Evidence of meeting #93 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was nicotine.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Robert Strang  Chief Medical Officer of Health, Nova Scotia Department of Health and Wellness
Bruce Cran  President, Consumers' Association of Canada
Peter Selby  Professor, University of Toronto, Director of Medical Education, Centre for Addiction and Mental Health, As an Individual
Flory Doucas  Co-Director and Spokesperson, Coalition québécoise pour le contrôle du tabac
Clerk of the Committee  Ms. Marie-Hélène Sauvé

3:35 p.m.

Liberal

The Chair Liberal Bill Casey

I call our meeting to order.

Welcome to meeting number 93 of the Standing Committee on Health. We're continuing our study on Bill S-5. I want to welcome all our guests.

Dr. Strang and Dr. Selby, we have seats here for you with signs on them, but we can see you and we thank you for working with us on this study.

We'll start with Dr. Robert Strang, chief medical officer of health with the Nova Scotia Department of Health and Wellness. Thank you for attending.

From the Consumers' Association of Canada, we have Mr. Bruce Cran, president. Thank you.

As an individual, we have Dr. Selby, professor, from the Centre for Addiction and Mental Health, University of Toronto, by teleconference.

From the coalition québécoise pour le contrôle du tabac, we have Flory Doucas, co-director and spokesperson.

Thank you all for coming.

Before we start, I will mention that we're going to have committee business at the end of our round of questions. I was asked to tell you that members can get a technical briefing on this bill from the department officials if you want one. If you want a technical briefing on the bill, they'll give you the details and technical aspects of it.

Again, we're going to have committee business after we finish our questions.

Dr. Strang, if you'd like to make a 10-minute opening statement, we'll start off with you. Each speaker will have 10 minutes for an opening statement, and then we'll go to questions.

Dr. Strang, the floor is yours.

3:35 p.m.

Dr. Robert Strang Chief Medical Officer of Health, Nova Scotia Department of Health and Wellness

Thank you very much.

Good afternoon. Thank you for the opportunity to speak to the committee today. I'm appearing on behalf of provincial and territorial chief medical officers of health and am providing a collective public health perspective, not individual provincial-territorial jurisdictional positions.

To start, I would like to acknowledge the ongoing work of the federal government to continue to advance tobacco control in Canada. Bill S-5 is an important next step in that work. I would also like to thank all the federal political parties for their support at the second reading of Bill S-5.

Tremendous gains have been make in tobacco control in Canada, but the use of tobacco products remains our number one cause of preventable death. There is much more that needs to be done. As you heard from Minister Petitpas Taylor on February 14, the federal government is committed to the goal of reducing tobacco use rates to 5% by 2035. Reaching that goal will require a collective focus on two areas: preventing youth and young adults from starting to use tobacco products, and supporting current users to quit. Bill S-5 will make important advances in both areas, and is supported by the provincial-territorial chief medical officers of health. However, we would like to offer suggestions to strengthen the bill and maximize its impact.

I will start with plain packaging. Restricting the advertising and promotion of tobacco products has been a critical part of the success to date in tobacco control in Canada. Requiring plain and standardized packaging, as per Bill S-5, will remove one of the few remaining ways for tobacco products to be marketed to Canadians. It will prevent initiation and will support long-term cessation. If you look at the full body of evidence on the impact of plain and standardized packaging in other countries, as has been previously provided to the committee by the Canadian Cancer Society, it clearly shows the potential contribution that plain and standardized packaging could make in continuing to decrease the use of tobacco products in Canada. It has also clearly been established that claims by the tobacco industry that plain and standardized packaging increases the use of contraband tobacco products are inaccurate and exaggerated.

Two areas where Bill S-5 could be improved regarding plain and standardized packaging are, one, amend the bill to provide regulatory authority to allow health warnings directly on tobacco products in addition to packages, as the bill does for vaping products; and, two, amend the bill to provide regulatory authority to allow provisions of the act to apply to herbal smoking products, including herbal water pipes, in the future.

I'll now move to electronic nicotine delivery systems, ENDS, or as they're more commonly known, e-cigarettes.

Eight provinces have ENDS legislation covering areas such as legal age of sale, public use, retail sale, and point-of-sale advertising. Provincial and territorial chief medical officers of health are pleased that the federal government is moving forward with their legislation on these products, but we share concerns regarding the advertising and promotion already provided to this committee by other tobacco control organizations. The evidence to date on ENDS is that while they may help some individuals to be successful in cessation, ENDS may also inhibit cessation by facilitating the alternating use of ENDS and tobacco products. In short, the evidence on ENDS as a cessation product is at best equivocal. There is also growing evidence that, likely because of ultrafine particulate in inhaled vapour, the risk of cardiovascular disease from the use of ENDS is similar to that from smoking tobacco products. Furthermore, evidence from Canada and the U.S. shows that youth who use ENDS are at increased risk of starting to use tobacco products.

The regulatory approach to ENDS, including advertising and promotion, needs to find an appropriate balance based on existing evidence between any potential net benefit as a tobacco cessation product and potential risk to increasing youth initiation with tobacco products and inhibiting tobacco use cessation. In our opinion, as currently written, Bill S-5 does not provide that balance and is inconsistent with existing and proposed approaches to advertising and promotion for tobacco and cannabis respectively.

As it is currently written, Bill S-5 would allow widespread marketing and promotion of ENDS comparable to the 1960s tobacco industry voluntary code. We recommend that Bill S-5 be substantially strengthened by, one, requiring that ENDS advertising may only be information or brand advertising. This is the approach for tobacco in the Tobacco Act and the proposed approach for cannabis in the cannabis act. Our second recommendation is to remove provisions that allow lifestyle advertising in bars and in publications sent to adults. Third, restrict the provision of incentive promotions—for example, price discounts—to specialty ENDS retail stores. Fourth, place the same restrictions on the locations of ENDS advertising as are currently in the Tobacco Act and in the proposed cannabis act.

These amendments would create a much better balance between allowing those who currently use tobacco products to be informed about ENDS as a potential cessation support and protecting youth and young adult non-smokers.

I will end by noting that detailed language on these recommended regulatory changes has been supplied to this committee previously by the Canadian Cancer Society.

Thank you again for the opportunity to provide this information to you today.

3:40 p.m.

Liberal

The Chair Liberal Bill Casey

Thank you as well for providing it. Do you speak just on behalf of Nova Scotia, or other provinces as well?

3:40 p.m.

Chief Medical Officer of Health, Nova Scotia Department of Health and Wellness

Dr. Robert Strang

No, as I said, I'm representing the provincial and territorial chief medical officers of health from the 13 provincial and territorial jurisdictions.

3:40 p.m.

Liberal

The Chair Liberal Bill Casey

Thanks very much.

Now we go to the Consumers' Association of Canada and Mr. Cran.

3:40 p.m.

Bruce Cran President, Consumers' Association of Canada

Good afternoon, and thank you for having me here today. I appreciate it. My name is Bruce Cran, and I'm the president of the Consumers' Association of Canada.

The CAC has been advocating for consumers for the last 70 years, having been founded in 1947. We are Canada's oldest and most established consumer organization, and we're entirely governed by volunteers. We actually have no employees of any type. For the past 40 years, I have served Canadians as a consumer rep, and for the last 20 years as president of the association.

We oppose plain packaging of any product for five main reasons. First, it makes it difficult, if not impossible, for consumers to identify their preferred brands. Second, it increases the risk that consumers will be given the wrong product. Third, it greatly increases the risk that consumers will be provided with counterfeit products that have undergone no product or safety checks. Fourth, it is insulting to consumers, suggesting we cannot make decisions without being swayed by package design. Finally, it sets a very dangerous precedent for the packaging of all consumer goods.

We believe that consumers have a right to easily identify their preferred brand of a product, whether it be tobacco, alcohol, soft drinks, chips, or whatever. With that in mind, CAC polled consumers on plain packaging as soon as we saw it in the minister's mandate letter. Please let me share some of the results with you.

About 50% of consumers say it's important for them to be able to identify their preferred brand when purchasing, versus 22% who say it is not important. About 58% feel plain packaging will mean they are unable to distinguish their preferred brand from other brands. Some 71% feel that it will be more difficult to identify their preferred brand of a product with plain packaging. About 54% are concerned they will buy the wrong product by mistake, and 69% are concerned the product they are buying could be counterfeit.

Branding is the very basis of the consumer economy. It is what helps consumers make their purchasing decisions, recognize the product they want to buy, and know that the products are legitimate. If you take away branding, you're kneecapping consumers.

When all products must look exactly the same, the counterfeiting process becomes easier. The government itself seems to recognize this, as all the new designs and formats of our currency, for example, are increasingly sophisticated in an effort to fight counterfeiting. If we need more sophisticated designs of our currency to prevent counterfeiting, how does the government dismiss the fact that a less sophisticated design for a multi-million-dollar product will be leading to a counterfeiting explosion? There is no other logical conclusion.

However, we also polled consumers on whether plain packaging would be effective in reducing the products with negative health impacts and found the following: 34% of Canadians feel mandatory plain packaging will be effective in reducing the use of such products. Even fewer, 25%, feel packaging will be effective in reducing their own preference in brands. About 55% view taxation as a useful tool, 89% support warning messages to ensure consumers are aware of the health risks, and 90% support improving consumer education about these products and their health risks.

The CAC must take a principled stand against plain packaging, not because we have any particular affinity for smoking but because introducing these packages will probably create a precedent for many other products. We don't want to see plain packaging on our wine bottles or anything else that we buy and have become used to seeing labels on.

Finally, implicit in Bill S-5 is the notion that consumers are simpletons who consume unhealthy products because of the packaging, when in fact humans have been engaged in unhealthy behaviours of various kinds for as long as man has walked the earth. Therefore, it is incredibly simplistic to suggest that plain packaging is the solution. In reality, the solution is some combination of education, counselling, direct support, and outreach targeted at the most at-risk populations. However, that takes time and effort, whereas something like plain packaging offers government a feel-good solution without doing any actual work.

The CAC recognizes that taking a stand against plain packaging will lead to attacks from some in the public health community; however, those advocates long ago lost touch with consumers. Our polling clearly indicates that measures that are taken in a simplistic belief....

Sorry. I'm having dreadful trouble reading this without glasses, but that's my case.

I'd like to thank you for having me here today. Next time I'll see if I can get a proper pair of glasses.

3:45 p.m.

Liberal

The Chair Liberal Bill Casey

Thanks very much for your contribution. I'm sure we'll be asking you lots of good questions.

Now we'll go to Dr. Selby. The floor is yours for 10 minutes.

3:45 p.m.

Dr. Peter Selby Professor, University of Toronto, Director of Medical Education, Centre for Addiction and Mental Health, As an Individual

Respected chair, members of the House of Commons Standing Committee on Health, thank you for inviting me to speak about Bill S-5. I am Dr. Peter Selby. I'm a medical doctor and professor at the University of Toronto, specializing in addiction medicine with a strong focus on tobacco addiction treatment as a clinician, researcher, and educator. I am the deputy physician-in-chief of education at the Centre for Addiction and Mental Health, where I also hold a post as a clinician scientist. As some of you may know, CAMH is the largest hospital of its kind in Canada.

I can tell you that I witness first-hand the devastation of addiction to tobacco and the difficulty my patients experience in quitting, even with the best help available. I also have programs running in over 300 sites in Ontario. I can tell you that the patients who are coming through those sites across the province are struggling. At best, only one in three will respond to the treatment available. When we have a goal to get to 5% by 2035, we need to get current smokers to stop now. It's indisputable that in addition to prevention, the most effective thing we can do now to save lives is to get current smokers to stop. However, we are stuck in tobacco control, in part because we haven't done enough of what works, of what we know works. There is a “know-do” gap. For example, we know that price, availability, and attractiveness of the product, especially to young people, are big promoters of why people will access these products, use these products, continue to use these products, and, might I say, relapse back to these products after they make an attempt to quit.

As a society, we need to be detoxified from the advertising that has made all of us collectively believe that smoking cigarettes—which, if you think about it, delivers 7,000 chemicals and 60 known cancer-causing agents and is the number one cause of house fires and premature deaths—is cool and a personal choice. Addiction is not a free personal choice, because when nicotine is delivered through combustion, it actually robs people of a choice to varying degrees. If you don't believe me, go outside any hospital in the middle of winter and tell me how many people you see out there puffing away at a cigarette while they have an IV going into their arm. No person who exercises free choice would choose to do that willingly when they're in a hospital because of a condition often caused by that addiction.

We should note that although nicotine is the addictive substance in the cigarette, the overall harm is caused by the combustion of the tobacco and the paper that is holding that tobacco, and the fact that it forces people, once they become addicted, to have that reloading almost every 90 minutes. It means that on average, Canadians who smoke are smoking 13 cigarettes a day, almost one per waking hour. In other words, it's a design flaw in how people are forced to get their nicotine if they want or need it.

We need to catch up to other countries that have introduced plain packaging, with the associated enhancements of warnings on the cigarette itself, and crack down on contraband tobacco manufacture and sales. We need to undo this attack on the choice of the addicted smoker by making the cigarette less attractive, with associated information on the package to prompt people to quit and to help them seek help if they are unable to stop on their own. Anything less is allowing commercial entities to prey on people with addictions, who more and more are the most vulnerable people in society.

Therefore, plain paper packaging needs to be supported. There is good evidence for it, scientific evidence. There's good evidence that as part of comprehensive tobacco control, it is an important strategy. People can look at it as if it's the only thing, but I don't think the Canadian tobacco control strategy is in its infancy; it requires enhancements to make sure it's more robust. I would not look at plain packaging as the magic solution, but as one more way in which we can advance the goals of a healthier society and a healthier next generation.

Having said that, I'll turn my attention to electronic devices that deliver nicotine. They are very promising innovations that we need to figure out and support in their development. The current products on the market have suffered from a lack of regulation, and I think this bill will allow for that innovation to occur and will also allow for that to potentially make cigarettes obsolete.

The regulations that have been proposed make sense and will allow researchers such as myself to study these devices. If we want to make a health claim for cessation, then we can go through this process and obtain evidence-based scientific proof that electronic devices, like other nicotine replacement products, can help people to quit tobacco. On the other hand, if a claim can't be made but we see a substitute that can reduce, by an order of magnitude, the exposure to many of those products of combustion, then we need to study it. The legislation and the regulations should allow for ongoing surveillance and study so that we can make sure there are standards in place for what exposure should be and for the maximum exposure allowed. Included in this should be the way the product is manufactured, the electronic juices put into it, the flavourings allowed or not allowed, and where and how it should be consumed. All these things need to be put in so that we can find the balance whereby people who are unable or unwilling to stop the use of cigarettes can choose to do something that will mitigate the harm to them.

That fits in with how Canada's drug policies have evolved, whether it's supervised injection facilities or cannabis legalization. We need to understand that legalization doesn't mean no rules. Rather, it means strong regulations to reduce the attractiveness and uptake by youth, which would include the advertising restrictions suggested in the submissions from the Canadian Cancer Society and my esteemed colleague Dr. Strang. We need to make sure this is put in place so that youth don't find it attractive because it has flavourings and labelling that make it seem like a cool thing to do. At the same time, these products and the facts about them should be made available to people who are addicted, in such a way as to help them switch from the combustible form and start breaking away from their addiction.

I will stop my comments there. Thank you.

3:55 p.m.

Liberal

The Chair Liberal Bill Casey

Thank you very much.

Now we go to Ms. Doucas.

3:55 p.m.

Flory Doucas Co-Director and Spokesperson, Coalition québécoise pour le contrôle du tabac

Thank you.

I'll make a few remarks in French, and then I'll switch to English.

Good afternoon.

My name is Flory Doucas and I am the co-director and spokesperson for the Coalition québécoise pour le contrôle du tabac.

We appreciate your invitation to testify today in the context of your work on bill S-5.

With regard to Bill S-5, the coalition is fully supportive of the implementation of plain and standardized packaging in Canada, a measure supported by an impressive list of organizations across the country, including some 200 from Quebec, ranging from the association of pulmonary specialists to the City of Montreal.

Before we began, I showed you some packs to consider—a pack from Australia and one for the very same brand by the same manufacturer, sold here in Canada. Clearly, one of them is less appealing and attractive than the other. Clearly, the warning on one of them stands out more and is more persuasive. We encourage the Minister of Health and all parliamentarians to work together to implement plain and standardized packaging as quickly as possible.

That said, the Quebec coalition has serious concerns with Bill S-5's provisions regarding the promotion of nicotine vaping products.

First, allow me to provide some context. Dr. Selby actually pointed to some of it.

Manufacturers of nicotine vaping products can and always have been able to get their devices licensed as medicines or therapies to quit smoking. As for other medicines, manufacturers must provide proof and evidence regarding the claims associated with the therapeutic benefits of their products and show that when used as directed, the benefits outweigh the risks and the medicines alleviate a condition. They don't have to prove that their products are harmless, and many medicines actually have important side effects.

Getting a product licensed as a cessation therapy has its advantages. The Food and Drugs Act allows medicines to be advertised on TV and on the radio, with provisions as to how that can be done. Furthermore, as medicines, these products are reimbursed by many private and public sector plans.

To date, no manufacturer for these products has proceeded to get their nicotine vaping product licensed in Canada or anywhere else in the world.

Thanks to many public sector research dollars from all over the world, we now know enough to say that these products are less harmful than conventional cigarettes, at least in the short term. Also, as all other health groups that previously testified have said, the coalition supports the regulation of these products and believes that smokers should have access to them. The issue here is not access, but rather how these products should be promoted and to whom.

We acknowledge and welcome the amendment voiced by the health minister a week and a half ago. Before this committee, the Honourable Ginette Petitpas Taylor said:

Protecting youth from the dangers of nicotine addiction is a top priority of mine. I share some of the concerns expressed by the Quebec Coalition for Tobacco Control and others, especially regarding lifestyle promotion.

We do not allow lifestyle promotion of tobacco products, and we do not intend to allow it for cannabis products. To protect youth

—and the emphasis on “youth” is mine—

and non-smoking Canadians, I intend to support an amendment that would prohibit all lifestyle promotion of vaping products.

While that is a very beneficial improvement to this bill and will indeed better protect non-smoking adults, especially young adults who would have likely seen ads for these products in bars, such an amendment does nothing to better protect youth. Bill S-5 would permit lifestyle advertising in adult-only venues.

However, we do agree with the minister that youth deserve to be better protected from the promotion of addictive nicotine products, and we recommend that amendments be adopted to achieve this. This can only be achieved by further limiting locations where advertising can occur so as to ensure that kids do not see the ads.

Let me explain. We believe that the language in Bill S-5 has falsely reassured many in terms of what advertising would not be allowed. The language regarding content—not location, but content—of permitted advertising in Bill S-5 is essentially the same as what is currently allowed for tobacco products. The huge difference is with respect to the channel or location where permitted ads can be seen.

Proposed section 30.1 of Bill S-5 bans advertising for vaping products if there are reasonable grounds to believe that the advertising could be appealing to young people. Well, guess what? Subsection 22(3) of the current federal Tobacco Act bans lifestyle advertising as well as advertising that could be construed on reasonable grounds to be appealing to young people for tobacco products.

However, as you know, the legalization of nicotine vaping products will open the market to larger players than those currently operating in it now: the tobacco industry. Restrictions on location or channels where advertising is allowed would go a long way in protecting youth. If tobacco ads were allowed in more locations, the restrictions on content would not mean much, since, based on what we saw when tobacco ads were still allowed in newspapers and magazines, industry still has the capacity to indirectly associate its products to lifestyles and to make their products attractive to young people. This is despite the restrictions on content.

Thankfully, the impact of such ads was limited because they were only allowed in very limited settings. Let me provide some examples of ads published in free weekly papers and magazines before the fall of 2009, when the Harper government banned tobacco advertising in such channels.

I point to the ad for super-slim menthol products. This ad, showing a sleek and pretty product, was not considered to be appealing to young people. The next ad is for smokeless tobacco. Keep in mind that Quebec is the only province to require prominent health warnings on tobacco ads. In other provinces, the same ads would have appeared with no warning or a small, unpersuasive one put there voluntarily by the manufacturer. However, as you can see, the wooden panelling in the background creates the impression of a rustic atmosphere conveying a more natural way of life. With colours, textures, and overall feel, the manufacturer is able to send a positive message regarding this brand of smokeless tobacco.

Here's the next example, with the three smokeless packs. Do you see the mesh background? Does this remind you of a hockey net being hit by three pucks, or maybe more like a batting cage? Keep in mind that for a long time, two tobacco products were used and highly associated with baseball players and other sport professionals.

The geniuses in the tobacco industry's marketing departments regularly use sophisticated graphics to convey indirect messaging and confer a specific aura to different brands. They have shown that they do not need to use real images or depictions of people, cartoons, or animals to evoke lifestyle, to capture a sensation, or to make their products attractive to kids.

The tobacco industry has a history of paying the highest dollars to get top marketing professionals to push the limits of whatever is allowed in terms of promotion. When issues arose with the interpretation of the advertising provisions in the Tobacco Act, Health Canada did not rein in problematic ads swiftly. They were published and republished across the country.

Corrections did not come from the courts either, which is undoubtedly also a long process. Corrections only came later, when the Tobacco Act was amended to ban advertising through the promotional channels that had the problematic ads that kids were seeing.

We ask you to consider the history of tobacco control and the lessons learned from the past, and to act now to avoid similar issues with vaping products. Why risk exposing all our teenagers to ubiquitous promotion for highly addictive nicotine products? Ideally, permitted advertising would be seen by adult smokers. Minimally, advertising should be seen by adults or through channels that are primarily viewed by adults.

All health groups who have testified, including Dr. Gaston Ostiguy, a staunch promoter of e-cigarettes, and the Canadian Vaping Association, have all said that they would either recommend or support stronger dispositions to rein in advertising for these products. Do we really want our kids to see these kinds of ads on billboards in our streets and neighbourhoods? We believe that most Canadian parents would say no.

Thank you.

4:05 p.m.

Liberal

The Chair Liberal Bill Casey

Thank you very much.

Now we'll go to our first round of questions, which will be a seven-minute round. Some of the questions, I suspect, will be in French, and some will be in English. If you need translation, I think it's provided.

We'll start our questions with Mr. Ayoub.

You have seven minutes.

4:05 p.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

Thank you, Mr. Chair.

First I want to thank the witnesses for being here and for sharing their expertise and thoughts on this very important topic.

We have heard all kinds of testimony, as well as statements from industry representatives such as Rothmans, Bensons & Hedges. They told us that their enterprise wants to leave the cigarette market. I will let you assess that for yourself.

I would like to point to something, and give you my thoughts on e-cigarettes.

On the one hand, smokers have access to this medication or means to help them quit smoking. On the other hand, we want to protect non-smokers and prevent young people from taking up smoking. There is, however, a very fine line between promoting a medication and promoting e-cigarettes as a lifestyle, as Ms. Doucas mentioned.

I asked Mr. Gaston Ostiguy, a Montreal respirologist, what he thought of the sale of electronic cigarettes in pharmacies. It always astounds me to see that vaping products are promoted in specialty shops, although the e-cigarette is considered to be a smoking cessation tool.

Dr Selby, could you share your thoughts on that inconsistency? Why can we buy these products in other stores, but not in drugstores? In my opinion, these products should be sold in drugstores. Why are large tobacco businesses promoting them?

4:10 p.m.

Professor, University of Toronto, Director of Medical Education, Centre for Addiction and Mental Health, As an Individual

Dr. Peter Selby

Thank you for that very insightful question. It is something that I have been thinking about for a long time when it comes to addictive substances.

One thing we need to look at is that a substance can be addictive but not harmful, and substances can be harmful but not addictive. There are two things we are trying to balance here. The worst is when things are addictive and harmful at the same time, and a good example is cigarettes. As society has evolved and as innovations have occurred, we've come upon this disruptive innovation—this electronic device—with which we say we can take away most of those products of combustion, and if people will give up cigarettes completely and switch to this, they will get nicotine without the same level of exposure to those toxins.

We need Bill S-5, because right now, when people are selling it in this way, it's not regulated. People are making the liquids without any regulation, and we don't know what the concentrations are. If this comes out and it does become a product for cessation such that somebody says they want to give up smoking and this is part of a program in which they commit to not smoking anymore and they completely switch over and use it for eight to 10 weeks, then yes, a pharmacist's role in that situation would be very strong.

On the other hand, if you have people who still want to have the nicotine and they're making no commitment to stopping and they want to switch away from the most dangerous way of getting this to a less dangerous way to get it, then they should be able to access it without necessarily having to commit to completely quitting that product for good. We have seen in some addictions that this is the best this person is able to achieve for maybe one, two, or three years. As we are seeing harm reduction come out, that sometimes transitions into quitting over time.

I think whether it should be in pharmacies or whether it should be in stores depends on what the intent and purpose are. Now with pharmacies having sections in which medication as well as consumer products are for sale, there will be some ways to try to work out what has which claims, and we have to make sure that people don't get confused in what they're choosing and how they're choosing it. One way to do this would be that the consumer products might not be covered by an insurance plan, whereas products that are for a cessation program might be.

4:10 p.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

Thank you.

Ms. Doucas, you spoke about neutral packaging and preventing the promotion of these products. In the documents you submitted, you even talk about music. Could you explain your perspective in more detail, and the recommendations you would like to make to the committee to prevent the pure and simple advertisement of such products?

4:10 p.m.

Co-Director and Spokesperson, Coalition québécoise pour le contrôle du tabac

Flory Doucas

Publicity promoting vaping products has not been prohibited on television, radio or the Internet. This opens the door to all sorts of clever ways of having these advertisements present another type of image, among others lifestyle images, as shown in these advertisements. As you know, sound and music and songs are very dynamic. You have to ask yourself who decides which melodies are associated with this lifestyle.

The point is not to say that there should be no publicity for these products. However, we feel that the publicity should target smokers. If they want to broaden the target audience, they should at least stick with adults and not address their message to young people.

4:15 p.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

In your opinion, this type of restriction would protect young people in particular, but would allow adults to have access to an alternative smoking cessation tool.

4:15 p.m.

Co-Director and Spokesperson, Coalition québécoise pour le contrôle du tabac

Flory Doucas

Yes.

An amendment was made to bill S-5 regarding relative risk. People thought it was important that Health Canada make a statement concerning relative risk, that there be a statement with regard to the level of harmfulness of a product, or a graduated ranking of the harmfulness of products. I believe we must inform smokers in that regard.

For the moment, information is printed on cigarette packages to help people to stop smoking. Nothing prevents us from pointing to relative risk to encourage smokers to turn to less noxious products.

4:15 p.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

Thank you.

4:15 p.m.

Liberal

The Chair Liberal Bill Casey

Now we'll go to Ms. Finley.

4:15 p.m.

Conservative

Diane Finley Conservative Haldimand—Norfolk, ON

Dr. Strang, I'm going to ask you a question first. Do you think it's okay for a witness before this committee to try to undermine the credibility of a subsequent witness prior to that second person's appearance here?

4:15 p.m.

Chief Medical Officer of Health, Nova Scotia Department of Health and Wellness

Dr. Robert Strang

I'm not sure what you're referring to. I think we all bring a perspective.

4:15 p.m.

Conservative

Diane Finley Conservative Haldimand—Norfolk, ON

It's just on principle, that's all.

4:15 p.m.

Chief Medical Officer of Health, Nova Scotia Department of Health and Wellness

Dr. Robert Strang

Well, I think we all bring our opinions to the table to be heard by the committee, and sometimes those opinions may be in conflict with other people's opinions and interpretation of evidence.

4:15 p.m.

Conservative

Diane Finley Conservative Haldimand—Norfolk, ON

We did have a witness who made some allegations against some subsequent witnesses, and the allegations were later proven to be false. I'm concerned that many of the members at this table here had a first book that they read, and that's the story they're sticking to.

Some of that extends to some things to which you made reference: track records in other jurisdictions. Australia was one of the two places—the second one being England—where there has been plain packaging in place for a period of time, and it has been shown that it has had no impact on reduction of smoking.

Do you disagree with that?

February 26th, 2018 / 4:15 p.m.

Chief Medical Officer of Health, Nova Scotia Department of Health and Wellness

Dr. Robert Strang

I think it's a selective use of evidence. As I said, when you look at anything, you have to look at the totality of all the evidence available, and when you look at the totality of all the evidence on plain packaging, it is very clear that plain and standardized packaging has an important impact on decreasing the use of tobacco products.