First of all, just to introduce myself and let you know who I am and what I do, I am a physician, I work at Vancouver General Hospital, and I spend my clinical time in the smoking cessation clinic. Essentially, I eyeball people who want to quit smoking and help them in their quit journey using evidence-based treatment.
I'm here to speak about electronic cigarettes. The first thing I'd like to do is just preface any comments I have by saying that clearly this is a highly contentious area, with great polarization and dispute among people within the public health community and people within the tobacco control community. The areas of contention really span the whole issue, but they probably focus on a couple of main areas. The first is whether these products are safe, or indeed safer than traditional cigarettes. The second is whether these products have utility as a cessation device. Do these products actually help people to quit smoking? Third, there is some dispute over the harm that may or may not be caused to those who are secondarily exposed to vapour. There is also some concern around youth uptake and so-called renormalization of smoking behaviour.
Those are, in a nutshell, the areas of contention. Many individuals on different sides of the debate would hold differing opinions. I can't really begin to provide you with a succinct summary of that debate. All I will say is that it's contentious, and people with different positions will give you an entirely different answer to each of those questions. Sometimes it may be worth looking at the vested interests for those individuals. Certainly the industry that manufactures these products has a position, and that's worth noting.
I'd like to comment on three areas that I think I can provide some expertise in. The first is that the evidence is probably best summarized by the World Health Organization paper that was released this summer. It was a review of the evidence, and if you're not aware of that publication, I can certainly make it available to you. They made a number of recommendations in that publication, but two recommendations stand out—the need to, one, limit advertising, sponsorship, and promotion to non-smokers and youth, and two, provide protection to bystanders from the effects of second-hand vapour. That World Health Organization review should be, I would suggest, a piece of evidence in any consideration that is given to e-cigarettes. It's also worth saying that the review itself has been criticized by those who are credible within tobacco control, but again, that reflects the debates around these products.
The second thing I'd like to comment on, again very briefly, is that I was part of a Vancouver Coastal Health authority delegation that recommended that the City of Vancouver do two things. One was to ban the sale of electronic cigarettes to minors. Two was to add electronic cigarettes to existing tobacco legislation and thereby limit the places in which electronic cigarettes could be used. We were really proposing bans in indoor public spaces and on patios of restaurants and bars, and a ban on use in parks and beaches, which is already in place for traditional cigarettes in Vancouver. That was unanimously upheld last month. The City of Vancouver has staked out its position quite clearly with regard to electronic cigarettes.
Third and lastly, I have just a brief comment on what I see day to day with smokers who are engaging in that journey to try to rid themselves of the use of tobacco. I see smokers every day, and almost every smoker will ask me, “What about the electronic cigarette? Is it safe? Will it help me to quit?” Many will also report that they've actually used the electronic cigarette and have absolutely no difficulty in purchasing the nicotine-containing product, which of course, according to Health Canada's directive, is banned for import and sale. So the nicotine-containing product is in widespread use.
In summary, there are concerns around manufacturing; around labelling, with thousands of products available; around second-hand exposure; around safety, particularly in long-term use; and around renormalization and uptake among youth.