{"id":36259,"date":"2026-04-16T09:37:05","date_gmt":"2026-04-16T09:37:05","guid":{"rendered":"https:\/\/clearingtheair.eu\/?p=36259"},"modified":"2026-04-16T09:41:46","modified_gmt":"2026-04-16T09:41:46","slug":"smoke-free-or-nicotine-free-clive-bates-unpacks-the-split-in-tobacco-harm-reduction","status":"publish","type":"post","link":"https:\/\/clearingtheair.eu\/en\/post\/smoke-free-or-nicotine-free-clive-bates-unpacks-the-split-in-tobacco-harm-reduction\/","title":{"rendered":"Smoke-Free or Nicotine-Free? Clive Bates Unpacks the Split in Tobacco Harm Reduction"},"content":{"rendered":"
\"\"<\/div>\n

Public health advocate Clive Bates, founder of the influential blog The Counterfactual<\/a>, joins Clearing the Air’s Peter Beckett for a candid discussion on the current battles in the world of tobacco harm reduction. <\/em><\/p>\n\n\n\n

Peter Beckett: <\/strong>Clive, welcome to Clearing the Air.<\/p>\n\n\n\n

Clive Bates: <\/strong>Great to see you, Peter.<\/p>\n\n\n\n

Peter Beckett: <\/strong>We’ve been looking forward to having you on. The blog that you run has been so influential in the harm reduction world. It’s called The Counterfactual. What’s the Counterfactual?<\/p>\n\n\n\n

Clive Bates: <\/strong>The Counterfactual is my brand, my organisation, my consultancy, and my advocacy practice. It’s the vehicle through which I do work on public health, energy, climate, and so on. A counterfactual is a concept in policymaking in which you consider what would have happened in the absence of the thing that you’re focused on. So, a typical counterfactual in our world would be what would have happened to youth smoking in the absence of vaping.<\/p>\n\n\n\n

Peter Beckett: <\/strong>And what do you think would have happened to youth smoking?<\/p>\n\n\n\n

Clive Bates: <\/strong>Youth smoking would be much higher than it is now everywhere in the world had there not been vaping.<\/p>\n\n\n\n

Peter Beckett: <\/strong>Okay, there’s another counterfactual that I was thinking about, listening to a podcast on the history of the tobacco industry. It seems to me the original sin of the tobacco industry was not selling cigarettes, but lying about how awful cigarettes were when they figured it out. Maybe if they’d done it differently, we’d be in a very different world today. If that scenario played out and maybe we didn’t think of nicotine as the enemy, where do you think we might live now?<\/p>\n\n\n\n

Clive Bates: <\/strong>Well, the way I would see the evolution of views in the tobacco industry is that they moved from a position of confirmation bias, in which they were rejecting steadily mounting evidence that these products were extremely harmful, into one of protective deceit. All the track record they’ve got of lying, misrepresenting, and sowing doubt became known as the merchants of doubt. In some ways that’s human nature. I do think they persisted with that for far too long. At some point they should have said the game is up and accepted, as they do now, that their products are harmful and warned about them. The counterfactual history of the tobacco industry, if they’d done that, is very hard to know. I think they would be in a better situation than they are now. The thing that got them into all the litigation and trouble was the lying and misrepresentation. It’s all right to say that with the benefit of hindsight, but how they must have faced that as it was coming towards them, perceived as an existential threat to their business, was very challenging.<\/p>\n\n\n\n

Peter Beckett: <\/strong>I understand that would be difficult. But the reason I find the counterfactual interesting is because there does appear to be this split within the public health world between those who want a smoke-free world and those who want a nicotine-free world. I wonder whether or not in that counterfactual we’d be much closer to thinking that what we actually need is a smoke-free world and the acceptance that some people rationally choose to use nicotine. We just need to move towards the safest way of consuming. Pouches could have existed 70 years ago, but they didn’t. Maybe had they done something about it, we would have been in that place for 30 or 40 years.<\/p>\n\n\n\n

Clive Bates: <\/strong>That’s true, but we are in that position now, Peter. Remember, the vast majority of the tobacco control establishment doesn’t want to go down that route. It doesn’t want to separate out nicotine pouches, which are minimal risk, from cigarettes, which have very high risk. It wants to lump them all together as generically dangerous nicotine products. What I think you’re getting at here is a really interesting insight: the fact that in the past, there were multiple objectives and motivations that all pointed in the same direction. You could be against smoking, tobacco, cancer, or addiction. You could be a non-smokers’ rights activist, worried about children, or hate corporations. All of those were unified when the tobacco industry produced mainly cigarettes. What happened later is that as those de-conflicted, you now have to make active choices about whether you’re against smoking, tobacco, or nicotine. The problem is the tobacco control establishment hasn’t handled that deconfliction at all well. It has basically said, we like it how it was before, when everything on that side was awful.<\/p>\n\n\n\n

Clive Bates: <\/strong>We were righteous and we didn’t have to make any hard choices. Unfortunately, that is where we are today. If that deconfliction had happened earlier, I don’t know that it would have been that different. We had a trial run with that with snus. There was a massive moral panic that started in the UK in the late 80s that led to a ban in the UK and then at the EU level in 1992, even though there was plenty of evidence at the time. People saw that as a win because they got something banned. It was a safer alternative to smoking, responsible for holding down smoking rates in the Nordics. Nevertheless, people still wanted to run with the fact that they’d beaten some tobacco or nicotine. That ban was reinforced in 2001 and again in 2014. It will likely stay in place with the third Tobacco Products Directive in 2027. Nobody has learned any lessons from that or found it interesting to de-conflict nicotine from harm and base policy on reducing harm.<\/p>\n\n\n\n

Peter Beckett: <\/strong>What I find interesting about that observation is that I often conceive of this split in the public health community having happened around 2009. But you’re saying the fault lines already existed within the movement.<\/p>\n\n\n\n

Clive Bates: <\/strong>Yeah.<\/p>\n\n\n\n

Peter Beckett: <\/strong>And you just didn’t have to address them while there was a unified entity.<\/p>\n\n\n\n

Clive Bates: <\/strong>That’s right. I was the director of ASH from 1997 to 2003, and I remember trying to make the case that in the 2001 revision of the directive, we should be trying to lift the ban on snus. It’s obviously successful and much lower risk. There was absolutely no interest in that because it was seen as a big win to get something banned, even if it was a stupid thing to ban.<\/p>\n\n\n\n

Peter Beckett: <\/strong>Should we just ban cigarettes as well, and take them off the market for good?<\/p>\n\n\n\n

Clive Bates: <\/strong>There are people who say that. Some suggest removing all the nicotine from cigarettes, which is essentially a ban on cigarettes because people smoke for the nicotine. The problem is that the demand doesn’t go away. There is a deep and resilient demand for nicotine, and while there is a more fluid demand for any particular way of taking it, that doesn’t mean the demand for cigarettes would go to zero if you banned them.<\/p>\n\n\n\n

Peter Beckett: <\/strong>The demand for cocaine isn’t zero, and yet we’re still happy to keep it illegal. Just because there is demand for something doesn’t mean we should allow it on the market.<\/p>\n\n\n\n

Clive Bates: <\/strong>Well, the question is: what is the market that we’re talking about? There’s the market for nicotine, in which people will move between types of nicotine more easily than they will move from nicotine use to abstinence. But there’s also demand for particular ways of using nicotine, like smoking cigarettes or cigars. That demand doesn’t go to zero just because you ban a product; all the demand for nicotine then flows into these other products. People do like smoking; it gets people in a way that’s different to a vapor or a heated tobacco product. There’s a great guy in Australia called Wayne Hall who refers to this thinking of banning things as “victory by policy masterstroke.” It’s, “we\u2019ll just take the nicotine out of cigarettes” or “we’ll just close down all the retail outlets so no one knows where to buy them,” or “we will just do a generational ban and eventually everything will be banned.” What they never think about are the behavioural reactions. When the EU banned menthol cigarettes, did all the people who like menthol cigarettes just say, “well, that’s it, I will no longer smoke”?<\/p>\n\n\n\n

Clive Bates: <\/strong>No, they turned to menthol cards, mentholation capsules, or even bootleg menthol cigarettes. Unless you think about the behavioural reaction to legislation, you’re going to get in a mess. The problem with the simple idea of banning cigarettes is that you would get in a massive mess. We’ve got proof of concept for this in Australia. As tax gets higher and higher, it starts to look like a form of prohibition because the product is basically unaffordable. In Australia now, the tobacco market is 50 to 60% illegal, despite police, customs, and intelligence services fighting organised crime.<\/p>\n\n\n\n

Peter Beckett: <\/strong>So why did the UK lead on this? You served in government, and the UK did take a leading role initially with the behavioural economics unit, and then a proactive role of encouraging harm reduction. What thinking did they do that other people missed?<\/p>\n\n\n\n

Clive Bates: <\/strong>I think what happened in the UK was a coming together of several influential factors. There was a core of academics who were the proteges of Michael Russell, who understood that nicotine was a relatively benign drug, albeit dependence-forming, but the harms were done primarily by smoking. As Mike Russell famously said, people smoke for the nicotine but die for the tar. Then you’ve got a sensible activist organisation, ASH UK, backed by the Royal College of Physicians. Finally, the Behavioural Insights Unit, or the nudge unit, saw this as the perfect policy. It’s a preventative policy where people reduce their own risk on their own initiative and expense, taking burdens off the NHS.<\/p>\n\n\n\n

Clive Bates: <\/strong>It has a health inequalities dimension. It’s absolutely perfect for a behaviour change, nudge unit kind of thing, because it doesn’t involve any public expenditure\u2014just a realignment of people’s preferences in line with their own health. Perfect. Then there’s a whole bunch of people who are like, “We don’t like the big state.” Here’s some innovation. I think people just basically went with it. There was a backlash in 2013, though initially in 2011, I think the MHRA had tried to shut this down and say that all vapes had to be medical, which would have closed the market completely. Then most of the health groups in 2013 were campaigning for medicalisation through the last Tobacco Products Directive. It wasn’t all plain sailing, but I think they thought they were doing the right thing. They thought this is what would make tobacco harm reduction work. I think you and I both worked on making the case that it would actually be a complete mess if they did that.<\/p>\n\n\n\n

Peter Beckett: <\/strong>Let’s make the case now. Why can’t we have some kind of medical license for these products? What would go wrong in the market?<\/p>\n\n\n\n

Clive Bates: <\/strong>We already have nicotine replacement therapies, and that is what the medical licensing system has thrown up. For products to be medical, there has to be a therapeutic indication like stop smoking, and you have to do clinical trials. You also have to be concerned about so-called abuse liability. The flip side of abuse liability is being an attractive alternative to cigarettes. NRT manufacturers can never make products as pleasurable. You have to use sedate branding for the medicines regulator. It enters the consumer’s perception in a completely different place. Do you conceptualize yourself as a patient with a disorder that needs treatment, or as a consumer who wants to use nicotine in a better way than smoking?<\/p>\n\n\n\n

Peter Beckett: <\/strong>This gets to the heart of the debate. I started smoking at 11, which I now rationalize as a response to childhood ADHD. It was a rational decision for me to continue to use nicotine today, and I like that there’s a licit industry that can sell me products I enjoy using with minimal harm to my health. But we hear, even from people in the industry, that the ideal state is zero nicotine use. I just think that’s wrong.<\/p>\n\n\n\n

Clive Bates: <\/strong>I agree that it’s wrong. I think the industry makes a mistake when they say that. My advice is to explain why there is a demand for this. Anti-nicotine organisations say there is no real demand, only predatory marketing to young people. The reality is quite different. It’s a psychoactive substance, and people like its effects. They find it pleasurable, relaxing, or mood-modulating. For conditions like ADHD, it may be stabilising. Some people get cognitive benefits in terms of memory and concentration. I’m not endorsing it as a substance; I’m saying that’s an explanation of why there is demand. People use it for the hedonistic, cognitive, and sensory effects.<\/p>\n\n\n\n

Peter Beckett: <\/strong>I don’t understand why this argument isn’t made more often. The line has always been that nicotine is always bad if you’re not already using it. I can’t see that as sustainable.<\/p>\n\n\n\n

Clive Bates: <\/strong>No, but look at how we deal with alcohol. The Chief Medical Officer is not going to stand up and say, “Well, that’s something you should use because it makes you feel cool and think you’re funnier,” even though it doesn’t. We have to understand it as a phenomenon in society. People use it because it works for them; it makes them feel better and function better. That is the foundation of the demand. All this stuff about nicotine use going to zero is nonsense. We have to deal with the recognition that there is a realistic demand for this, and it’s quite resilient. Once you accept that, the challenge for public health is how to make it available in an acceptable form that doesn’t trigger a black market response. And that includes new users; teenagers try things that adults do, and some carry on doing it. That should not be a shock; it’s what happens with alcohol.<\/p>\n\n\n\n

Clive Bates: <\/strong>It happens with caffeine and cannabis. We have to be pragmatic in public health and deal with the main harms. Nicotine policy should be all about harm. You can do some prevention work, have age restrictions, and stop gratuitous marketing, but there will still be demand. My hunch is that demand will go up over time because as smoking fades away, the main deterrent to nicotine use\u2014the harm and anti-social aspects\u2014is gone. I’m not worried by that, because the use of nicotine will be so much safer than it was with smoking.<\/p>\n\n\n\n

Peter Beckett: <\/strong>I want to close by thinking about the effect of the nicotine debate on trust in institutions and public figures. In 2016, there was a campaign called Vapers for Britain, which garnered support from people who felt offended that European institutions had labelled them agents of Big Tobacco. There was a feeling that the system was screwing them. Given where we are in the world today, we need trust in institutions.<\/p>\n\n\n\n

Clive Bates: <\/strong>Yeah.<\/p>\n\n\n\n

Peter Beckett: <\/strong>And I realized I’ve massively led you on with this build up. But is there a risk that the nature of this debate is leading to even more populism? <\/p>\n\n\n\n

Clive Bates: <\/strong>I think, look, there are 94 million people who smoke\u2014roughly one in five adults in the EU\u2014and maybe 20 million or more who use alternatives. That is a huge number of adults who have life-and-death health decisions wrapped up in EU policy. Most are unaware or disinterested, but for the EU to approach those adults with contempt for their welfare, using rhetorical gambits from pressure groups in the Brussels “hive mind,” is despicable. In the end, there will be a price to pay. We’ve seen the Health Commissioner saying that vaping, pouches, and heated tobacco products have comparable risks to smoking. It couldn’t be more ridiculous. He’s the top official in Europe’s main regulatory body. If that is the standard of reasoning, science, and argument, what are people to make of that?<\/p>\n\n\n\n

Clive Bates: <\/strong>[00:24:18] And I noticed that not one of the Brussels anti-vaping or anti-smoking organisations has bothered to correct him. They’re quite happy to have that misinformation out there. In the end, there will be a fracture, a breach of trust. People will ask why they are in this organisation, voting for people who are taking away the products that keep them healthy and safe. Why be exposed to dodgy underworld characters now supplying the products they want? It plays into the populist narrative, giving wind to the sails of people like Orb\u00e1n or the Slovaks. It doesn’t help the EU maintain a sense of professionalism and integrity, which is exactly what they need right now.<\/p>\n\n\n\n

Peter Beckett: <\/strong>Thank you very much.<\/p>\n\n\n\n

Clive Bates: <\/strong>Pleasure, Peter. Thank you.<\/p>\n

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