Health Committee on Feb. 12th, 2018

[The Chair, Liberal, Bill Casey]

We'll call our meeting to order. Welcome, everybody, to the 89th meeting of the Standing Committee on Health.

Today, we're starting a new study on Bill S-5, an act to amend the Tobacco Act and the Non-smokers' Health Act and to make consequential amendments to other acts.

It looks as though our witnesses today have brought lots of homework for us. From Physicians for a Smoke-Free Canada, we have Neil Collishaw, research director. From the Canadian Cancer Society, we have Rob Cunningham, senior policy analyst. From the Heart and Stroke Foundation of Canada, we have Lesley James, senior manager, health policy. As an individual, we have Dr. Gaston Ostiguy, chest physician, associate professor and past director of the smoking cessation clinic, McGill University.

Welcome, everyone. We'll ask each of you to make an opening statement of no more than 10 minutes and then we'll go to questions. We'll start with Physicians for a Smoke-Free Canada.

[Neil Collishaw, Research Director, Physicians for a Smoke-Free Canada]

Thank you very much, Mr. Chairman.

Honourable members, thank you for your invitation to present our views on Bill S-5, An Act to amend the Tobacco Act and the Non-smokers’ Health Act and to make consequential amendments to other Acts.

I am the research director at Physicians for a Smoke-Free Canada. Although I'm not a doctor, I have been working for 35 years in the area of tobacco control. I worked at Health Canada in the 1980s and at the World Health Organization in the 1990s.

Bill S-5 will legitimize what is currently a grey market for vaping products. It will give some clarification that facilitates the introduction of plain packaging and will make a small number of other important advances for tobacco control. Sadly, however, the bill, as currently drafted, contains unnecessary risks to public health. If these flaws are not corrected, we predict that the bill will create more problems than it solves.

The fundamental flaw in the bill is that it opens the door too wide for the promotion of vaping products. One consequence of legalizing vaping products is whether it will invite tobacco companies into the Canadian market with new vaping products. They do not participate now in the grey market.

Royal assent on this bill will be the starting gun for the race to sell as many of these products as they can, using every marketing tool that this law will hand them. The bill hands them too many such tools. As currently drafted, it will allow them to advertise on television, radio, billboards and retail outlets, social media, direct mail, text messaging, contests, and giveaways. Once again, girls in skimpy outfits could be sent into bars to offer samples to patrons. We have seen the same companies use these same tools to recruit and addict previous generations to nicotine.

Our recommendation for minimizing this risk is simple: restrict advertising for vaping products the same way it is restricted for tobacco, which, you will remember from your review of Bill C-45, is also under the same types of restrictions that are in place for cannabis. Permit only information and brand advertising advertisements and allow that only in a very few places. Even if the marketing rules are the same, vaping products will still enjoy a marketplace advantage over tobacco products as they will be sold in branded packages with lesser health warnings and without taxes. We are not alone in making this recommendation. Most major health organizations also suggest that vaping products be subject to similar restrictions.

In response to these concerns, the Senate adopted the amendments proposed by the health department to give the government regulatory authority to curb advertising of vaping products in case things went wrong. A few months later Health Canada issued a consultation paper on the types of regulations it was considering, and these were a throwback. They were very similar to those that the tobacco industry used to govern itself in place for cigarettes in the 1960s and 1970s.

Restricting television advertising to certain times of day, billboards to certain distances from schools are not good enough, and we know this from bitter experience. No one should be encouraging a consumer product that has a better than 30% chance of addicting people to lifelong use. Regulations cannot put the advertising genie back in the bottle. We need to restrict advertising for vaping products now, not later; and we need to do it strongly, not weakly.

If this bill passes as currently drafted, Canada will be virtually alone in allowing such liberalized rules for promoting vaping products. Most OECD countries that allow vaping products to be sold apply similar advertising restrictions to those that exist for tobacco. Only the U.S.A. allows largely unrestricted advertising for vaping products, and what has this meant for young Americans? Well, I think the title of the December 2016 press release from the U.S. Surgeon General is the answer: “Surgeon General Reports Youth and Young Adult E-Cigarette Use Poses a Public Health Threat”.

Now I turn to another flaw in BillS-5, one that could be described as a serious omission.

While opening the door to vaping products and their advertising, Bill S-5 fails to start closing the door to other tobacco products. Bill S-5 legalizes vaping products in the hope that they will offer some reduction from the harm that tobacco causes. It's a nice hope and I hope it comes true, but it's still only a hope. To guarantee that harm will be reduced, we need a plan to get rid of the conventional cigarette.

A few months ago the U.S. pushed forward with its vision of how to ensure that the benefits of less harmful forms of nicotine use were accompanied by a reduction in the use of the most harmful forms. The U.S. Food and Drug Administration announced a comprehensive harm reduction framework in July 2017 in which they plan to reduce the amount of nicotine in conventional cigarettes as a way of shifting smokers to less harmful forms. Because of particularities of American law and regulation, the FDA is constrained on how it can regulate cigarettes and they have chosen nicotine reduction because basically the law doesn't allow them to have any other options. But in Canada we do—you do, as legislators.

We can follow and improve on the American lead by creating a harm reduction framework that aims to reduce the supply and demand for cigarettes by using a range of approaches. These might include cap and trade programs, financial incentives, performance requirements, and other modern regulatory tools. The government has set a goal of achieving less than 5% tobacco use prevalence by 2035, “less than 5 by 35”, but so far it seems to be less of a plan and more of a slogan. However, there is now an opportunity through Bill S-5 to establish a harm reduction framework that will ensure that legalizing vaping helps reduce smoking.

Here are some key changes that we are proposing in very much summary form: expand the purpose of the act to include reducing the burden of disease, preventing addition to nicotine, and achieving the minister's goal of less than 5 by 35; expand the scope of the act once again to establish regulatory authority over new heat-not-burn products as well as other new tobacco products that may be introduced in the future; and impose new requirements and obligations on the tobacco industry.

We have prepared detailed suggestions for how these changes could be introduced during clause-by-clause review of the bill, and I will be happy to share our suggestions with you later on.

This committee can greatly assist in achieving the goal of less than 5 by 35. Don't allow Bill S-5 to be passed without the safeguards needed to protect young people and others from tobacco and nicotine industry marketing. Make sure that Bill S-5 is a step towards ending the sale of combustible tobacco products and not a way to recruit future smokers.

Thank you for your attention.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we go to the Canadian Cancer Society. Mr. Cunningham.

[Rob Cunningham, Senior Policy Analyst, Canadian Cancer Society]

Mr. Chair, committee members, my name is Rob Cunningham, a lawyer and senior policy analyst for the Canadian Cancer Society.

Thank you for the opportunity to appear before you today.

At the outset, we acknowledge the federal government and Health Minister Hon. Petitpas Taylor for their support in advancing tobacco control. We also acknowledge all parties in supporting Bill S-5 at second reading, and the role of all parties over decades to contribute to advancing tobacco control in Canada.

We support Bill S-5 and have a number of recommended amendments to improve the bill.

First, I will speak to plain and standardized packaging. This is a key tobacco control measure, including to protect youth. Canada will join the eight countries that have finalized plain packaging requirements: Australia, United Kingdom, France, Ireland, Norway, New Zealand, Hungary, and Slovenia, and the many more in progress.

This binder that has been distributed to you includes an international review of where things are at.

Plain packaging advances several objectives: reducing tobacco product appeal, curbing package deception, ending promotional aspects of packaging, improving health warning effectiveness, and reducing tobacco use. The package is the most important type of tobacco advertising that remains in Canada today. Tobacco is addictive and lethal and should not be sold in packages to be made more attractive, period.

Imperial Tobacco has stated there is no evidence to support plain packaging. In fact, the evidence is overwhelming. Beside me is an extensive 13-volume evidentiary compilation submitted to this committee. It is available for your review and consideration. The compilation contains abundant studies worldwide that provide compelling evidence that plain packaging would be effective. There are more than 150 studies and reports and other evidentiary items specifically on package promotion and plain packaging, not to mention a vast number on package warnings and other related packaging aspects. Distributed to you separately is a table of contents.

Of course plain packaging would be effective. Why else would the tobacco industry be so opposed?

Implementation of plain packaging in Australia has been a success, but the tobacco industry claims that plain packaging in Australia has been a failure, claims echoed by Sinclair Davidson, who will testify later today. Mr. Davidson is a senior research fellow with Australia's Institute of Public Affairs, an organization that has received tobacco industry funding. The real benefit of plain packaging will be seen over 20 years but the initial years are already encouraging. If I can invite members of the committee to turn to tab 4 in this binder, you will see a graph with respect to the trend in smoking prevalence in Australia. Plain packaging was implemented in 2012, and you see a decline in smoking prevalence after. It's not the case that smoking declines have stalled.

If we turn to the next page, this is for 18- and 19-year-olds. Again, we see a decline in smoking prevalence. This is the national drug strategy household survey. The sample size for youth is smaller, but the next page has a much bigger sample size; current smoking in 16- and 17-year-olds in Australia, and there's a decline. When smoking rates get low, even a couple of percentage points are very important in terms of potential health impact.

There are other graphs that follow different sample size to the extent that they're reliable, and there's caution, but they're encouraging.

In France, the tobacco industry points to a decline in cigarette sales of 0.7% in the 12 months following implementation of plain packaging on January 1, 2017 to say that plain packaging is not working. However, there was also a decline of 5.1 % in roll-your-own tobacco, an important category in France. When considering population growth, the per capita declines are about 2% and 6%. Those numbers do not take into account inventory movements and changes in contraband levels, which can distort things. Just prior to implementation, retailers would have decreased their purchases to get rid of old stock and not to be stuck with things that would be redundant. After January 1, they had to replenish their inventory, so that distorts things.

The French government has strongly supported plain packaging and in 2015 even hosted a 10-country ministerial meeting to promote plain packaging with ministers of health from other governments.

One claim that has been raised is that, with plain packaging, it will take more time for a store employee to retrieve a package for a customer. This has not been the case in Australia, where many retailers simply place brands in alphabetical order. Studies in Australia found that there was actually a decrease in the time it took to retrieve a package.

Regarding contraband, industry claims should be disregarded as without merit for numerous reasons. Tab 3 of the binder responds to their claims. Keep in mind that the three major tobacco companies in Canada in 2008 and 2010 were convicted of contraband and paid fines and civil settlements of $1.7 billion.

The only reports cited to support the claim that plain packaging increases contraband are funded by the tobacco industry. KPMG, author of various reports, was forced to take the unusual step of writing to the British health minister denying that its report indicated that plain packaging increased contraband, as the industry has cited. The report found no counterfeit products, none, packaged for the Australian market. The total volume of all contraband in 2016 of 2.3 million kilograms was less than the 2.4 million kilograms in 2010 prior to plain packaging.

Imperial Tobacco argues that taking the brand name and logo off cigarettes will cause contraband. This is not the case. In part, companies will be allowed to place an alphanumeric indicator on cigarettes unique to each brand, as is done in Australia. There should also be a mandatory marking, something that Ms. Gladu and other members of Parliament raised during second reading debate. Such a marking would provide an indication as to what is intended for legitimate sale in Canada and would assist responding to contraband concerns. The best mandatory marking would be a health warning, a measure supported by research.

An amendment to the bill should provide regulatory authority to allow health warnings directly on tobacco products themselves, in addition to packages, just as the bill currently does for vaping products.

Our recommended amendments to the bill are included at tab 1 of the binder.

A further amendment should provide regulatory authority that some or all of the provisions of the act in the future could apply to herbal products for smoking, including herbal water pipe products. Water pipe use, hookah, is on the increase among youth and needs a response. An amendment should modify the process to adopt regulations under the Tobacco Act. It should no longer be necessary to submit regulations to the House of Commons for approval. Almost no other federal legislation has such a requirement, which inhibits effective and rapid responses that are essential when dealing with an epidemic.

Regarding e-cigarettes, we recognize that e-cigarettes are less harmful than conventional cigarettes, and we support the changed regulatory status in S-5. Through Bill S-5, the government is making e-cigarettes available as a less harmful product to smokers unable to quit. At the same time, the government recognizes that there are potential negative risks. Legislation is needed to deal with those potential risks, such as youth use, as well as marketing tactics that would discourage cessation where that would appeal to ex-smokers and non-smokers. Many of the bill's e-cigarette advertising restrictions are weak compared to other jurisdictions.

An amendment should ban all lifestyle advertising. Examples could include tropical beaches, sports cars, and glasses of wine by a romantic sunset—examples allowed by this bill. The Canadian Vaping Association, in Senate committee testimony, supported a lifestyle ban.

An amendment should clearly specify that the only advertising allowed is information advertising or brand preference advertising. This is reasonable. This is in fact the government's stated intent, but the intent is not reflected in the bill's current wording. Again, the Canadian Vaping Association testified that it wanted advertising limited to information advertising.

An amendment should further curtail sales promotions, such as e-cigarette purchases giving a chance to win a free vacation or tickets to a rock concert. Again these are lifestyle associations.

An amendment should restrict the location of permitted advertising and thus reduce youth exposure, though still permitting advertising to adult audiences. At present there is no restriction in the bill whatsoever on location; it's weaker than for tobacco or cannabis. Advertising is allowed on television, public transit, bus shelters, billboards, comic books—virtually everywhere.

Other countries, such as New Zealand, that are legalizing e-cigarettes with nicotine will ban e-cigarette advertising while allowing some at retail, in a way that matches provisions for tobacco.

What we have in Bill S-5 is provisions so weak that they're comparable to the 1964 Canadian tobacco industry voluntary code. They are very weak, even when you consider proposed regulations that the government has released for consultation.

Even with the proposed amendments on e-cigarette promotion, federal and provincial legislation would still allow retail displays and the provision of product information in specialty vape shops as well as in other specified locations.

We urge support for Bill S-5 and our proposed amendments. Bill S-5 is a critical component to a renewed and strengthened federal tobacco control strategy.

Before concluding, I would like to comment on the claim by Rothmans, Benson & Hedges that they want to end smoking and stop cigarette sales. This is a public relations claim; it is not believable. Why are they not supporting plain packaging for cigarettes, if that is their objective? Why are they funding convenience store associations to talk about contraband and to oppose tax increases for cigarettes?

Tab 5 of your binder shows the global campaign for Marlboro with lifestyle advertising—the “Be Marlboro” campaign. This is not a company that's sincere about ending cigarette sales, when they have advertising like that. This is a company that today, on packages of Canadian Classics, has a mountain lake scene that looks like Banff or Lake Louise. That's a lifestyle association. It's an example of why we need plain packaging.

They sell Benson & Hedges super slim cigarettes, which are very appealing to young girls and women. Those should be banned.

We have other companies.... For example, this is a company that has marshmallows over a campfire; this is Pall Mall. It's an association with lifestyle that is very appealing, and plain packaging would deal with it.

Just as a final example, because there are so many of them, this example is from Rothmans, Benson & Hedges. They have a package of cigarettes, but with a sleeve that has advertising. That's how they get around restrictions on bans on billboards.

This is an opportunity for us to implement plain packaging.

We express our appreciation to all committee members for the opportunity to appear.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we will go to the Heart and Stroke Foundation, Ms. Lesley James.

[Lesley James, Senior Manager, Health Policy, Heart and Stroke Foundation of Canada]

Good afternoon, Mr. Chair, and members of the committee. I'm Lesley James, senior manager of health policy at the Heart and Stroke Foundation of Canada. I'm also a doctoral researcher.

It's an honour to speak to you today about Bill S-5, a key piece of legislation in achieving Heart and Stroke's vision of a Canada free of commercial tobacco use.

Your committee will hear from many of our health coalition partners and tobacco control experts on this subject. Our common agreement is that we support aspects of Bill S-5 as related to plain and standardized packaging but have significant concerns with the bill's permissiveness around the wide-scale marketing of e-cigarettes. As such, we recommend amendments.

Bill S-5 represents an important step to strengthen tobacco control. It aims to protect the health of our children and youth from the industry tactics that target young Canadians and hook them to addictive and harmful products.

While Bill S-5 in its current form recognizes the power of tobacco marketing in appealing to young Canadians, it fails to protect that same vulnerable group as well as non-smokers from persuasive, e-cigarette advertising. In this regard, Bill S-5 contains a fundamental flaw, and we hope to see amendments made to address this disconnect between marketing restrictions.

The federal government has committed to a goal of less than 5% tobacco use by 2035. Despite efforts to reduce tobacco use in Canada, smoking rates remain unacceptably high at 17%. We support the 5% target and strongly believe that Bill S-5 is a key piece of legislation to achieve this target.

Getting to 5% is important because tobacco use remains the leading cause of premature death in Canada, killing over 45,000 Canadians each year; that's 120 of us every day. Nearly one in five deaths in Canada can be attributed to tobacco use. We have much work ahead of us, especially as it relates to young Canadians.

Smoking rates are greatest among young adults, aged 20 to 24, at 18.5%. Sadly, almost 10% of 15- to 19-year-olds in Canada identify as current smokers. We know that most smokers start as teenagers, but 20% of Canadians try their first cigarette as young adults.

How do we address this issue and reduce tobacco use among all Canadians, with a particular focus on youth and young adults? The answer is plain and simple. Heart and Stroke strongly encourages and supports the adoption and expedited implementation of plain and standardized tobacco packaging. Our organization has been urging for the adoption of this policy measure for decades, and I would like to show you why it's so important.

I have examples of packs sold in Canada. This is a pack targeted towards young men. We call it the hipster pack. It's trendy. It's kind of rustic looking. These ones are targeted towards young females. They're meant to look like cosmetics packages. The lipstick that I bought last week looks just like this. You can see that the product inside is equally as appealing as the outside. It's appealing and glamourous.

As a woman who understands and recognizes that these products shrewdly appeal to gender-specific beauty norms and ideals, I want to emphasize that these gender-oriented tactics, preying upon young and vulnerable women, are offensive, demeaning, and need to be stopped.

The use of the words “slim” and “vogue” along with the delicate but sparkly cigarette also demonstrate that the product itself should be mandated to be unappealing. This would entail banning slim cigarettes and would provide an opportunity to use the product itself for health messages.

As such, we ask for an amendment in this bill providing the regulatory authority to require health messaging on the product itself. This is already the case for e-cigarettes in this bill. Messages like “tobacco kills” or the promotion of cessation programs on each cigarette would be highly effective in dissuading use and increasing quit attempts.

Plain packaging has been endorsed by the World Health Organization and adopted in many countries. Evidence indicates it has a variety of benefits including accelerated declines in tobacco use, curbing deceptive marketing messages, increasing the visibility and effectiveness of health warnings, reducing the appeal of tobacco among youth, and increasing smoking cessation attempts.

After the policy's implementation in Australia, positive image associations across all tobacco brands fell, and the greatest decline was seen among adolescent smokers.

Concerns about contraband in relation to plain packaging are inaccurate, overstated, and exaggerated by the tobacco industry. Contraband concerns are often used as an industry narrative to stall tobacco control policies.

We applaud all parliamentarians for forging ahead with plain packaging and recognizing the tactics used by the tobacco industry and its front groups. Plain packaging is a powerful policy measure fully endorsed by Heart and Stroke and hundreds of health experts in Canada.

With regard to vaping products, Heart and Stroke's position on e-cigarettes has evolved over time with advances in research, and while the evidence regarding e-cigarettes continues to grow, there is still much left unknown. We continue to strive for a balance between potential risks and benefits and to that end it is important that regulations ensure product safety and protect Canadians against potential harm.

Experts agree that complete tobacco cessation over the long term rather than reducing the number of cigarettes smoked per day is the most effective way to reduce risk for disease and premature death. Heart and Stroke encourages people in Canada to strive for complete cessation as the best means of reducing tobacco-related illness.

We recommend Canadians use cessation tools like nicotine replacement therapy, quit medications, and counselling. Some Canadians may find cessation benefits for reductions in tobacco consumption from the use of vaping products, but in Canada, as elsewhere in the world, dual use of both e-cigarettes and tobacco is common, which puts into question the public health benefit of these devices.

Heart and Stroke agrees that e-cigarettes are less harmful than combustible tobacco, and for this reason we support increased access to e-cigarettes for adults. However, e-cigarettes are not without risk. Claims made by researchers that quantify the difference in associated harm between e-cigarettes and combustible tobacco are based on faulty methods and draw inappropriate conclusions.

We have known for years that e-cigarettes are appealing to Canadian youth. A study found that 18% of non-tobacco-using Canadian high school students had tried e-cigarettes and another 31% were interested in trying them. Current use of e-cigarettes among 15- to 19-year-olds has more than doubled in the past few years. Studies also show that more teens are using e-cigarettes, seeing them as cool and fun, and research in Canada shows a link between e-cigarette use among youth and later tobacco use.

We want to ensure that e-cigarettes do not result in nicotine addiction and tobacco use. It is essential that young Canadians be protected from marketing exposure aiming to increase the use of these products. Not only are there potential harms with the liquid constituents of vaping devices but we need to protect non-smokers and youth from nicotine, which will become legal and more readily available once Bill S-5 is passed. Nicotine is a highly addictive drug that increases blood pressure, makes your heart work harder, and can cause blood clots.

It is essential that Bill S-5 be amended to further restrict the marketing of e-cigarettes in Canada. In its current state, wide-scope marketing would be permitted for advertisements everywhere and anywhere, television, online, video and advergames, newspapers, magazines, billboards, public transit, social media, and the list goes on.

Of great concern is that marketing can happen in bars and night clubs, places where young people often congregate and are under the influence of alcohol. This can make them more susceptible to marketing messages and create opportunities for young Canadians to experiment with e-cigarettes. There is no need for marketing in places frequented by young people or the widespread marketing of vaping products to the general public. The only group that should be exposed to the marketing of these products are current tobacco smokers.

The proposed ban on lifestyle advertising will not be strong enough to protect young people from the multi-billion dollar marketing machinery of the industry. As such, we ask that Bill S-5 be amended in relation to vaping products to include strengthened restrictions on e-cigarette advertising to align with the restrictions in the Tobacco Act and proposed cannabis act and the removal of the provision that allows lifestyle advertising in bars and adult publications.

Heart and Stroke also formally endorses the recommendations proposed by the Canadian Cancer Society.

To conclude, Heart and Stroke strongly supports the proposed legislation related to plain and standardized packaging and is recommending amendments to increase the impact of the bill. We urge that this committee make Bill S-5 a key piece of legislation that truly protects our kids and prevents uptake by non-smokers in further restricting e-cigarette marketing.

In adopting these amendments, Bill S-5 will become a strong and powerful piece of legislation to drive down tobacco control and put the health of Canadians first.

Thank you for your time.

[The Chair, Liberal, Bill Casey]

Thank you.

Now we go to Dr. Ostiguy. You have 10 minutes.

[Dr. Gaston Ostiguy, Chest Physician, Associate Professor and Past Director, Smoking Cessation Clinic, McGill University Health Centre, As an Individual]

Thank you very much, Mr. Chairman, and members of the committee. I thank you for allowing me to speak to you today. I'm grateful for the invitation.

I've been directing a smoking cessation clinic for quite a few years. My experience is dealing with ill and very ill smokers. This is more or less the sense of my intervention.

It is rather naive to think that all smokers want to stop smoking and are able to stop smoking. Nowadays even the best clinical studies usually have a success rate of less than 30% abstinence of one year. Approximately one in three smokers in the United Kingdom currently attempts to quit each year but only about one in six of those who try to quit remains abstinent for more than a few weeks or months. It is about 5.5% altogether. In Canada, 66% will attempt to quit in the next six months.

Cigarettes are the most addictive tobacco product. As it is well recognized, if it is the most addictive tobacco product, it might not be that easy to stop smoking. It takes more than just willpower.

We know very well that tobacco smoking has very dreadful consequences on health, both for the smoker and for the ones who are exposed to second-hand smoke. Smoking tobacco kills, but nicotine does not. Nicotine does not cause cancer, does not cause cardiovascular disease, and does not cause pulmonary disease—COPD, for example. But nicotine creates a dependence. As a chest physician, I've seen enough lung cancer and cases of COPD, asthma, and chronic bronchitis to know that this is a dreadful consequence of smoking. Lung cancer and COPD represent our daily bread in chest medicine. Fifty per cent of smokers will die from a tobacco-related disease. Smokers will die eight to 10 years earlier than non-smokers. Smokers who stop smoking before the age of 35 have a longevity similar to non-smokers. Smokers who quit by the age of 35 can live as long as non-smokers, both men and women. Very little attention is paid to this group of smokers.

I don't have the time to talk about all the illnesses related to tobacco smoking, so I'll concentrate on cancer. Smoking is involved in the etiology of at least 14 different cancers. For some of these it is the main cause, like lung cancer. E-cigarette vape might contain some carcinogenic substances but it is less than 1% of the threshold limit value in the workplace and up to 450 times lower than in cigarette smoke.

Swedish people have used snus for many years, since the beginning of the 20th century. They have the lowest lung cancer rate in the world. It is lower than the United States and lower than Norway. It represents an important fall in the number of deaths by cardiac attack, a fall of 22% in men between 1987 and 1995. It has a low rate of buccal cancer, which keeps on falling in spite of increased use of snus.

Despite controversy, it is clear that e-cigarettes are far less hazardous than tobacco—95% less. I hope that people had a chance to look at the fourth Public Health England report confirming this conclusion, which was issued last week. Smokers smoke primarily for the nicotine, but die primarily from the tar, the combustion of tobacco.

If you look at the number of illnesses related to tobacco smoking, and on the other side, at the addiction that might be created by nicotine, you see that the question becomes, for nicotine-addicted tobacco smokers, is it ethically and morally correct to discourage them from using a 95% less harmful nicotine delivery system?

In conclusion, e-cigarettes can save many thousands of lives. You have the numbers that have been figured out by Great Britain, U.S.A., and China, but they have to be regulated. They must not be advertised, like my predecessors have spoken about, but their availability must not be made more difficult than buying tobacco cigarettes.

Dr. Polosa just recently published a study showing that it is very important that the addicted smoker who wants to switch to electronic cigarettes be coached and shown how to use them. In my experience, when older people buy electronic cigarettes, they don't use them properly.

Thank you very much for your attention.

[The Chair, Liberal, Bill Casey]

Thank you all for your presentations.

Now we'll go to our question period. Each member will start with seven minutes, starting with Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

Thank you very much for your testimony, the research, and leadership you've been showing on the issues of smoking and smoking cessation in Canada over the years.

To me, there are two issues we are dealing with here. One is stopping non-users, in particular youth, from becoming addicted to nicotine, and the numbers are still quite alarming. I read just recently that there are about 100,000 new daily smokers per year in Canada, and something like 82% of people start smoking at the age of 18 or younger, so there is clearly an issue of stopping young people and non-users from getting the habit.

The second grouping is those who are addicted to nicotine, and trying to move them to a less harmful form, given that the evidence isn't quite clear yet, but there is a fair bit of it, and/or helping them quit.

My first question deals with that second population, people who are addicted and want to move to a less dangerous or harmful form. I had somebody in from the tobacco industry to meet with me to talk about their view, and that was fine. They were sort of doing their rounds. The concern they raised was on proposed section 20.1 where it says:

No person shall promote a tobacco product, including by means of the packaging,

(a) in a manner that could cause a person to believe that the product or its emissions are less harmful than other tobacco products or their emissions...

and the example was heat-not-burn consumption.

I'd like to get your reaction to that first of all. If the tobacco industry does believe they have found a safer way to consume nicotine, they wouldn't be able to advertise or promote that on packaging. Do you agree with them or disagree with them? I'd like to hear your perspectives on that one, from all of you.

[Rob Cunningham]

The international standard is for a complete ban on tobacco advertising. That's in the WHO framework convention on tobacco control. We support that.

Canada does not have a ban. We have restrictions, but many countries do have a ban, including where e-cigarettes and tobacco products are sold. That product will be more harmful than e-cigarettes. E-cigarettes will be able to be marketed, and Health Canada, with an amendment at the Senate committee—it was already in the bill but there's a clarifying amendment and a consultation document—is intending to allow certain messages for e-cigarettes with the health aspect.

We support a total ban of tobacco advertising far stronger than what's in this bill.

[Neil Collishaw]

I'd perhaps add another comment. I think you heard from several of us that we want the same or approximately the same level of restriction for e-cigarettes and cigarettes. It's important to realize that tobacco can be advertised through information and brand preference advertising. You don't see much of it, I guess because the tobacco industry isn't proud of the true information about their product, but it might be different for e-cigarettes if they're allowed information advertising and brand preference advertising. Maybe we will see some that's legitimate.

[John Oliver, Liberal, Oakville, ON]

Speaking more specifically to whether there is a safer way to take in nicotine for those who are addicted, should the industry be able to advertise that?

You're off on a bit of a different topic there.

[Neil Collishaw]

Yes, we're supporting legalization of this bill precisely so that current smokers can legitimately get this product that may possibly offer them a less hazardous way of getting nicotine. The problem is that, while supporting that view, you have to be concerned about the danger of introducing this product as well.

[John Oliver, Liberal, Oakville, ON]

I understand. Thank you. I'm dealing specifically with proposed section 20.1.

[Neil Collishaw]

What we're looking for is the balance.

[John Oliver, Liberal, Oakville, ON]

Thank you.

Lesley, do you have any comment on this?

[Lesley James]

Again, we support legalization of e-cigarettes with nicotine, to offer Canadians the option. That said, there are better standards and devices available for cessation.

If we want to target current people addicted to nicotine, as you mentioned, we have a vehicle in the tobacco package itself: a message saying that e-cigarettes are less harmful. That's marketing to the exact audience we want to market to, and nobody else has to see it.

We thus have the solution right in front of us now.

[John Oliver, Liberal, Oakville, ON]

Wouldn't proposed section 20.1 make that not possible?

[Lesley James]

If it were a Health Canada message, it would be allowed, but the industry wouldn't be able to make that claim.

[John Oliver, Liberal, Oakville, ON]

Okay, thank you.

Moving on, then, I think I've heard every single one of you say that Bill S-5 is not strong enough in terms of preventing youth and non-users from picking up the nicotine habit or becoming addicted. Every one of you said that there should be greater advertising restrictions for the e-cigarette vaping products and have it match the....

Do you have any understanding of why Health Canada wouldn't have adopted that, given that we all agree that nicotine in and of itself is a harmful substance?

[Rob Cunningham]

I think it's a matter of getting the balance right. This committee had a study with a report in 2015 with respect to this. It's a new area, and they're trying to get the balance right. We think that the line is drawn in the wrong place, and we'd like to move the line along, with further restrictions.

[John Oliver, Liberal, Oakville, ON]

I'm certainly with you on that. I have to say categorically that anything we can do to stop new generations and non-users from becoming addicted to nicotine, we should be doing, as a society. It's an incredibly addictive drug. It's in all of our interests to see the addiction to nicotine ended in Canada, if we can get there.

Doctor, I missed you in the first go around and the second. Do you have any thoughts about advertising, and is Bill S-5 restrictive enough for e-cigarettes and vaping, or do you think we should be doing more?

[Dr. Gaston Ostiguy]

I think one of the problems we're facing at the moment is that if you deal with a case of emphysema or a case of throat cancer, and the patient has tried five, six, seven times to stop smoking with all the available tools that exist at the moment and hasn't been able to do so—and this is the sort of clientele we have—then we could suggest to them, “Why don't you try the electronic cigarettes?” They will say, “Well, doctor, why should I use the electronic cigarette? It is as harmful as the tobacco cigarettes.” This is what is publicized; this is the common thinking in the population, so it's very difficult.

As a matter of fact, in the last few years people were coming to the clinic who had already bought their electronic cigarettes but hadn't started using them because of this confusion that was existing in their minds, and they would ask, what you do you think?

Of course, this does not prevent us from suggesting to them the approved pharmacotherapy. I mean, you don't treat hypertension with one drug; you treat hypertension with various drugs and treat diabetes with various drugs. Why don't we treat tobacco addiction with various means? The message believed by half the population at the moment—and I feel that this is very sad, and it's true also in Europe and in Great Britain—is that electronic cigarettes are as harmful as tobacco cigarettes. It's very unfortunate.

[The Chair, Liberal, Bill Casey]

Okay, thank you very much.

Now we go to Ms. Gladu.