Thank you very much. It's a pleasure to be here.
I'm a lawyer. I've spent now over 30 years working on public health policies on tobacco in Canada and around the world. I've testified in front of quite a few committees over the years and I think it's fair to say we've literally made history on other issues of tobacco in Canada.
When I first got involved in the beginning of the eighties among 15-year-olds to 19-year-olds, 42% in Canada were daily smokers, and in the space of 10 years we got that down to 16%. That was policy. We led the way on using things like tax policy, advertising restrictions, package health warnings, smoke-free spaces. A few people now remember we were the first country to get smoking out of airplanes. Now many of us have trouble even remembering how awful that used to be, but it was because of things like this.
And I must say, at a personal level, it's fair to blame my wife on some of this because as I was a young lawyer starting out, deciding I was going to change the world, she was a young doctor, and she was talking about how many people were sick, how many people were in hospital beds because of smoking. And at one point I said, “Well, if smoking is as big a problem as doctors say it is, you ought to be doing more about it.” She said, and she's usually right, “You don't get it.” And this was not the only time in our relationship she said that. “Figuring out why people are getting sick is a medical-scientific problem. Dealing with it is a social-legal-political problem. It's up to lawyers and politicians to deal with it.” And I think she's right, and I've been spending over 30 years trying to deal with it. And that's why I think we're here today.
We have had these great successes. We've reduced per capita consumption of cigarettes in Canada very dramatically over that 30 years, probably by about two-thirds. But because of an increase in population and the fact that a lot of people reduced, but didn't quit their smoking, the total number of smokers in this country went from just over seven million to somewhere around five million. It's still our leading cause of preventable death.
I have no written submission for the committee, but what I'd highly recommend is that Clive Bates, who was to testify here, has sent in a very good submission. I think Clive, who is a friend and a colleague for many years out of the U.K., is one of the best thinkers we have in public health on tobacco. And instead of reading anything that I would submit, I suggest you read what Clive submitted twice. It's that valuable.
If the committee is interested, I can certainly submit other things that I've written over my career, including on this topic. I should also say that I have no financial conflicts of interest. I don't get money from anybody on any side of this, whether it be people trying to sell the products or people trying to oppose the products.
Why are these things important? Why is it we're talking about them? Well, frankly, it's because cigarette smoking is still by far our leading cause of preventable death. It's still killing somewhere in excess of 40,000 Canadians per year. Based on the status quo, if we simply continued to do the things that we're doing now, we can expect another million deaths in the next 25 years. Those are all totally preventable. We can do something about it.
And one of the really odd things that I've experienced in my career working on this is that we have done all sorts of things about the periphery of the cigarette, but not dealt with the cigarette itself. We've not dealt with the fundamental problem. We've talked about things like what price because of taxes you have to pay, where you can buy it, who can buy it and who can sell it, where you can use it, what sort of labels you need to have on it, and what sort of advertising there will be for it.
But the product itself is the fundamental problem because cigarettes are just an incredibly deadly delivery system for a drug. If people got their caffeine by smoking tea leaves, it would also be killing a tremendous number of Canadians because essentially, it's the smoke. As you've heard from others, we know that smokers smoke for the nicotine, they die from the smoke, and the public health tragedy is that they don't need to. Even if they were going to use nicotine, they can use nicotine in a way that simply doesn't cause those problems. As I've been saying, we haven't worried a whole lot about people drinking tea and coffee. It can be addictive; there are risks. It's low enough that we don't worry much about it. If they were smoking coffee beans, smoking tea leaves, it would also be a huge problem.
We've known for decades that we could reduce the problem. We could essentially eliminate the problems by simply getting rid of combustion-based delivery. And we now have products that are coming onto the market that provide that sort of opportunity.
Wells Fargo, the giant investment bank, has estimated, and their belief is, that within a decade electronic cigarettes will outsell cigarettes in the United States, depending what sort of regulation facilitates or gets in the way of that happening. That's a huge opportunity.
What we're seeing here is something that I think follows the history of what we've seen in other areas of public health, whereby we're getting an intervention that isn't a medical intervention per se; it isn't because of government or health departments telling people what to do. This is coming from entrepreneurs who come out with a product to meet a demand from consumers who are saying, I don't want to smoke; I want something that will help me get off smoking.
People are incentivized to come out with better products. Among other things, people are spending $700 billion a year buying cigarettes around the world. Most of those people don't want them.
This is similar to what we've seen before. In the early 1940s, the leading cause of cancer death in Canada wasn't lung cancer, which is by far our biggest problem now; it was stomach cancer. Stomach cancer deaths fell precipitously, and they fell not because of a hugely expensive government intervention; they fell because entrepreneurs leveraged innovative technology to meet a consumer demand—for refrigerators. We used refrigeration; diets changed; stomach cancer rates plummeted.
Look at what happened with automobile death rates. When I was young.... I think all of us growing up, certainly in small-town and rural areas, can name lots of friends who died in car accidents. More than 6,000 Canadians were dying each year. It's fewer than 2,000 now, even though there are more than twice as many cars on the road. We changed the delivery system; we changed the product; consumers were able to access something; entrepreneurs were incentivized to come out with better auto safety features. The death rates are down by more than 80%.
When we look at nicotine, we could do something that would lower the death rates far more dramatically and far more quickly, and we simply have to figure out how to seize that opportunity. How do we de-normalize smoking? That's what these products can do; they are a fundamental threat to the cigarette status quo.
It's very hard to imagine somebody now wanting to get into a car that doesn't have air bags, seatbelts, safety glass, etc. It's very hard to imagine somebody wanting to buy the snake oil medicines that existed in the 1930s now, rather than modern medicines.
We have the ability to give a real option to smokers, and in doing that we have the potential to then use the tools we've been using to try to reduce smoking—regulation, litigation, etc—to further change the market. I think we have the potential to make cigarettes history; to make one of the biggest breakthroughs we've ever had in public health.
In terms of how we do this, a key thing is to identify what not to do, because I think we've been seeing a lot of that. I don't think we need to engage in moral panics; I don't think we need fearmongering; I don't think we need people hyping potential, minor, hypothetical, and containable risks; I don't think we want to use regulation that protects the cigarette business because of some fear that something might go wrong with products that are massively less hazardous. We have to be aware that the unintended consequences people worry about have to be seen in relation to the 40,000 deaths a year by cigarettes.
That's the problem. How are we going to avoid being held responsible in future years for having maintained that epidemic when we had the option to do something about it.
What should we do?
I think we need fit-for-purpose regulation. There's a tendency for people to look at the regulations we now have on nicotine and say that it has to be a medicine or it has to be a tobacco product. It isn't either of those. Just as, when somebody says “sort these blocks into squares and circles” and then hands you a triangle, it's important to say “I need another pile; this isn't either of those”, we need to look at regulation that is aimed at getting the most effective measures in place to move smokers off combustion-based delivery and get people on to not just the e-cigarettes that exist now, but to wherever innovation will take us.
We have, even here in Canada, leading medical researchers who are developing what I think are phenomenal products—products that could be far more effective at getting people off cigarettes but that are stymied by regulations—saying, we can't market them in Canada; the barriers to getting these things into the market are simply too great. We need regulation that opens up the opportunity to do things such as that.
We need to have truthful, non-misleading information to consumers. The history of public health tells us that often the biggest breakthroughs are based on two very simple concepts. One is that you give people enough information to make an informed decision; and two, you give them the ability to act on that information. If we do that, amazing things happen when people are able to act.
Look around at what is now happening with electronic cigarettes. As you've heard from other speakers, in the U.K. the anti-smoking groups there estimate that more than 700,000 smokers have totally switched to electronic cigarettes. There are higher numbers in France.
In the U.S., with the best numbers I can see, over two million have already switched entirely to these products. These are huge potential breakthroughs, but it's very much the general patent line, “there's no such thing as an obstacle, only a new opportunity”. Rather than looking at this and asking what might go wrong, let's think of what might go right. What could we do that brings us within the realm of what we've had a history of doing in Canada, of getting public health right and setting precedents here that save the lives of a heck of a lot of Canadians and that are then exportable to the rest of the world as good public policy?
Thank you.