The Great Antidote – Michelle Minton

By The CGO

Published:

On this episode of The Great Antidote podcast with Juliette Sellgren, she is joined by guest Michelle Minton. In their discussion, Juliette and Michelle cover vaping, tobacco use, and regulations regarding public health.

 

Guest Bio

Michelle Minton is a senior fellow at the Competitive Enterprise Institute. Minton specializes in consumer policy, covering regulatory issues that include gambling, tobacco harm reduction, cannabis legalization, alcohol, and nutrition.

Minton has authored numerous studies, including topics like the effectiveness and unintended consequences of sin taxes and history of gambling regulation. Her analyses have been published and cited by nationally respected news outlets such as the New York Times, the Wall Street Journal and USA Today as well as peer-reviewed journals. She regularly appears in news media to discuss the unintended effects of laws and rules designed to save adults from their own choices which, not only conflicts with the principle of individual liberty, but often the goals of public health.

Ms. Minton holds a Bachelor of Arts from the Johns Hopkins University and is currently completing her Master of Science degree in Applied Nutrition at the University of New England.

When not working, Minton engages in hands-on “research” in her areas of expertise by spending many hours playing poker, enjoying salty foods, and drinking delicious craft beers.

 

Episode Transcript

Juliette: Hi, welcome back. Today it is my pleasure to be interviewing Michelle Minton, a senior fellow at the Competitive Enterprise Institute. She specializes in consumer product safety, vaping and cannabis regulation, and also nutrition regulation. Today, we’re going to be talking about vaping, cannabis, and salt. Not salt, like bath salts though. It’s sodium chloride salt. For a little bit, I was like confused, but then I was like, wait, this makes sense. Okay. Anyways. Welcome, Michelle.

Michelle Minton: Hi, thanks for having me on.

Juliette: So before we jump into this, I want to ask you what is the most important thing that people my age or in my generation should know that we don’t.

Michelle Minton: Right. So I assume you’re talking about college age, and I would say this applies to your generation and all generations really, including my own a little bit older than you just a little, I think what I would communicate the importance of understanding integrity, and why it is important to have personal integrity. And not just in terms of, “well if I have a bad reputation, I’m not getting jobs or people aren’t going to like me,” but for interacting with people, for having a satisfying work life, social life for personal pride. I find integrity to be something missing in the conversation as an important value for people to have of adhering to certain principles and values. Mine, in particular, are objectivity where I try and communicate with people and engage in my research in an objective way. Even while recognized I have biases like everybody does, but trying my best to adhere to the specific principles that I find valuable. Always every time. I don’t succeed every time, but I think it’s important. And I think more people should take personal integrity, seriously.

Juliette: That’s a good point. Thank you. I mean, I always forget about it because in middle school it was a big thing. That was one of our school’s values that they tried to uphold. But like since then, I’ve not heard the word integrity that often. So nice reminder. Thank you. Okay, so you’ve been a fervent advocate of vaping, which to many white suburban mothers it’s like, “Oh no.” So can you explain to us exactly what vaping is and what the benefits of this technology are over smoking tobacco products?

Michelle Minton: Yeah, personally, I like to not describe myself as an advocate of vaping. I am an advocate for people to be able to make their own best choices for their own lives, whatever that means to them. And vaping is just such a clear example of a product that has benefits for individuals smokers, people who are habituated to nicotine who want to find a way- everybody knows how dangerous it is to be a lifelong smoker, how deadly it can be, all the diseases, all the problems that it can cause everyone knows this people continue to smoke anyway. And I would say almost every single one of them would love to be able to get the benefits that they feel they derive from smoking in a way that was not going to kill them, frankly, and vaping, electronic cigarettes, nicotine vapor products as well as other products now that are non-combustible, so things that you don’t light on fire. These have all been pretty conclusively- I mean, it’s hard to argue at this point that they aren’t substantially safer than lighting something up and inhaling the products of combustion into your lungs every day for decades of your life. Really the dangers associated with smoking primarily come from the fact that you are inhaling the products of burning paper, burning leaves, whatever it is. Nicotine itself, really not that dangerous, which is why the government has authorized in many iterations, nicotine patches, gum, et cetera. They even prescribed them for, for kids, for minors who are trying to quit smoking nicotine itself. Not really all that harmful. It does have some effects and those effects can become- they have risks associated with it, but it’s nowhere near- you’re not going to get lung cancer from nicotine. And lung cancer and heart disease are the big primary drivers of smoking related deaths and disease.

Juliette: Yeah. I mean, e-cigarettes, vaping it’s been around long enough now for respected health authorities to conclude, especially after so many studies that it is safer than smoking cigarettes because of its delivery of nicotine. I mean, it eliminates something like 95% of the harm that smoking cigarettes gives. Britain’s Royal college of physicians called any attempt by public health officials to discourage smokers from switching to vaping, “unjust, irrational, and immoral.” Can you tell us more about the harm reduction that scientists have observed with vaping?

Michelle Minton: Yeah, not just with vaping. So, I mean, if you look at Sweden where there’s a product called snus in Sweden, and it’s basically a tobacco chew, a moist tobacco chew. It’s from the types of tobacco chew that we traditionally use in the US, but in Sweden they’ve been using it for decades pretty much since in the sixties and seventies when it started to become very clear how dangerous smoking was a huge portion of Sweden’s smoking population switched over to snus. It’s now I think about 15% of their population use the product and they have almost zero smoking in Sweden and they have Europe’s lowest rates of lung cancer and lung cancer death, not surprisingly. They also have among the lowest in Europe, mouth cancer, which might surprise some people. We’ve seen harm reduction work in Japan where heated tobacco products, like I think the only really commercially available one that I’m aware of is called IQOS from Philip Morris International that was introduced in Japan, I think about three or four years ago. And since then- they don’t really seem to monitor smoking rates too closely- but cigarette sales have declined by 30%, which is absolutely astounding in Japan when the government owns- they have Japan Tobacco. So you just have in certain countries, it is not just those two, it’s in a lot of places in the world, including the US And England where the smoking rates are dropping so much faster than they are in other countries. And it’s primarily because you can’t stop. You don’t stop people from pursuing substances that they want to use simply by banning it, taxing it, trying to discourage or stigmatizing it’s use. People will still either keep using that or something similar or something worse. However, you can encourage people to reduce the harm associated with behaviors and harm reduction, not just with tobacco. Harm reduction is an accepted principle in global public health, right? We have clean needles for intravenous drug users because people wisely realized that simply banning intravenous drugs didn’t stop people from using it, but it did push them into riskier behaviors, sharing needles and spreading disease. But if you have supervised sites, you can mitigate the risks of overdose. If you give them clean needles, you can mitigate the spread of diseases. And that’s all worked really, really well. You know, in some places in Canada, when they open up supervised injection sites, you see the overdose rate pretty much disappear because for the most part, people don’t want to die, and they do want to use certain substances. They just want to do it in a way in the safest way possible.

Juliette: Yeah. That’s, I mean, that’s a really good point. I don’t know a lot of people, especially talking to like health teachers at school and stuff. When we have to learn about this stuff first, they don’t mention any of the benefits that certain drugs can have and like the health benefits and like medical uses. But they really just talk about like drug users as though they don’t necessarily care for their lives. And as though they’re willing to die for it, but really like, I feel like that’s an unfair connection to make. Because I mean, some people might not care at all if they live or die, but the thing is that’s true with any group of people. But when you think about drug users wanting to use clean drugs and clean needles and all of that, why not, if it’s available and you know, it’s safer, you probably don’t want to die.

Michelle Minton: The way we talk about drug users is so offensive and really harmful to people who use substances. You know, there’s a lot of stuff- Most adults in America are substance users. We use caffeine every single day. You know, we drink a cup of coffee, so people drink a pot of coffee. And that is a drug that has effects on the body physical effects. It’s also a drug that you can become habituated to. You know, I’m not going to say the word addiction. I don’t like that word. I think that’s overused and improperly used, but people have a caffeine habit and they go into withdrawal if they don’t have caffeine, but it’s perfectly acceptable. You know, a child can walk into Starbucks and get a coffee without too many raised eyebrows. But when it comes to other substances, certain substances are deemed unacceptable. And then when you have the stigma and you criminalize it, that’s really where a lot of the problems come in. You know, when people were using opium- when opium was wide in total widespread use among white people in America, in the 19th century, there were some overdose deaths, but not all that much. There were plenty of opium addicts if we want to say that, but it wasn’t really seen as a problem until Chinese immigration started to increase in opium smoking, even though that’s fundamentally the same as using opium through medicinal tinctures, then it was seen as a social menace, a moral problem. And I think we’re seeing that a lot with drugs and other aspects of public health is that you can always point to the harms of any behavior. Literally, any type of behavior can be associated with some kind of risk. We’ll say not necessarily harm, but risk. But what rises to the level of national priority, legislative priority, really does seem to be dictated by a certain group of people in this country and their cultural norms and their values, the society they want to live in. And right now with nicotine, as I said, nicotine has loads of benefits, scientifically proven whether or not that balances against the risks associated with nicotine, in whatever form you want to use. That’s a question I think should be up to individuals and their doctors. There’s no doubt about it, that there are benefits to nicotine, even if the benefit is simply, some people enjoy it, they enjoy the feeling of using nicotine, but it is a moral issue, right? So if present some people in public health and a lot of these, as you mentioned, white suburban moms with the challenge of somebody could use nicotine with functionally zero harm, they’re not going to get cancer of the lung. They’re not going to have heart disease because of this, maybe because of their other habits, but not because of nicotine. Would you still find it acceptable? And the answer that they have clearly given us at this point is no. And why is that? Because you’re still addicted to something and addiction is bad when it is this thing, because nicotine is intimately associated with smoking because of public health campaigns in the eighties and nineties. Smoking is not seen as a white middle and upper-class thing to do. And unfortunately, white middle-class suburban people are the most politically empowered in this country. So, they pretty much dictate drug policy in this country.

Juliette: And I think about alcoholics, a lot people who drink alcohol to the extent that it can be an addiction, that’s all like cute. And I mean, not necessarily cute, but it’s more accepted. And I mean, coffee, caffeine is a good one too. It’s just the idea that’s a different type of addiction is just wild to me. And in America, it seems that it’s more vaping is more of an issue than in other countries. I mean, the UK has embraced it as a way to get smokers to stop, but health authorities freaked out here. And I mean, that definitely has to do with the people who are dictating drug policies, as you said, but what is the difference between why we approached it in the way we did and why the UK embraced it?

Michelle Minton: Yeah. There’s different theories about that. A lot of people I’ve talked to ask “why did England embrace vaping?” Whereas America is treating it like alcohol in the 19th century, let’s prohibit it. And one of the arguments that has been made is that in England, they have a national healthcare system. So their healthcare policies materially affect the economic wellbeing of the country. And I mean, to an extent that’s true here in the US as well, but politicians in the US. if they make a decision, for example, banning vaping and having people continue to smoke or switch back to smoking the economic effects, they’re not as culpable for that in our politics. It’s not as easy to connect it because our healthcare system is still largely privatized. That’s one of the theories I personally think it has to be influenced at least in part by America’s history with substances. Our sort of colonial past of oh we don’t like anything that’s just purely fun. And we see it as immoral, anything hedonistic, or enjoyable physically. We value restraint in some ways, a morality, all of that. I think that really is the primary driver and the influence of morality. I think it really becomes clear when you’re talking about it, and the influence of the white middle-class priorities on smoking in the US is really low at this point. It has been declining pretty steadily since the nineties, and really started to drop off since the around the time of the introduction of vaping in the country. But there are populations within America where smoking rates are still extraordinarily high. If you look at indigenous populations, people with mental health disorders, the LGBTQ community smoking rates are in the thirties, 40% of the population. Sometimes people with schizophrenia it’s been reported I think something like 70 to 80% continue to smoke. But vaping is only really popular among affluent whites or middle-class whites pretty much. So that’s why- and I think the clear- the fact that white middle-class values dictate not just U.S. Policy, but global public health policy in a lot of ways can be seen really clearly by the fact that in countries like the U.S. And countries like Australia and New Zealand, global public health entities are pursuing stricter regulation of nicotine products like vaping. But when they go into countries that are low and middle income like India, or the Philippines, they are recommending outright bans, outright prohibition. They put out papers saying you can’t regulate these effectively, so you should just prohibit it. And in those countries, smoking is way higher than it is in the US. 80% of the world’s population of smokers live in low and middle income countries. So it’s absolutely startling that they are choosing to prioritize vaping in these countries. And even in the US to a huge extent, they are functionally ignoring the issue of smoking, which kills people. Whereas vaping does not. It’s really astounding.

Juliette: Yeah. I think we have something like 38 million cigarette users in our country, and it kills about 480,000 people a year, which is a lot. And so when you look at nicotine and vaping specifically that it’s more of a public health thing. It’s a better alternative than “Oh, it’s just another way to like, smoke.” Well, yeah, it is but it’s safer. But it seems like banning it is ignoring the fact that you’re actually trying to help people and that this is it’s healthier. It’s safer. It just- it frustrates me.

Michelle Minton: Yeah. It’s ironic that the pharmaceutical industry tried to make vaping in the nineties. They have inhalers and they just weren’t accepted. Smokers did not find them effective. And I think it is frustrating to anti-tobacco people. It’s not everybody in public health, but people who are really within the tobacco control movement. I think it’s frustrating that the market itself, that a smoker in China, and then the rest of the world’s smokers came up with vaping and embraced it, and had it evolve and played around with it and then found something that became extraordinarily effective. I talked to so many vapers and I’ve read some studies about it as well. So many who didn’t even intend to quit smoking. They just started trying vaping cause they were curious or they wanted a way to get their nicotine fix in, in spaces where smoking wasn’t allowed or in their house, for example, without making their house smell like cigarette smoke. And they accidentally ended up switching because they ended up preferring it to smoking. That’s absolutely mind-boggling. And when confronted with those facts, it’s even more mind-boggling that people in public health who profess to care about saving lives and helping people live healthier lives, that they can ignore that for the sake of keeping kids away from something they’re going to do anyway.

Juliette: Yeah. I mean, it’s just crazy because it seems like you’re pushing first, not only a group of people who are already very likely to suffer the consequences of using cigarettes and like smoking, you’re pushing them further into that. And also kids. Okay. Well, if kids are gonna be like doing drugs, doing whatever, wouldn’t you rather it be a little bit safer?

Michelle Minton: So one of the things that made me kind of not happy, I’m not happy to see young people- I frankly, it’s not that I’m happy or unhappy to see young people taking risks with their health. That’s just what they do. They’re just going to do it. But the fact that vaping was adopted with so much more gusto in the younger cohort of American society; it kind of made me appreciate that young people do care about their health. They want to rebel and they want to experiment. They want to take risks, but they’re not stupid. They don’t want to do it in a way that’s going to kill them. So the fact that they chose vaping over combustible cigarettes is something that should be- not exactly celebrated, right? You don’t want to encourage it. I don’t think you can stop it, but you don’t necessarily want to encourage it. Furthermore, I think honestly, the focus, the absolute succession on youth vaping is what has caused spikes in youth vaping in this country. If you look at the UK, they have all the flavors, they have significant amounts of nicotine in their vapes. They have never experienced the surge and experimentation with vaping among youth that we have in the US. And I think part of that is because all of their public health communications from the government on vaping have been about, “Hey, are you an adult who smokes? You should try this, go to a clinic. This’ll help you quit.” Whereas in America, it’s a sensationalistic thing of “this is reefer maddness all over again!” And then that compels teenagers like, “Ooh, this is a new way for me to rebel. Ooh. You know, olds are telling me not to do something now I’m interested.”

Juliette: Yeah. I mean, I see that a lot. And it kind of reminds me of the entire campaign about in public schools. And I know at my school for like the longest time, I mean, not while I was there, but they talked about whenever they were talking about like sex and stuff, it was okay. It’s abstinence-only, that’s all we’re teaching. And of course it’s less safe because then kids have no idea what they’re doing. They’re going to do it anyways, whatever it seems to be the same thing here, kind of except now kids like understand, “Oh, well this is safer,” but it seems to be taking the approach instead of being “okay, you shouldn’t do this. There are risks regardless, but this is safer than this. Like these are alternatives. Or if you already struggled with this problem, here are alternatives.” It just seems to completely ignore educating kids about that sort of thing. And I don’t know. I mean, I’m very glad to see like kids around me and people my age, and even like older- Like younger generations adopting vaping instead of using cigarettes because it is safer. And like they educated themselves because our schools haven’t necessarily, I mean, I don’t want them to embrace it, but at least-

Michelle Minton: I think for education, the message should- and I don’t know honestly what the messages are right now in schools- but I think the message should be somewhat similar. You know, whatever you’re telling the youth about using cannabis should be very similar to nicotine vaping, right? You say like, “well, we wouldn’t encourage you to engage in this, but if you’re going to here’s a safe way to do it.” One of the jokes I made, but I still think what would have worked for public health prior to the COVID outbreak was I think if you want to stop youth from vaping- because so much of it- if you’re looking at the numbers and they’re saying almost 30% of youth are vaping, they’re not. Those are once a month numbers asking “did you use it at all in the last month?” That is someone at a party taking a hit off of their friend’s Juul, right? So if all you care about is reducing those numbers start a campaign that says, “if you share vapes, you can spread herpes” and then show pictures of kids with you know cold sores on their mouths. And that instantly will make the numbers probably drop in half because most of those kids aren’t going to go and try and get an actual device themselves. But if they are then also afraid of sharing a device with their friends, which herpes is not a desirable thing, you probably should be concerned about that. And now with COVID, I think people are not doing that at all. But you know, that would have dropped the experimentation numbers. Most of the youth who are regularly vaping, people who- to habituate to nicotine, you pretty much have to use it every day, every couple of days, something like that. Those numbers? That’s in the 1% range or maybe 5% range. But then if you say, “okay, let’s take out youth who are already smoking,” then it’s like less than 1% of users are regularly using nicotine vapor products who never smoked. So those numbers are not something to be really scared about it, but if you want to control those numbers I would just say give kids the real information. Say, it’s not risk-free because it’s not, neither is caffeine. Neither is cannabis, neither is alcohol, but you should know that if you were going to pursue- definitely do this before you smoke. Absolutely. And I would say the same thing with cannabis, it would be better to use an edible or to vape it legally, get buy them from a licensed retailer. That is safer. Or using a bong or something like that than smoking it, because it’s like if you stood in front of a fire, if you look at people who live, where they have to burn wood in their homes, they have high rates of lung cancer. They have a lot of other health issues because human beings cannot process that amount of particulate matter and tar and all of the stuff that comes from burning product.

Juliette: Yeah. It’s kind of amazing because the more I read about the source of- and as you were talking, I was like, wow. Like I bet that all these people I know just don’t really know that because I also didn’t know that people who lived and like made fires regularly had higher rates of- I mean im not surprised now that I know it, but it’s not something that I would just think I was always like, Oh yeah, it’s just smoking because smoking and drugs. No, not really. I mean, yes, maybe, but like if you’re using it in a different form, that’s not necessarily, what’s going to cause you to have lung cancer. And also the whole thing about the herpes campaign. I definitely,-I see that once, I’m never thinking about trying, ever again, like that’s number one way to dissuade kids. You heard it here. A lot of the arguments- I mean, we’ve been talking about this against vaping are for the children. And we hear that we face this epidemic in the youth vaping and that the flavors are the things that are enticing kids, but they really don’t help adults. But then you see in Britain, they’re completely fine. They’re dealing with this. How are these arguments misleading and kind of dangerous in a way?

Michelle Minton: Well, I mean the most dangerous aspect is that it focuses exclusively on youth behaviors besides the fact that it’s totally unsupported scientifically. If you just look at youth smoking rates, we had the biggest spike pretty much ever in the last 50 years of youth smoking occurred in the 1990s, just after they banned flavors and cigarettes. So those youth who were suddenly smoking in really huge numbers in the 1990s, they all were smoking just normal tobacco cigarettes, maybe menthol flavors in vapes. You know, one of the arguments I make is politicians will always hold up a vape and say, “look, it’s gummy bear flavor. This is clearly marketed at youth.” I was like, no youth who want gummy bears and only gummy bears, will, just go buy gummy bears. They’re cheaper. Honestly, there is something else. Or another argument I would make is if you did a survey of all the people who eat pizza in this country, I bet you’ll find that most people eat pepperoni pizza, but it’s not pepperoni’s that are hooking people on pizza. They have a preference for it. If they’re going to eat pizza, why not get it with pepperoni’s right? So when you’re vaping, part of the pleasure is the way it tastes, but that’s not what drives people. You know, if I want strawberry-flavored something to drink, I don’t necessarily go to a strawberry margarita. You know, I could have strawberry tea or something else, or strawberry juice, something like that. There’s something else going on. And then once someone has made the decision to use these products, of course, they’re going to use flavors. Frankly, from what I’ve heard from most users, tobacco-flavored e-cigarettes tastes like crap. They don’t taste like cigarettes. Because it’s synthetic. Because you have to flavor the nicotine. There is no actual tobacco in a nicotine vapor product. You have to try and create some approximation of what, of what tobacco tastes like. And it doesn’t have the burning, which some smokers like. It’s just not, it’s not right, but the other flavors- and one of the most important things for adult smokers. So first of all, most adult smokers use flavors and most adult smokers who quit using e-cigarettes to successfully transition completely are using fruit and candy-flavored E-cigarettes. Part of the reason is because when you switch and when you stop smoking your taste buds come back. Great. You could taste more flavors and then you become used to the flavors in the e-cigarette. And then when you try going back to smoking, it tastes like crap. And people don’t like that. So it reinforces their switching because they’re like, “well, I forgot how- I don’t remember it tasting that bad. My vaporizer now tastes much better to me. So I’m not even going to bother going back to smoking.” It’s a really important factor in why vapors quit and you really can’t undervalue how important the pleasure aspect is. So people who try and quit smoking with the patch, the gum, the lozenge, those have really low quit rates. You know, it’s not nothing, people do quit using those products. It takes a lot of willpower to do that, but it’s medicinal. It feels like you’re making amends. You’re going through treatment. When adults switched to vaping and when they try vaping, it is something fun. It is something pleasurable. It doesn’t feel like punishment. And that makes it easier for people to stick with it. They feel good about themselves. Which self-efficacy these feelings of empowerment? Those are really important to helping people change their behaviors, whatever the behavior is.

Juliette: Yeah. The whole thing about gummy bears are they are cheaper? Dude, I get frustrated to hear people make those arguments because I know there’s also like a completely different feeling that you get from using drugs than eating candy. So if the drugs are candy flavored, you’re not just going to do them because they’re candy.

Michelle Minton: And I almost hesitate to say this, but you know it’s almost always politicians who were holding up the unicorn poop vapes or gummy bear vapes or chocolate vapes. And I say, why aren’t you talking about cannabis right now? What is the difference when you can literally get edible gummy worms, but we’re not. And if they ever get that question, the response is usually, “well, we’re not talking about that right now.” And I hesitate to say it because I do fear that very soon, the same groups who are saying we need to ban flavored vapes are going to turn their attention to cannabis products with the same arguments.

Juliette: Yeah. And edibles are safer because as you said, the smoking component and the burning component, that’s not present.

Michelle Minton: You’re more likely to have a bad experience because people have a hard time dosing with edibles, from what I’ve heard and experienced myself, unfortunately. But you know, you’re not going to die from it. And it is way safer than someone who’s habitually smoking cannabis.

Juliette: Do you think considering the failure of the government to win the war on drugs and despite spending hundreds of billions of dollars in this effort, do you think that the government can deliver a risk-free nicotine-free world? Because it seems like the goal is no nicotine at all instead of safe nicotine.

Michelle Minton: Yeah. I think the goal for at least the tobacco control movement is as a nicotine-free world. They’ve even started to say that a nicotine free world instead of just a smoke-free world. But, I don’t think the goal of the drug war is actually to win it. I think there are other goals that are achieved simply by having an ongoing war on drugs. And those include power. You know, people get a lot of power when you can pass laws criminalizing certain behaviors and certain individuals. And money. A lot of- and this is why the word epidemic has become epidemic in the public health discourse. Because when you say that word, people holding the purse strings and Congress freak out, their constituents freak out and put pressure on the politicians. And then the politicians they just say, “well, we’re going to take these millions or these billions and give it to these groups to do something about this epidemic.” Even if it never actually works, everyone kinda wipes off their hands and says, “well, we did something now everyone can stop worrying about it.”

Juliette: And that just makes me laugh now because the big scary word is “pandemic.” And so “epidemic” is like a little baby tiny non-problematic cousin of pandemic. I don’t know that just, I was thinking about that and It made me laugh. So kind of on the same trail of talking about the people in power who are kind of doing things about this and the politicians who are like, “Oh, don’t use this, this is bad.” There’s kind of a double standard between cannabis and vaping. So back in September, you wrote a piece about this and you noted that the biggest advocates for legalization of cannabis in the United States are also the worst drug warriors when it comes to vaping and kind of policies about that. Can you explain what is happening and what the inconsistency is about? Because to me it just doesn’t make that much sense.

Michelle Minton: Yeah. Republicans, conservatives, people on the right side of the political divide in America, they have generally, typically not cared too much about big tobacco about smoking. Generally. They just like big business. They sometimes pay lip service to individual choices and rights, but most for the most part, they just don’t care. And the same is true with vaping. For the most part they just don’t care. Liberals, Democrats, people on the left side of the political spectrum have for since the 19th century been the ones leading any drug war, they are progressive, they are reformers. And they are the ones who have been leading the anti-vape charge while at the same time leading the cannabis reform charge, which is kind of a mind trip, honestly. I think the best example of this happened in San Francisco last year, maybe two years ago where the city board, the board of supervisors, try to enact an ordinance that banned smoking and vaping in apartment buildings. In your own apartment. And it died because too many of the members said, “well, we have to, we have to exempt cannabis, cannabis smoking even. That should be allowed. Of course, even though we’re going to ban vapor if it has nicotine in it.” And that got attached to the bill and then it failed for hypocrisy because people said, this makes no sense. Where’s the evidence that cannabis smoking is somehow less harmful to bystanders than nicotine vaping? And there is absolutely none. I mean, if anything, there’s obvious evidence that if there are any harms associated with your neighbor smoking something, those are going to be way worse than if your neighbor is vaping something. And you know, some Democrats, some liberals do recognize the inconsistency in the position, the lack of integrity let’s say. But there are a few of them are saying anything about it publicly anyway and they continue to fight this two-pronged war. And I think honestly, part of the reason that they care at all about marijuana reform is again, when we’re talking about white, suburban mothers. Cannabis use now is seen as a white behavior, whereas before it was pegged as being a foreign menace from Mexican immigrants. But now since the seventies, pretty much, it was white kids who were getting arrested for possession. Once cannabis was criminalized, possession was criminalized. And so to white parents the threat was no longer the drug, the threat was drug enforcement. So it switched. So now the imperative the priority is to save the white suburban kids from law enforcement and from having criminal records. So the narrative has shifted and the priorities have shifted. And now we’re all interested in cannabis labels. I mean, they pay tons and tons of lip service, and some of them are sure, genuinely understand the harms done by the drug war, by cannabis prohibition, to minority communities and marginalized communities. But that’s not the reason that the narrative actually shifted and the politics started to move in the other direction.

Juliette: So I read a piece by Kevin Williamson a while ago, and he kind of makes a similar point. He wrote that this is “not a regulatory issue or a law enforcement issue or a public health issue. It’s a class issue.” And he says, “think of it this way. Smoking is a problem for people who shop at Walmart, but our public policies are made by the people who shop at whole foods.” First I laughed at that because it was just a very clever way to make that point. But it seems in line with what you’re saying.

Michelle Minton: That’s perfect, I love that quote. That’s absolutely spot on. And that, like I said, they’re the most politically empowered class in this country. And part of that is from our past, our history. There is a huge dichotomy between the dominant group, which is white, suburban middle-class people and everybody else. So it really is white suburban people who dictate government policies and approaches and perception about substance use, right? So when a drug or a substance is associated with white culture is acceptable. Even if there are problems with like alcohol. When it is associated with an “other” as cannabis was in the early 20th century, opium smoking was with Chinese people in the 19th century, even acid, which is associated with urban youth and urban culture rebellion against the 1950s, 1960s, wholesome middle-class family. Those are deemed elicit problematic and need criminal penalties. They need to be controlled. But if those drugs ever do become reassociated with white culture with white middle-class culture, then they need to be decriminalized. We need to do treatment, overcriminalization. We saw that with the opioid epidemic. You know, if you look at the way the news talks about the opioid prescription opioid epidemic and P.S. This is fundamentally the same as heroin use. Opioid addicts are always portrayed as either poor Southern people, poor Southern whites or middle-class whites. There are tons and tons of stories about the new face of addiction “heroin in the suburbs,” which is opioids. And the approach to the opioid addiction epidemic has generally been treatment. We have drug courts. We don’t want to put these people in jail for using prescription opioids. It’s the bad doctors who prescribed it to them. We want to help them. We have methadone, we want to make sure they don’t die. We can revive them. All of this. Whereas the portrait of heroin use, if you look at the anti-drug commercials that were on television and not to mention crack cocaine versus cocaine does the same things. Non-white substance use behaviors, they always get the criminal treatment. You know, they have commercials from those eras. They’ll have the the evil criminal pusher trying to get your kids hooked on drugs. Cops need to come in and deal with them. And it’s always urban, broken families, all this stuff, minority communities, whereas white substance use behaviors are maybe “problematic,” and maybe we need to take a nice soft touch with it.

Juliette: And in the same piece that Williamson wrote it kind of shocked me in a way, especially because of the way that it’s being dealt with in this follows kind of what you’re saying is he said that “teenage marijuana use for example, is about 35% more frequent than teenage vaping,” which is what we don’t hear. We don’t see. I feel like it tells you a lot.

Michelle Minton: So one of my big issues with drug use in public health, the drug control, even drug educational stuff, it always takes the issues in isolation. You know, we say, “well, kids are smoking or vaping, whatever it is using cannabis. And we don’t like that. We need to address that.” They rarely address why. Why someone chooses to engage in behaviors. What is it about their life, their brain chemistry their situation, what is it that is compelling them to experiment with or become habituated to addicted to whatever it is to these drugs. Oftentimes- a friend of mine Sally Satel tells the story pretty frequently. When soldiers were in Vietnam, American soldiers, the rates of heroin use were extraordinarily high. And Richard Nixon was becoming very concerned with the end of the war, that we would have a flood of addicts coming into the country. So they started to try and incentivize people to quit. They said, “well, you have to you have to give us a urine sample and it has to be cleaned before you can come home.” And most of the soldiers were able to do that, come home, almost none of them relapsed. Why? What’s the difference? Heroin, which is considered commonly one of the most addictive substances, why once they were home, did almost none of them use again? And it’s because their life situation changed. You know, they had family, friends, social support, things to do. They weren’t surrounded by you know, boredom punctuated by terror, which they were experiencing in Vietnam. So I think we really need to look at the whole situation. And like I said, we’re worried about youth and drugs, which I think is a valid concern for public health. Like I said with young people in sex, how do we encourage young people to engage in the best behavior to do things in the safest way possible, make the best choices for themselves? One of the biggest risks to people your age actually is suicide. I think it’s the second or third leading cause of death among people under the age of 35. And that is not something we’re talking about at all. And public health isn’t talking about at all. And I think because unlike substance use issues, you instantly recognize the complexity involved in suicide and that it has so much to do with a person’s mental health, with their economics, with their social life, all of that. So I think one of the reasons it’s not being addressed is because there aren’t seemingly easy solutions in policy for it.

Juliette: Yeah. I think that makes sense. It’s easier to be like, Oh, we got rid of the gummy banner vapes. Look, we did something, but there’s nothing really, there’s nothing you can do. That’s tangible like that with an issue like suicide, or at least that they’ve thought of yet, which I don’t know. We’ll see. So now I want to talk about a policy study you wrote about salt, kitchen salt, sodium chloride. And you start in there by explaining that “the notion that if you eat too much salt, you will have high blood pressure has been perceived as medical gospel that most people including this author believed for the past three decades.” Your paper, however, concludes that 40 years of government policies meant to reduce sodium consumption for the sake of reducing hypertension have failed. So first, can you kind of tell us why hypertension is such a big priority for the government?

Michelle Minton: Like smoking, with hypertension comes a lot of problems. You have cardiovascular disease, it stresses out your vasculature system and can lead to death. A lot of people die from, as it seems, hypertension-related disorders. Hypertension, like with most medical issues, there are so many other factors involved. You know, someone who has hypertension likely also has cardiovascular disease is likely also obese is probably smoking is also probably old. They also don’t exercise. Which one of these things is resulting in death? But, hypertension is very serious. There is nothing more fundamental to the survival of a human body, honestly, than fluid dynamics. Than making sure that your body has the right composition of water and soludes like salt, metals, things like this. This helps your blood and your cells transfer nutrients between and get rid of toxins. Without the appropriate balance, you can’t get rid of toxins in your body, your kidneys fail. You get a build up of toxins, you die. This is one of the reasons that you can live for 30 days without eating food. Up to that amount, anyway. Most people can live at least a week or two. You’re going to die in a couple of days without water because your body will not be able to pump its own blood enough to get it to your organs. It won’t be able to clean your blood and get it where it needs to go. And you will experience organ failure pretty quickly. And salt is fundamental to that process. Salt is what helps your body move water and nutrients around. And I think some people have talked about a salt hunger as being the third kind of instinct. Do you know where you have food hunger? Salt seems to be an instinctual thing for most people where if you know, they’ve done experiments where half the group will get a placebo tablet and the other half will get a sodium tablet and then they will have them eat and you can add salt if you want to. And the group that was getting the sodium tablet would not use the salt shaker pretty much, And then the group that wasn’t getting sodium, they were getting the placebo, they would add salt to their foods. So both sides of the group were functional eating the same amount of sodium. If you look around the world, I’ve heard researchers describe it as eerie, how similar- except for in countries that are disrupted by Wars where there’s extreme and widespread poverty- almost every country eats around the same amount of sodium in their diet every day. And it’s about, I think 35, 4,000 milligrams per day, which is about 1000 to 2000 more than the government recommends. And I always say, “who are these people who looked at the entire world and said, you are all wrong. We are right.” All of humanity is wrong, but we are right. You need to eat this amount of salt. And in my research, like I said as you mentioned, I believed all of this stuff before I went into the research with a really simple question. I thought initially I was only thinking I would do a blog post before I functionally wrote a small book, which the question was “where and why did we come up with the sodium guidelines that we currently have?”

Juliette: I think about that a lot.

Michelle Minton: Where does this number come from? And I started digging through congressional testimony and the research, and I found that it was, it was basically out of nowhere. It was out of thin air.

Juliette: Yeah. I see that happening a good amount. What is the government done in addition to kind of setting this guideline to try to address this problem and kind of deal with all the salt stuff?

Michelle Minton: Well no shock, it started with the children. So at first the government started to strong-arm the makers of baby food to reduce sodium in the baby food, and that worked. Then they started putting pressure on them to do voluntary sodium reductions in adult foods. And we see that around the world. In the Western world and United Kingdom and America and Canada and Australia, where there’s a big push to reduce the sodium amounts in foods. Because the theory is that people will just eat salt. They will just eat salt. And if you put it in the food, they don’t know how much is in there. And they’ll just eat and eat as much as much as they possibly can without knowing what they’re getting too much. If you have healthy kidneys functioning properly, that is not what happens. First of all, your body can process an extraordinary amount of sodium. We’re talking in the 50,000 milligrams a day range without any problems. It cycles that around. It retains it instead of just flushing it all out. Sometimes you’re body is like, “we still need this, circle it back around.” So every day your kidneys are doing that amount, getting 4,000 milligrams a day extra in your diet. If you have healthy kidneys, it really shouldn’t be an issue. And most people will instinctually choose foods that are higher or lower depending on what their body needs.

Juliette: That’s amazing. That just amazes me so much, but also the fact that the government, at this point, it makes me think the government’s like, “Oh, not only do you not know what’s good for you, but your body, your body doesn’t know what’s good for you, but we do.” We and our arbitrary numbers.

Michelle Minton: I will say, in my research, one of the things I did find that was really, really fascinating was there is a certain group of people, maybe about 25% who become salt sensitive. And in their case, if their body’s not telling them they’ve had enough sodium, if they’re eating too much, they can have salt sodium related or diet-related hypertension. But there’s also an almost same amount in the population that are inversely salt-sensitive, meaning if they don’t get enough salt, they will become hypertensive because it’s their body trying to balance out. Your vessels will constrict in order to move the blood around without the salt because the salt helps you retain water. And that basically helps you retain water so that your blood can move it. Or I’m sorry, your vessels can move it around your body and get everything going where it needs to go. If you don’t have enough water, your vessels constrict so that it can- kind of like putting your finger over the nozzle of a hose to get it, to move faster. That’s what your body’s doing when it’s restricting. So that’s what hypertension functionally is. It is that your vessels are constricting chronically, and that causes a lot of stress on them.

Juliette: That’s the human body fascinates me. It’s just amazing. So what have the effects been of this government war against sodium?

Michelle Minton: I mean, honestly, I think people feel frustrated. A lot of times people feel like they don’t know what’s good for them, frankly. And I think that’s very problematic. They feel ineffectual, especially people who are at risk for hypertension or who already have hypertension. They’re told, “reduce your amount of salt to this extremely low level.” And if you’ve never tried it, you should, it’s really, really hard. Everything tastes horrible. I’ve tried to do it myself. I don’t eat an extraordinary amount of sodium. I’m pretty close to the guidelines actually most days. But, when I tried to reduce it to the actual guidelines level, it became very difficult to eat foods, eat my normal, healthy diet, because it was just filled with too much sodium. Even egg whites, pretty much my whole breakfast. I just burst through the the guidelines limit. And then you have someone with hypertension says, “okay, my doctor tells me to reduce my sodium, reduce my sodium,” and then they can’t do it because for one thing, they feel bad for another thing, they don’t enjoy food, which is important for just life and they give up. Then they give up and they’re like, “well, if that didn’t do it nothing will.” When the government isn’t telling people- they’re not emphasizing other strategies that are way more effective for a bigger number of people. If reducing the risks of hypertension is the goal, eat more fiber, eat more potassium, get some exercise, lose weight. All of these are more effective than trying to force people (which is almost impossible) to force people to reduce sodium below their body’s natural craving for it or what it needs. It’s really hard. It’s like telling someone to not eat when they’re hungry.

Juliette: Yeah. And that doesn’t really work. That’s frustrating. Well, the knowledge on this sort of stuff is changing slowly but surely. Thank you so much for this. I’ve learned a ton. So to wrap up, what is one thing you believed at one time in your life that later changed your position on and why?

Michelle Minton: I mean, that’s a tough question. I know I change my opinion on small things. Loads of times. I think honestly, the biggest change in my life that has occurred, and through the work that I’m doing, that we’ve been talking about is when I was younger- high school college- I thought there was a capital T truth and solutions that things could be fixed. You know? That if people just had the knowledge or the government had the right tools that we could fix people’s problems. I’ve really come to the position that, that is neither true nor advisable. In that there’s no amount of cajoling, stigmatizing, banning, forcing, whatever that will make people do what you think is best for them. And that I don’t think it’s appropriate either. I really think people are happiest and they’re living their best lives when they are making informed choices that are best for them. And that may not look right to the rest of us. What they’re doing may not look good, and we may not think that it works for our lives, but for them, their goals, what they enjoy, how they want to live their lives, how long they want to live. Not everybody wants to live forever. Some people would rather enjoy 70 good years than 80 kind of rough years. What I’ve learned is that it is always inadvisable to try and force people to change. And especially inadvisable when the government tries to do it.

Juliette: I think I see that a lot around me, but like only with specific things like kids will be posting on their social media, don’t assume like what’s best for this type of person. And then they go and in the other direction or telling people what is good for them and what they have to do. And they’re like, if the government doesn’t do this, then we all are going to like fall off the face of the earth because we don’t know how to take care of ourselves. But like they say it in a nicer way.

Michelle Minton: Thats other thing I’ve learned is that adults know almost nothing. Even scientists know almost nothing. They talk like they do. And they certainly know a lot. They can be experts in their area, but even experts, even people who know more than any other human beyond earth, what they do know is so small and they speak with such authority and such righteousness, that is in my opinion, unwarranted. I’m not necessarily a fan of misplaced humbleness, but I really think having some, having some recognition about the limits of knowledge, the knowledge that we do have is really important in any, not just government, not just policy, not for experts, even just your normal everyday life of recognizing that “I don’t know everything. And that’s okay. Here’s what I think I know.” And then go from there when you talk to people or when you engage with research or trying to understand something.

Juliette: Yeah. That’s true. I do think about that a lot. I’m like, “okay. They know, but what if the research changes and indicates something else later? Well, then they don’t know. And the thing is also how does that fit into the greater world? Well, I don’t know. You don’t know that?” So how I don’t know. So thank you again. This is all the time we have for today. Michelle, thank you again for your time and for your insight. I would also like to thank everyone who listens, subscribes and shares the Great Antidote Podcast. If you would like to be on the podcast, or if you have a guest in mind, please feel free to reach out to me [email protected] Thank you. Bye

CGO scholars and fellows frequently comment on a variety of topics for the popular press. The views expressed therein are those of the authors and do not necessarily reflect the views of the Center for Growth and Opportunity or the views of Utah State University.