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Few things are as emotional as nicotine.

In the four years since our last movie about smoking,

things have gotten even more serious.

As new technologies advance

some countries see fewer people smoking,

but now find teens using nicotine in new ways.

Panic has ensued.

- As of today we're declaring a war on vaping.

One teen in Vancouver had a disease

that affected his brain.

He was rushed to the hospital when he passed out.

They sent him home without a brain scan,

because it was suspected he used nicotine.

He died the next day from a disease related stroke.

The autopsy showed no nicotine in his system.

While they reported vaping deaths were blamed

on nicotine for months.

People continued to buy tainted marijuana cartridges

and kept dying.

Some law enforcement agencies even began prosecuting

young people for nicotine possession.

- Prosecuted criminally.

- Many people who used nicotine vapor technology

to quit, switched back to cigarettes.

People need answers.

I used to think I knew nicotine.

Ever since my friend died years ago from lung cancer

after a lifetime of smoking cigarettes,

I dedicated a large chunk of my life

to helping reduce smoking related death and disease

around the world.

I tried to ban smoking

at the 100 bed medical facility I ran,

despite protests from the residents and staff.

I made a movie drawing attention

to the projected 1 billion lives that will be affected

by smoking this century.

Because of this, I was invited to the board

of the National Tobacco Reform Initiative

with current or retired leaders

of the American Cancer Society, Truth Initiative, Harvard,

American Heart Association and other anti-smoking groups.

I investigated smoking trends in 13 countries

for a series with the foundation for a smoke-free world.

Many of our Kickstarter backers lost loved ones to smoking.

The stories are heartbreaking.

Sadly, against our best efforts,

smoking cigarettes is on the rise worldwide.

The main reason is nicotine.

In addition, new nicotine products are gaining traction

in developed countries.

As we began this project a massive wave

of nicotine headlines swept across many parts of the world.

The headlines were alarming,

so we went on the hunt for truth.

What we found shocked us.

At first, we were angry, then we were sad.

The truth became unbelievable.

We had this unsettling feeling

that there was something deeper here.

We wanted to know nicotine.

What were the dangers of it outside of cigarettes,

and why do so many people want to use it?

We know why people use other drugs like caffeine,

alcohol, and opioids.

Nicotine was named after the French explorer Jean Nicot

in the 1500s after he began promoting nicotine

for its claimed medicinal properties.

So we went to France to the home region

of a nicotine expert we met years ago

while learning why people smoke.

Let's start at the beginning.

- Nicotine is a long story.

Most of my career which is basically only on nicotine.

I started with my PhD thesis,

and I've been working in nicotine since.

It's been with humans for more than 8,000 years.

I mean, it's was used by shaman in South America

and in North America as well.

- Jacques told us that tobacco

was the first plant discovered that produce nicotine.

By the mid 1800s,

most people simply smoked it

through pipes or cigars.

That is until 1880,

when the cigarette rolling machine was invented.

Trillions of cigarettes would be mass produced.

In 1962,

the world's most prestigious medical research group,

the Royal College of Physicians

issued an alarming report claiming that smoking was harmful.

Initially, the report was met with a hostile reaction

from governments, cigarette companies,

the media, and society.

Two years later, the US Surgeon General join the British

in sounding the alarm.

Once the public finally believed

that cigarettes cause death and disease,

a fierce war against smoking began.

The campaign for Tobacco-Free Kids started

with a grant from the pharmaceutical industry

and rapidly expanded

once their leader successfully negotiated truce

with Big Tobacco.

To date, US states have received nearly

a quarter trillion dollars in payments

from the cigarette industry that were tied directly

to cigarette sales.

Michael Bloomberg gave a billion dollars

to fund anti-smoking groups around the world.

Smoking would never be the same.

- For more than 30 years in every anti-tobacco campaign,

because we want people to quit smoking,

nicotine was the culprit instead of smoke.

- Just try one if you don't like it, it's easy to give up.

- Oh-oh Nick O'Teen I better move fast.

- Kids know far too much.

- You no good windbag nicotine.

- No, no, superman.

- Thanks.

- So every smoker has fear against nicotine,

'cause nicotine is seen as the devil.

- I always thought nicotine was a toxic chemical invented

and added by the big cigarette companies

to get people hooked on cigarettes.

During a research for this movie,

I learned that nicotine is produced by a variety of plants,

for example, tomatoes, potatoes, eggplants,

and bell peppers.

It was an interesting conversation

when I had to tell my wife, Jenny,

that we were growing nicotine in the garden,

and serving it to our kids.

After talking with Jacques,

we visited tobacco seed farm to learn from their experts.

- All the seed bags are sealed and classified by order.

Okay.

- Everything has a coding number,

and I don't know if you've ever seen tobacco seeds,

naked tobacco seeds, - No, I've never seen.

- But it's very very small,

very tiny seeds. - Oh, those are very small.

- Here it's our greenhouse.

First we are growing the plantlets for artificial test

for pathology that you've seen in other little greenhouses.

We will look for some flowers,

so here you see the seeds come from here.

- Oh wow.

- So here's the seeds, they are maturated seeds

ready to be harvested. - Oh yeah.

A lot of people don't understand

why does the plant make nicotine.

Do you know, is nicotine have a purpose in the plant?

- Nicotine is used as an insecticides,

and it's the same in tobacco.

It's a way of defending itself.

So nicotine is produced by the root system,

and each time that the plant is stressed

by the weather condition,

by an attack of disease,

or for example cutting the flowers as we saw

in the fields,

it stresses the plants,

and the roots start to create more nicotine.

There is also a difference between varieties,

for example, we breed varieties

for low nicotine amounts for shisha,

that we breed also nicotine for plants

for high nicotine levels for E liquids or Snus.

After we learned about the plants,

we wanted to see a farm where these seeds were grown.

I pictured a giant tobacco operation with armed guards

and hidden secrets.

I was a bit nervous.

However, once we arrived at the 300 year old village

and met the family,

I immediately felt at ease.

The oldest daughter was taking over the family farm

and offered to give me a tour.

This wasn't what I expected at all.

- Here it is a very little- - Your babies.

- It is very little babies.

One day old, two days old.

- Oh, really new, oh.

As someone who spent part of my summers working

on grandpa's farm,

it was easy to get caught up in the beauty.

This felt very natural.

However, it was sobering to remember

that the main way people get nicotine

is by burning tobacco plants and cigarettes.

I was reminded of my friend who smoked until he died

from lung cancer.

This is serious.

A midsize company nearby that processes these plants

into nicotine for vapor liquids,

offered to show us how they create new kinds

of nicotine products.

The kind you see in the headlines every week.

We wanted to see this process for ourselves.

- So welcome to our process of production of nicotine.

We have a French tobacco from Dordogne.

Their lead scientist explained

that once the leaves from the farm we visited

are dried and burnt,

they get boxed and shipped to the processing center

where their ground up, mashed, and steamed

in these large machines.

What's left is the condensed nicotine water

that runs through the pipes to the next area after cooling.

- Aaron, you have seen the extraction process.

Now, I will show you her purification process.

In the purification lab,

he explained to me how they bind another molecule

to the nicotine water so it can be filtered.

Then it travels through a complex system of pipes

and glass vessels as they extract the pure nicotine.

This liquid form of nicotine is similar

to what's used in nicotine patches, gums,

and in recent years, vapor liquid.

Now we were getting somewhere.

In a nearby area they were testing their liquids

for government compliance with all the people in white coats

and their high-tech lab equipment.

This felt very different from the farms.

When I first heard about nicotine vapor technology

five years ago,

I saw a ton of posts about anti-freeze,

toxic metals, cancer causing chemicals and more.

Kind of scary.

Most of the public still has no idea

what's in the vapor liquids

50 million people are using worldwide.

This was the chance to find out firsthand.

While inspecting the production process,

they showed us how they add varying strengths of nicotine

into a blend of pharmaceutical grade propylene glycol

and vegetable glycerin that allows the nicotine

to be heated into a vapor.

They also add flavoring because the base liquid has little

or no taste.

At the same time we were in France,

new campaigns were launching in the US

to respond to the growing use of nicotine by young people.

We wanted to learn about this new crisis

from the people on the front lines.

It was time to head home.

- Ever since we were really young,

our parents have always told us that smoking

and tobacco is really bad for your body.

And both of us have asthma,

so we know how scary it is when you can't breathe,

but in the past few years we've noticed

that smoking isn't the problem, it's vaping.

Kids in our high school are vaping in the bathrooms

and some are even vaping in class.

- I actually had a teacher that would let us vape

in the classroom.

He would act like he didn't see it.

And there's been times where security guards

just act like they don't see it.

- One day when we were walking in the mall we saw,

but a group of teens just vaping

exhaling this huge cloud of smoke.

And we didn't know about it at first,

so we did our research and we found out

it was what kind of things are-

- Chemicals they use-

- Were kind of chemicals it releases into your body

and not just themselves but to others.

- After seeing how much vaping how big a problem was,

we started researching it

for the 2019 Student NPR Pockets challenge,

and no one knew the consequences,

and that's how we started our journey

to spread awareness and educate others

on the harmful effects of vaping.

- What do you know about vaping?

- That it's very addictive

and a lot of teens do it these days.

- I know about it that it was made

to help people stop smoking,

but then when they like if people just kept on using it

as kind of a substitute,

and then it became equally like kind of equally as bad.

- People probably stop smoking

to go to the vaping 'cause maybe they thought

that it wasn't that maybe,

'cause you get really addicted to it.

- But it's actually the same.

- Do any of you know anything about nicotine

that you could tell me?

- Really addictive,

and I feel like you think that people do it,

because you think you're not gonna get addicted to it,

and then you end up getting addicted to it.

- And you also think nothing bad will happen.

- Yeah, and then-

- But then bad stuff does happen.

As the dad of a teenager,

I naturally get alarmed hearing

about bad things happening to kids.

We headed east to spend time with a group of concerned moms

that were banding together to protect their children.

- He thought it kind of helped with some anxiety.

It was making everything just a little bit worse,

and he got caught in school Juuling.

He lost his captainship and was suspended his senior year.

And I think it was then that everything kind of came

to our head so to speak,

and that we determined that there was a problem,

and then having other parents reach out,

saying that they feel kind of in the same boat,

they don't know what to do,

or how to get their child help.

- Teens are already dealing with so much

that to then add this addictive element.

Nicotine is a game changer.

It's been a game changer for this epidemic.

It was a game changer,

when they launched cigarettes, camel launched,

and then it was a game changer when menthol was introduced

and this 100% re-introducing nicotine to kids, game changer.

I mean, that there's no other way really to put it.

I found a great group of people

who are equally passionate about doing the right thing

for our kids, and getting nicotine out of the hands of them.

After seeing Caleb's experience with e-cigarettes,

his mother Meredith Berkman co-founded

Parents Against Vaping E-cigarettes, or PAVe.

- We're an army of parents,

and if I refer to myself as a mom of a kid,

we're an army of motivated mom for kids

who are not going to allow our kids

to become a generation of nicotine addicts.

- Emotions were running high all over the country,

social media was full of nasty arguments and half truths,

both for and against nicotine,

both sides were attacking us.

To gain deeper understanding of the issue,

we met the grandfather of nicotine science,

Dr. Neal Benowitz.

- Clearly, there is a huge upswing

in e-cigarette use among youth.

Some people say that in some schools 30% of kids

have used e-cigarettes in the last month.

They're finding pods all over the parking lots

in the high schools,

so there's no question

that e-cigarettes are being widely used.

We also know that some people are using it all day long

even in school,

and that is a huge concern.

What we don't know is whether this is a fad,

or this is the beginning

of what's called primary nicotine addiction

which is not addiction to cigarettes,

but sort of addiction to nicotine per se.

If that's the case that would be pretty new

because there's never been an addiction

to nicotine without tobacco in the past.

Sweden has been fighting a teen nicotine crisis

for more than 50 years.

Almost one out of five young Swedish men

use an oral tobacco product called Snus.

We went to Sweden to learn more

and meet another great pioneer

in the field, Dr. Karl Faegerstrom.

He's famous for his groundbreaking nicotine research.

They even named the nicotine dependence test after him.

His work has been cited in over 22,000 scientific papers.

- We have done what's not part of any of the two world wars.

Where cigarettes were really dispensed

and given away free of charge to soldiers

to get them to fight,

to get them to get some order

of their anxiety, and fear et cetera.

One particular tobacco product

that they call Snus which is a smokeless tobacco product,

low in nitrosamines survived in Sweden.

So if we are talking about the '60s when the harms

from smoking started to become strong,

and no one and advertise that smoking is very harmful.

Then this product Snus was on the market,

and some understood in some way without really being told

or that there was evidence around

that may be that is less harmful,

and it started as a smoking cessation thing.

In the turn of the century we had around 21%

of male using Snus.

Now we have 80 and something

and five, 6% smoking cigarettes.

During this time which is 40, 50 years you can then look

at cancer because they don't develop overnight,

the cancers if you start to smoke,

so we can see it and the full effect of switching

to a much less harmful product.

What is the attitude by not only the public

which I would love to hear,

but also the tobacco control folks here in Sweden?

- They are very troubled by young people using Snus

and starting on Snus.

What's your personal feelings on that?

Is it worth it to save the kids from nicotine,

if the smokers, existing smokers are dying?

- This is really a very difficult thing to talk about,

because it gets so emotional also when you talk about kids,

and I'm afraid that there are people that find it so hard

to see only one kid getting addicted on nicotine,

so therefore they would deny

for example, electronic cigarettes to be on the market.

But on the other hand then you have thousands

and maybe millions of adult smokers that are not close

to dying yet but are in the 20s and 30s,

that could benefit from electronic cigarettes,

and how many saved lives there

do you need to have to measure up with one addicted kid?

And this is more emotional than mathematical

and scientific,

but I do think we need to try to wrestle reasonably

with that problem and not just throw it.

I don't want any kid to be addicted you see.

It's a superficial argument when you don't put

or see the whole spectrum of the problem.

- With lives on the line,

we wanted to avoid superficial arguments

and listen deeply to all sides.

People generally know the dangers of smoking,

but we wanted to know the dangers of nicotine itself.

We hadn't gotten very far.

It was time to dig deeper.

Are there certain go-to researchers that you recommend?

- So Stan Glantz out in California,

leading expert.

- Dr. Stanton Glantz, he works in San Francisco,

and he's dedicated most of his life's work to vaping.

- Our next step was San Francisco,

the epicenter of the teen vaping crisis.

We had heard a lot about Dr. Glantz from the students,

parents and news media.

He's a recognized leader around the world.

His work has been cited more than 29,000 times

in scientific papers.

We were hoping to finally learn more about the dangers.

- Most of my work originally was around secondhand smoke.

Few had come to me in 1978 when I started getting involved

in this issue, and said, you know,

smoke free bars would be something

that everybody takes for granted.

Smoke free beaches would be something everybody takes

for granted.

I would have thought you were completely out of your mind.

And so the whole social environment surrounding smoking

and tobacco use has really changed

rather than being a social plus

it has become a social negative,

and that's why people have been quitting.

Well, one of the things I used to enjoy telling people

is you know, some of that stank

is the nicotine settling out of your clothes,

but others is like you breathing it in and sweating it out,

so if you do that you'll often notice

that your underwear smells worse than your outerwear.

Well, thankfully I don't really do much smoking.

- Yeah, well, that's a good thing.

- Can tell us a little bit about "The Tobacco Papers",

obviously, the library, you're famous

for that whole exposé type thing

can you just tell a little bit about how did that happen,

and kinda what was your work with that whole thing?

- One day May 12th, 1994, a box of documents ended up

on my desk.

And it was about four or 5,000 pages

of internal industry documents.

And it was really the first consistent view

behind the curtain inside the tobacco industry.

- We were at a meeting with a bunch of moms

who are in the PAVe group,

I don't know if you're familiar

with Parents Against Vaping E-cigarettes.

So we just got done with that, those meetings last week,

and then got a chance to come over here.

Can you kind of explain to the general public,

what are the dangers of nicotine

and what should parents and teachers know about it?

- Well, the biggest danger of nicotine is an addictive drug,

it changes your brain.

And one of the things that's particularly bad

about this for kids at the same time

that your brain is wiring itself up into the adult brain,

you're putting chemicals in there

that are screwing up the way those connections

are being made.

And that's why the earlier a kid starts smoking or vaping,

the more likely they're gonna be getting that addicted,

the more heavily they're gonna use the product

in the long run.

I mean, we don't know that for e-cigarettes for sure yet

those are too new.

So the most obvious problem with nicotine

is that it's an addictive drug.

But nicotine does a lot of other bad things,

it's probably not the worst thing in cigarettes,

and nicotine hasn't been identified as causing cancer,

and one thing I find that you know, teenagers,

and college students are interested in cigarettes,

and e-cigarettes are kinda like "Anti-Viagra".

What happens in erectile dysfunction,

you don't get enough vasodilation,

blood vessels getting bigger in your penis

to get an erection.

And what the erectile dysfunction drugs do

is they stimulate nitric oxide synthase,

so you get the vasodilation so the arteries can't get engorged.

- Well, that was not at all what we were expecting.

Since Dr. Glantz told us

that addiction is the biggest danger of nicotine,

we went to Hollywood to meet a famous nicotine addict,

YouTuber, Grim Green.

Would you call yourself a nicotine addict?

- Sure, I mean, I'm sure that I'm addicted to it,

enthusiast, maybe is what I would say.

And I think there's a different level,

there's certainly a different level of addiction

between being addicted to nicotine,

and being addicted to heroin.

- What would be the downside of using nicotine

for most of a person's life?

You've done it,

so I mean, for you, what kind of side effects

are you noticing from using nicotine?

- Not really, I mean, not side effects,

like physical side effects,

maybe some mental side effects where I'm trying

to do something, or be creative, or remember a thing,

and I'll vape, and nicotine helps me focus

on things like that,

but I mean, certainly not physical side effects,

like physical symptoms of prolonged nicotine use

or addiction, or anything like that.

I mean, there are those times

where sure maybe I haven't had nicotine in like six hours,

and I go, all right, that feeling

of being addicted to something where you need

to have this nicotine like,

"If I don't get some nicotine soon,

I'm gonna be in a real cranky mood."

That is a weird feeling to have your whole life constantly,

"Where's my vape?

where's my thing?

Where's my vape?

Is my vape?

Where is it?

Is okay?

I have it, I have it."

And when you have it you feel safe,

like being tied to something like that.

Maybe is a downside, but in the grand scheme of things,

how big of a deal is that?

Are we upset about addiction

just for addiction sake regardless of the harm?

I feel the best I've ever felt in my life.

And I know that if I had continued smoking this whole time

at 42 I wouldn't feel this awesome.

- So some people might say,

"Oh, you're just saying that because you're involved

in the industry."

I mean, any thoughts on that?

- Yeah, I mean, I am involved in the industry.

I wasn't always involved in this industry

for the first, probably six years of being a vapor

and being on YouTube,

I had a full-time job,

and this was really just a hobby,

and I was putting information out there,

and we would talk about legislation

that was happening and trying to be as informed as possible.

And I didn't make any money on youtube for like, six years,

six years of just information,

and trying to build an audience and doing it just to do it.

- Pretty and-

- I feel like that's pretty grassroots activism right there.

My stake in all of this is that I think everybody

should be able to quit smoking the same way I did,

and it's crazy to me that there's people trying

to prevent that from happening.

- They don't call it wrestling with the facts for nothing.

Now, we needed a referee.

While watching one of the US congressional hearings

about this topic,

we heard a neutral sounding scientists

give straightforward answers to the members of Congress,

- Dr. Raymond Niaura

of the Department of Social and Behavioral Sciences

of the College of Global Public Health

at New York University.

He was once the chief scientist

at the Truth Initiative,

and was cited in over 25,000 scientific papers.

We were off to New York.

What does it do to the user?

- Well, it's been described as a mild stimulant,

and that's true,

so when people use it,

their heart rate will increase a little bit,

their blood pressure may increase a little bit,

they become a little bit more alert,

but what's going on in the brain?

And it's only in about the past, 10 or 15 years

where I think we were finally getting a more clear picture

with neuroimaging studies,

and those sorts of studies where we get some insight

into what nicotine is doing.

There's something called the default mode network

of the brain which sounds fancy,

but all it means is what does your brain do

when you're sitting around

and not doing anything in particular.

It's not inactive.

In fact, it's tremendously active.

For most people their minds are darting around,

and kinda thinking about a bazillion things,

but the thoughts tend to be turned inward.

You're thinking about this or that,

or what I have to do tomorrow or a million things.

So what does nicotine do to the default mode network?

It calms it down.

So it takes all the internal chatter,

and it ratchets it down a few notches.

So that's fascinating, right on its own,

and you hear a lot of smokers tell you,

"Well, cigarettes help me to relax,

they make me feel more calm,

they make me feel like I'm better able to deal with stress."

And maybe that's part of the reason

because the internal chatter gets ratcheted down.

That ratcheting down at the same time,

leaves more cognitive capacity for you

to be actually pay attention to certain things,

or remember certain things.

So you're getting two things out of nicotine;

one is the internal chatter goes down,

and two, you get a real pick up in terms of your ability

to pay attention to things,

and direct your attention and focus.

Generally speaking that would be surely a good reason

to wanna use it.

But I also think that some people benefit more

or maybe more sensitive to its effects,

so that for some people those effects are really profound,

and almost to the point where they can't live without it.

And maybe that's where we're seeing a link

to use it on people who have mental illnesses

and so forth,

that they're really relying on this drug

to do certain things to help with their thinking literally.

He said, "They can't live without it."

If that's true,

then that would represent a major shift

in understanding, becoming a human rights issue.

We have read that up to 90% of people

with certain mental illnesses are using nicotine daily.

Could this be part of that puzzle?

Could there be benefits?

We promise not to seek doubt but chase truth.

This was a point of no return.

At NYU there was another renowned clinical psychologist

and professor named Dr. David Abrams,

who is the former director of the Office

of Behavioral and Social Sciences Research

at the National Institutes of Health.

He was also the founding executive director

at the Schroeder National Institute of Tobacco Research.

In addition to these prestigious positions,

he also wrote some of the first papers cautioning

against the use of nicotine vapor technology.

I asked him what makes nicotine so addictive

for young adults.

- What's been missed is that maybe teens

who are attracted to nicotine,

and then find that they can't stop using it,

may well be improving their concentration, their memory,

and it's got similar chemicals in the nicotine to the drugs

that help prevent attention deficit hyperactivity disorder

that help with mood stabilization,

and improve concentration, and attention focus,

as well as alertness as opposed to the thrill

or reward that we attribute

to things like heroin or cocaine.

So nicotine is not a big reward drug compared

to heroin, cocaine, or the worst of all methamphetamine,

but it does help your brain feel good and work better.

Nicotine may be a good drug for some people as a medicine.

And we haven't been as open to that as we should be,

because again, it was previously demonized

by being coupled with toxic smoke,

but whether it's an FDA approved gum, patch, or lozenge,

or a vape product,

we know that nicotine can be used as a medication.

Medicinal nicotine.

we were definitely in unfamiliar territory.

We were reminded of something Dr. Neal Benowitz told us

when we met earlier.

Now that new technology allows for nicotine

to be separated from deadly smoke consumption,

he too agree that more digging was needed

to understand nicotine's effects.

- Smoking which has been the first concern

is so confounded with social, cultural,

environmental factors,

so in most cases cigarette smokers

are already risk takers,

and they already do less well in school

than non-smokers in general.

So it's very difficult to establish

that there's any difference in smokers compared

to non-smokers that is nicotine related,

because of other confounding factors.

If you look at adult smokers,

if they quit smoking, there's no evidence

that there's permanent brain damage.

Now, interestingly, with electronic cigarettes

it provides not only the concern,

but also the possibility scientifically to look at this.

Because now when we step back e-cigarette use in adolescence

in the beginning was mostly by cigarette smokers,

and therefore was the same as looking at cigarette smoking.

Nowadays, at least in the US there's a difference.

Now, many of the kids are using e-cigarettes

have no desire to smoke cigarettes,

they think cigarettes are bad,

it's not cool,

but e-cigarette use is.

They're more affluent people,

they have much lower risk factors,

better academic performance,

and this is something I think is an important area

of research to try to find out is there an impact.

We searched long and hard

for who was doing the most new research

about nicotine in the brain,

who didn't have a background in tobacco research.

It seemed like the history of nicotine being coupled

with cigarettes was influencing the science.

We found a scientist at Vanderbilt University

who was conducting the biggest study ever

about nicotine in the brain called the Mind Study.

We went to meet him at his laboratory.

- After my army obligation was done

I came back to the National Institutes of Health

and did a postdoctoral research fellowship there.

And I joined this great group of guys

that were all working on Alzheimer's disease.

This guy was working on one aspect,

and that guy was working on another aspect

of this system in the brain that we were very interested

in at that time.

And nobody was looking at the nicotinic system,

and I thought, "Well, there's a niche for me,"

But turns out that these nicotinic receptors

in the brain turn out to be really important,

really important for development,

and for normal brain function.

Long before there is gum, or patches, or anything,

there was just cigarettes.

And so basically, I bought nicotine from a chemical company,

and we made it into a pharmaceutical at the NIH,

and we had to give it intravenously,

'cause that was the only way it could be given

in those days.

And actually, it was Neal Benowitz was the only other person

that had done that.

So I remember e-mail, or this is even before e-mail,

I may have called Neal,

and I said, "How do I do this?"

And he said, "Well, I'll send you my recipe."

So he sent me his recipe,

and we made it at the NIH Clinical Center

in about 1984 or 85,

and we took it to the FDA,

and they said, "Sure."

We proved that it was safe to administer nicotine

to non-smoking older adults with memory loss,

and that there were no adverse effects.

We saw a little bit of weight loss,

not surprising nicotine is an appetite suppressant.

People's blood pressure actually went down, not up,

but it did not produce the cardiovascular side effects

that everyone thought it would,

and so it appears smoking is very different

from nicotine by itself.

And that was sort of what launched this long journey

to try to figure out

if we can make something useful out of nicotine.

There was a guy at Georgetown named Ken Keller,

and Ken who's still there, still kicking.

Ken had what been one of the first people to identify

that Alzheimer's disease patients lost nicotinic receptors

in the brain.

And that was about the same time

that I suggested independently

that we could maybe stimulate those receptors.

People who are taking nicotine

actually increase the number of receptors they have

in their brain.

We wanna take advantage of that

to see if we can use that therapeutically.

In the early 2000s I came up with a crazy idea

with two other colleagues, Ken Caldeira at Georgetown,

and Ed Levin at Duke.

We got a grant funded to do a small trial with patients

with mild memory loss.

It had positive results.

This first study was so important

that a massive new grant was approved

to continue this research.

In 2018,

Alzheimer's became a trillion dollar disease worldwide,

and every three seconds someone is diagnosed

with this tragic disease.

Dr. Newhouse's first study showed that nicotine

could improve the memory of those with MCI,

a precursor to Alzheimer's.

On a personal note,

Jenny and I have had loved ones forget our names.

It's one of the saddest things I've ever experienced.

Living with someone who can't remember their favorite song,

or the names of their children is devastating.

This felt big.

A deep dive into the peer reviewed scientific literature

shows that nicotine outside of cigarettes

can have positive effects on depression,

high blood pressure, brain function,

obesity, Parkinson's, and a variety of other issues,

including Tourette syndrome

which affects up to 10% of children.

- My daughter was diagnosed with Tourette Syndrome

when she was six.

To watch our child having these uncontrollable tics

it's painful to watch.

These movements or this breathing.

it's terrifying for you as a parent.

- We saw our daughter really suffer.

She suffered, she would scratch herself bloody,

and she just couldn't stop,

and she would cry because it hurt,

and we watched her suffer like that.

- And it was Christmas, two years ago,

and her tics were so unbelievably bad

that I panicked and so I started hitting Google

just trying it was actually at night,

and I was panicking.

And in Google I found this one tiny little story

about a study they did at the late '90s

where they tried using a seven milligram nicotine patch

on children with Tourette's.

The study said, "All of the children reduce

their Tourette's by half."

So I said I'm going to buy a patch right now,

and I went to the store and I said,

"We'll put it on her in the morning."

And my sister-in-law actually found a German version

of the story which went into more detail,

and they said use the patch at night.

- I had a choice to make to watch her suffer like this,

or to put a little patch on her.

- So we put on the patch,

and the next morning there were no tics.

It was almost that instantaneous.

- Yes. - When a child realizes

is that other people notice their tics-

- And watch them.

- And now they're aware- - They laugh.

- That their classmates are watching

and this nicotine patch,

I mean in 24 hours remarkedly different.

And then over time as they got less and less

nobody noticed in class anymore,

nobody asked, "Why do you keep making these noises

that are bothering everybody?"

- And she completely came out of her shell.

It very simply made her life easier,

a hundred times easier.

She's socializing, she has friends.

She didn't socialize before,

she was embarrassed and afraid to go out to meet kids,

have a slumber party to sleep over at other kids houses.

- Just recently, my daughter looked at me and she said,

"You know, I'm not using the patch anymore."

She says, "My tics are almost gone.

I didn't need it,

so I stopped wearing it."

And all those things you think like me as a parent

I would have thought," Oh, I need to wean her off

of this patch we need to go slow."

But she says, "I've been off it for two weeks."

I said, "Did you notice anything?"

She says, "No, I just stopped wearing it.

I didn't feel anything, no withdrawal symptoms

or anything crazy like that."

And she used the patch and and it worked for her.

Nicotine gave us our daughter back.

- We're doing a lot more with nicotinic stuff

than just what I've told you.

So I guess that we're investigating

in late life depression,

we're invest as a potential adjunct to antidepressants,

MCI, early Alzheimer's disease, HIV, Down syndrome.

patients with cancer chemotherapy,

other cognitive problems that occur subsequent

to medical treatment or to other diseases.

- Nicotine. - Nicotine, yeah.

So nicotine increases brain function

for millions of people around the world.

Switching from cigarettes to a safer delivery method

for taking nicotine was estimated

to reduce hundreds of millions of early deaths this century.

We calculated the potential lives impacted

with all these medical conditions, not just cancer,

but Alzheimer's, obesity, anxiety, depression,

the number was over 2 billion.

Nicotine has benefits for people.

Why is this conversation shrouded in doubt?

Why are these people subjected to shame?

How can we pretend that this is not a human rights issue?

Our first reaction to this realization was fear.

Would anybody believe us?

Will this film be called Pro-smoking Propaganda?

It was a lot to take in.

Nobody wants to be called crazy.

With billions of dollars being spent by activists each year

to stigmatize people who use nicotine,

it was clear that there was a war ahead.

Why would anyone use nicotine medicinally,

if they're afraid of it,

or bullied for using it.

Looking ahead we saw three big battles on the horizon,

but the frantic pace of most people's lives

much of the public relies on their health leaders

to help them.

Whenever new evidence appears,

the Public Health Committee often move slowly.

The first big obstacle to better health is usually pride.

Any benefits to nicotine?

- No.

- There's deep deep mistrust and a bordering

on hatred of the tobacco industry

which has been deceitful, and lied to people, and killed.

And just like the song by The Who,

"Won't Get Fooled Again."

- FDA invited me to a meeting a few years ago

to talk about this data.

And I remember getting up there

and showing this blood pressure data,

and showed, sounds like a good anti-hypertensive.

And this woman who's an internist, who's on the panel said,

"Well, I just don't believe this data."

And I said, "Well, I'm sorry, it's the data,

you can believe it or not,

but I'm just showing you what the data is actually."

- Like many people when the first appearance

of e-cigarettes occurred around 2007 in the United States,

we didn't have a lot of science.

And as a scientist I actually published two early articles

and did one of the very first scientific studies

of the toxicants in e-cigarettes.

And all of that told me that we didn't know enough

to know how much harm there was,

whether they were really less harmful

than burning cigarettes,

and so I took a stance of conservativism,

and I said, these could have a potential.

I said, they have promise and there's peril,

but until we know more they should be taken off

the market completely,

and only when the science shows

that they are safe and effective should we put them back

on the market.

The science actually in the last two or three years

has become incredibly strong,

and there's now a consensus on that.

So I changed my mind and it was the science that drove me

to change my mind, nothing else

in order to use the science to see how we can thread

that moving needle to save more lives more quickly

than we've been able to do so far.

But it's a long haul.

What keeps you going?

- Well,

we're winning.

If you go back and look at this battle

you have this rich, powerful, unscrupulous industry,

and a relatively ragtag group of rebels has taken it down.

- Many of the anti-tobacco people I think their fight

isn't fight with the harmful effects of smoking.

It's more to get down the tobacco industry,

that's the goal.

- Suddenly, we had a new technology

that disrupted that and said,

"We can deliver nicotine in a satisfying way

that doesn't kill you."

- You hear these arguments made all the time.

It's like, "Well, are you gonna ban coffee?

Are you gonna ban chocolate?"

You know they say there's nothing wrong with nicotine,

it's just another harmless drug.

And unfortunately, even the FDA,

sometimes you hear them saying it

which I think is very irresponsible.

I know you get a lot of trolls too.

- I know, I know.

- And they're throwing a lot of stuff at us,

like Royal College of Physicians.

I mean, they seem to be sort of governmental,

I mean, what do you say about that?

- Well, the Royal College of Physicians,

I don't know if you know the old science fiction movie,

"Invasion of the Body Snatchers"

where people's bodies got taken over by aliens.

I mean, that's how I look at England and e-cigarettes.

- They get you when you sleep.

Sit up.

"Invasion of the Body Snatchers."

- If it's not showing a four,

that's a nonsmoker reading.

Nonsmoker usually-

- Ina uses an e-cigarette.

The test is overseen by Professor Peter Hayak.

- Many people out there saying that nicotine itself

is a dangerous poison,

but if nicotine is taken without the accompanying toxicants,

then the health effects would be very similar

to drinking coffee.

- They haven't seen any evidence

of e-cigarettes causing cancer or these other diseases.

- We produced a practical document for midwives,

and crucially, if you see the age of the organizations

that have endorsed it here,

we also have the Royal College Of Midwives.

Can I use an e-cigarette to help me quit smoking?

The answer is yes and explains why.

Is it okay for others to use e-cigarettes around me?

The answer is yes.

We just tried to be very clear.

- It's not dangerous to be near someone

who's using an electronic cigarette.

There's really no evidence and actually very little reason

to believe that it's gonna re-normalize smoking,

so what's the problem?

- And I have a lot of friends over there,

people I've worked with for a long time,

who just are in love with e-cigarettes,

people with long credentials of working,

doing good work on tobacco.

- It's very hard to change one's mind

when for 30 or 40 years you've believed one set of facts,

and pride yourself in having made recommendations

based on that and then you begin to see a big change.

- And one of the things that's to me as an academic

who's old,

is very gratifying

as I've seen all this before.

Health groups are kind of scurrying around trying

to get their act together.

But I've seen this before,

I'm confident with the health groups

and people like me will.

- There is ego involved,

and it's hard to admit

that something is changing so radically.

And I still struggle with that,

because my brain is wired to think all the old things

that I've thought for 40 years.

- I mean, I just continue to be totally befuddled.

- And you scratch your head,

and the first reaction I think is I wanna be conservative,

I'm not convinced that this new science is real.

- It becomes part of your self-identity and self-worth,

people look up to you, whatever,

all of that, it's all in play.

- My friends who have their midlife crisis,

it's like, "Oh, my God, I've turned 50,"

which seems a long time ago to me,

and "Oh, my God, what have I done with my life?"

Well, I don't feel that way,

I mean, you look around the world.

It's a different place because of the work people

like me have done,

and it's very satisfying.

We're winning.

- The second big obstacle

to helping people understand the risks

and benefits of nicotine is misinformation.

Once people and the media get talking points from leaders,

it's very hard to change their opinion.

We asked people around the world

what they thought about nicotine.

Their answers were not surprising.

We are doing a documentary about nicotine

that's called "You Don't Know Nicotine."

What do you know about nicotine?

- I know it's not very good for your health.

- Very addictive.

I wouldn't recommend it.

- It ruins you.

- It's in cigarettes and it's not healthy for you.

- What do you know about it?

- Not much I guess.

- That works for the name of it.

- It's supposed to be bad for you, right?

We were curious what elected officials

were being told by traditional health leaders

about safer ways to take nicotine.

We learned about a hearing that was happening

in the Montana legislature

before they voted on a law

to ban certain clean nicotine devices

anywhere smoking was banned.

So we packed up our gear and drove 21 hours to Montana.

Just as we arrived we got word

that the hearing was canceled.

We were contacted by one of the local shops

that sells nicotine vapor devices.

They had some surprising information.

- Sidney, Frederick you're ready? - Yeah.

All right, let's go.

Total crisis.

- Yeah, what happened on that?

- They were trying to say in the community,

well of course all health care people were up there

just happy, big shitty and smiles on their faces,

'cause we weren't there. - How did they?

- And they did all their testimony

and all their lies like they always do,

and I'm like they're hearing our bill.

He's like, "I'm on my way down there."

And he went down there and says this is bull,

we got noticed that it was canceled, showed it,

and said there nobody's here,

all these people were gonna be here to oppose this.

It just happened, we watch it live.

- Oh, you are... - There's a lot,

yeah, there's a live stream.

Come on in.

And you pull it up in Montana,

and you can sit there and watch it.

- Oh really.

And this is the-

- Okay. - Total crisis.

Okay, so is that actually the one right there?

- Yeah, like they're live right now.

It's live right now.

- Canceled hearing and here's what he sent.

- This says I just want you to know,

so you don't waste your time and money coming up here

that it's canceled. - Oh my goodness.

- Canceled hearing Hb 653.

- Well, that is some shady stuff.

- Yeah, it was bad.

It was really bad.

- This is the Bill.

And so what it would do,

yeah, they wanted to change it

to electronic smoking devices.

- Oh my goodness.

- Somebody wanna show me what that is.

Smoking device?

Oh goodness. - Yeah.

This felt like a deliberate effort

to keep this information away from the public,

but who was behind it?

Thankfully the United States has a law called

the Freedom Of Information Act, or FOIA,

which allows the general public to gain access

to government documents.

- We filed a Freedom of Information Act

when we were in Ravalli County

when we walked in to pick it up.

It was 5,000 pages of double-sided printed papers.

Boom, on the counter that'll be $1300.

So we paid it and it turned out

to be the best $1300 I ever spent,

because now,

I know how they're doing things

behind the scenes, and it's pretty dirty.

I feel like there's some corruption going on,

I think there's some kind of behind the scenes dealings

going on right now,

that we're unaware of.

We've had strings of e-mails where they were trying

to make ads.

They're going back and forth between one of these employees

at the health department with a media company.

She says in here,

"Hey Laureline, thanks for the sample images.

If you could just alter labels of the vape juices

to portray toxicity that'd be great.

You could show a mod bean filled with antifreeze.

Below are a couple of photos of vape flavors

with vape around them.

I can alter those labels to for a nasty ingredients."

Is it reaching to show a young person on a respirator

with an asthma inhaler with vaping isn't harmless.

We could do shots of kids vaping

and shots with them with inhalers.

This was from Jen McFarland,

she works for the Gallatin County Health Department.

They're saying, "alter the labels, make the kids

think they're horrible."

And they're lying about it.

- There are a lot of different sources

of information that kind of are blurring together

and amplifying to all of this.

- I was involved in a lot of underground activism,

and now, I mean, I do a little bit of that.

But there are other people who they're doing

that full-time and I can really devote my energies

to continuing to build the knowledge base,

and as one friend of mine described

that we make the rocks that we hand to the people to throw.

- Nicotine is as addictive as heroin.

- Nicotine is highly addictive

and can cause loss of control.

- Let's start with just nicotine itself.

We know that nicotine is extremely addictive.

- And nicotine is so addictive.

Don't forget, nicotine is one

of the most addictive substances out there.

Is nicotine equally addictive

in all forms of views?

- Yes.

- It's just not true.

It's not true if you look at the objective evidence,

nicotine by itself is not very reinforcing.

- Nicotine effects depend on the delivery system.

So the cigarette, really, we shouldn't be saying nicotine

in this context.

We should be saying nicotine in a cigarette.

- I can tell you that nicotine patches aren't addictive.

Why do I know that?

Because they're sold over the counter in every drugstore

in this country, and no one buys them for fun, okay.

Now kids aren't trading nicotine patches on the playground,

because it's not reinforcing.

Nicotine directly administered to the bloodstream

is not a fun drug.

- We do not have a problem

of seeing the users taking too much

and chewing up all their gums or taking more patches

than necessary.

The problem is actually to get them to take enough

and for a long time enough.

Whenever I hear the word addiction,

I picture someone on the floor passed from a drug overdose,

or my high school teacher who died

from alcohol related heart problems

after a life of struggling with cigarettes and alcoholism.

Addiction is a serious problem.

- I am a licensed clinical psychologist

and I've treated severe addictions for many, many years

in an outpatient and inpatient psychiatric hospital.

Addiction is a tricky word,

and unfortunately we use it very loosely,

so it can mean a severe addiction,

like hooked on methamphetamine to the point

where almost nothing else matters in your life,

and you go into a downward spiral where all you care

about is getting your next fix.

And to me that's a true addiction

that has massive, harmful consequences.

Given the research that the FDA reviewed

before approving nicotine patches and gums,

and the experience in Sweden with Snus,

the lifelong use of nicotine itself does not seem

to fit the definition of addiction

any more than lifelong use of caffeine.

However, if it's not addictive why do some people use it

for their entire lives?

That feels like an addiction.

- To get rats to become regular responders

to nicotine on a lever,

you need to make them either very hungry for example,

or you make them anxious with electrical shock

in their tail or something,

then they are more likely to take the nicotine

- So it's not like heroin, or cocaine, or opiates

that rats will do anything for.

- If they do not seem to have any

of these troubles and problems,

they are less motivated to take nicotine.

So that might have similarities

to what kind of people today become tobacco users.

Looking at available data, this all makes sense.

The highest rates of nicotine users around the world

are found in societal groups facing significant issues

or hostility,

specifically Indigenous tribes,

the LGBTQ community,

and those with mental illness.

Often the users of nicotine products are ignored or shamed.

It feels like their voices get lost.

So we talked to a couple people who use nicotine

to get their perspective on this.

- If you have home problems

or other things going on in your life,

that it definitely.

Once you start using it,

it's definitely much more appealing.

So if you have something hard going on,

and you're trying to get through things,

it definitely helps if you've got something like that.

- When I was younger struggling with mental illness,

I turned to anything that would make me feel different,

and cigarettes was probably one of the first things.

I struggled in the beginning with wanting to quit cigarettes

because I heard of how bad it is,

the cancer scares and all that stuff.

And as soon as vaping hit the scene,

I was so excited to find a healthier alternative,

and I wanted to also just quit nicotine in general

and just taper off,

and then I did more research on why people

with mental illness actually enjoy nicotine so much.

There's all these studies saying

it actually helps your brain,

it helps you calm down,

it's for like Alzheimer's,

and I will probably use nicotine for life.

- Some people may not be able to give it up

not because they don't have the control,

and it's an addiction.

And everybody beats themselves over the head,

"Why don't I have the willpower?

Why am I so addicted?

Why can't I quit?"

And the reason may be because your brain likes nicotine

and wants to use it.

- Now the problem with just giving it to everybody,

is that it turns out that nicotinic functioning

is on an upside-down U-shaped function.

So if you're already functioning up at the top here

of the curve,

then I stimulate you with nicotine,

you'll just actually get impaired.

If you're already functioning well,

nicotine isn't gonna help.

But if you're functioning at the bottom of the curve,

you're all the way down here,

and now I stimulate,

I push your nicotinic functioning this way,

you'll go up towards the top.

So far, it seems like there are good reasons

to use it,

but some reasons not to.

If your brain is functioning at full capacity

without major distractions or illness,

it appears to lower your ability for the brain to function.

It's also not a good idea for most people

to use it while going through adolescent brain development.

The same goes for caffeine, alcohol, or sugar.

They all affect how the brain develops.

That's a few good reasons why most people should not go out

and buy a bunch of nicotine patches right after the movie.

Another reason that some people give

for why clean nicotine is bad,

is because it might get people

to start smoking cigarettes

which are very dangerous to long term health.

They call this the gateway effect.

- So much research has shown that using e-cigarettes,

it's actually a gateway to smoking,

- Watch the vape here we go. - Okay.

- Boom, if you vape you're more likely

to start smoking cigarettes.

- It's the fact that it is a gateway

to traditional cigarette use.

If this is true,

that would be a major reason

to never start using nicotine.

Smoking is simply not worth it because the chemicals

in the smoke are proven to lead to higher risk of stroke,

heart disease, and cancer.

While in Montana, we met a popular YouTuber named Matt Kelly

who got mouth cancer from smoking.

- When I was 30, I got squamous cell carcinoma on my lip.

Basically right where a cigarette,

that my cigarette would hit.

After I had oral cancer and then had surgery and stuff,

I didn't smoke again for a few months,

and then something comes up,

and you get stressed out,

and you reach for that cigarette.

And around then was when I got my first gas station vape,

and that was just enough to like intrigue me into thinking,

"Okay, there's gotta be something to this here."

And that's when I started researching online

and realizing that there was a whole new world

of products out there that was the ticket to quit long term,

and I haven't had a cigarette

in I think almost seven years now.

I mean, it's one of the most effective tools

for people to get off cigarettes.

As the risks of nicotine use went down

with new safer nicotine delivery methods,

the use of nicotine among teens went up.

We saw Wells Fargo analyst Bonnie Herzog speak about this.

Smoking is dead.

But a new problem is here.

- As innovation keeps hopefully coming to the marketplace,

I would imagine that that could accelerate in the future.

I thought this quote the last one at the bottom

of this slide if you guys can see

in the back was interesting.

The Gen Z which my God they're young,

they're not smoking, retails are too high.

This retailer said pricing power is dead

and people are moving to vape.

- So obviously, it's not a good thing

that a kid is starting on nicotine at that early age,

but then they throw out these other arguments

that it's like it's a gateway to smoking.

- You see on on the news,

or the news shows, or whatever significant numbers

of new users that there was an epidemic,

so new users among the youth population.

That may be true,

but they didn't give us the whole story.

We're still kind of digging

into the what the numbers actually really tell us.

So for example, are these new users

like as in they've never used any nicotine product before?

Or are they people who've tried smoking,

but now are using vapor products?

And none of that was actually provided to the public.

So we downloaded the data from the CDC,

the short story is that I can tell you yes,

there's an increase in nicotine naive youth

who are using vapor products,

but the vast majority of new users are among kids

who've already tried cigarettes.

- The only way that it's gonna be a gateway

is if they severely limit access to vaping

for people and then they eventually go to cigarettes.

The vaping experience is like a very fine steak like

a filet or something.

Why would you go backwards to the inferior way

of using it?

Well, one way to get people

to not want nicotine is to call it poison.

- An attempt to hook a new generation

to the poisonous product of nicotine.

Leno's bill is sponsored

by the American Cancer Society's Cancer Action Network.

It is true that nicotine is a poison.

Plants use it to defend against insects.

However, most things are poisonous if taken

in the wrong quantity.

As the saying goes, "The dose makes the poison".

Surprisingly, even caffeine is fairly deadly

in small amounts if taken in a pure form.

But how come there are so few deaths from nicotine?

We went to Austria to find out.

At the University of Graz,

we met a medical scientist named Bernd Mayer

who had done the work for us.

- Many decades smoking was by far the most frequent

form of nicotine use.

And so nicotine was blamed in fact,

for the effects of smoking,

what's not true, yeah,

but still then nicotine is a toxic compound,

it's easier to warn from smoking.

At some point, the question was raised

about the toxicity of nicotine

and everybody was referring to a lethal dose

that you find in textbooks, some toxicity data sheets,

it was circular references,

and nobody could tell me why the hell do we know

that 60 milligrams of nicotine orally ingested

will kill an adult.

So I started to research and I went back

in history further and further,

there were no references,

and then suddenly I discovered one paper published in 1933.

And they mentioned this 60 milligram dose,

and in brackets they wrote, Corbett,

and he referred to a report from somebody else

from a pharmacologist in Vienna.

And he had assistants

who did self-experiments with nicotine,

and they self-ingested nicotine and reported the symptoms,

and this was done in about 1850.

And there were a huge amount of symptoms

with a small amount of nicotine,

and they got unconscious,

they get seizures, and whatever.

They simply miscalculated the amount of nicotine they took.

And based on this report,

Rudolph Corbett 50 years later estimated the lethal dose,

so it was a very unsure estimate.

And this was cited in the journal,

this was all in German, of course,

German literature until World War II,

and then everything changed.

The scientific language changed from German to English,

and the source was lost.

Nobody cited anymore, but they just copied this value.

It's a funny story isn't it?

It's like a history crime story.

Obviously, 60 milligrams isn't deadly.

That's the amount of nicotine found

in roughly half a pack in nicotine chewing gum

at the local grocery store.

However, we still wanted to know how deadly is it.

- I did some research on actual fatal

or non-fatal nicotine poisonings,

and I estimated the correct daily dose,

and my calculations ended up with a value of one gram,

and to be on the safe side I split them to half,

and I said it's 0.5

until one gram of nicotine orally ingested

in the absence of vomiting.

There was a public meeting of the FDA in the United States,

and Neal Benowitz who's famous research in the field

was asked by somebody from the audience

whether my estimate is reasonable or not,

and Benowitz said, "Yes" he thinks it's reasonable.

And from then on,

actually the experts have accepted my estimate.

In reality, much higher amounts have survived.

I found one case where a guy tried to make suicide

with four grams of nicotine and he still survived.

Four grams of nicotine is equivalent

to 1,000 pieces of common nicotine chewing gum,

not recommended to use that much at one time,

but it's worth noting that nicotine is unique

in that it signals to the body when it's had enough.

This is why some people feel sick to their stomach

when they use too much the first time.

It's also why people usually aren't able to die

from nicotine poisoning unless they inject it.

They vomit first.

- The State of California

has a great public education campaign going on right now

and the tag is "Nicotine Equal Brain Poison".

And one of the things I particularly liked

is the equal sign is two Juuls.

- Nicotine harms brain development

and result in long term consequences.

- Number two, changes the brain, impairs cognitive function.

- There's a very strong meta analysis

which puts all the best studies together,

and it shows unequivocally that nicotine improves alertness,

concentration, mood, and memory.

It's a form of self-medication.

Some people may use it

because it makes their brains work better,

and that is another argument for why you need

to find a less harmful form.

If we truly want our loved ones and neighbors

to quit smoking and allow them to switch to using nicotine

in much safer forms; like Snus, patches,

vapor technology, gums, or other ways to take nicotine,

then we as a society need

to reject the slick marketing campaigns relying

on doubt and fear,

and we need to demand clear communication instead.

Clean forms of nicotine do not cause people to smoke

unless smoking is the only option,

or safer options are taken away.

In countries where people

are using popular nicotine alternatives,

the smoking rates have dropped dramatically in recent years.

In Norway, they allowed Swedish Snus to be imported

and now have less than 1% of women smoking cigarettes.

Iceland has experienced a similar revolution.

Australia bans most user friendly ways

to get nicotine besides cigarettes.

Their rationale, it's a poison.

In addition to pride,

money is also a powerful motivator.

This is rarely discussed in public

or acknowledged by misguided experts.

So we went to an old friend who worked

on the inside for decades.

Former Winston man, David Goerlitz.

- So when I quit smoking it was a big deal for me

because having made a lot of money from tobacco industry,

having been a smoker my brother was dying of cancer,

and I had to make a decision and I did in November of 1988.

It was probably one of the toughest things I ever did

because I didn't know how to quit.

I really saw very quickly within like 72 hours

that I was gonna be needed by the anti-smoking industry.

American Cancer Society,

American Lung, American Heart,

Matt Meyers from the campaign for Tobacco-Free Kids,

all these usual suspects that we now hear of today,

they saw me as a resource to now get a real hook

against Big Tobacco and I was their guy,

and I went on every talk show circuit.

I went with Stanton Glantz.

I was doing all these tours all over the world.

I didn't make the connection

as to how sociologically this was going

to impact not only Big Tobacco,

but also the people who are now fighting it

because there was so much money to be made

which wasn't anywhere near as big as it is today.

We're talking billions of dollars here.

The anti-smoking and now anti-nicotine lobby,

gets significant funding from marketing campaigns

and lobbying from pharmaceutical companies donors,

like Michael Bloomberg and taxes on cigarettes.

This money is paid to media outlets

which are often slow to report on emerging research

that hurts their clients.

It took decades for the news media to report

on the full dangers of smoking cigarettes.

A big percentage of their funding was coming

from cigarette companies.

Also, lobbying funds are often spent

to buy the time of former politicians

who have deep ties to current lawmakers.

Money buys enormous power.

- Cancer, lung, and heart was paying me $1,000 a day,

$1,000 a day to go to three programs

at a school out in California,

'cause that's where most of the money was coming in.

Then they use me in Wisconsin,

they use me in Texas,

they use me in Maine,

and they use in North Dakota, and then Florida.

So I was traveling 265 days a year

with the people who were making millions and billions

of dollars,

the American Cancer Society

is worth over a billion dollars,

the American Legacy Foundation

which is now the Truth Initiative,

they're all billion dollar industries,

and they're all non-profits.

How can you have a billion dollar

501c3 non-profit organization?

It doesn't make sense,

I can't grasp it.

Most of the public thinks

that these anti-nicotine charities are 501c3 organizations

which are not allowed to lobby for laws.

We were troubled to find out that some of them

are actually 501c4 organizations.

These are the type of organizations most political analysts

refer to as dark money groups.

These groups are not required to disclose their donors

and can take unlimited money from corporations

for lobbying purposes.

Two of these, the Tobacco-Free Kids Action Fund,

and the American Cancer Society Cancer Action Network,

received more than Then $50 million in 2018

that they could use for lobbying our elected officials

and elected officials around the world.

- I knew that I made a major mistake again.

I worked for Big Tobacco that was a mistake,

but I learned from it,

I became an anti-tobacco activist,

I learned from my mistakes,

'cause they are as corrupted and as greedy

as all of the people at Big Tobacco

and the big pharmaceuticals.

They wanted me to say things that I didn't really believe.

- In the FOIA document they were asking Missoula

how they got their ordinance done,

and we had to work really hard to dispel the myth

that vaping is safer than tobacco.

And she goes on to say, "I mean, well, what isn't safer

than smoking tobacco?"

And she said, "But we made it through with various science

and arguments, including application

of the precautionary principle."

So we need to pass this just in case it turns out

to be harmful we should do it.

She said, "I can help out on the front if you need it,

and MTCA, and MTUUP helped.

MTCA up front and the MTUPP behind the scenes."

So who funds the behind the scenes activities

of the Montana Tobacco Use Prevention Program?

One of these dark money organizations,

the American Cancer Society Cancer Action Network.

- They state we need to run this

through to American Cancer Society Cancer Action Network

before we do anything.

How powerful are these organizations

that are lobbying against the use

of safer nicotine products?

We talked to an elected member of parliament

and perhaps one of the most anti-nicotine countries

on the planet, Australia.

- If scientists could speak in a slightly plainer language,

that would be helpful,

and that would certainly be helpful for politicians.

Having said that you can put an enormous amount of evidence

in front of a politician.

But if they think that the cancer accounts

who's going to be cross with them

then they won't contradict them.

- So anytime they will write policies,

and they would say in there send it over to Kristin

at the Cancer Action Network so she can approve it.

They started with really small, easy counties

where there wasn't gonna be any kind of defense,

so that they can go back and say,

"Look, how many counties are doing this,

you need to pass it on a state level."

- And I'm not saying they were evil from beginning.

I'm saying their intentions were good,

like mine were,

but sometimes greed outweighs fear,

so therefore, you take shortcuts,

and you start doing things that you shouldn't do,

and I'm saying that's what they did.

Now, we know what we know,

and we have the facts,

we have the data, but we have liars.

Matt Meyers and these people

that I'm talking about from 30 years ago,

they were not evil people,

they were trying to find a way to do some good things.

Where are some of the other rebels

with you back in the day?

- Oh well, they're still around.

I mean, the people who got me involved

in the clean indoor air movement were a couple of lawyers.

- They were lawyers trying to fight,

they saw something here,

but they didn't see it to the extent that it became.

- I was so naive when I first started my shop,

and our first bill came up and we went up to Helena,

and I was so excited

that the cancer people were gonna be there heart, and lung,

and I was gonna tell them my story

how I was a three pack a day smoker,

and I was sick all the time.

And I tried everything over years and years to try to quit,

and this one I quit within days,

and I never touched another cigarette,

and I couldn't wait to tell her my story.

And I told her all that,

and I said you know,

and I this is why I opened my shop,

so that I can help others

in the community quit smoking too.

And my dream someday is that I get everybody

in the state of Montana to quit smoking,

and then I close my doors,

because everybody's done.

And she looked at me and she just said,

"Why don't you just close your doors now

and save everybody some time?"

Okay, I guess you're not with me.

Have you ever come across a reason

why the Cancer Action Network cares

about whether people are using nicotine

in essence that doesn't cause cancer.

Have you ever heard any reasoning for that?

You know, I ,

no, I mean, the only thing that I would say

is because they're gonna lose a lot of money.

If everybody switched over to vaping and quit smoking,

there wouldn't be a lot of sickness,

there wouldn't be a reason to have a Cancer Action,

or American Cancer Society at least not as big as it is.

There was a certain lobbyist with the Cancer Action Network

that was always there.

From the beginning in 2015,

every single hearing that we ever went to this lobbyist

from the Cancer Action Network was there.

When we filed our Freedom of Information documents

with Gallatin County we specifically named her,

because we knew she was the key of everything

that was happening with us.

She's the one who they had to send everything

to have approval through her.

And when I did that,

and specifically asked for any communications

with her name on it,

she disappeared.

I have to wonder why would you hide.

And we started hearing troubling things like this

about health groups that are highly respected

by the general public.

We reached out to hear their side of the story.

However, one after another they declined to be interviewed.

They were indeed hiding.

This made us even more skeptical,

so we started digging into their financial reports.

Most of the groups pushing non-scientific information

to the general public and elected leaders,

are taking enormous amounts of funding from one source,

the Campaign for Tobacco-Free Kids,

and their Tobacco-Free Kids Action Fund

which is a dark money political organization,

both are led by Matt Meyers, an attorney.

We don't know who funds the Tobacco-Free Kids Action Fund,

because it's designed to operate in the dark.

But we kept digging because groups as powerful

as Tobacco-Free Kids,

don't just operate on their own

without a lot of help.

Then, we found it.

Michael Bloomberg,

one of the richest men in the world was funding them.

He has donated over a billion dollars

to anti-nicotine efforts.

It turns out that he also funds activities

at the World Health Organization which bans the media

from their meetings about nicotine,

and applauds nations that prohibit safer nicotine products

while keeping deadly cigarettes on the shelves.

Bloomberg also funds the CDC Foundation.

When people started getting sick and dying in 2019,

the CDC blamed nicotine vapor products

instead of identifying illegal tainted THC products

as the real culprit.

The mainstream media which runs Bloomberg funded ads

against nicotine,

parroted the CDC's warning.

Elected officials lobbied by Bloomberg funded organizations,

use this confusion to push bans on safer nicotine products

while leaving cigarettes on the market.

People started to smoke cigarettes again.

Why is Michael Bloomberg funding

all these anti-nicotine organizations?

We tried to get interviews,

but they refused.

Just as editing of this film was wrapping up,

we made a chilling discovery.

A company tied to Michael Bloomberg,

invested in a new nicotine vapor device called Hale.

As of 2020, they're working toward FDA approval.

It looks like a flash drive, sleek, modern, uses flavors.

It contains nicotine.

This sounds very familiar.

The harsh legislation pushed

by the Bloomberg funded lobbyists

and their fear campaigns,

will put all the small shops out

of business that helped more

than 50 million people stop smoking worldwide.

It has created a regulatory environment

where only the wealthiest people will be able to play.

The wealthy people can own nicotine businesses,

and fund dark money organizations that change public opinion

to match their own worldview.

That's why we think they're hiding.

Hopefully, someone with more power can dig even deeper

to get the full answer.

- I just think that we're at a point now

where these people need to be called out on the carpet,

and asked to explain why they have some

of their philosophies that they do have

on something that everybody else

and a lot of the world thinks is beneficial.

- As we looked around at interviews

with experts in Asia, Africa, and Europe,

it was clear that their voices were being drowned out

by the voices of a few American billionaires.

Sadly, this battle is affecting small countries everywhere

who are struggling to make evidence-based policies.

In one last step to the other side of the world,

we decided to visit Armenia

after our friends in Los Angeles told us

about the situation there.

Armenia recently went through a peaceful revolution

against the ruling class who had corrupted their country.

They called it the "Velvet Revolution".

They replaced all government leaders with people

who'd make the best decisions for the citizens

who wanted change.

We got a chance to speak with their new health minister

who was quite open about the options he had

for funding his push to reduce smoking deaths in Armenia.

Where do you get most of your support and information from?

- We get a lot from WHO in terms of directly

for tobacco control,

we get starting from technical support,

how to write these legislations,

how to implement it.

We also get support from lots of other organizations.

We recently signed a grant with Bloomberg Foundation,

one of their institutions National Institute of Health,

and other Tobacco-Free Kids from America.

But now I think that regardless of WHO

or other foundations we have to spend our money

to make our people healthier.

With over 60% of men smoking,

and smoking among women on the rise,

this is an important crossroads for the health

of the Armenian people.

These Bloomberg funded groups like WHO,

and Tobacco-Free Kids are going country to country

to fight safer nicotine options under the guise

of ending smoking,

just as the American Cancer Society Cancer Action Network

is doing to counties and small states in the US.

As we met more and more of the wonderful people in Armenia,

we also met more and more of the people who'd be affected

by anti-science propaganda,

imported from the other side of the world.

It was sobering.

As we began the long journey home,

we discussed this whole situation,

the voices of thousands of people

from all walks of life were difficult to ignore.

♪ What the hell am I supposed to do ♪

How will these same powerful people try

to mute or twist our message?

♪ No matter what I choose, I loose ♪

How many leaders will make the wrong decision

because of false information?

♪ I've got my neck in on this ♪

♪ What the hell am I supposed to do ♪

Will the voices we met along the way even be heard?

It was overwhelming.

How many people will lose their jobs?

Or their lives because of this corruption?

♪ How am I supposed to heal ♪

♪ I take your pills so I can't feel ♪

♪ I know it's wrong but it's right ♪

♪ How am I supposed to heal ♪

The health societies around the world were struggling

to navigate these complicated nicotine issues.

It is clear that we need a plan.

♪ Who the hell am I supposed to be ♪

- What can be done now?

Like, you know,

- Yeah. - we need an action plan now,

we need a call to action now.

- Educate teens and see what they're doing.

- Most of the kids who are using nicotine

are using it less than they're using e-cigarettes,

less than 10 days a month.

And the people using it more than 20 days a month

are a relatively small percentage

which I think is reassuring to me as a health care person

'cause I think most kids are not using it

in an addictive pattern.

we need to focus on the highest priorities first.

We need to stop the unnecessary deaths.

Cigarette smoking has killed so many.

Clean forms of nicotine can prevent those deaths now.

We need to be brave enough to have honest conversations

that value saving lives,

and help teens make wise decisions for their health.

- Together, we can discourage use,

but we need to find the balance between that and prohibition

that deprives any smoker

or teen and who would become a smoker anyway

from a much less harmful form of nicotine use.

- I think consumers telling their stories is so important,

and it's so important.

Politics is personal,

and we have to hear from the people.

The people who are saying: "This is saving my life",

hearing those stories out are very important.

- I spent every day for four years thinking

about smoking cigarettes

and thinking about getting that nicotine again,

and now I don't have to do that,

and I don't have to die.

- 7 million people per year are dying globally

of a completely preventable behavior.

That's what the conversation should be,

is about smoking not tobacco or nicotine.

These conversations are already happening.

We just need to listen with our hearts

and look at the science.

On top of that,

almost all the voices both professional

and public in this debate are white men

in western countries.

We need to lift up other voices,

including those affected most,

Indigenous tribes, and stress groups

like the black community in the US

who die from cigarette related illnesses 20% more

than their white neighbors.

We met Chris while learning about the impact

of San Francisco's ban on nicotine vapor products.

- Regardless if you wanna vape,

if you wanna chew gum, whatever.

The important thing is to try to get people

to quit smoking cigarettes,

we have to get more people of color involved

in the whole vaping aspect,

get people more involved in patches and gums,

because once you quit smoking,

it's like you get your life back.

Instead of seeking doubt

on behalf of their funders,

scientists need to seek the truth.

- We need to tell the truth to people.

We need to tell the truth to smokers first,

but also to everybody.

Nicotine is not that.

- If we don't, then we might as well pack up our bags

and go home, and rip up our PhDs

because we're not doing what we're supposed to be doing,

and what we're paid to do.

We have hope that the nicotine delivery methods

will keep improving,

that the science of how nicotine works would keep expanding,

and that this will help people

where it matters most.

- More research is needed,

but we're actually getting to good places with research.

- This large national study

that we're doing will be the largest study ever done

in non-smokers. Of nicotine's effects on brain function.

In my initial grant application to the NIH

for this big study, I said,

"Look, if this works, we're gonna have an immediately

available, inexpensive, repurposed treatment

that has no IP, that isn't gonna cost a million bucks a year

for somebody to take,

and that could help them right now."

That's a pretty strong argument for nicotine.

So who gets hurt

in this game of big money politics?

The grandmothers and grandfathers

who are seeing their cherished memories fade,

the underfunded countries and states

who are struggling to make helpful policy decisions,

those who are struggling with mental illness and you.

The big issue is that

with non-stop agenda driven PR campaigns,

the world has become a very noisy place.

Leading journalists need to report the truth

and connect people to the information

that will change their lives forever.

- It's hard to be optimistic right now,

but I think in the end the science will prevail.

I mean, you can't,

you just can't argue with science,

and when you have so much of it showing

so many benefits to this.

I think in the end science has to win, right?

- Will the truth get out?

It's not guaranteed.

Pride, misinformation,

and big money stand in the way so it's up to you.

Demand real science and clear communication.

Reject doubt and shame because every human being

has the right to truth.

You deserve to know nicotine.

♪ Breathe me in ♪

♪ Speed it up just to slow it down ♪

♪ It's too much to take ♪

♪ Too much to take ♪

♪ Give me a minute ♪

♪ You know the truth but we'll let it out ♪

♪ It's hard to escape ♪

♪ And I don't know how to figure it out ♪

♪ Can you show me how ♪

♪ Can you show me now ♪

♪ Maybe we don't know better ♪

♪ Memories we can forget ♪

♪ But through it all ♪

♪ The questions leave me unsettled, unsettled ♪

♪ Unsettled, unsettled ♪

♪ We're under too much pressure ♪

♪ Trying hard to redirect ♪

♪ But through it all the questions leave me ♪

♪ Unsettled, unsettled ♪

♪ Unsettled, unsettled ♪

♪ Unsettled, unsettled ♪

♪ Reel me in, reel me in ♪

♪ Bring it up just to tear it down ♪

♪ Throw me the bait ♪

♪ Jump off the deep end ♪

♪ Holding on there but I'm slipping out ♪

♪ Don't make me wait ♪

♪ And I don't know how to figure it out ♪

♪ Can you show me how ♪

♪ Can you show me now ♪

♪ Maybe we don't know better ♪

♪ Memories we can forget ♪

♪ But through it all the questions leave me ♪

♪ Unsettled, unsettled ♪

♪ We're under too much pressure ♪

♪ Try had to redirect ♪

♪ But through it all the questions leave me ♪

♪ Unsettled, unsettled ♪

♪ Unsettled ♪

♪ Maybe we don't know better ♪

♪ Memories we can forget ♪

♪ But through it all the questions leave me ♪

♪ Unsettled, unsettled ♪

♪ We're under too much pressure ♪

♪ Try hard to redirect ♪

♪ But through it all the questions leave me ♪

♪ Unsettled, unsettled ♪