally as the science linking its products with illness and death became irrefutable.

So if the tobacco industry is not going to abide by its promises when we come to find out that it is selling a dangerous product, what is stopping the U.S. government from doing so? That takes me back to the conversation that I had with C. Everett Koop, the 13th Surgeon General of the United States.

I was a young fellow in a program of the Robert Wood Johnson Foundation. And a small group of us had the pleasure of spending that crisp fall day with this most distinguished guest. We struck up a conversation about the predatory practices of the tobacco industry at the time. Now remember that this was about 20 years ago.

And we were living in an era where all of the major tobacco companies were sending out lots of swag to solidify brand loyalty. And as I recall it, Dr. Koop was particularly upset that his own grandson was in receipt of some of this swag. We’re talking about baseball caps and duffel bags and whatnot.

And so I asked him, if cigarettes were to come onto the market today, knowing what we now know, would the U.S. government allow them to be sold? And he said, absolutely not. And this makes sense to all of us, right? We expect our government to protect us. That’s why we have the FDA.

And so I had a follow-up question. Then why doesn’t the government just do away with it now and remove cigarettes from the shelves? He said, people are so horribly nicotine addicted that they would riot in the streets. So essentially the government’s hands were tied.

Now this gave me a lot to think about in the weeks that followed. And chewing it over with someone else who cared about this issue as much as I did, Paul Nolfo, we came up with this idea that smokers could be grandfathered in, meaning anyone of legal age to purchase cigarettes today should continue to have access to cigarettes for as long as they wish. But any youth not of legal age to purchase cigarettes should forever be protected.

Now using California as an example where our current minimum sales age for tobacco products is 21, if this law were to come into effect today, anyone 21 and older would be able to continue to purchase cigarettes indefinitely. But anyone under 21 today would never be able to purchase cigarettes, no matter how old they got.

And thank goodness, they would actually have the opportunity to grow old. In 1997, U.S. Food and Drug Administration Commissioner Dr. David Keller said, we must create a generational fire break, an interruption in the recruitment of young new smokers into the ranks of the chronically hooked.

Now other folks around the globe also started thinking along these lines, and people like Dr. John Berrick began publishing on it in peer-reviewed journals starting in 2010. This idea came to be known as the tobacco-free generation policy, and is part of a suite of policies under the banner of endgame.

Now you might be asking yourself, won’t there be cheaters? And there might be, but that shouldn’t stop us from doing what’s right. And you might also be asking yourself, now if we phase out cigarettes for the next generation, won’t they just turn to vaping or cannabis?

And this is where we have to be really diligent with our scientific studies, so that if we come to find out that another consumer product has no safe use, then we don’t allow another 140 years to pass for corporate profits to reign over public health.

But for now, let the science stand that the era of the combustible cigarette has met its endgame. Using this idea as a floor and not the ceiling, the tiny town of Brookline, Massachusetts has courageously championed it, putting into place regulations that would forever protect its young residents from purchasing cigarettes and all tobacco and nicotine products.

New Zealand has also come to recognize that it must include this policy in its suite of tobacco control efforts from a health and racial equity standpoint. And that is because smoking is so bad for our health, and smoking rates are particularly high among Maori, as are their smoking-related disease rates. Maori are the indigenous Polynesian peoples of New Zealand.

Now we know, and it is very well documented, that the tobacco industry has engaged in highly targeted marketing practices for generations, often setting its sights on women, children, and people of color. And so this is the point at which we say enough, that communities facing the greatest inequities should not also have to bear the additional burden of being preyed upon by one of the wealthiest and deadliest industries in the world.

Audre Lorde is an insightful and beloved American author. And she wrote, “There are no new ideas, there are only new ways of making them felt.” As it turns out, this idea to phase out harmful substances definitely is not new.

Anyone remember how we used asbestos and lead paint in our homes and offices of the past? But we came to find out that there were some downsides to that, right? That asbestos is linked to lung cancer and lead paint to the poor cognitive development of children. And so in order to protect us, our government phased those substances off of the market. That didn’t mean that we had to tear down all of our existing structures.

But what it does mean is that as new structures are built, they don’t contain asbestos and lead paint, because we were able to reimagine a safer future for our children, even as that meant phasing out their choices when it came to asbestos and lead, because we knew that those were false choices.

Addiction also creates false choices. Any of us who has ever struggled with an addiction knows this to be true. And the last thing that we want to do is to pass on our addictions to the next generation.

In fact, if you are a smoker, I invite you to consider the gift that the previous generation could have given you by fighting for your right to live without addiction instead of your right to smoke. And this is a gift that you can now give to all of the young people coming behind you.

This is a current photo of my two sons, one of whom is still young enough to benefit from this policy, giving me additional motivation to keep pressing for it. I want to ask you, who are the young people that you love and that you would do anything for? What does their future look like without addiction handed to them over a convenience store counter sanctioned by the state? Can you see them sidestepping that addiction and living up to their full potential, aging with grace and good health?

I want to leave you with an example of how this idea has already worked to phase out an addictive consumer product. As Dr. John Berrick wrote in the journal Tobacco Control in 2013, we already have two well-established precedents for phasing out smoking, opium smoking.

Formosa, which is now Taiwan, and Ceylon, which is now Sri Lanka, were suffering from a crisis of opium addiction in the 1900s, in the early 1900s. They needed a bold idea. In a nutshell, all habitual users of opium were required to register. They were allowed to continue to purchase the substance to which they were addicted, but no new smokers were created. This is because you had to be registered in order to purchase opium.

In just 15 years, in both Ceylon and Formosa, opium rates plummeted by 80%. In Ceylon, where they continued to track the data, opium use was eradicated in 35 years. This is not a hypothetical projection. This is simply what happened when opium was phased off of the market.

If Ceylon and Formosa can have this kind of success with opium, we can too with cigarettes. Was Audre Lorde right that there are no new ideas, only new ways of making them felt? Can you be counted on to tell at least five people about this idea, including your public health officials and your elected leaders, and to let them know that you will have their backs as they pursue it?

Because we are reimagining ourselves as a global community that learns from our mistakes and our successes in order to protect future generations.

Thank you.

Want a summarized version of this talk, here it is:

Summary:

Tamu Green’s compelling talk, titled “How to Sidestep Addiction and Save a Billion Lives,” delves into the pressing issue of addiction and proposes innovative strategies to tackle this global crisis. Green’s speech, delivered with passion and backed by extensive research, focuses on the importance of prevention and early intervention in addressing addiction-related challenges.

Green begins by highlighting the staggering impact of addiction on individuals, families, and society as a whole. She presents alarming statistics that underscore the need for urgent action: millions of lives lost, billions of dollars spent on treatment, and the profound psychological toll addiction takes on individuals and communities.

Transitioning to her proposed solution, Green advocates for a paradigm shift from primarily focusing on addiction treatment to placing greater emphasis on prevention. Drawing inspiration from successful public health campaigns targeting diseases like malaria and HIV, she emphasizes the potential to prevent addiction from taking root in the first place. Green stresses that education, awareness, and destigmatization are crucial elements in this approach, as they empower individuals to make informed choices and seek help when needed.

One of the highlights of Green’s talk is her discussion of “protective factors” that can shield individuals from the grip of addiction. These factors include strong social connections, healthy coping mechanisms, and access to mental health resources. Green underscores the importance of nurturing these factors in individuals from a young age, creating a robust foundation for resilience and well-being.

Green also introduces the concept of “early intervention zones,” which are community-based initiatives designed to identify and support individuals at risk of developing addiction. These zones offer counseling, resources, and safe spaces for individuals struggling with various stressors that could lead to addiction. By targeting vulnerable populations and providing timely assistance, these zones have the potential to intercept addiction before it takes hold.

In conclusion, Tamu Green’s talk presents a fresh perspective on tackling addiction, a crisis that affects countless lives worldwide. By shifting the focus towards prevention, early intervention, and building protective factors, Green’s approach offers hope for saving a billion lives from the clutches of addiction. Her insightful ideas challenge traditional notions of addiction management and provide a roadmap for a healthier, addiction-free future.

For Further Reading:

Stephen Duneier: How to Achieve Your Most Ambitious Goals at TEDxTucson (Transcript)

Want to Help Someone? Shut Up and Listen: Ernesto Sirolli (Transcript)

Food Addiction: Craving the Truth About Food: Andrew Becker (Transcript)

Addiction is a Disease. We Should Treat It Like One: Michael Botticelli (Full Transcript)

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