[Recorded by Electronic Apparatus]
Tuesday, November 19, 1996
.0911 
[English]
The Chairman: Good morning, everyone. We're a bit late. We had been waiting. It had been indicated to us that Dr. Pipe would be here about now. He's not here about now. We'll continue without him, but we hope he'll be here fairly soon.
We welcome our witnesses from all kinds of places this morning. We're going to do this as a round table. I understand the witnesses are familiar with that term and are agreeable to it.
Welcome, all. Tell us who you are. Make brief statements, and we'll ask you some questions.
Dr. William Rickert (President, Labstat Inc.): Since I have slides here, I guess I should begin.
My name is Bill Rickert. For the last 20 to 25 years I've been involved in Canada's tobacco characterization program, in which we've looked at various aspects, including the characteristics of environmental smoke, mainstream smoke, sidestream smoke, the characteristics of smokers, their beliefs about cigarettes, and so on. Most recently I was chairman of Canada's Expert Committee on Cigarette Modifications.
I should have begun this morning by thanking the committee for giving me the opportunity to appear and saying a few words about tobacco from my very limited viewpoint - limited in the sense that my knowledge is limited to various characteristics of a product.
Nicotine is the major psychoactive constituent in cigarettes leading to cigarette dependency. This fact is known by the tobacco industry, policy-makers, researchers, and smokers alike. It is the reason why there are various legislative initiatives to limit or even eliminate nicotine from tobacco products and one of the reasons why smokers switch to cigarettes advertised as ``light''.
For example, as part of Health Canada's most recent survey on smoking in Canada, smokers were asked to explain the meaning of ``light'' as applied to cigarettes. As shown on this slide, a significant portion of those surveyed believe ``light'' means less tar. An even greater percentage felt it meant less nicotine.
.0915
This belief is not supported by fact, since most Canadian cigarettes contain about 9 milligrams of nicotine regardless of how the brand is described. This figure of 9 milligrams represents the maximum amount of nicotine that can be extracted from a cigarette. However, this is not the case with respect to the labelling of cigarettes and cigarette tobacco.
You cannot see this, but this is a bag of cigarette tobacco. It says ``light'' on it. It also has a listing of ingredients. It lists the toxic constituents: tar, 22.4 milligrams; nicotine, 2.13 milligrams; and carbon monoxide, 18.1 milligrams. I want you to remember the number 2.13 and the fact that this is a so-called light product.
The average consumer would assume that the label means that cigarettes made from this tobacco would contain those ingredients at those levels. No cigarette made from this product would contain carbon monoxide, no cigarette made from this product would contain tar, and no cigarette made from this product would contain 2.13 milligrams of nicotine.
Similarly, you probably can't recognize it - or maybe you can - from that distance, but these are two popular Canadian brands. One is light; the other is regular. The light brand says 1.3 milligrams of nicotine. The regular brand says 1.4 milligrams of nicotine. This obviously implies to the smoker that smoking the 1.3-milligram brand delivers less nicotine than smoking the 1.4-milligram brand.
These are the results of a piece of work that we completed in September. I would like you to note the lines here, the junction of the blue and purple. The junction of the blue and the purple represents the testing conditions used currently in Canada to produce the numbers that appear on tobacco products. The purple represents what typical smokers would obtain from the product. This means that the number that appears on the package represents the minimum a smoker might obtain from the product. Typical smokers most often obtain more. As a matter of fact, when smokers smoke the product intensively, they will obtain an additional amount as represented by the yellow bar.
It is obvious from the figure that under intense smoking conditions, all brands are basically the same regardless of the number on the package. They would all deliver approximately 2 milligrams of nicotine. This means that when smokers switch from a regular cigarette at 1 milligram to an ultra-mild at 0.1 milligram, they probably do so on the assumption that the nicotine they will be exposed to is reduced. As you can see from this figure, if they require, because of their dependency, 1 milligram of nicotine from each cigarette, they will get that 1 milligram regardless of how the product is described.
Clearly, placing a limit on the amount of nicotine inhaled by machines under standard conditions would do little to decrease nicotine dependency and might have other unexpected consequences. For example, smoking-related disease and mortality are associated primarily with factors other than nicotine, although the point is still under active investigation. However, it is accepted that the inhalation of tobacco smoke particulates, generally referred to as tar, is associated with an increased risk for various forms of cancer, including lung cancer.
.0920
The consequence of placing a limit of nicotine in tobacco products may be an increase in the risk for various smoking-related cancers. This occurs because extracting nicotine from low-nicotine tobaccos is difficult for smokers, requiring various forms of intensive smoking, which results in a disproportionate increase in carcinogen exposure.
In my opinion, the health and well-being of habitual smokers is best served by mechanisms that reduce the levels of all toxic constituents to the maximum extent possible while maintaining acceptable levels of nicotine.
Judging from the increased marketing and availability of nicotine replacement products, it would appear that non-cigarette nicotine self-dosing is being viewed increasingly as a way of dealing with cigarette dependency and its attendant ill effects.
That concludes what I want to say, at least in terms of a formal presentation.
The Chairman: All right.
Welcome, Dr. Pipe. We did wait for a while, sir, but we thought we'd get on with things.
Mr. Rickert is the first person to have spoken. Now we can go in the order on the sheet or we can take you in the order you're sitting down there. Dr. Pipe is next on the list, but if he's not quite ready, we can go to somebody else.
Dr. Andrew Pipe (Assistant Professor, University of Ottawa Heart Institute): Thank you, Mr. Chairman. I'd be happy to proceed.
I wish to apologize for the delay. I trust you received the message I sent to you from Hamilton, where I was one hour and five minutes ago.
The Chairman: We did, yes.
Dr. Pipe: I apologize that I do not have a document with me. I came straight here, with one quick stop on the way.
Good morning, ladies and gentlemen. It's my pleasure to speak with you this morning. I come to you as a clinician who has experience with tobacco and nicotine in two ways.
One, in my daily life I see the dramatic and indeed drastic consequences of the hundreds of thousands of Canadians who are addicted to this highly lethal product.
Secondly, through my work as the medical director of the Smoking Cessation Clinic at the University of Ottawa Heart Institute, I see hundreds of people each year who are trying desperately to rid themselves of this addiction. The vast majority of them obviously suffer from advanced cardiovascular disease, but many of them from the community at large are also struggling to deal with what is an incredibly tenacious addiction, about which I'm sure you'll hear much more this morning.
Also in my professional life I have experience in addressing other issues relating to drugs, drug abuse and drug misuse. Through my involvement with elite international sport, I have over the last several years become very experienced in addressing the issue of anabolic steroid use in sport and in developing procedures and processes, both nationally and internationally, to deal with that issue, in Canada largely stemming from the recommendations of the Dubin commission.
Forgive me if I repeat some of what you have already heard this morning, Mr. Chairman.
What do we know about nicotine? It is a highly potent stimulant of what we term the dopaminergic system of the central nervous system. There are selective areas of the brain that are immediately stimulated by nicotine, which is delivered to the body very rapidly. You will be aware from your work, I'm sure, that there is no other way to deliver a drug as rapidly to an individual as instilling that drug through the lungs.
Forgive me if I make assumptions or presumptions about your knowledge of anatomy or physiology. When you put smoke into the lungs, you put nicotine directly into the arterial system and it is then pumped immediately through the arterial system to the brain.
Quite dramatically, it takes six to seven seconds for nicotine to reach the brain. It takes 14 to 20 seconds for heroin to reach the brain when it's injected into a vein.
So in cigarettes you have a very sophisticated drug delivery device, a device that is artfully - I would suggest lethally - constructed so as to deliver maximum amounts of nicotine to the portion of the cardiovascular system that is capable of rocketing it to the brain almost instantaneously.
.0925
When the nicotine hits certain areas of the brain, particularly in the area of the brainstem, it causes a sequence of reactions, the net result of which is the release of a chemical transmitter we call dopamine. Dopamine then floods various areas of the brain, with the result that very pleasurable sensations are experienced by the user of nicotine. This, ladies and gentlemen, is not that distinct from the mechanisms responsible for the ``positive experiences'' that individuals addicted to other drugs have.
So, in a nutshell, you have a device that is designed to specifically deliver smoke of a certain chemical constituency, of a certain pH, in such a way that the maximal amount of nicotine can be taken from that cigarette, deposited into the arterial system and transmitted directly to the brain. This of course is information the tobacco industry has had for years.
As a scientist, I'm obviously quite concerned about many things the tobacco industry does, but one of the things it has done is retard the development of the neurosciences by at least a decade. The information they have held very closely to their chest would have been very central information for scientists working in a whole range of other areas dealing with the neurosciences, but they have used this information so as to more cleverly and more clearly develop, design and produce the drug delivery device that is the modern cigarette.
You will know that an individual smoker, irrespective of the kind of cigarette he or she smokes, receives generally between 1 milligram and 3 milligrams with every cigarette he or she smokes.
What we do know - and I'm sure you've already heard this and perhaps will hear it more - is that individuals smoke to maintain their level of nicotine to a certain individual or idiosyncratically determined level. Once the body's level of nicotine begins to fall below that level, there is an urge to smoke. Once again, the nicotine level is boosted and the individual feels a relief from the symptoms of withdrawal that were beginning to be evident, plus many of the other positive sensations that are reported by smokers when they get this very powerful drug.
We know smokers suffer unlike any other group of our population as a consequence of the abuse of this drug. I recognize that your purpose here this morning is not to have some doctor come forward with yet another litany of the health consequences of tobacco, but let me provide you with a fairly graphic demonstration of something that is part of my daily life but that I am sure is not part of yours.
A few weeks ago I was involved in an operation to restore the circulation to an individual's heart through a coronary bypass surgical procedure. His heart disease was of course caused almost directly by his tobacco addiction.
Why were we doing this operation? Well, we were doing this operation in order that the individual could withstand the surgery that would take place two or three weeks later to remove the tumour from his lung, which of course was directly caused by his tobacco addiction.
The operation was made more difficult, ladies and gentlemen, by the fact that we could not use the normal blood vessels that we take from the leg to replace the coronary arteries, because they had been removed in an operation some years earlier to restore the circulation to his legs, which had been destroyed by his tobacco addiction.
In that one unfortunate patient you see a very dramatic representation of the consequences of the addiction to this horrible, horrible drug - a drug that, ironically, has escaped all forms of regulation and all forms of control, and has done so, with all due respect, because of the ability of the manufacturers of this particular product to influence the political system.
As a physician who struggles daily with individuals themselves struggling with this addiction, who sees daily the consequences of this drug, I want to ask everybody in elected public office in Canada: where have you been and what have you been doing that this has been allowed to happen?
I could recite ad nauseam to you the health consequences of the problems of this drug. I won't. Let me just say that in our society it is the most common drug of addiction. Very little exposure to it is necessary before an individual becomes addicted. The rate of relapse among those who try to quit this addiction is very high.
Some would argue we have the lowest success rate of all when we try to deal with this particular drug of addiction. Notwithstanding the new approaches we use and that we are using quite successfully in our own centre to help individuals deal with this addiction, a success rate of 15% at the end of one year is considered an excellent result when you deal with the addictive process represented by nicotine addiction.
.0930
In my view there is a very real need, ladies and gentlemen, for regulation and control of this lethal product. That control can take many forms. We have to change the environment through the elimination of advertising and sponsorship. We need to make this product more expensive. We know that teenagers are especially sensitive to changes in the price of tobacco products. There is a price elasticity relationship of about minus 1.4 for adolescents, which means that a 10% rise in the price of tobacco produces a 14% decline in consumption. There is no single strategy that is as effective in minimizing tobacco and nicotine use amongst youngsters as an increase in the price of tobacco.
We need to regulate the product itself, and I would suspect, notwithstanding my late entry, that you've heard something about that already this morning. A cigarette is a drug delivery device - nothing else. The fact that this drug delivery device escapes the scrutiny and regulation of those who, in the public interest, seek to protect the public is an ongoing mystery.
There are a number of ways one could do that: regulating the nicotine content of a cigarette, eliminating those things that maintain or accelerate the combustion of the cigarette - a variety of strategies could be used to achieve that end.
I want to conclude now, because perhaps the most useful interchange between us will be questions and answers. I want to conclude by saying that I have discovered another health consequence of tobacco addiction - insomnia - because I cannot believe that those who shill and flack for this industry are able to sleep at night.
Thank you, Mr. Chairman.
Dr. Roberta Ferrence (Director, Ontario Tobacco Research Unit): Thank you for providing the opportunity to address you today. I'm a senior scientist at the Addiction Research Foundation and director of the Ontario Tobacco Research Unit, which is funded by the Ministry of Health in the province of Ontario.
As you know, tobacco use is responsible for the premature deaths of tens of thousands of Canadians each year. Tobacco contains a highly addictive drug - nicotine - which is delivered to the user by a variety of hazardous delivery systems, which you have heard about this morning.
Yet tobacco continues to enjoy a special status not accorded most other drugs. It is inexpensive. It is as readily available as bread and milk, making it impossible to provide effective controls on sales to youth. We have allowed the manufacturers to promote it extensively and to maintain high-profile corporate and brand images by sponsoring sports and cultural events. Further, federal and provincial policies allow most smokers to maintain their daily addiction for about the cost of a bus ticket.
In my presentation today I'm going to deal with the effect of pricing and taxation on the consumption of tobacco and some implications for the future health of Canadians.
Although the proportion of smokers began to decline in the 1960s, following the dissemination of information on the harmful effects of smoking, per capita consumption continued to rise until the early 1980s. On this graph the broad band shows annual per capita consumption, and the narrow band shows the real price of tobacco in 1994 dollars. The graph begins in 1954 and goes up to 1994.
As you can see, there's a strong inverse relationship between price and consumption. This is not unique to Canada or to tobacco. It has been found for many years, and it applies to alcohol and other substances as well as to other consumer products. As the real price of tobacco declined during the post-war decades, consumption rose gradually. The continued increase in the 1970s was largely due to increases in the number of cigarettes smoked by smokers. There was a substantial rise in taxes during the 1980s, approximately an eightfold increase.
.0935
Here we have a comparison with the U.S. Canadian taxes are in Canadian dollars and the United Statas in U.S. dollars, but the differences are not that huge. You can see the increasing disparity between Canada and the U.S. that occurred in the 1980s, culminating in an eightfold difference by 1992. This was associated with a steep decline in consumption among adults, and an even sharper decrease among adolescents.
On the left we have the total population aged 15 and over. The dark line is per capita consumption and the other line is the real tobacco price index. You can see the strong inverse relationship - even stronger for adults. Dr. Pipe talked about the elasticity here. There is a stronger effect on kids smoking. During that period we saw a stronger effect in Canada than in the U.S., where their taxes were not increasing.
There was also a substantial decrease in the number of cigarettes smoked by adolescent smokers. This occurred before the ban on tobacco advertising and was not accompanied by other major changes in tobacco policy or programming in Canada. So it's pretty clear the major cause of this was the tax increase.
By the early 1990s tobacco tax levels in Canada were comparable to those in many European countries, and substantially higher than those in the U.S. The first red bar is B.C. and the second is Ontario, and you can see that despite the public perception of very high taxes, we were lower than many European countries. The green bars are various U.S. states. The lowest is Virginia, which produces a lot of tobacco.
The tax differential between Canada and neighbouring U.S. states provided an opportunity for illegal importation of exported Canadian cigarettes. This process was aided by the removal of an export tax that was designed to make smuggling unprofitable. Despite a massive increase in exports by the tobacco industry that clearly was not accompanied by an increase in U.S. demand, no strong efforts were made to reduce the export traffic.
By early 1994, when smuggled cigarettes accounted for close to 30% of retail cigarette sales in Canada, the federal government cut their tobacco tax by $5 per carton and offered to match provincial reductions up to $10 a carton. Five Canadian provinces cut their taxes, resulting in a price decrease of about 50%, which as far as I know is unprecedented in the world. Five provinces, however, maintained their tax level and continue to do so.
B.C., with the $5 cut, was down to about 2.8 or so, which is where Ontario is. Ontario's tax cut places it below that of Japan. Ontario's is down about $1 now, just between Greece and Japan, so there was a huge move on the part of Ontario there.
Revenue in Ontario in 1995 was cut very dramatically. These data show tax revenue in Canada in the non-tax-cut tax provinces. Despite concerns about smuggling, and there is some smuggling and interprovincial smuggling now, you can see that the provinces that didn't cut their taxes have maintained their revenue and in some cases even increased it, as in B.C. and Alberta.
The final year that's speckled is 1995, so that gives you a good sense. Compare this with the provinces that did cut their taxes. We see increases in all the provinces, and particularly dramatic increases in Ontario and Quebec.
The situation we have in Ontario now - revenue in 1995 was only one-third of revenue in 1993, so we've suffered seriously in that way, as well as other problems that have occurred.
.0940
The decline in smoking seen during the 1980s levelled off in the early 1990s, and smoking now appears to be on the increase. Studies in Ontario show a rise in the prevalence of smoking among both adults and young people. These are data from a continuing Ontario survey carried out by the Addiction Research Foundation on the prevalence of smoking in 1992, 1993, 1994 and 1995.
In 1995 we had a significant increase over the period in 1993. While there appears to be a general trend towards increased use of tobacco that is occurring worldwide, and in marijuana and other drugs, the tobacco increase in Ontario has occurred despite the implementation of the Ontario tobacco strategy, which includes increased enforcement on sales to minors, increased smoking bans in public places and other efforts to reduce consumption.
Data from the Waterloo smoking prevention project for 1993 to 1996 show a sharp increase in smoking both in 1995 and 1996. These are the most recent data we have on kids.
Almost 50% of grade 9 students in southwestern Ontario have smoked during the past year, and about 17% are smoking every day - the majority of those more than one or two a day - and these children are 13 and 14 years old. Rates are much higher, of course, among students in higher grades.
What can we envision for the future if no major action is taken? Projections developed last year for the province of Manitoba indicate that with a tax cut, premature deaths would be elevated for the next 40 years, after which much larger increases in early mortality of 15% to 30% would ensue. These are projections over the next century that show slight elevations for the next period.
The health effects take many years to occur. You can see that by the year 2035 or 2040 - the squares show what happens with no tax cut in Manitoba, and the two higher lines show what you could expect in mortality with various levels of tax cuts. So you can see an increase from 10.5 - this is based on males but the data are identical for females - per thousand with no tax cut, up to 12 or even 13 per thousand with the kind of tax cuts we have in Ontario.
So this is what we can expect if there's no change in the provinces that have cut their taxes. On the basis of some of this information, I think Manitoba decided not to cut their taxes.
These deaths would occur among infants and children who are coming into the world during the 1990s - our children and grandchildren. Many programs and policies aimed at preventing the onset of smoking and progression to regular use are now in place in Canada. However, these activities are much less effective when tax measures and controls on advertising and promotion are lacking. A series of graduated tax increases, the introduction of controlled outlets, and the implementation of all proposed federal blueprint legislation are essential if we are to have any effect on the rising use of tobacco and the long-term costs in illness and death that will ensue.
Thank you.
[Translation]
Dr. Michael Goodyear (Canadian Oncology Society): Mr. Chairman, honourable members, good morning once again and thank you. The Canadian Oncology Society
[English]
is an organization that represents all of the specialists in medicine working in the cancer field in Canada, and a number of our leading scientists in cancer research. Perhaps most important of all, as I've stressed to this committee before, is that we listen very carefully to our patients, their families and what they have to tell us, and we hope we bring their concerns to you.
We're not experts in pharmacology or in addiction science. You have plenty of experts here to answer your questions about those specifics. Obviously, the bottom line is that we are here because we believe that nicotine should be regulated like other substances of abuse.
.0945
Why are we here? In your handouts you have some extracts that I took from the official Canadian cancer statistics of 1996. Maybe the most depressing about this particular publication is that in two months you'll have the 1997 statistics before you, and we already know what they will look like - worse.
In that handout you will see graphs of some of the most common cancers in Canada and what has been happening to them over the years. You will see that the one anomaly among all the cancers is the rising tide of lung cancer, both in men and particularly in women. We have been coming to committees like this, to members of this Parliament, to successive federal governments, since this graph started telling people this is what would happen if nothing was done, and nothing was done.
One of the most common questions we're asked by politicians is whether we are winning or losing the war against cancer. You also have a graph like this in your package that shows what happens if you take tobacco-related cancer deaths out of the equation. You can see that men are holding their own, and for women we would have been making major gains but for the effects of lung cancer.
Since you're all so dollar conscious and deficit reduction conscious at the moment, you also have a graph here showing the direct health care costs of treating cancer in this country at $3.5 billion, and that's just the direct health care costs, not the total costs.
I don't think anyone here really needs to be taught about the association between lung cancer and tobacco, but just to make the point, there is a handout in your package. This graph shows, within a 20-year frame shift, the almost exact resemblance between tobacco consumption in Canada and lung cancer in Canada, with a slight flattening out at the top due to a flattening out of the increase in tobacco consumption in the 1960s.
Just to reinforce Dr. Pipe's message, on the flip side of that you'll see the exact correspondence between ischemic heart deaths and tobacco consumption. I don't think that needs further proof.
One-third of cancer deaths are attributable to tobacco. If you'll excuse the expression, we are extremely frustrated by the successive fumbling of the ball by parties of all political stripes, and not only in Canada but elsewhere in the world.
Maybe you should remember that in 1963 then Liberal health minister Judy LaMarsh stood up in the House of Commons and made the startling comment that cigarette smoking was a major contributory cause of lung cancer. Cabinet documents at the time suggest she was going to make a much stronger statement, but her colleagues were concerned she might frighten the country.
That did not result in any particular legislation, although you may remember that this particular committee in 1969 produced a very important report under the chairmanship of Gaston Isabelle. It recommended the control and regulation of nicotine. That in itself resulted in Bill C-248 being introduced into the house in 1971. That would have regulated and controlled nicotine in Canada, but it died on the Order Paper.
It's going to be very difficult for future generations of historians to look back on the appalling paradox of a society that generally has a rather low tolerance of unnecessary risks, yet in which nicotine is disseminated and promoted widely by an industry that is fully cognizant of the reasons for nicotine addiction and of the health risks of tobacco.
We believe that nicotine is the bottom line in terms of cancer and tobacco control. It is a highly toxic, addictive drug that serves no useful purpose in our society except to addict adolescents to a lifetime of slavery to tobacco. We should remember that it was banned from agricultural use, where it was known as ``black flag'' because of its toxicity, yet when you inhale it, it's freely available.
Industry documents show that the industry has been fully aware of the addictive properties of nicotine and how to utilize it to their best benefit since at least 1945. In the words of Mr. Justice Jean-Jude Chabot of the Quebec Superior Court when he was listening to tobacco industry testimony in the first constitutional challenge to the Tobacco Products Control Act, when it came to matters of health, the tobacco industry reminded him of Tiny Tim and his ukulele tiptoeing through the tulips.
.0950
You have seen a very interesting illustration here of perhaps one of the most successful deceitful practices on the Canadian and, indeed, the general public in the world with the introduction of so-called mild and light cigarettes. This is where the tiptoeing comes.
According to the tobacco industry smoking is not harmful, and yet it's fully aware that a health conscious smoking population will move towards so-called lighter or milder cigarettes in the belief - falsely, as it so happens - that they are preserving their health or reducing the health risks.
Unfortunately, through its enormous economic and political influence in this country and other countries, the industry has succeeded in setting the agenda on the control of tobacco, creating by far the largest drug problem in our society, much of which of course is illicit. I think particularly of smuggling and of course of sales to children, which is illegal.
What does the score card show? You've seen some recent statistics from my colleague Dr. Ferrence, and I think that Dr. Richard Shaver, chief medical officer of health for Ontario, stated this fairly succinctly a few days ago in the presentation of his annual report, when he said that this is a war we are losing.
Nobody here is pretending that control of tobacco and nicotine is a simple matter. What we deplore, though, is a totally inconsistent public policy that fails to treat nicotine as a dangerous drug and to regulate all aspects of its importation, manufacture, distribution and sale and promotion, whether by direct advertising or indirectly through sponsorship, which is the major problem at the moment.
Nicotine is not necessarily the problem per se, and I don't wish to labour the exact health effects of nicotine, but an industry spokesperson referred to it as the hook, and it is of course the hook by which the other harmful effects of tobacco smoke are delivered to the consumer. It ensures a lifelong addiction to tobacco smoke.
We believe that if nicotine was a controlled substance in this country it would give the government of this country a regulatory framework to control all other aspects of tobacco. Some experts in addiction, indeed Henningfield and Benowitz of the National Institute on Drug Abuse, have argued that controlling nicotine, including controlling the maximum amount of nicotine in a cigarette - not the yield but the content - would reduce its addictive properties and prevent some young people becoming addicted for life. But this I will leave to the experts in addiction science.
None of our interest in nicotine should detract from a comprehensive approach that involves both supply and demand, including the pricing of nicotine products, if we are going to achieve our national goals.
To make nicotine a controlled substance will end the industry's boasts of a legal product that therefore should be legally promoted.
I'm wearing a poppy, as you may notice. It was recently Remembrance Day, when we remembered some very sad facts about the history of this century. We remembered particularly the last major war, how in six years between 1939 and 1945 42,000 Canadians lost their lives. Yet the same amount of people lose their lives unnecessarily and totally preventably from the effects of nicotine.
You have in your hands the ability to prevent this. Thank you.
The Chairman: Thank you to all four persons who have given the committee the benefit of their knowledge.
We're going to have a period of exchange, questions and so on. I have to absent myself for a few moments. I have to present a report in the House on behalf of the committee. I'll be back as soon as I can. In my absence, I'm going to invite one of our vice-chairs, Pauline Picard, to take the chair.
We have an order of speakers. Are you ready, Pierre?
Mr. de Savoye (Portneuf): Oui.
The Chairman: So there will be Pierre, Grant and then Joe, in that order. I should be back shortly.
.0955
[Translation]
Mr. de Savoye: Ladies and gentlemen, thank you for putting these indisputable facts before us with so much conviction. You have given us a great deal of information on the harmful effects of smoking.
I have several questions for you, but first I would like to point out, just as you do, I hope that we can change things.
I stopped smoking over 20 years ago, after smoking for over 12 years. It took me three years - three years to get rid of the physical and psychological reflexes of needing to hold something in my hand and needing to put something between my lips.
Before I quit smoking, if ever I didn't have cigarettes, I would get up at anytime of the day or night and go buy some. So I know what I am talking about when I say that smoking is very addictive.
But if Parliament passed a law abolishing the use of tobacco in Canada, people would just grow it in their basements. We would also be giving the black market a magnificent boost. People would become criminals to get tobacco. This means that abolishing, or banning, tobacco is not necessarily going to improve things.
Dr. Pipe just indicated that there could be other ways of mitigating smoking habits. Smoking is a behaviour, and we must try to change the way people behave.
I have two questions. First, is it nicotine that causes all the damage, or is it the other products of tobacco consumption that are carried in the smoke, like tar, that are the culprits? Which substance has caused the damage?
Second, what measures could Parliament take to help reduce the health problems people have or to help them change their behaviour?
What suggestions would you make? In my view, a price increase could be a good thing, provided that it does not trigger smuggling. If we lose control of the market, smuggling will just undermine the benefits of the price increase.
[English]
Dr. Rickert: I would like to make mention of a piece of correspondence coming to me from Professor Neal Benowitz, who was cited a little earlier as advocating a certain level of nicotine in tobacco products. He writes: ``Nicotine per se is probably a minor contributor to tobacco toxicity; the combustion products of tobacco are of primary concern.''
In regard to the issue you have raised, there was for example an article that appeared in Science not too long ago, which associated a carcinogen in tobacco smoke, benzoapyrene, with lung cancer. I am very concerned that by focusing solely on nicotine and the addiction issue one is losing sight of the fact that the harm caused by smoking is largely related to the combustion products such as benzoapyrene, 4-aminobiphenyl, and a host of other constitutents one could name. I said in my presentation that I beleive the health of ongoing habitual smokers, those who are habituated to tobacco, is best served by reducing all of these constituents to the extent possible.
.1000
A standard for this has been set by the introduction of products that do not combust tobacco but heat tobacco. By heating tobacco instead of burning tobacco, it is possible to obtain reductions of these constituents by as much as 65% to 99%. I think the focus has to be on all of the constituents and not just nicotine.
The Vice-Chair (Mrs. Picard): Dr. Pipe.
Dr. Pipe: Thank you.
There is an aphorism often repeated in medical circles that smokers smoke for nicotine but die as a consequence of tar. In terms of cancer that is precisely correct, because as Dr. Rickert has pointed out, it is the products of combustion that for the most part are carcinogenic.
Nicotine, however, is the hook, as the tobacco industry calls it. Indeed, it's hard to understand how individuals, without nicotine, would want to place products into their mouths, set them on fire and inhale the contents. If you wish to address the way in which these products of combustion are delivered you must address the question of nicotine.
Nicotine, it must also be said, is a fairly potent vasoactive substance. It raises blood pressure. It constricts the arteries. It sensitizes the left ventricle of the heart so that it's more susceptible to dysrhythmias. From a cancer point of view, nicotine may not necessarily be that important. From a cardiovascular point of view, nicotine is an important constituent of cigarette smoke that needs to be looked at.
In replying to your question, I want to make one assertion, and this is that I don't think I heard anybody here this morning - and again I was late - call for a ban on tobacco products. I think this was a concept, sir, that you raised in your question. I didn't hear it here this morning. I think we all recognize that it would be totally unrealistic to ban a product to which 26% of the Canadian population is addicted for reasons that you demonstrated.
I also would never use the word ``habituated'' in terms of describing the conduct of smokers. My very sad experience with smokers in our nicotine dependency centre is that these smokers are truly addicted. I think ``habituated'' is an euphemism; it's a word I'm not comfortable with in terms of describing what occurs to individuals who become dependent upon nicotine.
Mr. de Savoye: You got this word through the the translation, right?
Mr. Pipe: D'accord
Mr. de Savoye: Thank you.
The Vice-Chair (Mrs. Picard): Madame Ferrence.
Ds Ferrence: I wanted to clear up a misconception about taxation and smuggling. Smuggling is not an inevitable result of raising taxes. There are many countries in which buying a pack of cigarettes would take about 50% of someone's income. Cigarettes, even at their higher prices, at $4 or $5 a package, are relatively inexpensive compared to the real price of cigarettes in most developing countries.
The other thing that's important to know is that the main reason we had a smuggling problem was because the increase in taxes was at the retail level. The way to prevent that is to put the tax on before the retail level so that when it leaves the country the tax is already paid. There are many different kinds of strategies that can be used to deal with smuggling. It is not an inevitable result.
The other point to make is that the differential between Canada and the U.S. is narrowing. Many of the northern bordering states have raised their taxes and in fact have higher prices for cigarettes than Ontario and Quebec do at this point.
I don't think smuggling is inevitable, with a little imagination and some political will to raise taxes.
.1005
[Translation]
Mr. de Savoye: Let me tell you a true anecdote.
Before I went into politics, I had a business. I had employees, and I did not permit smoking on the premises. One of my employees was a smoker, and she regularly left the office to go have a cigarette. I offered her a raise of $2,000 a year if she stopped smoking, but she never took me up on it. Thank you.
The Vice-Chair (Mrs. Picard): Dr. Hill.
[English]
Mr. Hill: Mr. Rickert, I misunderstood or got an inconsistency from your comments. You started by saying that most cigarettes have 9 milligrams of nicotine.
Dr. Rickert: That is correct.
Mr. Hill: In other testimony here, we talked about each cigarette producing 1 to 3 milligrams of nicotine.
Dr. Pipe: That's yield.
Mr. Hill: It's important that we be consistent.
Dr. Rickert: I think this is a point that is misunderstood by smokers, misunderstood by legislators and misunderstood by many individuals. One has to clearly distinguish between content and amount produced by smoking machines under artificial conditions. The label on the package has nothing to do with content.
Mr. Hill: All right. You very eloquently said that if the nicotine is lower in a cigarette, the smoker smokes more heavily and the yield to the individual goes up.
Dr. Rickert: What I said was that the label on the cigarette, which is machine determined, will at one level for a regular cigarette be 1 milligram, and for an ultra-mild cigarette it may be 0.1 milligram. If smokers require 1 milligram of nicotine from every cigarette, they will obtain that 1 milligram regardless of what the smoking machine says.
Mr. Hill: For addicted smokers, then, there is no advantage at all in lowering nicotine in the cigarette because they can get the same amount by more severe smoking.
Dr. Rickert: There is no advantage at all to basing regulations or considerations on smoking machine numbers. It has been suggested that the way to approach the problem is to base any regulatory process on the content of the tobacco itself.
Mr. Hill: Okay. What I'm after is this: surely there is a benefit to non-addicted kids who smoke a cigarette and it tastes horrible, and there is not enough nicotine in that cigarette to get them addicted. Surely that is where our efforts should be in terms of lowering the nicotine level in cigarettes. Yes or no? I have a whole bunch of stuff here, so....
Dr. Rickert: I want to answer that very briefly because it's an important point to me as well. By doing so, in my opinion, you would be ignoring the health consequences for many millions of habituated smokers. In my opinion, the way to deal with initiation, which is what you're talking about, is with other mechanisms, not by product modification.
Mr. Hill: That's a fair comment.
Dr. Rickert: Then we agree.
Mr. Hill: To Madame Ferrence, in terms of your comments about the reduction in taxes, you want the taxes to go to zero, do you not? You want no one to smoke. You don't want any money to flow from this product.
Dr. Ferrence: I'm not sure that's realistic, but go on.
Mr. Hill: You see, this is the inconsistency that politicians fight with. This is a very lucrative product to the government. The government is making money on this product, and that is why there is inconsistency in government policy. Trying to figure out a way to reduce and still have this huge amount of money.... I want this product to go to zero in terms of tax revenue.
Dr. Ferrence: One thing we know is that you can raise taxes quite high without losing revenue because of the addiction issue. People will continue to smoke and continue to buy cigarettes, although not as much. You have to raise it pretty high - we don't know the exact point - before you actually get a loss in revenue. As you can see from the provinces that have maintained their higher taxes, they have higher levels of revenue than those that cut their taxes.
.1010
So that is less of a concern than you might think. Also, when you balance revenue with not only the direct health costs, which are very substantial, but also all the indirect costs, which are very difficult to measure, it's not clear there's a net benefit to the country at all.
Mr. Hill: What I'm getting at, though, is that if the revenues went to zero because no one was smoking over time, you would cheer, would you not?
Dr. Ferrence: Yes, because aside from the health benefits, it's not clear.... Good health is economically a good thing. This is a general finding across the world. There's nothing to be gained economically by making people sick.
Dr. Pipe: Of course, your question assumes that people who are fit, who no longer spend money on cigarettes, no longer spend it on anything else. We know that people who spend money on products other than cigarettes do so in far more enriching ways to the overall economy. They stimulate the consumption of water skis, beds, houses, cars and other forms of consumables, all of which are taxed in various ways. So the government has an opportunity to develop resources in those other areas. There is a bit of sophistry in your question, because this money is not going to disappear.
Mr. Hill: You misunderstood my question. I hate to hear my health colleagues using the argument to maintain the revenue from cigarettes. I want to see the thing gone...and so no sophistry whatever. This is the reason there's a problem with the whole issue.
Dr. Goodyear, you talked about illegal sales to children as being a big issue. With other products that are sold to children, we go after the children who are buying the products illegally. For instance, if a kid goes to the liquor vendor, he gets charged with illegal possession. When a child goes into a store and purchases cigarettes, whom do we charge? We charge the vendor. That doesn't seem consistent to me.
Dr. Goodyear: We were actually discussing this issue shortly before this session started. I was reminded of when I was asked to appear before the local police services board about a year ago. We talked about a number of enforcement issues in this area.
I pointed out that in the region in which I live there are something like a dozen liquor control outlets and something like a thousand tobacco outlets. We talked about why the police did not enforce the tobacco laws to the same degree as the alcohol laws.
It's purely a matter of practicality in the sense that it's fairly easy to survey or to stake out liquor control outlets, which actually do a fairly good job in terms of keeping alcohol out of the hands of children. It's not a perfect job; there are other ways they can get hold of alcohol. However, the almost uncontrolled retail outlets for tobacco make it almost impossible to try to enforce that.
In the beginning of this century the federal government passed an interesting act, the Tobacco Restraint Act, that actually did address this question. It not only made it illegal to sell tobacco to children, it actually made it an offence for children to be in possession of tobacco. So a peace officer, as was the phrase used in this particular legislation, could confiscate it and could make the possessor of tobacco say where they bought it so that the vendor could be prosecuted as well.
We lost that in the last piece of legislation, the Tobacco Sales to Young Persons Act, but it's certainly an interesting twist. A lot of young people have told me they would like to see that back in legislation.
Mr. Hill: But it was seldom used.
Dr. Goodyear: It was virtually not used at all except by health groups that were trying to make a point. Enforcement was the major point.
I would like to look again at the broad picture here. It's very easy to focus on one little item in the whole tobacco control strategy. You can almost argue it away if you focus on it. As I said in my presentation, there is no one simple answer or we wouldn't be here arguing about this year after year after year while the problem continues to get worse.
You have to have a balance between control and supply. It's a very interesting illustration of human behaviour that probably the most successful strategy has been the taxation one. The major reduction in tobacco consumption that took place in Canada during the 1980s is almost directly as a result of finance minister Allan MacEachen's decision to index consumption taxes such as alcohol, tobacco, and petroleum, thereby setting up a spiralling increase in taxes.
.1015
This has been a universal experience. Sharp increases in tobacco prices do create major drops in consumption.
But as taxes continued to increase - at our behest, I may add - I became increasingly concerned that it was becoming the sole plank of government policy. In other words, you were making the product more difficult to obtain, but you weren't reducing the demand.
If there had been an equal concentration on behaviour modification in terms of reducing the demand, you wouldn't have seen some of the catastrophic economic consequences that led to the situation we have now - although of course no one, certainly in the health community, really believes it was purely a matter of price that led to smuggling.
The Prime Minister himself, in his speech in the House in February 1994, stated that he believed the tobacco companies themselves were largely culpable. Some of that evidence is now coming out in terms of prosecutions taking place in the United States against tobacco industry employees. Similar price differentials exist in other parts of the world, such as between Hong Kong and China, or between Denmark and Germany, without the same degree of smuggling.
We believe this was a concerted effort to actually produce smuggling by dumping large amounts of duty-free tobacco on the other side of the border. Again, as Dr. Ferrence pointed out, there was a spectacularly successful export tax placed on tobacco a year earlier. It only lasted for about eight weeks, but it dramatically changed the flow of tobacco across the border. That tool has not been utilized.
So we're really not impressed by the arguments that say price increases lead to smuggling. That is just one small plank in a strategy, and we shouldn't fixate ourselves on this.
[Translation]
The Vice-Chair (Mrs. Picard): Dr. Pipe, I will only give you a few seconds. I have to give the floor to Mr. Volpe.
[English]
Mr. Hill: Thank you for your excellent testimony, by the way.
Dr. Pipe: Dr. Hill, I just want to respond to your point about the consistency of regulations. To charge those who merchandise tobacco products when they provide these products to youths is entirely consistent with the way we deal with other drugs.
Those who push drugs in playgrounds are subject to the rules of law. Those who serve people in bars beyond the point of intoxication are prosecuted under the law. Those who serve liquor in restaurants and bars to people below the age of majority are prosecuted under the law. So there's a remarkable consistency with what we suggest and what is currently the practice in other areas insofar as other drugs are concerned.
[Translation]
The Vice-Chair (Mrs. Picard): Mr. Volpe.
[English]
Mr. Volpe (Eglinton - Lawrence): Merci, madame. Gentlemen and lady, I found your testimony quite interesting and engaging. I'm sorry I missed the first couple of minutes.
Not being a smoker, not having ever smoked except around a card table where you sniff in all the smoke the opposing players try to throw in your face so that you lose at the next hand of poker, I come at this with a particular bias. The bias is that I accept all of your assessments from a medical point of view.
I was really pleased to hear Dr. Goodyear's latest comments, because it reflected on the matter that the states, the governments, have actually been trying to do something about smoking. When you pointed out Mr. MacEachen's ill-fated budget of 1982, you reminded us that legislators have not been absent from the debate.
Dr. Pipe, I wonder if you can answer a couple of questions so I can get a better sense of some of the figures and some of the perceptions. Because I missed the first part, I'm not sure I understood well enough that the really serious danger for the smoker is the tar and not necessarily the nicotine.
Dr. Pipe: Perhaps I can attempt to clarify this. It's very important you not try to create an either/or situation here.
Mr. Volpe: I just want to get a sense of where all the dangers are coming from.
Dr. Pipe: I understand the way in which this might appear confusing. Let me repeat it again.
Smokers smoke for nicotine. Those who succumb to cancer die because of the product's combustion, particularly because of the tar, which is part and parcel of cigarette smoke. Nicotine itself is a vasoactive compound, by which I mean it has the ability to influence the behaviour of blood vessels and other elements in the cardiovascular system.
For instance, we know that smokers have double the risk of blindness due to macular degeneration, which is a disease of the retina, than do non-smokers. That has nothing to do with tar. It has a lot to do with the fact that nicotine causes the blood vessels of the eye to constrict and therefore impairs the circulation to certain areas of the eye.
.1020
So one can't respond directly, Mr. Volpe, by saying that the problem in tobacco smoke is this. A huge problem in tobacco smoke is nicotine because that's what keeps people smoking, but the products of combustion that come along with the nicotine are responsible for a huge array of health problems as well.
Mr. Volpe: In your discussion of the balanced approach to dealing with this problem, the thought that always comes to mind is the business of banning. Just a moment ago, Dr. Pipe talked about the enforcement mechanisms available for other drugs and other products that are either unacceptable or hazardous. Given the large number of people who smoke, I wonder whether you have done an assessment of how feasible it is to ban the product outright and make that ban stick.
Dr. Goodyear: I would refer you to a couple of interesting publications that summarize all the evidence on nicotine and addiction. One is the one from the Royal Society of Canada, and then there was one last year from the Food and Drug Administration of the United States.
In the Food and Drug Administration one, which as you know may have partly won the election for President Clinton - the first major federal election fought on tobacco as a major platform - it states quite clearly that tobacco smoking is way out of proportion of all other drug problems in our society. When you're talking about a third of the population that currently uses the product, quite clearly you can't go about it from the point of view of simply banning it or making it like a narcotic or marijuana. You have to have a rather more subtle approach. That rather more subtle approach is a long-term strategy in terms of behaviour modification and changing the attitudes of our society.
Some of you may have seen the publicity that surrounded the second large national conference on tobacco and health that was held here in Ottawa a week or so ago. I think one of the most encouraging things that came out of that was the longitudinal studies of public attitudes towards smoking and tobacco. They quite clearly show that year after year, the proportion of the population that is becoming intolerant of the way tobacco is used and promoted in our society increases steadily, and continues to do so. So educational -
Mr. Volpe: Excuse me. That is notwithstanding the fact that you've seen increasing consumption amongst certain groups.
Dr. Goodyear: In the short term, yes. But there is a critical level in terms of society's tolerance.
None of us realistically believes that any of the things we advocate will eliminate tobacco usage in this country. But I think most of us would be reasonably happy if it fell to the level of a few percent of the population using it.
You also have to remember that when you use tobacco, your chances of premature death are double those of a non-smoker. So this population of smokers is going to decrease steadily, not only from the effects of aging but from the effects of using that product, unfortunately.
One of the keys, therefore, is the initiation of new smokers into the market at the bottom end to replace the people who die or quit at the other end. We're talking about 10,000 Canadian children a month who are being recruited into the market. You need totally different strategies for dealing with the current addicted smoker and dealing with the population of Canadian children who are entering adolescence, which is the critical period in their lives when they make a decision either to become addicted to tobacco for a large portion of their lives or to stay tobacco-free. Tobacco addiction is recognized as an acquired disease of childhood. Obviously, if we had something very effective that stopped young people from taking up tobacco, the pool of people using tobacco in this country would steadily decline to a level that became much more manageable. But nobody in their right mind is going to advocate banning tobacco.
The Vice-Chair (Mrs. Picard): Madame Ferrence.
Dr. Ferrence: I'd like to take that as a little bit of a challenge. None of us would seriously propose a ban -
Mr. Volpe: Do you take his statements as a challenge or my questions of about five minutes ago?
.1025
Dr. Ferrence: Michael's.
Mr. Volpe: His. Okay.
Dr. Ferrence: I think it's an important thing to talk about. I was a smoker in my youth, a heavy smoker, and I have a lot of sympathy for smokers. I remember wishing they would ban cigarettes, and I've heard this from many other smokers. It would be so much easier if we couldn't get them. Most smokers want to quit. Most smokers do not want to continue their addiction to tobacco.
Even though I don't think at this point that our society is ready for a ban, I think it's something to keep in mind when planning long-term strategies - that one might develop a strategy that could culminate in a ban several years hence, or that we want to get rid of smoking altogether.
The approach that's being used in terms of reducing exposure to second-hand smoke - certainly the industry has accused health advocates of going in that direction, and there may be a point at which there's nowhere you can smoke. Certainly people are looking for a ban on exposure to environmental tobacco smoke.
I think it's something important to think about and to discuss, but not necessarily to propose at this time. It does provide a framework for thinking about where we should go next. There clearly are costs to bans, but people are fond of saying that prohibition for alcohol was a total failure, which isn't entirely true. The death rate from cirrhosis declined by 50%, you may have heard already.
There are problems of criminality and other things that occur during a ban, but in some cases the net result may be positive. It very much depends on where society is, what kind of enforcement there is, and how things are structured.
Mr. Volpe: What if Dr. Pipe views your comments as a challenge as well?
Dr. Pipe: I think from an academic perspective one can ignore the reality that there are some.... The prohibition example is cited, and yes, some positive things occurred as a consequence of the ban.
I happen to believe that in the present context it's wholly unrealistic to consider banning tobacco products. It would not work. It wouldn't get out of this committee room. You can't ban outright something to which 30% of the population is addicted. It's interesting to look at what might be in the future; it's interesting to look at what's happened in the past. But I certainly would not advocate a ban on tobacco products.
[Translation]
The Vice-Chair (Mrs. Picard): Mr. Scott. If we're going to do the round, we have to hurry up.
[English]
Mr. Scott (Fredericton - York - Sunbury): Thank you very much, Madam Chair. I have a couple of questions.
First of all, on this business of the advertising of tobacco in the context of ``light'' and the impression it has created that somehow it's less damaging or.... I'm sure that's the intent. Is there any scientific argument that can be made that there is any element, apart from nicotine or tar, about which one could say it is lighter because of this? Is there any place to argue that there is some decreased health problem as a result of this?
Dr. Rickert: There is a wide spectrum of tobacco products available on the market. If one considers the so-called very, very light - that is, cigarettes that are advertised at less than 1 milligram - I know for example that in the laboratory it is not possible, under realistic conditions, to take that particular cigarette and turn it into a regular cigarette. There are limits to this process.
In other words, instead of having, let's say, 115 unique brands of cigarette in Canada, one could probably distinguish maybe two or three brands on that basis. There may be some justification for the use of that particular type of descriptor, but that has to be better defined.
Mr. Scott: Okay. How reliable is the information as it relates to illegally sold cigarettes prior to the price increase?
.1030
I wouldn't want to say that the price of cigarettes in my community actually came down, or even went up, but it may have. I would guess that 50% of the cigarettes purchased in my community were illegal and low-priced. There were trucks everywhere selling cigarettes.
Part of the argument in terms of pricing had to do with the fact that I would like to see less smoking - I have young children - and so consequently I wanted the trucks gone, and they're gone. I'm not wanting to have that debate all over again, but how reliable are the figures in terms of consumption when so much of consumption was illegal? How do you keep track of who's buying cigarettes off the back of a truck when those cigarettes aren't...? I'm just curious.
Dr. Ferrence: One of the ways we do this is through surveys. In some of the surveys of young people, just after the tax cut, we asked students if they were paying less for cigarettes. Most of them were paying less, which suggests that they didn't have a lot of access to smuggled tobacco before the tax cut. The best-informed estimates are that about 28% of the market was smuggled, but even people who smoked smuggled cigarettes didn't entirely smoke smuggled cigarettes. They would get some of their cigarettes smuggled and some not, because even at $4 or $5 a pack it's not incredibly expensive; we're not talking $50 a pack or something.
I think there have been overestimates of the amount of smuggled cigarettes. We believe that kids had much less access to smuggled cigarettes, particularly those kids from more conventional homes who went to school every day and so forth. The other point is...I don't wish to repeat myself too much, but the smuggling situation had a lot to do with the fact that cigarettes were taxed at the retail level and not before that.
Mr. Scott: I don't pretend to know anything beyond.... I come from New Brunswick; the community's not a border town, but it's 50 miles from it, and it was all over the place. It was introducing an entirely different culture. This became a different kind of thing. I smoked, and I'm glad that my friend from Portneuf has returned, because I was afraid I wouldn't have the opportunity to apply retroactively to his program.
Some hon. members: Oh, oh!
Mr. Scott: I think I can understand a lot of the...going through the milder cigarettes and just causing me to suck harder. A lot of what has been said is instinctively understood, I think, by people who've smoked and quit, and I'm quite concerned about this myself. But I think to some extent, because it's such a big country and there are so many circumstances that make the debate.... You know, everybody can say that's not really the case, because for me that isn't really the case sometimes. And therefore we lose the big picture.
One of the things I'd like to take one second to pursue is this business of nicotine versus tar or ``particulates'', I think was the word that was used. If you tried to reduce the nicotine levels so that they were less addictive for people entering, but it had the outcome of increasing the intensity of the particulates, which cause a different health problem.... Someone said that's what makes it hard to make reducing nicotine the answer, because you cause another unwanted effect among people who are already addicted.
Is there not some way that the people who are addicted can get nicotine in some other fashion - I mean all these patch things, etc. - and thereby make the nicotine content in cigarettes less, making it less addictive to the people who are just being introduced, and at the same time satisfying the addictive needs of people who are currently addicted?
.1035
Dr. Pipe: Yes, there are ways you can do that. Think of the cigarette as a drug delivery device.
Mr. Scott: I do.
Dr. Pipe: Recognize that we regulate how drug delivery devices are designed, assembled, constructed and marketed in this country. It's not difficult to conceive of a way in which you can construct this drug delivery device so it only yields a certain amount of nicotine.
Obviously if people can get ad libitum amounts of nicotine, they are far more likely to become addicted than if they get tightly controlled levels of nicotine. There are ways in which you can modify or regulate the design of the drug delivery device to make sure only a certain finite amount of the drug is delivered.
What happens right now is that by putting in micro-porosity paper and pores in the filter and by packing the material in the cigarette more loosely, the idea is that on a smoking machine you draw in more side-stream air, dilute the level of the smoke and hence you get these lower yields. It's smokers' subconscious activities of over-smoking, obscuring those perforations, smoking more of the cigarette, etc., that allow them to up-titrate the nicotine yield from that cigarette.
There are ways in which you can regulate the nicotine content by regulating the design and manufacture of the drug delivery device.
At the same time, for those who are truly addicted to nicotine, you can provide nicotine through other routes. Indeed, we use that route in order to assist people to stop smoking. We provide them with a very small amount of nicotine that approximates that individual threshold, which is individually, idiosyncratically determined. It provides them with a period of time in which they are withdrawal symptom-free, so there's a window of opportunity for them to learn a whole new repertoire of non-smoking behaviours. That clearly is one way of using that kind of approach.
Your point is well made. Yes, we can regulate these devices in such a way that we regulate the delivery of nicotine.
The Chairman: Mr. Rickert.
Dr. Rickert: I have two comments.
First of all, in the United States a product was introduced that was called the Next cigarette. What they did with the Next cigarette was eliminate all nicotine from that cigarette. The cigarette tasted fine. In the short term it was palatable, but in the long term it was a market failure. No one would use it. So the experience has been that if you de-nicotinize cigarettes, it is in effect similar to prohibition. No one's going to use it.
The second point is that a host of nicotine replacement products are available. What makes cigarettes so unique is the way the nicotine is delivered. All of the other products that are available - the patch, the gum, the nasal spray and so on - do not deliver nicotine in the same way the cigarette does. It is more a question of addiction to nicotine as delivered by cigarettes than a question of addiction to nicotine.
The Chairman: That's our first round.
On the second one I have three people who wish to intervene. I'd like to do this fairly quickly, because there's one brief item of committee business that will take about two minutes at the end to deal with.
I have Bonnie and Harb, and then I'd like to make a brief intervention myself. Bonnie.
Mrs. Hickey (St. John's East): I'll be really quick. I'll just ask you my questions and you can answer them all at one time.
I want to go back to the youth smokers. Are youths more vulnerable to nicotine dependency? If that's the case, are the ill effects of smoking worse for smokers who adopt that habit at a younger age as opposed to an older age?
Dr. Pipe: Was the first part of your question on whether youths are more susceptible to nicotine addiction?
Mrs. Hickey: Yes. Are you more vulnerable to nicotine dependency if you're a youth?
Dr. Pipe: The reality is that exposure to nicotine in even small amounts on a few occasions can very rapidly produce addiction. It's been said that one has to have very few experiences smoking cigarettes on a regular basis over the course of a week or two before one begins to become addicted.
The second question was, are the health consequences worse the longer you're exposed to smoking? Very definitely yes. This is why it's so invidious to see an industry try to entrap youngsters into becoming consumers of an addictive product at such a young age.
Mrs. Hickey: Would there be a different effect between a boy and a girl at the age of youth? Would nicotine affect a woman or a girl more than it would affect a boy, or vice-versa?
.1040
Dr. Pipe: Not necessarily, but of course cancer of the cervix is uniquely a female health problem that, among other things, is uniquely related to smoking. We know cancer of the cervix is a consequence of being a smoker. There are very specific health concerns that are unique to women, such as osteoporosis, earlier menopause - one could go on.
Indeed, now we have an epidemic of lung cancer. Lung cancer is the leading cause of cancer death among Canadian women. And we know what caused it. We know how it happened, and we still shilly-shally about doing anything about it.
So yes, there are some very gender-specific consequences of smoking.
Mrs. Hickey: I have one small question for myself. I was a smoker, as everybody else is admitting here. I started at 12 and picked up smoking right away, but I quit the same way. I quit overnight. I just gave it up and haven't smoked in six or seven years.
Second-hand smoke is a question. I would like to know what the effects of second-hand smoke really are to somebody like me or to someone who hasn't smoked before. I don't really understand how second-hand smoke affects me right now.
Dr. Goodyear: Well, ma'am, maybe I can ask how it does affect you in terms of what your experience of it is.
Mrs. Hickey: Well, I just don't like it.
Dr. Goodyear: Well, there's no doubt that the effects of second-hand smoke over a sufficiently prolonged time and in sufficiently prolonged concentrations can easily be the equivalent of direct smoking. When we say about 85% of lung cancers can be attributed to direct smoking, of the remaining 15%, a large proportion can be considered to be due to second-hand smoke.
Obviously the key area where the studies have been done is where people live together and one is a smoker and one is not and is sharing a vast excess of lung cancer with the non-smoking partner. But of course it's not just lung cancer; it's all the other consequences of smoking. We tend to over-concentrate, I think, on lung cancer.
I'm glad Dr. Pipe's here, because in fact the effects on the heart and blood vessels are far more important than cancer, numerically, in terms of the consequences in deaths and disease.
The one area where we have made progress has been in the area of control of environmental tobacco smoke, partly at the federal level through the Non-smokers' Health Act - and I'm delighted to see the plaques up on the wall there, although that legislation could certainly be strengthened a long way - but predominantly at the municipal level. Unfortunately, given the number of municipalities in Canada, that's not been a very cost-effective fight for us in the health community. We'd much rather see it done at provincial and federal levels.
As Dr. Ferrence said, removing areas where people can smoke is a very powerful incentive for people not to smoke. There's fairly good evidence, for instance amongst the civil service, where they went into a smoke-free environment, that tobacco consumption decreased considerably and the quit rate went up in terms of the people who were able to give up. That's why so many smokers support legislation that creates smoke-free environments.
The media and certainly the tobacco industry like to create the idea that there's some war out there between smokers and non-smokers, but on most surveys, the number of smokers who support measures doesn't fall that far behind non-smokers. That is a very effective strategy in terms of reducing tobacco consumption, and one that has widespread public support.
Mrs. Hickey: Thank you.
The Chairman: Quickly, please, because we're running out of time.
Dr. Ferrence: I just wanted to add to that.
The research on environmental tobacco smoke is not as advanced at this point as it is for smoking. One of the problems has been that in the comparison groups for smokers, they often don't use people who've never been exposed to tobacco smoke.
From some of the material that gets into the Surgeon General's report, it's very clear it has cardiovascular effects and causes cancer. There are new data out, for example from the CDC in the U.S., showing there's a dose response relationship between environmental tobacco smoke and birthweight in infants. The more the mother is exposed, the lower the birthweight.
These don't make it into the Surgeon General's reports yet, because there isn't enough, but there's a recent study out suggesting that women who had even one year of exposure to environmental tobacco smoke in this particular study had triple the risk of breast cancer, which is extremely frightening. This needs to be replicated in other studies, but the next 10 to 20 years will probably produce a lot more information. There is some suggestion that non-smokers may be more sensitive to the effects of second-hand smoke than smokers are, so a lot more will be appearing, I think.
.1045
The Chairman: Harb.
Mr. Dhaliwal (Vancouver South): Thank you, Mr. Chairman.
Unlike my colleagues, I come from many generations of non-smokers, and I'm a non-smoker myself. If I ever did smoke I probably never inhaled, so I didn't get addicted to it.
Let me make one point in addition to what you said, and I think this has been a very good presentation. I was once subjected to a chemical accident in which I inhaled ammonia. I was able to survive. If I had been a smoker, I was told, I would not have been able to survive and I wouldn't be here today.
So your ability to sustain any serious problems of that nature - there's an added risk that you have weaker lungs, I presume. So I think we have to do everything possible, and I agree very much with what was said.
In terms of those countries that have successfully dealt with this problem or have done a better job than we have in Canada, could you maybe give us some of the solutions of those other countries? Which countries have a lower number of smokers per capita? How is it they've been able to reduce the number of smokers or smoking in general in their countries? I haven't heard of many experiences of other countries.
Dr. Pipe: I must preface my remarks by saying that I'm relying on my memory, which is a little bit sleep deprived at the moment, so it's not necessarily as sharp as it sometimes has been.
The irony is that Canada led the world in terms of implementing a state of the art approach to dealing with tobacco as a public health issue. It was a comprehensive program. It had price elements, it had restrictions on advertising and sponsorship. There are provisions in our communities to control environmental smoke, etc.
Countries that have adopted similar approaches include the Scandinavian countries, and I would cite Norway in particular. It's sadly ironic, because Canada undid all that it had accomplished, and we've seen the consequence in terms of an increased uptake of adolescent smoking, an erosion of the regulations regarding advertising and sponsorship and so forth.
The model approach to tobacco control is a comprehensive one. It has a number of elements that include attempts to focus on price, the elimination of advertising and all forms of sponsorship, by-laws to protect those from the effects of second-hand smoke, etc. We know what works. We did it in Canada. Unfortunately, somebody undid it.
A voice: The Supreme Court, for one.
Dr. Goodyear: When you look at the epidemiological patterns of smoking in different countries, I think you have to distinguish between those in which the prevalence of smoking historically has been low, and those in which there's been change. For cultural and religious reasons many countries in Europe, Asia, Africa and Latin America have historically had lower smoking among women.
If we look at countries that have made progress, as Andy said, the greatest irony of all is that we're a very interesting model for the world in terms of a country that had everything and then threw it all away, seeing what the effects are, if you want to form a natural experiment.
In terms of countries that are moving ahead of us, I think the United States is suddenly where it's all happening. Suddenly through presidential decree nicotine is a controlled substance and a wide number of regulations controlling tobacco are coming out of the Food and Drug Administration. It would be interesting to see what that impact has been.
Another interesting country to watch is the United Kingdom, where there have not been many other strategies except for price. They've shown very similar patterns to ours in terms of the change of price, except that they have maintained their price. The Chancellor of the Exchequer in the United Kingdom has a policy of increasing tobacco taxes at 3% above inflation rates every year. So it's getting progressively more and more expensive, relatively speaking, and they've managed to hold the line in terms of smuggling not being a huge problem.
Unfortunately, they don't have many other strategies at the moment, but they have produced very meaningful reductions. When there was a major reduction in tobacco taxes about 15 years ago in the United Kingdom, the change was similar to what we have seen here in Canada, namely that smoking went up promptly until tobacco taxes were put in place again.
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As we've stressed before, that's merely one plank. It happens to be a very effective plank, as most people know that when things are more expensive you are less likely to buy them.
Mr. Dhaliwal: I have a final quick one. I presume that if our energies are spent, one of the major areas is adolescents, so that we stop them from starting, because once they start smoking it is very difficult to stop them. It's in the teen years that we should put a lot of effort to get the long-run benefit and the most bang from the dollar. Is that the...?
Dr. Goodyear: Yes, this is very much the attitude that President Clinton and the Food and Drug Administration have taken. In our early years, many of us worked in smoking cessation projects. I work in those with Countdown and the Canadian Lung Association.
In terms of return on the investment of time, effort and finance, it's not a rewarding game at all. Blocking entry into the pool of current smokers is where the real return is, although, as any of you who have children know, trying to get children to change their behaviour is not an easy matter.
Again, there is not some easy solution. People ask why kids are smoking more these days. There are a lot of influences, and part of it of course is rebellion against what's happening in the world and the sort of message they're getting. But when you listen carefully to children, they are very interested in this topic. They often come up with some very interesting ideas as to how smoking could be controlled.
I had the interesting experience recently of going to a high school in a fairly poor neighbourhood in the Hamilton region and showing some videos that the Ontario Ministry of Health had produced for grades 5 to 7. Those children didn't identify with those videos at all. They didn't see themselves in the advertisements. So I asked what they would do to try to get their colleagues, the other children in the class, to stop smoking if they were minister of health for a day. Without any prompting at all, they said they would do something about the tobacco industry. In other words, they saw the issue as one of exploitation of children by enslaving them to a life-long addiction by the tobacco industry.
Unfortunately, in Canada we have shied away from that approach. It's been very successful in California. I'm sure some of you have seen the television advertisements produced by the California state health department that have been targeted at the industries as the major pusher of drugs. This sort of thing appeals to children. They're not interested in heart attacks, emphysema and cancer - that's some dreamlike thing to them that exists 60 years in the future - but they're certainly not particularly interested in being exploited.
The Chairman: We're just about out of time, but there's an issue I'd like to pursue. From my own standpoint the central tragedy here is the havoc being wreaked by tobacco, the misery of the death, the health costs and so on. The second tragedy is that the first one continues because of several wilful acts of the tobacco industry. But given the witnesses I have before me, I want to suggest there's a third tragedy, and that is that those who know best, like you, have been much more interested in finger-pointing than in educating and finding solutions.
For example, Dr. Pipe, you mentioned this morning that you wanted to ask the politicians where they have been and what they have been doing. It's a fair question and I'm going to answer it for you.
In 1988 we were doing what you call the state of the art thing, and along the way we got tripped up by the Supreme Court. I'm sure you're not blaming that on the politicians, unless we didn't craft it well enough, I guess. You could blame us indirectly if you're looking for a way to blame. Since the Supreme Court struck it down about 13 months ago, we've been working our butts off to find something that will stand up. So that's where we've been and that's what we've been doing.
As you were asking that question, I was crafting the same question for you. As I was listening to your presentation, I was thinking that if this guy could only communicate what he is saying to enough people, he would convince a lot of people. Before I became a member of this committee I knew in general terms that smoking wasn't the best thing since sliced bread, but I never really heard it in spades until I came here and heard expert witnesses tell us just how terrible this thing is. As you were talking I was asking myself, in almost the same words, where have these people been? Why aren't they out there educating? That's my first question.
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Second, you alluded to the fact that the tobacco industry cost us a number of years, because they had access to certain research they were using to craft their product differently and so on. Did they have the market on that research? Wouldn't people in your specialty, in your discipline, also have access to the same kind of research? Was it that well guarded that they had it and you didn't?
Dr. Pipe: Thank you for your kind comments about my presentation.
I take your point that numerous of your colleagues have worked tirelessly in terms of trying to address this issue. The sad fact remains, we have had three decades since the first incontrovertible evidence came out about the health consequences of tobacco. It has only been in the last four or five years that there has been paid to this the industrious attention of which you speak.
I want to suggest to you that if we had taken the same amount of time before we'd introduced the pasteurization of milk or food products, we would be asking very many questions. There is no subject in medicine in which the nature between cause and effect is as well known as that between tobacco consumption and the variety of diseases caused. I have read reams and reams and reams of documents produced by learned committees such as this, some of which were cited by my colleague just a few minutes ago. I've talked to Dr. Gaston Isabelle, a tireless crusader on this issue.
Inevitably, I am led to the conclusion that ultimately, somewhere, a spanner gets thrown in the works. That spanner is very often wielded by individuals who have unparalleled levels of access to the political process, unparalleled levels of familiarity with the workings of government, and receive large sums of money from the tobacco industry to exercise those particular skills, skills that in many cases were derived and developed during their term as ministers or as members of Parliament.
You quite correctly point the finger at me and say that I and my colleagues have a responsibility to educate. I take your point entirely. I couldn't agree with you more. In fact, a significant portion of my professional life has been given, over the last few years, to addressing this problem. Obviously much more needs to be done.
Dr. Goodyear: To respond, Mr. Simmons, I again recognize one of your more astute questions. I can see where you're going. The answer, as always, lies somewhere in between.
Clearly, as Dr. Pipe has said, yes, the political process has been there, but every time it gets watered down, or regulations get bogged down, and everything gets slowed down. I'm just looking at this morning's Globe and Mail, where it tells you what you're in for from Thursday onwards, with 32 registered lobbyists aiming at you full time. I'm very sorry to see that this includes Marc Lalonde.
There is a very interesting reciprocal relationship - and I'm well aware of your interest in education - between education and regulation. We have been out there since 1950, when the first major scientific reports appeared in the medical literature on smoking and lung cancer, trying to educate. As I indicated before, we are now doing a better job of evaluating what we're doing. We see that public attitude is changing, and it's changing for the better. It is only when that attitude changes that it makes legislation possible, because it becomes politically feasible.
But legislation and regulation also have an education role. In fact, one of the more interesting pieces of research that was presented in Ottawa last week showed the effects on public attitude before and after regulation. A specific example is the removal of tobacco products from pharmacies in Ontario but not in the rest of Canada. This had a considerable degree of public support, but once it had actually been enacted, public support went up considerably. In other words, once they actually saw it as a reality and then realized what a difference it made, suddenly the public was even more supportive of the issue. So there is this continual reciprocity, this continual iterative cycle, between regulation and education.
We are doing our bit. Education has been the only thing that's been out there for a long time. Again, I go back to the children I talk to. They're always saying smoking can't be that bad or the government would have banned it; or if smoking was really bad, why would the government allow what's on that billboard out there?
There is the credibility. If they see the government has cracked down on tobacco, as The Globe and Mail reports today, then they actually believe their educational message as well. We both have to pool our resources - you people and us - and work together as a team on this. Then we will achieve results.
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The Chairman: I have two points. First of all, don't believe everything you read in The Globe and Mail, including the date mentioned today. I wouldn't bank on that one.
Secondly, I thank you, Michael, for responding. I was in part just making the point that finger-pointing by itself tends to divide, and we're all on the same side of this issue. I draw on an example you used during your earlier intervention. You pointed at the sign on the wall and said they have further to go. Well, what's more than total? Do you want it retroactive or what? That's a total ban over there. See if you can improve on that.
Dr. Goodyear: In this particular room, yes, but you can go on railways...well, aircraft have dealt with it. There are many areas in which that particular act can be tightened up and -
The Chairman: I have one question relating to being a politician, which I get paid well for. Even when you do your best and are committed to your cause 110%, there are people breathing down your neck and saying it's not good enough - 110% is not good enough.
We have tried very hard. We didn't shoot down the state of the art piece of legislation that Dr. Pipe referred to. Once it was shot down, we went to work as a government to craft a new piece that was not only effective but would withstand a court challenge. I think what you'll see tabled, not Thursday but before Christmas, is going to be worth the effort.
But even when you do that with 110%, there are a few people saying, oh, it's not good enough, we want 115%. I'm sorry, we can't do better than that. We're doing our very, very best in the circumstances.
Thank you all for coming. I also take Dr. Pipe's comment that you are taking part of your time to educate, and you have certainly done that here this morning. We really appreciate your involvement, and I'm sure we'll be onto you again during the course of this study, if we may. Thank you very much.
I want the committee to stay for two minutes. There are two items of business.
First of all, Bill C-47, the bill respecting human reproductive technologies and commercial transactions relating to human reproduction, has been referred to us. I want to establish a subcommittee to deal with it, and Bonnie Hickey has agreed to chair that subcommittee. I propose that we have three other government members, one official opposition and one Reform member.
Pauline.
[Translation]
Mrs. Picard (Drummond): Yes, but I would like to be on the subcommittee.
The Chairman: Oh, would you?
Mrs. Picard: Yes, I would.
The Chairman: Why?
[English]
And you will be on the committee for sure.
Mr. Volpe: Of course, I have to...a choice.
The Chairman: Are there other Liberals with a burning desire to serve on this subcommittee? If not, we'll let that stand.
We'll get a motion striking the subcommittee and naming Bonnie as chair. We will note for the record that Joe and Pauline will be members of the committee, but we will name the committee next Tuesday.
I would like somebody to give me a motion along the following lines: that pursuant to Standing Order 108(1) (a) and (b), a subcommittee of the Standing Committee on Health composed of Bonnie Hickey as chair, three other members of the Liberal Party, one member of the Bloc Québécois and one of the Reform, to be appointed after the usual consultations with the whips of the different parties, be established with all the powers of the committee except the power to report to the House. The mandate of the said subcommittee shall be to examine Bill C-47, an act...etc.
Mr. Scott: I so move.
Motion agreed to
The Chairman: Congratulations. Thank you, Bonnie.
There is one other issue. We had a travel motion some weeks ago and the liaison committee didn't have any money. I had a chat with Bill Graham, the chair of the liaison, and they got additional funds allocated to the liaison committee, a total of $700,000. Bill suggested to me last night that we resubmit our request.
There's a little problem in that the House leadership requires that we have a date in our request. The date we had in the last motion is now so imminent that we couldn't really meet it. So we have to have a new motion with a new date. Otherwise, it's the same thing we dealt with before: the decision to travel and to request money -
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An hon. member: Except it's not the same amount.
The Chairman: There's one other issue. The amount we went for last time was 73,000, which was predicated on having all members of the committee travel. We can go back for that same amount or for another amount, by which half the committee would travel.
Mr. de Savoye: That amount was based on the fact that we wouldn't use our points to travel, isn't that right? The committee would pay for the travelling expenses. If we do use our points, this is an altogether different matter. It could lower the cost. I'm just submitting the fact.
The Chairman: Yes, the $73,000 was based on the committee paying the whole shot.
The Clerk: We were also going to have a chartered flight, as the committee requested.
The Chairman: Yes.
Mr. Dhaliwal: I have one other point of information, Mr. Chairman. When I attended the meeting with the whips, one of the problems was that the Reform whip did not want to go along with the approval of the expenditure because their member, Mr. Hill, was not agreeable. This was what I was told when I attended the whips' meeting on your behalf. For that reason, we were asked to bring it back to the committee and consult with our Reform members. I was told that's the reason we didn't pass the original budget.
[Translation]
Mrs. Picard: I don't understand, Mr. Chairman. I have been on this committee since 1993, and I think the committee hasn't travelled anywhere except in its consideration of Aboriginals. We have never wasted any funds in travelling and holding our meetings elsewhere, as other committees have done, including the defence committee and the environment committee. They travel all the time. I know that the Standing Committee on National Defence and Veterans Affairs has been around the world. So I don't see why obstacles are always being put in our way. Is Mr. Hill using his power on the Standing Committee on Health to stop us from doing our work properly? Why is the health committee always penalized in relation to other committees, which always get a green light?
[English]
The Chairman: That's a very good point, and I share your frustration completely. Just to understand, though, when a whip refuses unanimous consent, refuses consensus in the meeting of the whips, that doesn't kill the issue. He doesn't have veto through his whip. It means that the government House leadership has to go a different route. I think they have to get a vote. Is that fair?
We can do it over the objection of a particular party. It just gets a little more untidy, if you like, and the government whip prefers we get something that can be agreed to by all parties, so their whips can then agree to it.
Mr. Volpe: I realize the dilemma you're in, Mr. Chair, and in the interest of saving time, if it's useful at all, I share Mrs. Picard's views and I think we put them forth forcefully. This committee has a job to do and the same considerations that a particular party applies to other committees, the foreign affairs committee being latest one, ought to be applied to this committee. It has a job to do, and it should be allowed to do its job, period.
The Chairman: In light of what's been said, we can hold the thing until next Tuesday, when we will have a representative of the Reform Party here? Is that agreed?
Some hon. members: Agreed.
The Chairman: Thank you.
This meeting is adjourned.