Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue No. 21 - Evidence - April 10, 2017
OTTAWA, Monday, April 10, 2017
The Standing Senate Committee on Social Affairs, Science and Technology, to which was referred Bill S-5, An Act to amend the Tobacco Act and the Non-smokers' Health Act and to make consequential amendments to other acts, met this day at 1:30 p.m. to continue its study on this bill.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I'm Kelvin Ogilvie from Nova Scotia, chair of the committee. I will ask my colleagues to introduce themselves, starting on my left.
Senator Eggleton: Art Eggleton, senator from Toronto and deputy chair of the committee.
Senator Griffin: Diane Griffin, senator from Prince Edward Island.
Senator Seidman: Judith Seidman from Montreal, Quebec.
Senator Cormier: René Cormier from New Brunswick.
Senator Hartling: Senator Hartling, New Brunswick.
[Translation]
Senator Petitclerc: Chantal Petitclerc, a senator from Quebec.
[English]
Senator Stewart Olsen: Carolyn Stewart Olsen from New Brunswick.
The Chair: Thank you, colleagues. I remind us that we are continuing with our welcome to witnesses concerning 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's commonly known as the Tobacco and Vaping Products Act.
We have three sessions today.
In this first panel, I am going to be welcoming them in the order they appear on my agenda, which fortunately has our distinguished visitor by video conference listed first, because we always go to our witnesses by video conferences first in case of any gremlins in the system at some point. It's critical we get their presentation and hopefully all of their questions. In that regard, I am going to invite Dr. John Britton, Director, UK Centre for Tobacco and Alcohol Studies, to please proceed.
John Britton, Director, UK Centre for Tobacco and Alcohol Studies, as an individual: Good afternoon, everybody. Thanks for the invitation to speak. I'm Professor of Epidemiology at the University of Nottingham, and I'm a consultant in respiratory medicine at Nottingham City Hospital. I deal with the effects of smoking in clinical practice every day.
In addition to the UK Centre, I also chair the Royal College of Physicians Tobacco Advisory Group. Through that role, I have been responsible for the production of two reports on tobacco harm reduction — one in 2007 called "Harm reduction in nicotine addiction;'' and last year, something called "Nicotine without smoke: Tobacco harm reduction'' which focuses particularly on the roll of electronic cigarettes.
We all know that smoking kills people, ends lives prematurely, causes untold damage to adults, harms children and harms the unborn child. It drives poverty and it is a major determinant of social inequalities in health. Treating smoking is a huge public health priority in all developed countries.
Conventionally, we have done very well in reducing the prevalence of smoking, in Canada and the U.K. and in many other countries, through sound approaches to tobacco control, which have been things like advertising bans and the health warnings that Canada championed, smoke-free policies and so on. Those have had their effects. There is no question about it. If you look at the figures on smoking prevalence within age groups,. in the U.K. for sure, it is very clear that those measures have been very effective in preventing children from becoming smokers, but they have been far less effective at helping established smokers to quit. In fact, if you are a 25-year-old smoker today, the likelihood that you will quit smoking in your lifetime is probably far less than it was as a 25-year-old smoker 30 years ago.
We need measures that help those established smokers to quit. That's partly because it saves lives, but also because that pays off on our health services in our society now and next year and in the next five years, whereas preventing uptake of smoking pays off in 50 years.
We have had a sort of sacred cow of smoking cessation, which is that smokers should learn to give up nicotine in order to give up tobacco. The 2007 report from the RCP that I mentioned really made the argument that that necessarily isn't the case, that we could encourage smokers to switch to an alternative source of nicotine and just give up the smoke. The logic is that nicotine is about as hazardous as caffeine. It's the other toxins in cigarette smoke that kill.
At the time that report came out, there were few alternatives for smokers, but the proof of principle came from Sweden, where the use of oral tobacco has largely replaced smoking such that Sweden has one of the lowest prevalence rates of any developed country. This is a consequence of smokers shifting on to smokeless tobacco.
We didn't have products that were legal in the U.K. Electronic cigarettes came along in around 2007-08 and have since become extremely popular in the U.K.. Our government has taken a very liberal line on marketing and use of electronic cigarettes, and so we are now in a situation where 2.8 million smokers have used electronic cigarettes, and about 1.2 million are regular ex-smokers who are using electronic cigarettes.
That has been achieved by arguing the case strongly in favour of a switch to a less harmful product for those smokers who can't quit. We need effective regulation to make sure the products deliver nicotine and that they are as safe as is reasonable to expect, but the key thing is to be able to promote those products to smokers.
The reason that I asked to give evidence today on the Canadian bill is simply the clause about making comparisons with the safety of smoking, because I think it is absolutely vital that health professionals can say to smokers, "We don't know the long-term risk of these products. It would be much better if you quit all smoking and nicotine use forever, but if you can't do that, then it is a no-brainer to switch to a less hazardous product.'' I don't think there can be any question that electronic cigarettes are less hazardous than smoking.
If we don't give that message strongly from the health lobby or the health opinion, smokers get confused and start to think that maybe these products are just as hazardous, so why bother to shift? The default then is to continue smoking. That's my main issue and that's why I asked to give evidence today.
I'll stop there, but I would be happy to take any questions.
The Chair: Thank you very much, Dr. Briton. I am now pleased to welcome Dr. David Hammond, Associate Professor, University of Waterloo. Dr. Hammond, please.
Mr. Hammond: Thank you very much. Good afternoon. I am a professor in the School of Public Health at the University of Waterloo. I'm a scientist. I conduct research on tobacco use and e-cigarettes, including how products are designed, marketed and used by consumers.
I'll just note that I don't accept any industry funding. I don't represent any organization for or against vaping or tobacco products. I have served as an adviser to agencies around the world, including as an expert witness in tobacco litigation on behalf of the Canadian government and on behalf of the Australian and U.K. governments in plain packaging legal challenges.
Overall, it's my opinion that the measures in Bill S-5 have the potential to advance public health in Canada. In particular, the proposal to implement plain packaging would enhance tobacco marketing restrictions.
I've been following the hearings over the past week. I admit to being somewhat alarmed about some of the misinformation on plain packaging, in particular the impact of plain packaging in Australia. It is a fact that Australia experienced the largest ever decline in smoking prevalence after plain packaging was implemented. The most extensive analysis to date determined that after adjusting for tax increases and other measures that were implemented over the same time, plain packaging resulted in more than 100,000 fewer Australian smokers. If plain packaging were to have the same impact in Canada, that would translate to 190,000 fewer smokers. The scientific evidence on plain packaging includes close to 100 published scientific studies, which are consistent with the Australian data.
If anyone has any doubt about the importance of packaging or brand imagery, I would encourage them to read the hundreds — indeed the thousands — of previously secret industry documents that describe clearly how tobacco companies research and design brand imagery displayed on packages and its importance in promoting smoking.
The evidence is clear: cigarettes in plain packaging are less appealing to try. They increase perceptions of risk and they enhance the impact of health warnings. That's not only the opinion of the scientific community; it's also been established in legal rulings from the British High Court and the High Court of Australia.
I would like to address some misinformation presented to this committee about plain packaging and illicit tobacco. There is a range of different information sources on illicit tobacco in Australia, including data from the Australian Customs and Border Protection Services. These sources do not indicate any increase in illicit tobacco from plain packaging. In fact, there is only one source that suggests that plain packaging has increased illicit tobacco, and that's the tobacco companies.
The numbers presented to this committee by tobacco companies are from a study paid for by the companies and prepared by KPMG. What you have not been told is that due to the methodology used, KPMG has explicitly warned against using these numbers as an indicator of illicit tobacco in Australia. In fact, a partner at KPMG actually wrote to the U.K. Minister of Public Health stating that the numbers were being misrepresented to oppose plain packaging.
The companies have told you that plain packaging makes it easier to counterfeit packs. You were not told that KPMG examined more than 12,000 used cigarette packages over a three-year period after plain packaging was implemented. Their conclusion: "no evidence of counterfeit plain packaging cigarettes.'' Quite simply, the claim that plain packaging increases illicit tobacco is not accurate.
I would like to briefly discuss the proposals on vaping products. You have heard from Dr. Britton and in other testimony to this committee an emerging consensus that smokers should have access to vapourized nicotine products. I strongly support this position. Virtually all of the 5 million Canadians who smoke wish to stop, and vapourized products will help some of them to do so.
However, I do have serious concerns about the extensive level of advertising allowed under the bill. While the bill seeks to prevent advertising that would appeal to youth, this distinction will be far more apparent in the act than in real life. It would be naive for us to assume that adult-oriented advertising will not increase the appeal of vaping products among youth, and bans on youth-oriented advertising are very difficult to enforce.
There is little doubt that the advertising allowed in the bill would increase the use of vaping products. The question is whether it will increase the types of use that benefit public health.
E-cigarettes are used for many reasons. Only one of them results in public health benefit, and that is if used by smokers who are trying to quit. In my opinion, smokers do not require lifestyle advertisements to encourage them to switch. Most smokers switch not because vaping is glamorous, sexy or fun, but because they are addicted to nicotine and they don't want to die from smoking.
The only lifestyle worth promoting through advertising of vaping products is a non-smoking lifestyle. Ironically, this is one of the types of advertising that would not be allowed. Bill S-5 prohibits advertising vaping products in a way that suggests their use would have a health benefit or comparing the health effects of vaping and tobacco products. That's a problem. It's a problem if the goal is to target smokers. That means being able to say that vaping products are harmful but less harmful than smoking. On the other hand, the bill would permit vaping products to be promoted in ways that are likely to have little or no public health benefit: for fun, because it tastes good or because it's convenient for times when you can't smoke.
Finally, a quick note about flavours. I have struggled to understand the rationale for prohibiting the promotion of child-friendly flavours but not the flavours themselves. If the premise is that these flavours preferentially target youth, which is indeed the case, then they should be prohibited outright. Smokers do not need cotton candy and peanut butter-and-jam-flavoured nicotine to stop smoking.
In conclusion, it's my opinion that vaping products should not be promoted at all through lifestyle advertising, and advertising should not appear on TV, radio or other major channels. Restrictions on advertising should be similar to tobacco products, at least for the time being. Vapourized products can still be incentivized over smoked products through other means: lower taxation prices, deferential health warnings, packaging, et cetera. In addition, the bill should allow for tightly regulated claims that vaping products are harmful but less harmful than smoking.
Thank you.
The Chair: Thank you very much. Before I turn to my colleagues, I'll remind them that we are exercising one question per committee member per round. Because we have one of our witnesses by video conference, it's especially important that you identify which witness you wish to answer your question. Even if you want them both to answer, identify one first, and I will give the other an opportunity to come in.
Finally, I want to remind you that this session will end no later than 2:30 p.m. With that, we will begin our questions.
Senator Petitclerc: My first question will be for you, Dr. Britton. There are many things to cover in the bill. Before we get into that, I would like to have your perspective, because you did mention it a little bit.
Many have mentioned the short-term effect of nicotine in vaping, but I want you to elaborate a little bit on the expected or predicted long-term effect of e-cigarettes.
Of course, Mr. Hammond, you'll be free to follow.
Mr. Britton: Nicotine itself has effects of increasing heart rate, increasing blood pressure and constricting blood vessels. These are effects, as I said in my testimony, which, in the grand scheme things, are on par with the kinds of things we get from caffeine. It's not a particularly hazardous drug in its own right. You would be better off not using it, but it's not a drug that, on its own, will kill you.
We don't know what the long-term effects are of the other components of vapour. In fact, we don't know what the long-term effects of inhaling pure nicotine would be. We don't know the long-term effects of exposure of the lung to propolenglycol and those vapour solutions that have glycerine also, and then the toxins that are produced in the vaping process from the constituents of the fluid, which produce some nacroline, for example, potentially carcinogenic toxins, produce some particulates and, with flavoured solutions, oxidants in the vapour too.
Those things I expect to cause lung damage in the long term. This is covered in last year's RCP report. We would expect the spectrum of damage to include a similar spectrum of lung disease to existing smoking, but at a much, much lower level of risk. So there will, in my opinion, over the next 50 years, be a handful of cases of lung cancer caused by vaping, but that has to be set aside the likelihood of tens of thousands of cases of lung cancer caused by smoking.
While we have that perspective, electronic cigarettes are not safe, or it is very unlikely they are safe. We won't know how safe they are until two or three decades have gone by. But we can predict, from the levels of toxins in the vapour, that that risk will be very low relative to cigarette smoking. In the RCP report, we said it is very unlikely to exceed 5 per cent of the risks of smoking.
Could I comment in this response on flavours? I know David Hammond very well. I respect his opinions on most areas of tobacco control.
The experience of flavours in the United Kingdom is that many smokers find pure nicotine solutions aversive to use. I find that surprising, because they can inhale tobacco smoke, but they find nicotine solutions aversive. Many smokers use flavours that we might consider to be children's flavours to make vaping acceptable to them. That's why I think in many ways you have it right in that you are saying that you can't advertise a flavour as a child-friendly flavour, but I think taking flavours away from vaping will dramatically reduce the number of smokers who make the switch, and that will be bad for public health.
Mr. Hammond: I would echo everything that Dr. Britton said about the long-term health effects.
This debate has been one of the more difficult ones for the public health community. On the face of it, it would appear like there is a lot of contradictory evidence. Really, I think, there have been two arguments. One half of folks are saying that e-cigarettes are likely to be harmful. The other half is saying that they are less harmful than smoking. Both of those things are likely to be true.
I have read tens of thousands of industry documents. You can go back to the 1950s, when Philip Morris researchers said, even back then, "I don't think we can clean smoke very much. We'll try, but if we have to, we'll probably have to deliver nicotine through something else like vapour.''
We have a tendency to treat e-cigarettes as if they are an alien product. We already have medicinal products that deliver nicotine through different means. If you chew gum, you absorb nicotine in your mouth or upper throat. If you have a patch, you absorb it through your skin.
The mode of delivery is very important in terms of determining the level of risk. Nothing is as dirty as smoke.
The bind that we're in, as Dr. Britton has said, is that it will be several decades before we can precisely estimate what the risk is. That's because there is a lag period for a lot of these diseases. But there is ample evidence to state right now that vapourized products will be less harmful than smoked tobacco products, but they are also likely to produce harm. That's why I always use the frame harmful but less harmful than smoking.
I think it's taken a few years, but you're starting to see that consensus reflected in public health authorities.
Senator Seidman: Thank you both very much for your presentations. I would like to follow along in this line of questioning, if I may, because both of you have made reference to harm reduction and comparison of risks.
Dr. Britton, you in particular have talked about Sweden as an example of evidence where, in fact, a non-combustible tobacco product was used. You have specifically said this piece of legislation precludes this kind of comparison of risks. And although e-cigarette products can go through the normal Food and Drugs Act channels, non-combustible tobacco products cannot.
So what I would like to perhaps ask both of you, starting with Dr. Britton, because you refer to this issue, is: How can we fix that clause that you refer to in this legislation? If it's so important to be able to talk about harm reduction and comparison of risks, what should we do with this piece of legislation to fix that?
Mr. Britton: Well, I think it's important that health professionals, public health opinion leaders and governments can talk about these products in the way that Dr. Hammond has said, by just acknowledging the truth, which is they are not safe, but they are substantially less harmful than smoking. But without that strong message, smokers reach the conclusion that they are much the same. Therefore, if the government or if my doctor isn't endorsing them, I might as well carry on smoking. So I would just take out the prohibition of making any comparison.
This depends on how the Food and Drugs Act laws work for you. In the United Kingdom, electronic cigarette promoters are not allowed to say that this product will help you stop smoking because that's a medicinal claim. To make that, they would have to go through the British equivalent of approval through the MHRA, the Medicines and Healthcare products Regulatory Agency. It would be nice if some of them did that. However, our MHRA has taken what it views as a liberal line on nicotine regulation for products such as electronic cigarettes since 2010, but not one product has achieved a medical licence and appeared on the market. So whilst I think we would all prefer that these products met medicine standards to guarantee minimum risk to users, the reality is that medicines regulation is too complex and too slow, and people are dying as a consequence of the lack of products while we wait for medicinal approval.
Anyway, the compromise we have in the U.K. is that you can't make a claim that makes it sound like a medicine, but you can say, "This product is likely to be substantially less harmful than smoking, so make the switch.''
Mr. Hammond: Look, I think that's a very good question. I've been asking myself that over the last few days.
I'll start by saying that we have a framework for therapeutic claims in terms of cessation through the Food and Drugs Act. I think that's important, particularly given that it potentially allows for greater advertising, and companies should be incentivized to go through that process if they believe they have a therapeutic one. That remains important.
What I would suggest or prefer is a tightly regulated claim. I'm very conscious of letting the industry dictate the communication on health and relative risks. I think there are some concerns there. My preference would be to allow something like a tightly regulated claim, something as simple as "harmful, but less harmful than smoking.'' I believe that the message is a fundamentally important one. It's not an endorsement of use; it's an acknowledgment of fact. As I said, it's taken us a little way to get here, but I think it's time that we need to acknowledge the facts in terms of the potential risks. I wouldn't give the industry a blank cheque to go and frame that health communication. I would prefer to have it tightly regulated.
Senator Eggleton: Thank you very much to both of you for being here. You're excellent witnesses and I think you're helping us a great deal.
I buy the argument that the vaporized product is less harmful, even though we don't know the long-term effects and it will take some time. I think both of you have said that. But I'll come back to the flavours, because I think here, what we're trying to do is prevent kids from getting into this kind of product as much as tobacco, because we don't want them into that either. We don't want them in this, and the feeling is that having flavours that relate to things that they are attracted to — bubble gum flavours or whatever else — is something that may entice them and act as a gateway. So, on the one hand, we want to prevent that.
But, on the other hand, we're recognizing that this can be valuable to help cessation of smoking. Now, the people I have talked with, who are in that latter category, think that the flavour of the product is an important aspect.
Where do we draw the line, here? Where do we reconcile this in trying to keep it out of the hands of kids but also still trying to make it something that people who want to quit smoking will find appealing? I'm told that the taste is a factor in all that. I'll start with Dr. Hammond on that, and then Dr. Britton.
Mr. Hammond: I'll start by agreeing with what you said anecdotally and what Dr. Britton said, which is that the flavour is very important.
You can allow flavour without allowing all flavours. We have done research asking tens of thousands of youths if they have tried the products and what flavour, and we have done experimental studies to test the appeal of different flavours. There are some flavours that preferentially target kids, like many types of candy. There are other flavours that may appeal to both but aren't preferentially targeting kids, like fruit flavours, for example.
I wouldn't suggest a ban on flavours. I would simply suggest a ban on flavours that preferentially target kids. I think there is a wide scope for having flavours, like mint and fruit flavours and things like that, that we know many smokers use. In fact, those are some of the most common flavours out there to begin with. I wouldn't suggest banning those, but I don't think you need flavours that preferentially target kids. My favourite flavour that I have seen is unicorn horn flavour. I think we need some bounds in terms of keeping these to a reasonable scope.
Mr. Britton: I agree. I am perhaps a little more liberal on flavours. The data from the ASH survey I mentioned earlier in my testimony found that, in the U.K., 42 per cent of electronic cigarette users use fruit-flavoured products, 23 per cent choose tobacco and 13 per cent menthol. So fruit flavours for adults are very important.
We run a smokers' group panel in Nottingham to try research ideas out on adults and to get their feedback on what we're doing. We had a session once on flavours and how important they were. There were a number of vapers in that group, and they said, "Take the flavours away and it will be very difficult for me to continue vaping.''
I think the key is to allow the flavours to be there. I may have misunderstood the bill, but I thought what you were trying to achieve was to stop those flavours being promoted in a way that would appeal to children. I do not see why you can't have an electronic cigarette vapour on a shelf in a plain bottle that says cherry flavour. That would allow the smoker to use it.
Where flavours are a problem is that most of the flavours used in electronic cigarette fluid are food flavours, which were never designed to be heated. When you do heat them, much of the toxin that appears in different electronic cigarette vapours comes from the flavours. My advice to the smokers that I treat is very much that, if you can, use an unflavoured solution. If you have to use a flavour, use menthol because that's something that is probably better in most circumstances, but it's better to avoid the fruit flavours.
But the fact remains that many smokers want them, so I think it will be a mistake to withdraw that option.
Senator Stewart Olsen: Thank you for being with us.
Dr. Britton, in the U.K., has the government actually said this is a benefit to helping you stop smoking? Has the government actually come out and made that statement?
Mr. Britton: I'm trying to think of an explicit statement that says, "Use electronic cigarettes.''
Our government has come out several times in saying that harm reduction is an important complement to established tobacco control, in different ways — the last two tobacco control policies in our cancer reform strategy. Public Health England, which now leads on public health in the English National Health Service, has come out very strongly in saying electronic cigarettes are a good thing for English public health. The jurisdiction is England. A document was published a year ago listing the medical organizations that support that position, and it is the great majority.
We are in the situation where, as Dr. Hammond has said, we have a growing consensus that these products are helpful. They are being adopted into our NHS-run stop-smoking services. The teaching and leadership organization for those is something called the National Centre for Smoking Cessation and Training. They put out a briefing about a year ago explaining how to integrate electronic cigarette use when treating smokers and offering them evidence-based cessation care.
So we're pretty much there. There are some dissenting voices in the U.K., as elsewhere in the world, but we're pretty much there. Does that answer your question?
Senator Stewart Olsen: Yes, it does. I still am skeptical about politicians actually saying this is helpful. Thank you.
Mr. Hammond: I'm a researcher, so we always think there should be more research, but we do need more evidence to understand, for example, whether e-cigarettes are equally effective as other forms of nicotine replacement therapy. Are they more or slightly less? We know they're certainly more appealing to use.
But I would go back to what Dr. Britton said, which is that I think it's important to separate the two points: one is with respect to their relative harm and the other one is with respect to the efficacy as a cessation device. I suspect that both of those will come to be, but I think we have a lot more reason to believe certainly in the difference of relative harm at this point.
I'd like to make one small point about dual use. I always say I personally believe that vaporized products will have a public health benefit, but again, it depends how they're used. One of the dominant forms of use in Canada is dual use, where you smoke and use a vaporized product. The best science we have to date suggests that there may not be any health benefit from doing that — that you have to get off the smoke. Some people may be using it to cut back and plan to quit over the long term, and that will be a positive outcome. But we need to make sure that these products are framed as a way to get people off smoking and not just as a complement to smoking. That's where I would return to some of the messages around advertising.
I'm sorry if that was a bit broader than your question, but it relates to the idea of positioning the use of cessation products.
The Chair: Dr. Britton, you wanted to speak to this.
Mr. Britton: Yes, on the dual use issue, and a point that I think hasn't been yet made. Dr. Hammond is talking about our lack of understanding about where these products sit relative to established licensed nicotine replacement therapies.
There are two or three points relevant to this.
First, in the U.K., the NHRA, in its attempt to liberalize nicotine regulation or make it simpler, declared that any product that delivers nicotine is an effective smoking cessation aid. The efficacy there depends on how quickly and how much nicotine it can deliver. So if an electronic cigarette delivers nicotine, it works as a cessation aid.
But what's very important and where the strength of electronic cigarettes and other products that may come along like them lies is that they are a social consumer alternative to smoking, not a therapy, first and foremost. The therapeutic decision is made by the smoker who walks into a news agent or tobacconist or whatever the term would be in Canada and thinks, well, instead of buying a pack of cigarettes today, they will buy an e-cigarette. There's no commitment to quit. It's just experimentation, and it is inevitable that there will be substantial dual use of those products.
But the U.K. approach, which is embodied in guidance by the National Institute for Health and Care Excellence, is that encouraging smokers to take up an alternative source of nicotine and use it as a dual user will generate quit attempts. That's simply because a smoker who thinks, "I cannot get through the day without a cigarette,'' who tries an alternative product and finds that they actually can get through, say, to lunchtime without a cigarette, will think that if they can do four hours, they can do eight, and if they can do eight, they can do a day and so on.
The evidence is good that smokers who start using an alternative nicotine product alongside smoking are much more likely — twice as likely — to progress to quit than those who do not. I entirely agree with Dr. Hammond that the benefit to health is negligible while they're dual-using, but those who then make the step completely to an alternative source will get huge benefit.
The key thing is the consumer product positioning, not a medicinal product. We shouldn't think of these as cessation aids but as tobacco substitutes.
Senator Petitclerc: My question is for you, Dr. Britton. As you know, this bill is trying to achieve this balance between protecting our youth and giving access to smokers who want to stop. I want to hear about whether in your experience and the U.K. experience you saw a bit of a side effect in terms of the market. In other words, once you have the vaping products, the advertising and maybe the promotion or information about it, do you feel that the U.K. was able to contain vaping products to smokers wanting to quit, or did it attract a whole new market of non-smokers starting to vape? I know we're talking about the gateway situation with the kids on certainly a broader term but also for non-smoking adults.
Mr. Britton: The short answer is that, in the U.K., electronic cigarettes are being used almost exclusively by smokers. The concern that you express is one that we all share; namely, that children may become addicted to these products and move on to become smokers. For the four years or so that we have decent data in the U.K., that just hasn't happened. Use of nicotine by nonsmoking children is negligible.
If you think about it, that makes sense, because unlike most other drugs that have a street trade or an illegal trade, nicotine doesn't make you feel good. Early experiences with nicotine, as anybody sitting around your table now will recall, are actually quite adverse.
There is a lot of child experimentation with electronic cigarettes in the U.K., because adolescent kids try things. But for the great majority of those, it's a trial, followed by them thinking "what's the point,'' then moving on to the next thing.
Use by never-smokers is negligible. Thus far, at least, we have no grounds to be concerned that there will be a big gateway effect.
Mr. Hammond: I can certainly speak to the Canadian market. We have had a very large number of Canadian youth, including non-smokers, try e-cigarettes, but it is also true that very, very few of those go on to use them regularly. Most of them try it once or twice and that's it. Like the U.K., I think it's fair to say we have negligible levels of regular use among nonsmoking youth. That's very important, for all the reasons Dr. Britton said.
But I would state that that's not a fixed quotient. One of the things a lot of people talk about is the evolution of these devices and their ability to deliver nicotine. For a smoker, you want it to compete with cigarettes in terms of nicotine delivery. There's a lot of talk about promise of better nicotine delivery over the coming years. So that conversion factor, which is very low right now from trial to regular use, may not be a fixed quotient. I don't say that in an alarmist way. I've stated that I believe we should make these products more available to smokers, but I would just note that it's not a given.
Along with the product itself and the drug itself, that's where marketing and promotion are very important in terms of shaping who uses the product. The bill is trying to achieve that balance, and it's important that it seeks to do so.
Senator Seidman: Both of you are providing us with enormously important testimony, and I thank you both very much for that.
I did want to ask you about the gateway effect and whether cigarettes, e-cigarettes specifically, would tend to re- normalize smoking after long public health anti-smoking campaigns over decades. You've partially addressed that issue, but there isn't a whole lot of scientific evidence to date on this matter and I'm wondering if you can help me understand.
For example, one in every four Canadian youth aged 15 to 19 reported having tried an e-cigarette, and one in three young adults 20 to 24. These are the up-to-date 2015 numbers. So 18 per cent of students in Grades 6 to 12 have ever used an e-cigarette.
So it's pretty low, but what do you think and what kind of science do we need to determine that in fact we're not en route to re-normalization of smoking for a whole new generation? Dr. Hammond, perhaps you could start.
Mr. Hammond: We don't know and we can't know ahead of time. What we do know is the ways in which advertising and marketing shape social norms and how it has done that for tobacco. We have the first half of the last century in terms of promoting its uptake, and then we have the second half of the century trying to unravel that. We see it in the conclusion with something like plain and standardized packaging.
We know it can be done.
I consider myself to be quite a centrist on this type of issue, but when you think about allowing advertisements on TV and radio, even if you try to prevent cross-branding, it is extremely difficult, as I said, to determine what is adult- oriented and what is youth-oriented. By the time we figure it out and we act, it's five or ten years later.
I come back to: Will advertising and marketing promote use that benefits public health or will it promote the other side of use, which, although it's negligible now, may or may not undermine it? And even if it doesn't make kids want to try vapourized nicotine products, it could re-normalize smoking.
I'm not an alarmist on this issue, but it is alarming to think about the extent of marketing for nicotine products, particularly for companies that also have a primary interest in selling tobacco products. What is proposed in the bill is beyond what I understand will be allowed in New Zealand, for example, or what is currently allowed in the U.K., where they don't allow TV and radio advertising, based on a European directive.
I'm not sure I have a satisfactory answer to your question, but I think, even though we haven't seen it to date, it remains a possibility, and I think advertising and marketing, above all, will be the determinant of that.
Senator Seidman: You're making an important point. Are you suggesting that this bill ought to be more restrictive as far as advertising to youth is concerned?
Mr. Hammond: I am. I think about advertising in two ways: one is in terms of its content. That would be whether it's appealing to youth or not. The second one is where it's allowed in channels. Again, I do not believe that allowing lifestyle advertising will make a smoker any more likely to switch. They have every incentive to do so, and I think there are other very important ways of incentivizing that through price, differential health warnings and things like that. Personally, I don't see the value of lifestyle advertising.
Second, I'm concerned about advertising in channels, even if it's meant to be non-lifestyle advertising, that will be viewed by our children, and that would be TV, radio and some of those other mainstream channels.
Senator Seidman: Did you say there was a particular country that we ought to have a look at as a model?
Mr. Hammond: I was pointing out that my understanding is New Zealand has proposed new regulations as of last week and my understanding is that they have not allowed adult-oriented advertising in TV and radio. My understanding is that's no longer allowed in the U.K. Those could be possible models, but I don't pretend to know those regulations terribly well.
The Chair: Dr. Hammond, related to this, you made a comment earlier with regard to the possible conversion of vapour smokers into tobacco, one of the issues around this. Could you elaborate as to whether there is any evidence you are aware of on the percentage of youth taking up vaping who go on to be smokers?
Mr. Hammond: We will actually have a study coming out in a medical journal very soon showing that. We followed people up over time. We followed 20,000 kids over 12 months. Everyone was a non-smoker at the start. The kids among those who were non-smokers who tried a vaping product were much more likely to go on to become a smoker. But here's the thing with that: We call it the gateway effect. It's true for tobacco, alcohol and marijuana. Most of that is that the kids who are likely to smoke are also likely to try a vaping product.
This is, again, in the fog of all these findings. Is there association? Yes. Is it causal? It's probably just the common factor of the kids who like to do those things do those things. It's like predicting one nicotine product with another.
And I would reiterate that it is very low. It is very uncommon for a non-smoker youth to use e-cigarettes regularly. We have not seen it. I would echo what Dr. Britton has said there. But what I'm also saying is we don't entirely know what's going to happen as these products evolve, and if you have a wave of advertising and marketing for products like we haven't seen in several decades, I don't know that will be the case, but I can't tell you that wouldn't be a problem either.
Mr. Britton: It answers the question of how we keep tabs on what is going on, and it's more crucial than ever to be monitoring smoking and nicotine use behaviours in young people and in adults. That's where the proof of the pudding lies. We have the good fortune to have decent surveys of young people across the U.K., and they all show the same thing as Dr. Hammond just said, which is negligible use by non-smokers.
I entirely echo the comments that children who are more likely to try vaping products are also much more likely to be trying cigarettes anyway. They come from families where people smoke or maybe where those smokers have become vapers. They're exposed to the products; they're more likely to use them. We have to watch what is happening.
I share the concern about the ability of some of the commercial organizations involved in this market, even if not now, certainly in the future, to target children and target non-smokers with a lifestyle product. That would be negative for public health. So there is a very strong case to restrict and control and monitor advertising, but the proof of the pudding is in who is using the products and for how long. At the moment, the signs in the U.K. for sure are that, both among children and among adults, use by never smokers is negligible.
Senator Hartling: — A lot of us are familiar with second-hand smoke and how that affects us and is harmful. I'm wondering about vaping and e-cigarettes. Is any research done on the effects of that? Can it affect us and how can it affect us? Did you want to start, Dr. Hammond?
Mr. Hammond: Sure. I think you can make some inferences from what we believe to be the case with the direct health effects, which is there's a lower level of chemicals, fewer chemicals in the air. It may present a public health risk, but it won't be the same as smoking. My understanding of the regulations in Canada, which I understand are mainly provincial, is they prohibit vaping in public spaces where smoking is prohibited. I would suggest that is a reasonable preventive measure, which isn't to equate the two risks.
Mr. Britton: Yes, I agree on the levels of risk. We discussed this already. On use in public places, I think it's a serious error to categorize electronic cigarettes with tobacco cigarettes in that context. The evidence for harm from vapour to others is tenuous at best. In my view, not using an electronic cigarette in an enclosed area, particularly one that produces clouds of vapour, is a courtesy issue, not a pleasant thing to do.
Equally, I remember sitting on a train to Stockholm station and realizing, well into the journey, that the man sitting opposite may have been using an electronic cigarette all the way through that journey. He wasn't exhaling clouds of vapour, and I could no more object to that than if he had taken out a Salbutamol inhaler to relieve his asthma.
There's a further issue, for example, in Britain anyway, where we have a high prevalence of smoking in mental health populations. We have a big problem of smoking in hospitals providing secondary care. Electronic cigarettes can be part of the solution to that. When you come in and use our services, we ask you not to smoke. We will offer you the best help we can to help you quit smoking, but if you don't want that or can't do that, please, while you're here, don't smoke tobacco, but if you want to use an electronic cigarette, go ahead.
If we categorize e-cigarettes with tobacco cigarettes in the way they can be used, the message again comes to the public that these are the same in terms of risk, and they're not.
The Chair: Dr. Britton, in the last exchange, Dr. Hammond suggested that perhaps the U.K. has very recently tightened its restrictions around vaping products, if I understood him correctly. Could you comment on that in terms of advertising?
Mr. Britton: We have a voluntary code of practice through the advertising standards authorities. There's one for print media and one for broadcast media. They are not allowed to promote electronic cigarettes to young people at all. Some limited advertising is accepted, but it's not allowed to associate the vaping product, say, with a tobacco product.
There is a voluntary code that is followed, but I see very little advertising. That may reflect my low consumption of some of these media.
The Chair: We have voluntary agreements in our advertising industry, but it's restricted to those who are members of the association.
Mr. Hammond: My understanding is that in 2016, through a European directive, it banned tobacco advertising on radio. That's not voluntary. It gives countries the option to do things like billboard advertising. Scotland has decided not to do that. My understanding is that England right now is still permitting them. My understanding is that because of the European directive, TV and radio advertisements are no longer allowed.
Mr. Britton: That is in the process of coming into force. The new tobacco control directive becomes law on May 20.
The Chair: What Dr. Hammond summarized is in the process of becoming effective?
Mr. Britton: Yes. It went from free advertising through the Advertising Standards Authority controls, which yes, they are voluntary controls, but they are reasonably well adhered to, and certainly through a complaint process adverts that are deemed to have broken the code are removed. Yes, things are getting much tighter in May.
Senator Eggleton: I want to drill down a bit more on this marketing and advertising situation because we have to figure out where to draw the line. We obviously don't want to promote to youth. On the other hand, we want to make people who are willing to use this product or could use this product aware of its existence.
It's easy to say that you can't advertise directly to youth, but there is a crossover here. In trying to promote it as a less hazardous form of smoking and a way of moving towards cessation, there has to be some means of doing that, and there could be a crossover that can create a problem. Where do you draw the line here? What forms of marketing or advertising or promotion as a cessation product would we allow to be carried out for e-cigarettes that don't cross over that line?
Mr. Hammond: I was hoping nobody would ask me to be specific. Half of all of our smokers in Canada have used a vaporized product already. It's about 80 per cent, when you look at younger smokers. I don't think it's a case of making people aware of e-cigarettes.
I also stated earlier that I think it is important to provide market advantages to the less harmful products, so vaporized products should be allowed to be promoted more than smoked products. Your question was: What exactly does that look like?
I keep saying tax price because that is a very important determinant. I think you can have differential taxation price levels. You can have different types of health warnings. If cigarettes are ultimately sold in plain, standardized cigarette packaging, you could allow brand imagery on vaporized products. You could allow product displays in retail outlets, which are currently prohibited for smoked products. You could allow more price promotions. Perhaps you could allow some non-lifestyle advertising in adult-oriented settings, so bars, direct mail.
I don't pretend to have the exact answer on where you should draw the line, and there is no objective answer to your question, I don't think. It's possible that Dr. Britton or others would draw that line somewhat more liberally, but I suppose I'm guided by being a bit more cautious about allowing advertising. It's much easier to permit more advertising in the future than it is to scale it back. It's a lot harder to put the genie back in the bottle. Perhaps I'm being more conservative, but I think you can still incentivise vaporized use over smoked without necessarily going to the full lengths that are in the bill at the moment.
Mr. Britton: Broadly, I would agree with that position. The only thing is that many smokers have yet to try electronic cigarettes. In the U.K., we still have a substantial proportion of smokers who believe that nicotine is hazardous and that they shouldn't use these products for that reason. So I think there is a very strong case for health promotion messages to established smokers.
This also comes back to the de-normalization or re-normalization arguments. What's happening in Canada and in Britain is that smoking rates have fallen quickly, but in Britain, since electronic cigarettes became widely used, we've seen prevalence grow by .9 of a percentage point each year for the last three years, in the absence of any new significant policy. Our standardized packaging comes in next month. That is a huge fall for free, really, from just a consumer solution to the problem. We are seeing smoking becoming de-normalized.
The other side of that coin is that if electronic cigarette use becomes normalized, I wouldn't have a problem with that. The harm to society long term, if all of our smokers switched directly to electronic cigarettes as a result of advertising and even — let's say it — some people become nicotine users as a consequence of that process, will still be less than the status quo, which is to have a fifth or a sixth of our adults killing themselves with tobacco.
The Chair: I want to thank you both for your exceptionally clear testimony and detailed responses to the questions that have been asked. You've been enormously helpful to us.
Dr. Britton, thank you so much for joining us across the airwaves; and Dr. Hammond, for coming in to join us today, and to my colleagues, once again, for the nature of your questions.
In our second panel, we have again two witnesses, one by video conference. I will welcome and invite the first presentation from our video conference witness to ensure we get the testimony before any possible gremlins get in the system. Dr. Peter Selby, Clinician Scientist with the Addictions Division of the Centre for Addiction and Mental Health, we welcome your presentation.
Dr. Peter Selby, Clinician Scientist, Addictions Division, Centre for Addiction and Mental Health: Thank you. On behalf of CAMH, we are pleased to have been invited to make this submission before you. I will keep my remarks to seven minutes.
CAMH is a 500-bed hospital that conducts research, education and policy, and implementation, and our focus is on patients suffering from mental illness and addictions. We have a strong focus on tobacco addiction right from scientific studies from molecular levels to brain imaging level to genetics, as well as clinical research and research that has to do with policy and public policy in response of the Ontario Tobacco Research Unit and one of its founding partners.
With respect to our philosophy, we are strongly focused on helping people who suffer from disparity and disadvantage in society. As we know, the tobacco epidemic is rampant now in this population of Canadians and is killing roughly 37,000 Canadians annually. To put that in perspective, this is at least 10 times the amount of people killed every year from opioid overdose, and we know what that epidemic is doing to society.
The other caveat is that we have done research and have worked with companies, but not for companies, to develop smoking cessation treatments. We run a large smoking cessation treatment clinic in Toronto that treats roughly a thousand patients a year. However, through our programs in the province, we have amped that up to about 25,000 smokers who we help with standard treatments.
Having said that, a sobering fact from our research is that despite the most motivated patient and the most motivated person making an attempt to quit, most of them will go back to smoking within three to six months. That is the reason why we are very interested in looking at ways in which people can reduce the harm from tobacco use, especially because most of the people, as you know, die from the smoke and not the nicotine.
That is our focus, and when we look at this bill, we are very pleased to see the way it is separating out a therapeutic option, which clearly should go down a therapeutic arm and division and development as a medical product for cessation. However, we see the benefit of the amendment that will allow easier access, especially to patients with mental illness and other addictions, to a product based on the contents of what vaping devices bring compared to the types of combustible products that our smokers have and the health effects that they experience. Even though we don't have 100 per cent confirming evidence, we are very pleased to see the possibility of a harm reduction paradigm. This is consistent with our approach to harm reduction in Canada, whether it is supervised injection facilities, prescription heroin or the legalization of cannabis. We see this being consistent with paying attention to the number one addiction in Canada and creating a harm reduction paradigm for smokers who are unable or unwilling to quit at the moment.
So from the product, we hope that this bill will be tightened up to ensure that there is a clear distinction between vaping products and tobacco products. So for example, the heat-not-burn products should definitely not be considered vaping products under this legislation and should continue to be viewed as tobacco products until we can show, with clear certainty, that it does not have any of the combustible elements that are being put out by combustible cigarettes.
We also want to ensure that the framework includes that people selling vaping devices are manufacturing under good manufacturing practices, that there are standards in place, that right from the metal, right from the filaments, right from the cartridges, that they are all manufactured and generally safe for human consumption. In addition, we should ensure that the batteries meet some sort of standard so that they do not overheat and explode. Lastly, we want to ensure that the e-juice or the liquids are manufactured with concentrations that do not serve a danger to those who are not tolerant of nicotine, especially young children. We need to continue to ensure that the manufacturing happens in Canada, because when we talk to people who use a vaping device, most of them are buying the product in Canada, and it is an opportunity in Canada for us to ensure that people can choose a Canadian product.
In terms of the practices, clearly the policies need to further promote the practices to not allow vaping where tobacco is not allowed and keeping it consistent so that we do not create confusion in the market and in people's mind.
Lastly, we want to ensure that the policies that are in place do not favour tobacco products. So for example, in terms of the amendments to the advertising, we do want to make sure that adult smokers who are addicted and have an inability to quit or have tried or for whatever reason do not want to try the regular medications to quit can make an informed decision.
This means they should be able to have access to the current latest evidence at the sites where they do get that information, in a vape store, for example. We do need to ensure that they can make an informed choice if they are going to make that choice to switch from combustible tobacco products to vaping devices. We know that the Public Health England report has been controversial, but really we are quibbling over whether it's 95 per cent safer versus 30 per cent safer. In this day and age, where we have that kind of mortality and devastation of families and premature loss of life due to tobacco in the country, I think we need to take a pragmatic approach like this bill is trying to do and make sure that the adult public can make an informed choice to switch over.
In addition, we do want to make the playing field unlevel in the sense that it becomes easier for people to switch to non-combustible products and not have matters of legislation that somehow equate vaping devices to those of combustible cigarettes. Advertising and allowing people to make that choice so that they can be aware of it and reaching adults in ways that they want to be reached and using current market forces as a way to help them do that is critical.
At the same time, we do need to protect young people from using these products in the sense of initiating their use of tobacco and preventing that issue. I can tell you that our subset of patient populations, where their mental illness often starts at a young age, almost all of them are heavy smokers before their eighteenth birthday. We don't want them to start using cigarettes and have no option of using potentially safer products that might be on the market and somehow not allow health care professionals to have those conversations with them to help them not go down the path of combustible cigarettes.
The other relevant concern that we have is the issue of co-use of tetrahydrocannabinol, or THC, or the active ingredient in marijuana, in vaping devices, and we want to see that there is a deterrent to that co-use, although there does need to be a development of non-combustible ways of consuming marijuana that can be consistent with other legislation with the legalization of marijuana happening in Canada. What we don't want is people being able to smoke a vegetable product, which is a marijuana joint, and not get them off the combustible form of ingestion.
So when we look at this, we look at it as a society in terms of how this bill affects our most vulnerable Canadians. One in ten Canadians will have a mental illness who have smoking rates that are four to five times that of the general population.
In summary, we support what this bill is trying to do. We believe that some of the tweaks that can be made will allow adults, especially those who are unable to quit, to be able to switch over, knowing full well that the product has generally been regulated. We also know that it could help underage individuals not get access to or believe that this is a product to initiate. The ban on flavours, for example, is a good idea and we support that. In terms of information to the smokers, we agree that this is not a lifestyle product and should continue to provide factual information to the smokers so they can make an informed decision to switch.
With that, I'll stop.
The Chair: Thank you very much. Now I'm pleased to welcome Neil Collishaw, Research Director, Physicians for a Smoke-Free Canada.
[Translation]
Neil Collishaw, Research Director, Physicians for a Smoke-Free Canada: Honourable senators, thank you for inviting us to share our perspectives on Bill S-5. I am the research director, on a voluntary basis, at Physicians for a Smoke-Free Canada. Although I am not a medical doctor, I have been working in tobacco control for 35 years. I also worked for Health Canada in the 1980s and for the World Health Organization in the 1990s.
[English]
Bill S-5 will legitimize a grey market for vaping products. It will give some clarifications to support plain packaging and will make other important advances for tobacco control. In these respects, we support this legislation. We believe, however, that some changes are needed to reduce the risk to the health of young people and future generations. The changes we are suggesting are given in detail in a table of proposed amendments that we sent to you at the end of last month. Today I will speak of only two of the most important themes where we think this bill is in need of some sober first thought.
According to us, Bill S-5 opens the door too wide to the promotion of vaping products, and we think that door should only be partly open. One consequence of legalizing vaping products is that they will invite big tobacco companies into the Canadian market with their new products, and we can expect that Royal Assent will be the starting gun for their race to sell as many of these products as they can, using every tool that this law will hand them. This bill, as currently drafted, will give them wide scope, as it opens the door to television, radio, billboards, retail, social media, direct mail, text messaging, contests, giveaways, girls in skimpy outfits offering samplings in bars and many other marketing tools used by the same companies to recruit and addict previous generations to nicotine.
Our recommendation for minimizing this risk is simple: Subject vaping products to the same degree of advertising allowed for tobacco products. That is, permit information and brand preference advertising on signs in places where young people are not permitted and in publications addressed to named persons. Even if the rules are the same, vaping products would still enjoy a marketplace advantage because tobacco companies choose not to use these permitted forms of advertising. Unlike tobacco products, vaping products are not subjected to excise taxes and we are not recommending that they be so taxed.
We are not alone in making this recommendation. I note that the submissions by the Canadian Cancer Society and the Canadian Medical Association both make this request for equal treatment. If this bill passes, Canada will virtually be alone among countries after May 20 in allowing the public to be exposed to broadcast advertisements for tobacco products. Broadcast advertising for vaping products will be banned in the 28 countries of the European Union very soon. New Zealand is in the process of legalizing these products and is proposing an approach similar to that which we are asking for today.
Among the OECD countries, only the U.S. allows largely unrestricted advertising for vaping products. The title of the December 2016 press release from the U.S. Surgeon General says it all: Surgeon General reports youth and young adult e-cigarette use pose a public health threat. In other countries that restrict advertising for vaping products, no major public health threat has been observed.
Now, while opening one door to vaping products and their advertising, Bill S-5 fails to start closing the other, the door that leads to tobacco products. Bill S-5 legalizes vaping products, and it will offer some reduction in the harm tobacco causes. It's a nice hope, and I hope it comes true. But to guarantee that harm will be reduced, we need a comprehensive harm reduction framework that will, in return for legalizing vaping products, require that more be done to reduce the demand and supply for tobacco products.
Last week, Mr. Peter Luongo said on behalf of his company that he thought the goal of getting to 5 per cent smoking incidence by the year 2035 was actually not good enough. He said he thought we can do it faster. And I say, well, let's help him out with a comprehensive plan and timetable.
There is now an opportunity, through Bill S-5, to provide the legislative changes needed to help achieve this goal, and here are the key changes that we are proposing: Expand the purpose of the act to include reducing the burden of disease, preventing addiction to nicotine and achieving the minister's goal of less than 5 by 2035; give effect to the expanded purpose by reducing the supply and demand for tobacco products and requiring tobacco companies to assist the minister in this regard; charge tobacco companies an annual fee to defray the cost to government of effective tobacco control — an annual fee of $200 million is suggested — and create the necessary regulatory authority to achieve these ends. You can find detailed legislative language to implement these improvements on pages 4 to 10 of the table of proposed amendments we have sent to you.
In June 2015, Justice Brian Riordan of the Quebec Superior Court handed down his $15 billion judgment against the three big tobacco companies, two of which visited you last week. We commend one paragraph of that judgment to your attention. It follows:
Over the nearly fifty years of the class period, and in the seventeen years since, the companies earned billions of dollars at the expense of the lungs, the throats and the general well-being of their customers. If the companies are allowed to walk away unscathed now, what would be the message to other industries that today or tomorrow find themselves in a similar moral conflict?
Honourable senators, you can greatly assist in achieving the goal of less than 5 per cent smoking prevalence by 2035. Lend your approval to Bill S-5 so that the door to vaping products is legally opened, but please amend it to make sure the door is not left wide open in ways that harm young people and those who would otherwise end their addiction to nicotine. As this one door is opened, please ensure that the other door is progressively closed on combustible tobacco, the product that continues to harm many millions of Canadians.
Thank you.
The Chair: Thank you. We will now turn to questions from the senators.
[Translation]
Senator Petitclerc: Thank you very much for that presentation.
[English]
I would like to start with a question for you, Mr. Collishaw. You talked about advertising, something we discussed a bit earlier with other witnesses. I'm interested in having your perspective on that balance between advertising and informing. How important do you feel it is to inform smokers on how likely less harmful vaping is, and can we do it?
Mr. Collishaw: I think by allowing information advertising on both tobacco and vaping products, which is what our proposal is, then consumers can see for themselves that this one has smoke. Smoke contains all of these dangerous chemicals, causes all of these diseases. This one has no smoke. It has fewer chemicals and is at least not known yet to cause a great number of diseases.
Dr. Selby: I fully agree that we need to have exactly that, help smokers see the harms from cigarettes versus the harms from that by showing them what the contents are, and help them make an informed choice.
Senator Seidman: Thank you both very much for your presentations.
Dr. Selby, in your presentation, you made a point about saying that consumers should have access to the current, latest evidence on e-cigarette use. Do you think this legislation will indeed facilitate access to this current latest evidence, including, of course, the harm reduction and comparison of risks? You did mention tweaks, which was a bit of a suggestion that you felt there were some things that could be done. If you might address those, I would appreciate it.
Dr. Selby: I guess this whole concept of lifestyle advertising is a bit of a concern. If you're trying to tell people in a bar situation where they are consuming alcohol about this other product, then we are linking all those issues together and creating this idea that this product is about a lifestyle issue and that is what it needs to be.
My patient population aren't frequenters of bars where the middle class go, where this kind of information will be shared, and in a sense, I'm worried that we will create the idea that this is the popular or hip thing to do for people. We're pulling people in, and then the unintended consequences are that young people who don't take the time to understand start thinking of it as an attractive lifestyle choice, which it's not.
So being able to give factual information, as Mr. Collishaw said, in settings where people's brains are able to take that, such as when they are going to buy a product, whether it's a tobacco product, at the point of decision-making to buy a product or not, to me that's where people should be able to get that information so you can make a comparison.
Mr. Collishaw: I think the rules that we have on tobacco that allow information-only advertising in certain media have proved themselves over the years to be quite effective. They do allow communicating of factual information about the product. Of course, the tobacco companies have failed to use those provisions because they don't have anything good to say about their products, I guess. But there is an opportunity here for providing sound information to the public, without opening the door too wide and leaving the decisions about what information is to be provided in the hands of the people who want to sell you more of this stuff. I would prefer a tighter restriction.
Now, I can think of one more amendment that is not in the written material I have provided to you, but you might like to consider this: Right now, people are allowed to do information advertising in places where young people are not allowed to enter. If the law were amended to permit the sale of vaping products and tobacco products in stores devoted exclusively to that purpose, and the law also said young people aren't permitted to enter these premises, then tobacco companies could have as many stores as they want, where they can provide information advertising on tobacco products and vaping products. They could also sign up people by name so they can send them publications later with information on these products. It's something to consider.
Senator Seidman: Just to clarify, if I could. Mr. Collishaw, are you saying that there should be vape in tobacco shops, and that is where these products should be sold exclusively?
Mr. Collishaw: I am saying that we should authorize the creation of such shops and specify that young people couldn't enter, if any such shops are created, and then leave it up to the tobacco companies whether they were going to take advantage of those shops to sell their products, because then they could do quite a lot of information advertising in such locations.
Senator Eggleton: Mr. Collishaw, I get the impression from your presentation that you may not agree with what our previous two witnesses said, that is, Dr. Hammond and Dr. Britton from the U.K., in terms of vaping products being less harmful.
Mr. Collishaw: Oh, yes, I do agree. They are harmful but less harmful. If you detected some disagreement with my colleagues — and I did listen carefully to their presentations — I would be much more cautious about how wide we're going to open this door to promotion. That's perhaps born of my experience in dealing with tobacco advertising and its consequences over the years, and knowing it's the same people who are going to be doing this. I would rather proceed cautiously and just open that door to information advertising only.
I should add that by doing that, you avoid the whole problem of deciding what is a lifestyle ad, and what is an ad aimed at kids, and, of course, the tobacco companies would take great delight at playing at the margins of whatever definition you might have on that. If it's just restricted to information and brand preference advertising, as it is for tobacco, I think we're on the optimum path towards the balance that we're all seeking to achieve between making sure these products are available but are used responsibly by smokers as a worthy substitute for smoking tobacco.
Senator Eggleton: I didn't get my whole question out.
Mr. Collishaw: I'm sorry I interrupted you, senator.
Senator Eggleton: That's okay. You clarified that part of it.
I also want to go to this question of flavours, because the bill on schedule 3 talks about prohibition of flavours that could be described as confectionery, dessert, cannabis, soft drink, energy drink. Yet we also heard that flavours could be an important part of the cessation use of the e-cigarettes. What do you say to these particular prohibitions? Are they enough or too far?
Mr. Collishaw: As I understand it, the bill prohibits the advertising of flavours but not the flavours themselves. As was explained by one of the previous speakers, that seems to be a reasonable approach.
Although, we might adjust the list somewhat. I notice cherry is allowed, but not cherry cheesecake, for example, because it's a dessert. There is, perhaps, some fine-tuning there.
Dr. Selby: The advertising flavours part of the thing to make it attractive makes little sense because most people using tobacco products are smoking regular cigarettes that don't have those flavours. At least in speaking to my patients who have gone and bought products, especially in their attempts to switch over completely from combustible, they tend to go for cigarette flavours. They're not going for the fruit flavours and what have you.
I must say that's my view because that's my patient population.
I agree that advertising of flavours serves little purpose, but banning the flavours should only be based on whether they are generally safe for human consumption or not. We have seen good examples, like diacetyl not being a good product. As a flavouring agent, that's what brings the butter flavour in. Those things are harmful to be inhaled. Whatever we know is harmful to be inhaled, even in small quantities, should not be allowed. That's what is the attempt at making sure these flavours aren't, generally, harmful.
We do need to have a monitoring and surveillance system so we can be learning, as time goes on, as to how we refine these products. This is where we have to look at this as a product innovation, where it's not 100 per cent complete. When the first cellphones came out, they weren't what we use today. We've seen that innovation. In fact, it's a misnomer to call them e-cigarettes anymore. In fact, most modern, effective ones that people use actually don't look like cigarettes anymore.
We do need to think about this as an evolving product. We need to have surveillance over the use patterns and any harms and benefits there are when people use them. Flavourings would come into that category.
Senator Petitclerc: My question is for you, Dr. Selby. I'm interested to hear you speak a little more on the product, on nicotine, and exactly how addictive it is. I heard you speak at the Centre for Addiction and Mental Health about certain segments of the population that may be more vulnerable.
With the perspective that even if it is likely less harmful, we have this responsibility to protect youth and non- smokers. How addictive is it, and how careful do we need to be?
Dr. Selby: The addictive properties of nicotine are dependent on how quickly it can enter the brain. When people smoke it through combustible tobacco with very high levels of distribution, it hits the brain very quickly. When it hits the brain in that way, it leaves very quickly. In about 90 minutes, half of it is out of your body. That's what sets the person in the cycle of needing this nicotine regularly.
Clearly, therefore, chewing tobacco is less addictive than smoking it. That's why we don't get people addicted to the nicotine patch. Nobody is abusing the patch or putting on excess patches just to get a buzz or high. It comes into the system very slowly. You don't get the hit and the rush. Nobody gets addicted to the patch. Even non-smokers will not get addicted to the patch. They will get sick from it. How quickly it comes is a big determinant.
Second is what else goes with it. Tobacco has other chemicals that either enhance or affect the brain chemistry and make it have the effects we see. Anxiety reduction, mood enhancement and improved concentration are all effects that people get from nicotine.
Those are critical issues in our patients with mental illness, including the severe mental illnesses like schizophrenia, depression disorders, anxiety disorders, et cetera.
There may also be other genetic reasons why people are addicted to cigarettes, but it also determines their addiction to alcohol and other addictive behaviour.
What we say is if you're predisposed, we need to make sure that if you're going to use a drug, it doesn't cause you harm. Nicotine is not innocuous. I wouldn't suggest putting nicotine into the drinking water, because that doesn't have an overall societal benefit. For those who find it beneficial, the current system is forcing them to get it in a way that's extremely damaging, that will take 10 to 20 years of their life. It's not the nicotine; it's the smoke.
If we could tame nicotine — like we have tamed caffeine — by allowing people who want to use it in a way that doesn't cause them health effects, then this is the first indication we are in that direction, where people no longer have to use those dirty combustible forms of tobacco.
In terms of the actual health effects of nicotine itself, it may cause delayed healing of wounds, and it may cause effects on diabetes. In people who have cancer, it may promote the cancer. It doesn't cause cancer, but once the cancer cells are there, it increases blood flow and it may increase that.
I treat cancer patients who are continuing to smoke after their diagnosis. The smoke itself is also causing a problem for their chemotherapy. People who smoke will require double the chemotherapy if they continue to smoke. I can switch them to nicotine, and that nicotine doesn't interfere with the chemotherapy.
We give smokers everything that is there on the market right now. As you can imagine, when you have a cancer diagnosis, quitting your cigarettes is a very difficult thing. We don't have anything to tell them. It's either quit or too bad. I think electronic devices do potentially provide an alternative where people might have a better outcome.
Will electronic devices become addictive, where people will find it difficult to stop? I think it will for some people, but they may be already predisposed to getting addicted. They may have already had an addiction to cigarettes. We could help them quit it. I've helped people who have been using electronic devices to quit smoking and then need help coming off the electronic device, and they've done it successfully with a little bit of education.
Mr. Collishaw: Just to add a few extra points to what my colleague Dr. Selby has said, he said nicotine reaches the brain quickly. In some estimates, "very quickly'' means seven seconds, a couple beats of your heart. Nicotine that's in the pulmonary vein is in your brain. The reward does come quickly.
You asked how addictive it is. Well, there has been a lot of study of this, and, by many measures, it's about the most addictive substance known. When you ask heroin users who also smoke what is the most difficult for them to quit, they say it's cigarettes.
There's evidence that a very high proportion of people who smoke, perhaps almost all of them, are addicted to nicotine. That's not the case for alcohol, say, or other drugs.
Senator Seidman: Dr. Selby, our previous two witnesses talked about the importance of monitoring smoking behaviours with the introduction of e-cigarettes to be certain that we don't re-normalize smoking among youth. We talked a lot about the gateway effect and the fact that we really don't know the impact, and are we going to re- normalize smoking for a new generation?
You and CAMH are currently engaged in a study that is looking at patterns of e-cigarette use, and I'm wondering if you have any information to offer us on that score.
Dr. Selby: What I can say is this: When we look at studies that have looked at ever-use of an electronic device and then people who continue to use it later on, it's not as great, and clearly ever-users of cigarettes are much more likely to be ever-users of cigarettes 30 days on. From an addictive potential, roughly, we can't say it's causative, but there is an association, where you're seeing something at time point one and time point two.
There's a suggestion, and this is the controversy that exists with this whole gateway hypothesis. It has existed in addictions since the beginning of addictions. We get caught up on this idea if someone uses one drug, it will somehow sensitize them to use another drug. What we fail to understand and describe and what many researchers fail to tell you is that there may be a third factor that has made this person try substance one. For example, they may be impulsive: They tried substance one and they don't like it, so they move to substance two, or they keep adding substances along the way. You cannot make the conclusion that substance one causes the use of substance two.
Because we are looking at time one and time two but not following the same person over time and understanding these other conditions, we need to be very careful about that gateway hypothesis. It has great face validity and it's a nice conversational piece, but the scientific basis of the gateway hypothesis is just that: it's a hypothesis that's not been proved for all drugs of abuse. There are other genetic and environmental factors that determine why kids start using and what causes them to use over time.
What we do know is that with electronic devices, there's an association, at least in those countries where electronic devices have been on the market, like the U.K. and U.S., compared to Australia and Canada, where you do see a lower onset of youth smoking. Whether these youths will then transition to cigarettes, it's an open question, but one would have to wonder why you would move from a cleaner, more functional product to a more dangerous product. I have yet to see that happen in any other human behaviour where we say we're going to go away from our acceptable modern inventions and go back to an old one. None of us have gone back to the typewriter, as far as I can tell.
As long as we allow for this technology to innovate and move forward, it will be interesting to see whether the innovation pushes or sensitizes people to become drug users.
One of the things that the bill needs to pay attention to is that if we don't allow youth access to electronic cigarettes but, perversely, allow access to cigarettes, people will start off with cigarettes, which is a much more dangerous product that they will use instead of a safer product. I think that's an ethical conversation we need to have: What are we telling our youth when we say that they are not allowed to have access to safer products but only adults can have them? We do know that most youths get their cigarettes through social supply, and we need to make sure we don't inadvertently promote cigarettes to youth because we are so worried about the use of electronic devices.
Mr. Collishaw: Senator Seidman, your question concerned monitoring. I really think we need to up our game considerably, especially as we are introducing this new product and we hope it will substitute for the more hazardous product. We need to track carefully what is going on through a combination of annual surveys, and quarterly or monthly surveys that are smaller in size but perhaps probe some key questions for key indicators. I would like to see real-time monitoring. Industry already does this through access to cash register data, and I would hope the government could do similarly.
For tobacco, we need seed-to-smoke monitoring. We need to know how and where this stuff is produced, imports, exports, wholesale and retail, and from that, we're going to have better estimates of smuggling as well. All of these things are needed.
These points I'm making are perhaps more programmatic than questions of changing the law or the regulations, but nevertheless it all works together for our tobacco and vaping control system.
Senator Eggleton: Mr. Collishaw, you said that no flavours are going to be prohibited and it's only a question of the advertising of them. Yet there is clause 30.41, that says:
No person shall promote or sell a vaping product that has an appearance, shape or other sensory attribute or a function for which there are reasonable grounds to believe that it could make the product appealing to young persons.
We would agree with all of that, but the question is: Where do you divide the line between young persons and people using it for the purpose of a smoking cessation program?
I do want to ask another question. One of the representations we had here was going back to cigarettes and tobacco itself, and particularly the cigarette filters. Both of you could comment on this question of the manufacturing and importation of acetate tow, which we were told is a particularly dangerous part of the product. Do either of you have any comments on its abolition?
Mr. Collishaw: Yes, I do. If we put all of the inputs into making cigarettes and we call them precursors to cigarettes, including acetate tow, I think a very good case can be made for monitoring all of that stuff as well and making sure that these products, whether they be acetate tow, cigarette-making machines, cigarette paper or something else, do not go to places of illegal manufacture.
Furthermore, I would like to see such rules for precursors administered by the health department, not the finance or revenue departments. I think it's much more of a health issue than a revenue issue, and, of course, precursors for other hazardous and illegal drugs are already controlled by the health department. The health department has some experience in this regard.
I would say, however, that even if we were to do that, we would still have a problem in terms of smuggling control in that a lot of the untaxed cigarettes that are around are manufactured on the American side of the Akwesasne community and trucked or moved illegally into Canada, but, of course, Canadian law could only apply to Canadian locations. I think we would need to sit down with our American friends and see what could be done to apply similar controls to those manufacturing operations. I would hope that would be part of the solution as well.
The Chair: Dr. Selby, do you have anything to add to what Mr. Collishaw said?
Dr. Selby: I'm not an expert on the acetate tow aspect of the filter.
The Chair: Thank you.
Senator Petitclerc: My question will be, again, for Dr. Selby first.
I'm interested in your perspective on vaping products. When this bill comes into play, there is a market and there are companies with an interest in it. Is it your feeling that the bill will protect Canadians as much as possible in terms of the market not exploding the level of nicotine, for example, and heat-not-burn, where it will play a part?
What is your perspective on that? Do you feel the bill will protect us enough?
Dr. Selby: It's a good question. As Mr. Collishaw said, if we have good mechanisms for monitoring and frequent monitoring, I think the bill needs the ability to have tweaks built into it so you can make rapid changes as evidence starts coming forward. This knowledge cycle being so quick, any bill needs to have that ability when we're dealing with incomplete information and making decisions so you give yourself that ability.
Where it's at will create enough regulations that we've got a legal product that has enough regulation that you're not going to kill off the product completely and then be stuck with cigarettes because we don't have these products on the market. On the other hand, you've also got enough regulations that don't allow just corporate interest to go completely wild with its advertising and promotion that it starts now recruiting and undermining all the gains that we've made in tobacco control.
This is the same conversation that we have with any kind of legalization of any drugs. You want to be where you have made it legal, reduced the social harms of the use of that product and you've made it as safe as possible for people to use; and on the other hand, you haven't allowed for the illegitimate market to take off and corporate profits to drive consumption. It is a balance, and it's dynamic. This bill is a first step in the right direction to achieve that.
Mr. Collishaw: This question of balance is one that's abiding. As I indicated in my remarks, the approach I would favour would be somewhat more cautious than others have perhaps suggested in terms of opening the door to information advertising only.
Dr. Selby mentioned the importance of reacting quickly to changing circumstances, and I would heartily endorse that position. We spoke earlier of the need for extensive monitoring, but we didn't touch on what we need the monitoring for and how we would use the information that we collect. Of course, the two go together.
The people who will be administering this law need to be given the facility to react quickly and adjust our actions and our plans in order to best protect public health in the light of the information we have. They have to have the tools to be able to use the information for the good of all.
The Chair: Thank you both very much. This has been further enlightening on this issue. There's a great deal of interest in all of these aspects and differences of opinion. Nothing is absolute here. We're into a range of areas that have multiple possible views on what the impacts will be, but you both have been very helpful to us in keeping them in perspective. I want to thank you both for being here.
We now have a new panel with two witnesses in the room with us. I will invite them in the order that they appear on my agenda. I will invite Mr. Rob Cunningham, Senior Policy Analyst at the Canadian Cancer Society, to speak first.
Rob Cunningham, Senior Policy Analyst, Canadian Cancer Society: Chair and honourable senators, I'm a lawyer and Senior Policy Analyst with the Canadian Cancer Society.
[Translation]
Thank you for the opportunity to testify before the committee today.
[English]
At the outset we acknowledge Health Minister Philpott for her strong work in advancing tobacco control. We support Bill S-5 and have a number of recommended amendments to improve the bill.
First, I'll speak to plain packaging. This is a key tobacco control measure, including to protect youth. Canada will join the six countries have that finalized plain packaging requirements: Australia, United Kingdom, France, Ireland, Norway, Hungary and the many more in progress.
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 made to be more attractive, period.
Imperial Tobacco stated, "There is no evidence to support plain packaging.'' In fact, the evidence is overwhelming. Beside me is an extensive evidentiary compilation submitted to this committee, 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 140 studies, 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 is a table of contents. You can identify the authors and the peer-reviewed scientific journals in which studies have been published. That is one reference in terms of the breadth of the evidence that is available.
Of course plain packaging would be effective. Why else would the tobacco industry be so opposed?
Regarding contraband and plain packaging, the industry claims should be disregarded as being completely without merit for numerous reasons, as has been previously outlined.
Turning to amendments, first for tobacco related amendments, an amendment should ban tobacco manufacturers' sales promotions targeting retailers, such as bonuses for achieving higher sales volumes. Why should that type of promotion be allowed? Chances to win sports and entertainment tickets or Caribbean vacations are happening today, but they should simply be banned. Quebec has had a ban since November 2016 and the same provisions should be adopted federally.
An amendment should ban menthol in all tobacco products. Federally, at present, menthol is only banned in cigarettes, most cigars and blunt wraps. This means there's a loophole whereby menthol is allowed in all other tobacco products such as roll-your-own tobacco or so-called "pipe tobacco,'' recently introduced into the market to get around the menthol cigarette ban in some provinces, although some provinces have banned menthol in all tobacco products.
Bill S-5 should do so federally as well in all tobacco products. Menthol soothes the throat, masks harshness and makes it easier for kids to experiment and get addicted.
An amendment should provide regulatory authority to increase the minimum age higher than 18, as found in the current bill and in current legislation. Health Canada included a minimum age of 21 in its recent consultation paper launched in February. In the U.S., there is a minimum tobacco age of 21 in California, Hawaii and at least 225 municipalities, including New York City, Boston, Chicago and many others. This would reduce youth smoking.
An amendment should provide regulatory authority to allow health warnings directly on tobacco products themselves, in addition to packages, just as the bill currently provides for vaping products.
An amendment should ban tobacco brands and logos from appearing on lighters, matches and other non-tobacco goods. For example, du Maurier lighters are displayed on countertops and undermine plain packaging. With the chair's permission I can show some examples of this during the questions.
An amendment should provide regulatory authority that some or all of the provisions of the act in the future applied to water pipe equipment and herbal water pipe products. Water pipe use — hookah — is on the increase among youth and needs a response.
An amendment should provide regulatory authority to ban smoking in specified federal outdoor areas, such as an entrance to a federal building, Cavendish Beach in P.E.I. or a children's playground in a national park. These are existing gaps at the federal level at the moment that are typically covered by most provinces.
We recognize e-cigarettes are less harmful than conventional cigarettes and have potential benefits and potential risks. Legislation and regulation such as Bill S-5 is needed to deal with those risks, such as youth use, industry tactics that undermine smoking cessation and appeal to ex-smokers and non-smokers.
Many of the bill's cigarette advertising restrictions are surprisingly 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. The Canadian Vaping Association, in its testimony before this committee, supported a lifestyle ban.
An amendment should clearly specify that the only advertising allowed is information advertising or brand preference advertising. This is reasonable. Again, the Canadian Vaping Association testified it wanted advertising limited to information advertising.
An amendment should specify that e-cigarette brands and logos should not appear on t-shirts, baseball hats, backpacks or other products not related to e-cigarettes. Kids can become walking billboards at their schools.
An amendment should further curtail special sales promotions, such as e-cigarette purchases giving you a chance to win a free vacation or tickets to a rock concert. Again, these have lifestyle associations.
An amendment should restrict the location of permitted advertising to the same permitted locations as for tobacco and thus reduce youth exposure, though still permitting advertising to adult audiences. At present, there is no restriction on location whatsoever in the bill. Advertising is allowed on TV, radio, billboards near schools — everywhere.
The European Union bans e-cigarette advertising on TV, radio and many other places, as you've heard. New Zealand will ban e-cigarette advertising except at retail. Quebec has legislation now in place for e-cigarettes that has strict restrictions, although it is permitted at retail and it is permitted in publications with a certain adult readership. So Quebec goes far beyond what is currently in Bill S-5.
An amendment should provide regulatory authority to further restrict e-cigarette advertising and promotion to provide future flexibility. The government intends and needs flexibility to respond, but the bill as drafted does not contain it.
We urge support for Bill S-5 and for our proposed amendments. Bill S-5 is a critical component to a renewed and strengthened Federal Tobacco Control Strategy.
Thank you again for the opportunity to appear.
The Chair: Thank you, Mr. Cunningham. And you'll be pleased to note there is a requirement to be a member of this committee that you be efficient in speed-reading, so those 20 volumes are no problem to us whatsoever.
I'll move on now to invite Amy Henderson, Manager, Public Policy, Canadian Lung Association.
Amy Henderson, Manager, Public Policy, Canadian Lung Association: Thank you Mr. Chair and committee members for inviting the Canadian Lung Association here today. My name is Amy Henderson. I'm the manager of public policy for the Canadian Lung Association.
For 100 years, the Canadian Lung Association has been dedicated to improving lung health for Canadians. Our mission is to lead nationwide an international lung health initiative, prevent lung disease, help people manage lung disease and promote lung health. We do this because when you can't breathe, nothing else matters.
Tobacco-related disease is the number one cause of lung disease in Canada. It affects every aspect of lung health. Currently, 17.7 per cent of the Canadian population smokes tobacco. The Canadian Lung Association would like to see a tobacco-free future.
I'm here to express our support for the committee's efforts to amend the Tobacco Act, and the Non-smokers' Health Act and, in particular, your recommendations to ensure plain packaging will be brought forth for tobacco products and the new legislation and regulatory framework that will address vaping products. The Canadian Lung Association supports Bill S-5 and is encouraged by the government's commitment to improving public health. We also recognize the complexities in finding the right balance between regulating vaping products and making them available to adult smokers.
However, we believe there are important ways in which Bill S-5 can be strengthened, and this is really important to support the lung health of Canadians. We also support the amendments brought forward by the Canadian Cancer Society that have been submitted. But today, I want to focus on the ways that the bill can be strengthened to protect lung health.
First, tobacco products: Like I said, tobacco products are the number one cause of preventable lung disease in Canada. Plain packaging has the ability to bring attention to the graphic warnings on cigarettes and related to decreasing smoking rates.
I don't need to go into evidence, Mr. Cunningham has provided a lot, but I would like to bring to your attention that plain and standardized packaging has the support of public health groups from across the country. The Canadian Coalition for Action on Tobacco, whose members include the Canadian Cancer Society, Canadian Lung Association, Heart and Stroke Foundation, Non-smokers' Rights Association, et cetera, have provided the committee a document demonstrating the support of more than 340 organizations for plain and standardized packaging.
In addition to our support of plain and standardized packaging, we recommend that the regulatory authority be expanded to include water pipes and cigarette products themselves. Water pipe smoking is increasing among young people in Canada; 14.1 per cent of students 15 to 19 have tried water pipes. Smoke from water pipes contains many of the same cancer-causing ingredients that are in combustible tobacco as well as the related effects to lung disease. These toxic substances include nicotine, carbon monoxide, tar and heavy metals. Water pipe smoking is often done by individuals, and they don't see the packaging, so it's important to have a warning on the water pipes themselves.
To further strengthen the legislation, the Canadian Lung Association would like to see a ban on all menthol in all tobacco products. As earlier indicated, there is a loophole here. The menthol is only banned in cigarettes, most cigars and blunt wrappers. This should extend to all tobacco products.
Additionally, we recommend the legislation include a regulatory authority to increase the minimum legal age to purchase tobacco in the future. The current age is 18. Health Canada has introduced a consultation document that discusses the merit of increasing the age to buy tobacco to 21. Including the authority in this bill will enable the government to act on the results on the ongoing consultation in the future.
Now, on to e-cigarettes: E-cigarettes is a very complex topic, especially for the Canadian Lung Association. Tobacco smoking is the number one cause of preventable lung disease in Canada. We understand that there are advantages of electronic cigarettes or vaping products, mainly getting people off smoking. However, e-cigarettes are less harmful but not harmless. This is especially important for lung disease.
We recognize that the balance in this bill is between preventing youth from picking up vapourized products and allowing adults who smoke to use them, but we also really want to make sure that young people don't start using vapourized products. People who have already quit smoking don't go to vapourized products, and people who have never smoked go to vapourized products. We really encourage this approach. It makes it very important to have due diligence and conscience when we're looking at vapourized products.
With this in mind, there are some ways the current bill can be strengthened. The Canadian Lung Association recommends that the bill be expanded to provide regulatory authority to further restrict vapour products, advertisement and promotion. This should include both location and content restrictions. For example, the advertisement restrictions should include television and areas where children and youth are present, including hockey arenas. It's important that the advertisement only includes information on the products or brand preferences.
In addition, we recommend strengthening the bill so there is no exceptions for vapourized lifestyle advertisement in bars, publications sent to adults and in vape stores. There is no need for lifestyle advertisement.
We strongly support including vapourized products in the clean indoor air law, the Non-smokers' Health Act. I would be remiss if I did not bring attention to an existing loophole that exists with smoking tobacco or just smoking in federally regulated spaces. This is an amendment that needs to be included so this loophole no longer exists.
We are pleased to see this bill includes the regulatory authority over flavours in electronic cigarettes. As you know, 26 per cent of young people have tried e-cigarettes in Canada. Flavourings are an aspect of this.
The other thing I wanted to bring your attention to is e-cigarettes are available in flavours that are appealing to children, but there are associated risks with the flavourants in electronic cigarettes. We believe there needs to be a regulatory authority to act as more evidence becomes available on the associated risks of flavours in vapourized products.
Although it's out of scope for this bill, we encourage more investment into research of vapourized products in Canada, especially around respiratory health. This is extremely important as the long-term effects are not known, and often respiratory disease takes many years to develop.
Health Canada recently set an obtainable goal of getting the rate of tobacco use to less than five by 2035 with the new Federal Tobacco Control Strategy. The Canadian Lung Association is committed to working with all partners to ensure that this becomes a reality. This bill is an important step in reducing smoking rates in Canada and can greatly help improve the lung health of Canadians.
Thank you for your time, and I look forward to your questions.
The Chair: Thank you, both.
Senator Petitclerc: Thank you very much for your testimony. It's very useful.
My first question will be for Mr. Cunningham. I'm interested to hear — and you both mentioned it — about plain packaging. In a previous committee meeting, but also as a sponsor, I have heard some senators still have doubts. They wonder. Most will say, "Yes, sure, maybe, but does it really work? How does work? When we're talking about results, how big a difference can it make?'' Could you go back to that and give us a bit more detail?
Mr. Cunningham: Sure. To show examples of what tobacco companies do, this is a package of Belmont, it appears, but when you open it, the package comes out, but part of the package is really an advertisement. That's one way they get around existing advertising restrictions. That's one benefit of plain packaging. A standard format wouldn't allow this.
Another example here is a special box for du Maurier. You open it. You actually have the cigarettes, but you have an empty metal tin, and again you have a box with advertisements.
Plain packaging would work. The House of Commons Standing Committee on Health recommended it in 1994 after a study at that time with the evidence available at that time. The World Health Organization recommends it. Governments one by one across the world are considering the evidence and moving forward, despite very strong opposition from the tobacco industry.
Of course the tobacco industry will be opposed. They said that smoking didn't cause lung cancer. They said second- hand smoke was not harmful. They said restricting advertising and their sponsorship will have no impact. If you have a better warning on the package, it will have no impact. They are always in denial.
The strength of their opposition is a clear signal that we're on the right track. The evidence worldwide, available to members of this committee and to all senators, is very compelling.
Senator Seidman: Thank you very much for the presentations. You both proposed a lot of amendments. I guess that leads me to ask you whether you have been involved in the consultation processes on this piece of legislation. Mr. Cunningham, perhaps you could respond first and then you, Ms. Henderson.
Mr. Cunningham: We have been engaged in each of Health Canada's consultation processes. We appeared before the Standing Committee on Health at the House of Commons that had a study with respect to e-cigarettes. Health Canada and the minister hosted a national forum at the beginning of March — we participated in that — with respect to future directions in the tobacco strategy.
E-cigarettes is a complex issue. The bill deals with tobacco as well, but there is an opportunity for this committee to strengthen the bill with this. However, we have been involved in consultations.
Ms. Henderson: Yes, the Canadian Lung Association has also been involved. We did appear before the Standing Committee of Health on electronic cigarettes a couple of years back. We have also been involved in the consultations with Health Canada on the new federal tobacco strategy. Although we do have a lot of amendments, we always like to have like the best picture moving forward. We think that the bill is quite strong, but these amendments would make it much stronger.
Senator Eggleton: I am going to follow up on that because a number of these things don't necessarily need amendments to the legislation but could be done in the regulatory framework subsequently. Are there one or two of them that you think are particularly important to be an amendment to the legislation?
Mr. Cunningham: With respect to tobacco, further restrictions on promotion have been proposed, such as what Quebec has done in the sense of promotion.
Banning menthol: When Ontario banned menthol cigarettes, the ban did not affect traditional pipe tobacco, so a company came out with Bullseye Pipe Tobacco Menthol. It never existed before and was simply a loophole to get around the ban. This is one measure that would be very straightforward for the committee to do in terms of an amendment.
With respect to e-cigarettes, there are a number of measures with respect to advertising that you have heard from a number of witnesses. There is an opportunity with respect to that.
If we were to have a minimum age, potential for increase, there would have to be some at least scope for regulatory change. There is no regulatory authority in the bill at the moment.
Senator Eggleton: You are not suggesting the banning of menthol for e-cigarettes?
Mr. Cunningham: No. For nicotine replacement products, there are some flavours for nicotine gum and nicotine lozenge. The Standing Committee on Health did not recommend a ban on all flavours. It's important that the government have regulatory authority for flavours. There has been testimony that some consumers of e-cigarettes are using these as part of their switching.
No government worldwide yet that I'm aware of has really made a dividing line as to which flavours to ban and which not to ban as far as e-cigarettes are concerned. Clearly some will have a particular youth appeal. The government has the regulatory authority to ban or restrict flavours in future, and that regulatory authority is important.
Senator Stewart Olsen: Thank you both for being here. A lot of work has gone into your presentations, and I appreciate it.
I'm going to deal with the government's responsibility to launch a public relations campaign and continue the fight for a smoke-free country. The plain packaging sounds like a good idea and we have heard lots about it, but I'm wondering if they will continue the warnings on that plain packaging. We haven't seen a mock-up or anything. I would like your input as to what should be on the plain packaging.
Ms. Henderson: Absolutely. For plain packaging, this is a mock-up that has been created.
The idea would be that the graphic health warnings are still on the product itself and still reaches the current level of warning that is required. The standardized part of it is that it would be a drab brown colour or whatever colour is decided would be the colour allowed. It would also just include the brand name on the product itself.
This is very important because it really brings attention to the health warning itself, which can often be lost in tobacco products that, as Mr. Cunningham has shown, have very appealing marketing places. There is a very small tube called Vogue cigarettes right now. They are slim, and they are very appealing; they look like a tube of lipstick. So further restrictions to make this very shiny, metallic, appealing box of product that kills one in two long-term users is absolutely needed. There is no need for products to look attractive if they are going to cause such harm to public health.
The Chair: Let's follow up on this a little bit now. With regard to the current bill, do you believe the language is strong enough to prevent internal pop-ups, goodies and other things once you take the outside wrapper, as per the existing uses of the inside of the packages, to get you once you open it?
Mr. Cunningham: I think that in terms of the legislative authority for future regulations, the bill is very well drafted.
There is one issue with respect to brand names and how clever the tobacco companies can be with new brand names. Can they have a new brand that is called "sexy man'' or "pretty woman'' or "super cool''? I think this is a question for Health Canada to ensure that they have the regulatory authority to be able to restrict brand names.
We proposed an amendment that would provide some clarification. If Health Canada feels that regulatory authority is there, that answers the question. That is one thing that I think needs to be ensured to be done. Otherwise, it's clear that regulations will be needed after this bill is adopted, but this bill provides the legislative authority for the subsequent regulations.
Senator Griffin: You both mentioned that you had been involved in the consultations. I'm wondering, have you actually had consultation with the provinces? I'm assuming you have had consultations within your provincial counterparts, but have you had consultations with provincial governments? Obviously there are positive and negative impacts on them. The negative impact is they won't make as much in taxes. The positive impacts should cut their health care costs, which I would suggest would be much appreciated. Have your organizations consulted with the provinces?
Mr. Cunningham: Yes, and Health Canada has also consulted. There is a mechanism where there is ongoing consultation with provincial, territorial and federal governments with respect to tobacco control.
Eight provinces have brought forward legislation with respect to e-cigarettes to date. In every case, within specialty vape shops, it would be permitted to display e-cigarettes and to have other information available to consumers. This federal legislation would not affect those types of displays in those specialty vape shops.
I think there is a role for the federal government and provincial governments, and with respect to provincial issues, yes, we're in ongoing consultations at that level.
Ms. Henderson: Absolutely. The Canadian Lung Association has a provincial association in every province. Right across the country, our provincial associations have been involved in consultations with the various provincial governments. They have been very active in vaporized products, especially as it relates to smoke-free laws and various things like that to protect the health of people who are non-smokers and don't want to inhale any other products.
We have also been involved in the various consultations on all various types of tobacco amendments at the provincial level. I wouldn't be able to go into absolute detail of every single one, but it's an ongoing discussion.
The Chair: Just before I go to the second round, I want to come to an issue that you mentioned, Mr. Cunningham, and other witnesses have mentioned, which is that you are hopeful that the regulatory authorities will act quickly to plug loopholes that emerge.
Now, from our experience in dealing with prescription pharmaceuticals and other health devices, we know that in order for the regulatory authority to act quickly, they have to have the tools to do so. The regulatory authority is bound by legislation that contains them with regard to whatever it is that is being regulated.
Have you given thought to any particular changes that are required within let's say the legislation affecting Health Canada or another body? Because it wouldn't be just Health Canada potentially dealing with these devices. Have you given any thought to any new tool that a regulatory authority needs in order to be able to respond quickly to things that emerge in the marketplace to find their way around the legislation?
Mr. Cunningham: There are a number of answers to that question. I think in some cases, we have identified some problems with the existing bill, but amendments can be made here, so we don't have to wait for the regulatory process.
Second, we need to ensure that Health Canada has the regulatory capacity to be able to respond. That's why strength in the Federal Tobacco Control Strategy as of April 2018, properly funded, will be very important. There have been changes that have reduced that capacity, and we need to ensure they have that properly funded.
I don't think there are any legislative amendments needed to the legislation specifically for the Department of Health. It has been raised with respect to amendments for cellulose acetate tow in filters. That's maybe an amendment with respect to excise legislation where I think there are some aspects there that need to be amended.
I think ensuring we have the clear regulatory authority in the bill, and where possible, to adopt measures in the bill itself so we don't have to wait for the delays and the uncertainty with respect to that provision, as well as ensuring the capacity of Health Canada are the most important things.
The Chair: With regard to acetate tow, I think one of the suggestions was that this be placed in the restricted substances act. After all, it is a chemical substance.
Do you see that as perhaps being the most effective way? Should it be regulated, would that be the most effective way to deal with it?
Mr. Cunningham: I think a key strategy to deal with the unlicensed factories producing cigarettes that are unlicensed and a very important source of the illicit market now is to intercept raw materials outside of the reserve before they get to the reserve. That could include leaf tobacco, cigarette paper and the filter material such as acetate tow.
I think that it is a real opportunity and one of the most important measures available to us to reduce illicit trade. So to have whatever the mechanism is — and I won't comment specifically with respect to the legislation that you just mentioned — there may be a number of options. The bottom line is we need to have complete information about the source of this entering Canada and have complete control to be able to intercept it before it gets to reserve and the unlicensed factories.
The Chair: Thank you.
Senator Petitclerc: I hope I don't take you outside of your comfort zone, but maybe we can start with you, Ms. Henderson. I want to have a bit more of a moral and maybe philosophical position from your organization on the place of vaping in the bill. We continually talk about the balance this bill is going to achieve in terms of protecting everybody that your association is trying to protect while allowing access for smokers to something that is likely less harmful. How does your organization feel about that balance?
Ms. Henderson: The Canadian Lung Association has struggled with this because we want to prevent lung disease in Canada. That's our mission. But at the same time, we offer smoking cessation services. We want to help people who are currently smoking to quit smoking. People are highly motivated to quit smoking, and having the correct smoking cessation devices available is critical.
However, we have also seen this product emerge, and we have heard from people that it has gotten them off of smoking tobacco. Evidence has started to show that, and although there is going to likely be harms, especially to the respiratory system associated with vaporized products, we really foresee the need to regulate the products themselves.
This bill takes a good step in that direction until we know all the harms that are associated with long-term use. However, we also think there needs to be the regulatory framework available to adjust as more harms and benefits become available on vaporized products.
It has been a struggle within our organizations because we want people not to smoke tobacco. It's the number one cause of lung disease. But people have come to us and said, "We want to use these products. Can you tell us about them?'' But there are associated risks. It's something we have definitely struggled with.
This regulation takes it into a positive direction because it will give more restrictions on advertisement, promotion and that type of stuff. It will also make sure that therapeutic claims have to be based on evidence, and it gives regulatory approach to that. That's one reason why we support this bill moving forward.
Mr. Cunningham: We've had recommendations with respect to nicotine replacement products for decades. With respect to this particular bill, we support the bill. In terms of the balance, more can be done with respect to restricted advertising, to follow what's been done in some other countries, and also to ensure that Health Canada has the capacity to be able to respond in the future. In some respects, the flexibility they seek and need is in the current wording of the bill.
Senator Seidman: I did actually want to ask you about tightening up the advertising because we have heard this now from several witnesses.
Right now, the advertising for e-cigarettes is much looser than it is for tobacco products. We did hear that New Zealand, last week in fact, tightened up their advertising for e-cigarettes, and that might be a good model. If I understand correctly, that means no lifestyle advertising at all, not even to adults, and no advertising on TV and radio. But I ask you: How do you restrict advertising, for example, on the Internet? If you say no advertising for kids at all, then you have a serious issue with regard to that.
Could you comment on what we might do around advertising? I know you both spoke about it in your presentations, but it gets lost in all the other amendments. I think here is something that we might try to focus on.
Mr. Cunningham: Part of it is restriction on content. If you were to limit permitted advertising to information advertising and brand preference advertising, the Canadian Vaping Association were fine. They're only talking about information advertising. That would have a big impact in terms of what kids did see. I think that is part of the remedy.
Ms. Henderson: I would agree with what Mr. Cunningham said of including information and brand preference, and that's restrictive of the content. We do support the restriction around lifestyle advertisement and the restriction on where any type of advertisement can be, including bars.
One of the important things is to make sure that people who have quit smoking do not go to vaporized products. As we understand more evidence as it moves forward around the motivations to switch to vaporized products, we want to make sure that people who have already quit smoking do not go back to something that will have harmful effects as vaporized products, because they are currently living a smoke-free life.
Senator Eggleton: You've made a good case about the packaging. I don't know how prevalent that is in that industry, whether most of them are doing it or not. You can comment on that.
I want to ask you specifically about the use of trademarks, because the Intellectual Property Institute of Canada made a submission here. It says that the purpose of this submission is to ensure the government is aware of how the proposed amendments would affect trademark rights for brand owners in Canada.
This all comes to the question of what identification would be put on a plain packaging system in terms of the brand, Players or whatever. Would you see it as just a plain typeface as opposed to a trademark, and if the trademark were allowed, what difference do you think that makes?
Mr. Cunningham: Yes. You would have the brand name appearing on the package in a standard location, font style, font size, white on the background. It might appear in a few parts of the package. That's what Australia has done. That's what other countries have done.
From a legal perspective, the bill ensures that a trademark owner, including for graphics and logos and mountain scenes and other things you currently have on packaging, would continue to maintain registration and ownership of that trademark.
They also, if we were to follow the Australian example, would be able to use any trademark, any colour, any graphics and logos on a wholesale box shipped between manufacturers, wholesalers and retailers but not seen by consumers. So there would be some use in that respect.
These legal arguments have been raised in other countries and have been dismissed. In Australia, their highest court, the High Court of Australia, dismissed claims for expropriation. In the United Kingdom and in France, legal challenges have been dismissed. The European Court of Justice has dismissed a legal challenge.
In Canada, when federal regulations required 50 per cent warnings, the tobacco companies argued in Quebec Superior Court that this was an expropriation of their trademarks and packages. They lost. They appealed to the Quebec Court of Appeal and they lost again unanimously. They didn't try to appeal on that issue to the Supreme Court of Canada.
The courts have basically said that you need to have a change in property ownership. This has not been a transfer from the companies to Health Canada. It's a regulatory provision that restricts the use, but it's not preventing tobacco companies from preventing other people from using it. That is what it is. The trademark is to prevent other people from using it.
This is a legal issue that's been raised. In our view, it is without merit, and there are certain provisions with respect to Bill S-5 that help clarify that.
Ms. Henderson: I'm really not an expert in trademark, and I would defer to Mr. Cunningham.
Senator Griffin: In your pile of research, did you find anything that showed that plain packaging results in more contraband cigarettes being produced and sold? Because, of course, that's what the tobacco companies are telling us, that it will lead to a greater amount of contraband because of the plain packaging.
Mr. Cunningham: No. In fact, this is an argument we hear from tobacco companies year after year. They said that if you ban the visible display of products in retail, it's going to cause contraband. They said that if you increase the size of the warnings from 50 per cent to 75 per cent, it will cause contraband. In fact, contraband has gone down since the increase in size of the warnings based on certain estimates.
Contraband in Canada has gone down. It peaked in 2008. By a number of measures, including relocating a border post near Cornwall, it was a choke point, and it reduced contraband. Some other enforcement actions have contributed to it. The data referred to by Professor Hammond earlier today with respect to Australia refutes the claims of the tobacco industry.
They always say the sky will fall. We heard that if we have smoke-free restaurants, all these restaurants will close. Well, we have a thriving restaurant sector immediately after and well after the smoke-free laws came into force.
Senator Petitclerc: One question again on advertising, but on the other side of it in terms of information.
In your view, how does Bill S-5 provide information to a smoker that would want to use vaping, for example? Do you feel it is restrictive enough, yet allowing for the provision of information that might help someone make a decision?
Mr. Cunningham: The bill will certainly allow information advertising. I also point to clause 39 in the bill, which provides regulatory authority and an additional pathway with respect to health-related claims. The government may consider whether clause 39 needs to be clarified.
But that is in the bill.
As well, there's regulatory authority with respect to warnings. Health Canada has considerable latitude in terms of what health messages they would want to require in association with these product categories.
Ms. Henderson: I think it's very important to provide information, but I also would look under this legislation for Health Canada to provide information about vaporized products, both the benefits and risks associated to users. I think it's very important that we take the approach that Health Canada or the regulator would be able to provide this information instead of companies themselves, as we want to make sure it's very accurate.
Senator Eggleton: Just as a follow-up to the last question I asked, I can understand the plain packaging rationale from the standpoint of what you've shown there. That has to be stopped. But the use of the trademark or logo, what difference could it make? Aside from the legal aspects of it having been dismissed, if you put Players in plain language or Players in their logo, what difference does it make?
Mr. Cunningham: It makes a big difference because you can associate something with femininity. Here we have Vogue and a stylized Vogue that can be associated similar to the magazine and thinness and so on.
Senator Eggleton: It's just the name of the product. That's all you would be allowing.
Mr. Cunningham: You would still allow the name under the proposed plain packaging regulation, but you wouldn't be able to have stylized letters. You can certainly still have the brand name.
Companies can trademark anything. Here's one example. Canadian Classics cigarettes last Canada Day had a special Canada Day edition of this package. So here you have the maple leaf and here you have the names of provinces and territories and here you have "special ehdition," spelled "E-H.'' They can trademark all of that. On the regular Canadian Classics package, you still have the maple leaf but sort of a mountain scene that maybe it looks like Lake Louise. They can trademark that. Unless you're able to deal with that, they can exploit it.
Senator Seidman: This bill leaves a lot to the regulations — a lot. Are there aspects like, for example, the e-liquids and some kind of standards around the e-liquids, especially those that contain nicotine? Are there things that we should be aware that are not in the legislation but are going to go to regulations? Is there something that should be built into the legislation? Is there some kind of monitoring aspect, for example, legislative monitoring, say in three years or four years? I don't know. What would you respond to that?
Mr. Cunningham: I think it would be wonderful if a parliamentary committee could review progress with respect to this act, for example, every two years, and a report could be submitted to Parliament periodically, perhaps annually or every two years. In Quebec it's five years. The European Union has, for certain categories, every two years. There are some very good aspects in the bill with respect to reports to Health Canada and with respect to both tobacco and e- cigarettes so that we can have some information to respond quickly as developments emerge.
But again, certain things could be done in the bill itself, and that's why you have a number of amendments. Senator Eggleton invited us to select among our proposed amendments. We would certainly hope that you would consider all of them. We're not able to concisely highlight more than just a few in a short answer. But we've considered these, we've engaged in consultations and we offer all of them for your consideration.
Ms. Henderson: Additional monitoring is needed, without a question, on the youth use of vaping products as well as the current trends in vaping products. There also needs to be the ability to act quickly.
There needs to be restrictions on contents, but mainly emissions. I believe this bill does address emissions.
I will make note once again of flavouring inside vaporized products and the ability to have flavourants that might cause associated risks. In a report to the World Health Organization, they had identified this as potential risk. To have the ability to regulate that is really important as more information becomes available.
The Chair: In this regard, one final question, Mr. Cunningham, on the discussion we were having a little bit earlier and on the issue that Ms. Henderson has just raised: Let us suppose there is a signal in social observation that the new, great, sticky vapour product that is supposed to be very aromatic is causing health problems. I'm going to ask you again with regard to speed. Do you believe that within one of the current regulatory agencies such as Health Canada there is sufficient power for Health Canada to act to remove that product from the market on the basis of some significant issue, such as we see with baby cribs, for example? If there are a certain number of deaths, Health Canada has the ability to pull them off the market. When we studied prescription pharmaceuticals, we found Health Canada did not have the authority to remove prescription pharmaceuticals at that time, prior to the legislation that arose subsequent to our studies, to remove one product from a company's list of products, even though it might have been implicated in deaths of teenagers with regard to particular types of products.
My question is back to you: Let us suppose there is an observation that people are getting significantly ill, possibly even dying, from some new component of flavour within a vaping product. Do you believe the regulations currently are clear enough to an authority such as Health Canada to be able to order the temporary or permanent recall of that product?
Mr. Cunningham: I have a two-part answer to your question. The first is if it's some defect like a defective battery or defective heating device, there is the ability under the Canada Consumer Product Safety Act to have a recall.
But if it's something else, if it's just some harmful additive, no, there is not that ability for a recall. There is the ability to have a regulation to ban additives, but there is no ability to suddenly have immediate recall. You can have a regulation that could have nicotine levels that could be set to a maximum. You can ban certain additives and have limits on emissions. But at the moment, there's nothing in the bill that says you can have a recall just because of certain additives or nicotine levels.
The Chair: Thank you. I think we have completed our marathon of meetings this afternoon on this. We're all vaped out. That was awful, but anyway. It's just the state of the afternoon.
We want to thank you both very much for being here.
Again, colleagues, you've endured the afternoon very well and your questions have continued to elicit answers we'll have to wrestle with. Short of a report the size of the reports we've seen on the table today, we hope we will be able to get some issues resolved as we deal with this through the week.
Thank you both very much. I declare the meeting adjourned.
(The committee adjourned.)