Evidence of meeting #89 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was cigarettes.
A recording is available from Parliament.
Conservative
Stephanie Kusie Conservative Calgary Midnapore, AB
Ms. James, in your opinion, why do people start smoking? Do you think it is a coping method? Do you think it's to be cool? To me, this is just so much the crux of this. Why in your opinion do people start smoking?
Senior Manager, Health Policy, Heart and Stroke Foundation of Canada
People start smoking for a variety of reasons, and the marketing of tobacco products is definitely one of the reasons. Role modelling also plays a big part in this.
We see high levels of tobacco use among indigenous populations in Canada. It's quite hard for youth not to start smoking when they're surrounded by this in their environment.
Any strategy that aims to reduce smoking and prevent uptake needs to address youth use and indigenous use, and create opportunities where smoking cessation products are more affordable and accessible than tobacco products.
Conservative
Stephanie Kusie Conservative Calgary Midnapore, AB
It sounds likely cultural.
Mr. Cunningham, in 25 seconds, would you like to weigh in please?
Senior Policy Analyst, Canadian Cancer Society
There are many factors. Sometimes it because it's available. Sometimes it's because of the low price or attractive flavours. For a certain segment of youth, it's a very positive product. It has a positive image that marketing creates, and that's why we need plain packaging.
Conservative
Stephanie Kusie Conservative Calgary Midnapore, AB
Dr. Ostiguy, in 10 seconds, why do your patients start smoking?
Chest Physician, Associate Professor and Past Director, Smoking Cessation Clinic, McGill University Health Centre, As an Individual
Have you known of a teenager who doesn't want to try something that is a bit hard and a bit dangerous? Whether it's alcohol, driving, sex, or anything, it's part of the teenager mentality.
Conservative
Stephanie Kusie Conservative Calgary Midnapore, AB
I'll keep my hundred bucks.
Thank you, Dr. Ostiguy.
Liberal
February 12th, 2018 / 1:30 p.m.
Liberal
Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC
Thank you, Chair.
Dr. Ostiguy, you said—and I think everyone agrees—that vaping is safer than tobacco, that vaping is safer than cigarettes. That seems plausible to me. I can think of a number of reasons why that might be so.
I'm wondering about the body of research behind that. What do we have? Vaping has only been around, at least on the market, for about 10 years. Do we have really solid evidence that backs it up?
Dr. Ostiguy, we'll start with you.
Chest Physician, Associate Professor and Past Director, Smoking Cessation Clinic, McGill University Health Centre, As an Individual
For example, in Great Britain, three million people stopped smoking with the electronic cigarette. Farsalinos in Europe with a Euromonitor study said that they estimate that 27 million people stopped smoking with the electronic cigarette.
As I said before, if there were some ill effects of the electronic cigarette on the cardiovascular system or on the pulmonary system, they would have appeared in our scientific literature, and they haven't. I don't need a placebo-controlled, double-blind study to tell me that I am less likely to kill somebody if I drive 20 kilometres per hour in downtown Ottawa than if I drive 120 kilometres per hour.
Knowing that the carcinogenic substances, which could be a concern, are in such a low concentration in the vape of the electronic cigarette, I think that this is a risk....
I'm not saying that it is completely harmless. The Royal College of Physicians in London doesn't say it's 100% proven safe. They say it's 95% less harmful than the tobacco cigarette. Most of the damage from tobacco comes from combustion, and if you do have a product that doesn't have combustion, then you eliminate many of the ill effects of tobacco.
Research Director, Physicians for a Smoke-Free Canada
I don't think anyone here doubts that vaping is going to be less hazardous than smoking, certainly for smokers. The problem comes with the potential public health effects. What happens if these products are widely available, and people who never smoked start picking them up or ex-smokers start picking them up? Then they're going to become addicted, and some of them are going to move on to combustible cigarettes, and the whole epidemic is perpetuated. Those are the problems we're trying to avoid while maximizing the benefits that Dr. Ostiguy has referred to, whereby there is a potential for smokers who are unable to quit to at least have a somewhat less hazardous experience with satisfying their nicotine addiction. Once again, it's a question of balance. How can we get the benefits that are going to come from legalizing this product while guarding against the potential for harm?
I would further comment on what Dr. Ostiguy said earlier about how there hadn't been much problem in European countries with young people picking up these products. It should be noted that in most of these countries, advertising for these products is not allowed. Even in England, where some advertising is allowed and there's strong advocacy for the use of these products, the advertising that is allowed is much less than would be allowed under Bill S-5. Where there is a serious problem with young people picking up these e-cigarettes in large numbers is in the United States, where advertising for them is unrestricted. That is a situation we do not want to get into in Canada.
Liberal
Ron McKinnon Liberal Coquitlam—Port Coquitlam, BC
To play devil's advocate, if vaping is 95% safer than smoking, there are very much fewer health consequences of it. Nicotine is certainly addictive, but so is caffeine—and I certainly have that problem myself—but it's not a life-altering thing. Why do we care?
Senior Manager, Health Policy, Heart and Stroke Foundation of Canada
The 95% statistic is based on qualitative opinions. We can't quantify and say e-cigarettes are 95% less harmful than combustible tobacco. I caution against using that number and widely circulating it. We know e-cigarettes are less harmful, and Heart and Stroke believes that, but we don't know how much less harmful, and we won't know for some time. It will take decades for us to figure out what this means for long-term health consequences. We do know that nicotine is detrimental to youth development. We need to keep it out of the hands of young people. That's why marketing needs to be restricted.
Liberal
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Ms. James, I'm interested in exploring the difference between vaping and heat-not-burn. I don't think we've had very much testimony on the heat-not-burn products, which—from everything I've heard—the tobacco companies are at the gate waiting to come in and fully explore.
What are the health consequences or your thoughts on the heat-not-burn products?
Senior Manager, Health Policy, Heart and Stroke Foundation of Canada
Heat-not-burn products are very new, and they're being marketed as a reduced harm modality. There is no evidence to suggest that being the case. On the spectrum of harm, we see e-cigarettes on the one side, combustible tobacco on the other, and heat-not-burn somewhere along that line, but we don't know where they are. We shouldn't be recommending Canadians try these products because it still is tobacco, and that's harmful.
NDP
Don Davies NDP Vancouver Kingsway, BC
Okay. I'm going to stick with you if I can.
I'm a little confused about nicotine's long-term health effects. I don't want to put words in Dr. Ostiguy's mouth, but I almost had the impression that...you've mentioned its effect on rising blood pressure and heart rates and other—
Senior Manager, Health Policy, Heart and Stroke Foundation of Canada
Blood clots.
NDP
Don Davies NDP Vancouver Kingsway, BC
Blood clot risk.
Again, not to be unfair to Dr. Ostiguy, I heard him indicate that nicotine is not very harmful to our health. What do we know about the long-term health impacts of nicotine?
Senior Manager, Health Policy, Heart and Stroke Foundation of Canada
I'm not a clinician, so I'll let the physicians speak to the long-term impact of nicotine, but we know that the U.S. surgeon general has reported there's an increased heart rate and blood pressure and a possibility of blood clots, and we know that over a long term, nicotine use among youth is detrimental to development of their brains.
NDP
Don Davies NDP Vancouver Kingsway, BC
Mr. Ostiguy, I'll give you a chance to tell me, can I consume nicotine every day for the rest of my life with no health worries?
Chest Physician, Associate Professor and Past Director, Smoking Cessation Clinic, McGill University Health Centre, As an Individual
I don't think you should be very concerned about this. Your body adapts very rapidly to nicotine. Of course, after you smoke a cigarette, you might have a very temporary acceleration of your heart rate, but it comes back to its usual rate. It doesn't have any long-term effects.
I'm not promoting the advertisement of nicotine or any nicotine-delivery device. I agree that nicotine in any form should not be available to people under the age of 18. I quite agree with that, but I don't think we should exaggerate the harmful effects of nicotine, except that it's addictive.
Mind you, the smokers smoke.... There's no better way to control your mood than to have a cigarette. What were they giving to the soldiers at the front during the war? They were not giving them chocolate; they were giving them cigarettes.
Liberal
The Chair Liberal Bill Casey
Time's up.
We have some time left, however, so I'm going to propose that we have a round one again, with four-minute questions. That will allow us the five minutes to get to Question Period, but each side will have an extra question, based on our first round.
I'm going to hold you to four minutes, then, and we're going to start with Dr. Eyolfson.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you, Mr. Chair.
Dr. Ostiguy, you were talking about some data in England, particularly regarding vaping and young people, and you said it's very unusual for young people to start vaping who have never smoked.
An article in the Canadian Medical Association Journal in 2015 reported that people aged 15 to 19 actually are twice as likely to have tried vaping as smoking. They found that 20% of people aged 15 to 19 had tried vaping, whereas 11% of the same cohort had tried smoking.
Would it be fair to say, at least, that the studies you're referring to out of England would not be applicable to the Canadian experience?