TOBACCO CONTROL ACT, 1993 / LOI DE 1993 SUR LA RÉGLEMENTATION DE L'USAGE DU TABAC
ONTARIO CAMPAIGN FOR ACTION ON TOBACCO
CANADIAN ASSOCIATION OF CHAIN DRUG STORES
CANADIAN CANCER SOCIETY, ONTARIO DIVISION
ONTARIO PUBLIC HEALTH ASSOCIATION
ONTARIO DISCOUNT DRUG ASSOCIATION
SOCIETY OF INDEPENDENT COMMUNITY PHARMACISTS OF ONTARIO
PHARMACISTS IN SUPPORT OF BILL 119
ASSOCIATION OF LOCAL OFFICIAL HEALTH AGENCIES
CONTENTS
Tuesday 1 February 1994
Tobacco Control Act, 1993, Bill 119, Mrs Grier / Loi de 1993 sur la réglementation de l'usage du tabac, projet de loi 119, Mme Grier
Ontario Campaign for Action on Tobacco
Michael Perley, director
John Ronson, chair
Canadian Association of Chain Drug Stores
Jim Waters, representative
Rod Stamler, principal, Lindquist, Avey, Macdonald, Baskerville
Canadian Cancer Society, Ontario division
Dr Donald Cowan, chairman, joint medical advisory committee
John Watson, volunteer
Mabel Fraser, volunteer
Kelly Fairchild, volunteer
Ruth Lewkowicz, chair, public issues committee
Ontario Public Health Association
Jane Underwood, president
Peter Elson, executive director
Ontario Discount Drug Association
Zel Goldstein, representative
Marvyn Lubek, representative
Ontario Medical Association
Dr Tom Dickson, president
Dr Verna Mai, chair, public health committee
Dr Ted Boadway, director, health policy department
Society of Independent Community Pharmacists of Ontario
Jerry Taciuk, chief executive officer
Pharmacists in Support of Bill 119
Jim Semchism, co-chair
Nghia Truong, co-chair
Margaret Frankovich, founding member
Association of Local Official Health Agencies
Richard Cantin, vice-president
Dr David Butler-Jones, member
Dr Helena Jaczek, president
Canadian Oncology Society
Dr Michael Goodyear, spokesperson on tobacco and health
STANDING COMMITTEE ON SOCIAL DEVELOPMENT
*Chair / Président: Beer, Charles (York-Mackenzie L)
*Vice-Chair / Vice-Président: Eddy, Ron (Brant-Haldimand L)
Carter, Jenny (Peterborough ND)
Cunningham, Dianne (London North/-Nord PC)
Hope, Randy R. (Chatham-Kent ND)
*Martin, Tony (Sault Ste Marie ND)
*McGuinty, Dalton (Ottawa South/-Sud L)
*O'Connor, Larry (Durham-York ND)
*O'Neill, Yvonne (Ottawa-Rideau L)
Owens, Stephen (Scarborough Centre ND)
Rizzo, Tony (Oakwood ND)
*Wilson, Jim (Simcoe West/-Ouest PC)
*In attendance / présents
Substitutions present / Membres remplaçants présents:
Arnott, Ted (Wellington PC) for Mrs Cunningham
Haslam, Karen (Perth ND) for Ms Carter
Murdock, Sharon (Sudbury ND) for Mr Rizzo
Wessenger, Paul (Simcoe Centre ND) for Mr Hope
White, Drummond (Durham Centre ND) for Mr Owens
Clerk / Greffier: Arnott, Doug
Staff / Personnel:
Boucher, Joanne, research officer, Legislative Research Service
Gardner, Dr Bob, assistant director, Legislative Research Service
The committee met at 1003 in room 151.
TOBACCO CONTROL ACT, 1993 / LOI DE 1993 SUR LA RÉGLEMENTATION DE L'USAGE DU TABAC
Consideration of Bill 119, An Act to prevent the Provision of Tobacco to Young Persons and to regulate its Sale and Use by Others / Projet de loi 119, Loi visant à empêcher la fourniture de tabac aux jeunes et à en réglementer la vente et l'usage par les autres.
The Chair (Mr Charles Beer): Good morning, ladies and gentlemen. We begin our second day of hearings by the standing committee on social development into Bill 119, An Act to prevent the Provision of Tobacco to Young Persons and to regulate its Sale and Use by Others.
ONTARIO CAMPAIGN FOR ACTION ON TOBACCO
The Chair: I'd ask the representatives from the Ontario Campaign for Action on Tobacco if they'd be good enough to come forward. As they do so, I just note for committee members that we have received from the research group copies of the press clippings with respect to yesterday's opening hearings.
Gentlemen, welcome to the committee. If you'd be good enough to introduce yourselves, then please go ahead with your presentation. We have half an hour.
Mr Michael Perley: Good morning, committee members. My name is Michael Perley. I am the director of the Ontario Campaign for Action on Tobacco. With me is John Ronson, the chair of the campaign and also a senior volunteer with the Canadian Cancer Society. We have a considerable brief, which has been distributed to you, that we would like to summarize the main points of, and also respond to your questions.
First, a brief word on the Ontario Campaign: As you probably already know, we are made up of the major health charities in the province, notably the Canadian Cancer Society, Ontario division, the Heart and Stroke Foundation, the Lung Association of Ontario, the Non-Smokers' Rights Association and the Ontario Medical Association. At a conservative estimate, I'd say our groups represent in the neighbourhood of 300,000-plus volunteers and physicians and medical professionals across the province, all of whom share the concern we all do about the effects of tobacco and the need to control it.
Our campaign is based on four pillars, if you like, four main objectives that we want to see enshrined in legislation.
First is the control of sales to minors. We have placed a special emphasis on the need for a retailer licensing system, which we can perhaps discuss a bit later.
There is a need for plain cigarette packaging. This is an excellent way to break the link between the tobacco companies' sponsorship advertising, which you discussed briefly yesterday, which they've used to avoid the Tobacco Products Control Act federally, and also an excellent way to make the product less attractive to young people, as Canadian Cancer Society research published in January shows.
You've heard a great deal already about the ban on sales in pharmacies. You'll certainly hear more, particularly, I think, in the weeks ahead, from pharmacists who've successfully taken tobacco out and have not suffered. On the contrary, in some cases I think you'll see evidence that their financial and business position has improved subsequent to removing tobacco from the pharmacy. Also, there are the many ethical and professional issues you've heard discussed yesterday already. I won't summarize them here, except to say that we very strongly support this ban. It's one of our four main pillars, and in fact we feel, and we'll recommend later, that the legislation gives too long a time period for the implementation of that ban. We'll discuss that briefly later.
Finally, and no less important than the other items, is the need to further control environmental tobacco smoke. There are two aspects to this, one respecting Bill 119 and one respecting another piece of legislation. The public places designations in the bill are important. We'll have comments on how that might be improved. Also, though, the Smoking in the Workplace Act, which is not under the jurisdiction of this committee at the moment but which is an important vehicle for controlling smoking in the workplace, we feel needs to be strengthened. We know the Ministry of Health is interested in this. The Ministry of Labour is interested in this. I'm sure this committee will be interested in considering a recommendation along those lines, and Mr Sterling, whose long record on this issue is well known to us all, I'm sure will be particularly interested in this.
Those are the four main areas of our campaign. We'd like to very strongly congratulate the government for the initiative that it's shown in bringing this world-precedent-setting bill forward. I don't think anyone in the health community feels this bill is anything less than world-precedent-setting in its present form.
We'd also like to congratulate the opposition parties for their assistance in moving the bill forward through the legislative process to this point. We obviously have some disagreements over the substance, which we're all prepared to roll up our sleeves on, I think, and already have, but I think in terms of the overall progress of this bill through the Legislature, they're to be commended as well, and the government for its strong support of a strong initiative.
I'd like to very quickly summarize, realizing that our brief is probably somewhat more detailed and technical than other briefs you may get, because we've gone right down to the level of some language changes, some technical amendments. We've really given the bill a thorough going-over and have a number of what we've called initially technical or language-related amendments, which we don't believe are controversial. We hope they won't be, at any rate. These concern:
The prescription of identification required to purchase tobacco industry products. We think that can be better defined in the legislation and we have a recommendation in respect to that issue.
How a pharmacy is defined: This came up yesterday. We feel that a pharmacy can be better defined to prevent the possibility that was raised yesterday of easy access between a pharmacy and contiguous retailer who may sell tobacco products, whatever their relationship.
The definition of health warnings and other information required on signs and sponsorship advertising under sections 5 and 6: At the moment warnings only are required. We suggest a change to allow for other health information; for example, a quit-smoking telephone number or information of that type to be put on these signs. I think that should be a way to increase the information value of them. We don't think it will be controversial to the committee.
Make public the reports to be published about the activities of wholesalers under section 8.
The definition of school grounds: Again, you've already discussed this yesterday, and I think there's unanimity that we need to make sure that a school, as defined in section 9, includes the grounds. I sensed there was agreement yesterday on this matter.
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Somewhat more substantive suggestions we have to make concerning some amendments, which again we hope would be non-controversial, but they're not simply technical or language-related, particularly concern the control of tobacco paraphernalia. These paraphernalia are things like tobacco papers, tubes and in particular the cigarette cases that are now available with manufacturers' current logos and designs on them, which the manufacturers may more widely distribute if the packaging is controlled to limit the amount of design and colour and what not that's on there now that allows the link between the sponsorship advertising and the packaging. So we have a recommendation concerning that.
I will just very quickly summarize the items here -- I won't discuss them because of time limitations -- and then please question us on any aspect you're concerned with.
The banning of kiddie packs, that is, packages of cigarettes of less than 20: I think we're all concerned about that, a lower-priced package with fewer cigarettes, and not only the 15s that are available now, but there are fives that have been test-marketed in Ontario and elsewhere. These bring cigarettes within the price ambit of young people, and we think they're a problem. The packaging section should allow this by regulation, but you may want to make it more specific.
Types of identification: They're prescribed under the liquor licence legislation. We suggest using the same prescription for identification.
Control of point-of-purchase displays: These are the countertop displays that you find in many drugstores and convenience stores and in aisle displays as well. I think you'll hear evidence, certainly from some of our colleagues in pharmacy, that they, in their view, encourage shoplifting and theft, provide an excellent advertising vehicle for the industry and are not designed to encourage reduction of smoking or invisibility of the product, by any means; quite the contrary.
I mentioned the limitation of the time exemption for implementation of the pharmacy ban. Very simply, the college requested the legislation in June 1991, as you've heard, and recommended a series of progressive steps under which pharmacies should reduce the visibility and availability of tobacco products at their counters.
Now, anybody who's gone into a Shoppers Drug Mart store, in particular, recently, or many other pharmacies, knows perfectly well that not only have they not taken the tobacco out of their stores but it's just as visible and just as available as it ever was. They've taken no action under the voluntary ban. At the same time, you hear opponents of the ban argue that a voluntary tobacco reduction program is what the profession should be doing. So the two don't add up, just as the counselling versus going-out-of-business argument doesn't add up.
So we would strongly recommend that given how much time the profession has had -- and many pharmacies, and you'll hear from many of them during these hearings, have done something about it, but we feel that given the amount of time they've already had to do this, nearly four years probably by the time we get into the next sitting of the Legislature, we should simply give them three months from the date of proclamation of the act, which won't be for several months yet. Let's remove this item.
Another thing which is substantive and we hope will be non-controversial and will aid the Legislature very much in evaluating Bill 119's success ultimately is an annual report we would recommend that the chief medical officer of health be required to make to the Legislature on the effectiveness of the bill, how its various provisions are working, how it's contributing to the achievement of the provincial tobacco use reduction targets you're all familiar with and how we're doing on enforcement: Have we got enough personnel? What are the charges like? What are the fines that are levied? Are they serving as effective deterrents? I think that would be a useful way for the Legislature to keep close track of the success of this landmark bill.
We think that conviction under section 16 with respect to breaking the terms of the act should have a greater prohibition than simply a six-month sales ban for a third or subsequent conviction. If you get a wholesaler or retailer who's repeatedly defying this legislation, we strongly recommend that you increase that prohibition on a third or subsequent offence beyond six months; probably to a year would be effective, we feel.
Some qualifications on the use of tobacco by aboriginal persons: Our concern here is strictly that such uses do not expose anyone else involuntarily to secondhand tobacco smoke, and we say that in the context of secondhand tobacco smoke or environmental tobacco smoke, ETS, as it's called, as a known human carcinogen, a group A carcinogen as defined by the Environmental Protection Agency in the US. This is a very serious matter, exposure to this material, and we feel that uses which should be appropriate under spiritual tradition should not, nevertheless, be able to negatively affect the health of other persons involuntarily.
We have some other substantive amendments which we'd like to discuss with the committee. These are things that we think need to be done, need to be addressed. We would advocate that you consider them. We would like to discuss them with you. We would like, if you're interested, to prepare additional material on them. We'd like to put them on the table at this point. For various reasons, our groups feel quite strongly about them.
The first is a ban on spitting or chewing tobacco. We've presented some summary evidence in our brief about the negative health consequences of that material. It's not of epidemic proportions in Ontario at this point. We have an opportunity to cut it off before it really takes hold, as it has in the United States. There are obvious exemplars out there in the sports field of sports players who use it. That makes it very attractive to young people, as we all know. We feel that given the kind of damage it can cause, oral cancers being the most prominent type, there's no redeeming value in this material at all, quite the contrary, and we should do something about it sooner rather than later. You'll be hearing in more detail about this from medical experts as the hearings proceed.
We think, concerning the designation of public places where smoking is now prohibited under the bill, that this issue should more properly be addressed by simply banning smoking in public places, all public places, except where specifically exempted by regulation. This is called reversing the onus of this provision.
The reason we say this is that we think, given the seriousness of this issue from an environmental tobacco smoke point of view, direct use point of view, we all know the statistics, it's about time that the people who want to allow this, want to encourage it, want to promote it, want to expose others involuntarily to it should be forced to come forward to the ministry and explain their reasons why their proposed use is harmless or will not affect anyone unnecessarily or involuntarily. I think this would be a very effective limitation on public place exposure by many people to environmental tobacco smoke.
We also referred earlier to the Smoking in the Workplace Act and the need to strengthen it. This isn't something this committee would deal with, we understand, directly, but you may want to recommend that the Ministry of Labour and the Ministry of Health get together on this and move forward. There seems to be some consensus that this needs to be done. So it's important.
In light of the controversy that's erupted the last few days over the tax issue, just very quickly, because I see our time is shrinking rapidly, if the tax reductions happen, there's no question by anybody's estimates that smoking among young people will go up dramatically. We appear to be headed for greater numbers of young people entering the market than currently enter the market under the proposed tax rollbacks that may happen. We hope they won't.
If they do, control of retail sales becomes even more important. We now have a statutory prohibition in this bill. We feel that if the tax rollbacks occur and the greater numbers of young people come into the market as a result that are predicted by the Department of Finance and others, we definitely will need retailer licensing. We have done a lot of work on retailer licensing. We've drafted language of a system. We've investigated it. John will speak about it in a moment. We think that you'll need to look at that but, again, in the context of tax rollbacks.
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Finally, again if the tax rollbacks occur, the need for plain packaging requirements sooner rather than later. This will be an extremely important issue in terms of deterrence of young people. The cancer society's research shows it. Also, it makes it a lot easier to control what contraband there is.
Forgive me for taking a lot of time there, but I wanted to run over all those items for you and refer you to our brief where there is substantive discussion of them all.
John Ronson will now present to you on some of the aspects of the bill, particularly plain packaging, ETS and licensing.
Mr John Ronson: I'm going to cut this short because I know that a number of members of the committee have questions.
Let me just say that, like Michael, and speaking on behalf of the cancer society and the other agencies involved with the OCAT group, we congratulate the government and we congratulate the opposition parties for really treating this as a non-partisan issue. This issue is far too important for partisanship. We congratulate all three parties for the responsible debate that has gone on to date and that I'm sure will continue as this bill goes through the committee stage and back into the House.
As Michael has mentioned, we are particularly concerned, in light of what's been happening in Ottawa over the past week or so, with the whole issue of a tobacco tax rollback. Were that to occur, it would destroy or seriously compromise the strongest of the four pillars, in our view, which is the effect of price, particularly on consumption by teenagers. We know that if we stop them as teens, they won't start. If that happens, that is going to reinforce the need for a very strong provincial response in the form of this bill. We would urge the committee to report back to the Legislature not only with the bill as it's currently drafted, but with some of the substantive amendments that Michael has described in his presentation.
The presentation, as he's mentioned, goes into great detail with some specific drafting suggestions, and we would be pleased to offer our services to work with you and with legislative counsel as you work through that process. There is information on plain packs and recent cancer society-funded research, and if members of the committee would like a copy of that research, we will certainly provide it.
I think I'll stop there to give you plenty of time to ask questions.
The Chair: Thank you very much. We do have a little time for questions. I'm going to ask members if they can put their questions into one question. I have Mr McGuinty, Mr Wilson and Ms Haslam.
Mr Dalton McGuinty (Ottawa South): Thank you both, Michael and John, for your ongoing good work in an area which is a matter of grave concern to all of us. I use the word "grave" advisedly.
Thank you for your very comprehensive report. I particularly like your recommendation dealing with compelling the provincial medical officer to report annually as to how we're doing with respect to reducing smoking and how the bill is working.
I want to focus quickly on the two more controversial aspects and profit from your presence here and allow you to comment on that.
First of all, I don't think there's anybody, certainly whom I've met or spoken to or heard from in relation to this matter, who is against making it harder for young people to start smoking. And I think most people are prepared to implement reasonable measures to ensure that those who do not choose to do so aren't exposed to secondhand smoke.
Given that, and given that as the thrust of the bill, please tell me how banning sales in pharmacies will assist in that regard.
Mr Ronson: Let me lead on this one, Mr McGuinty. We are not suggesting for a minute that the ban on sale in pharmacies alone is going to have a dramatic impact in terms of either stopping teenagers from smoking or stopping anyone from smoking.
In our view it comes down to the fact that the Ontario College of Pharmacists, which is the regulatory body for pharmacy in this province, has stated publicly and has asked the government and supports the position that pharmacists are members of the health care team; they are primarily members of the health care team and only secondarily are they retailers. That's the fundamental choice that pharmacists have to make. We support that and the member groups of our coalition support that, particularly the Ontario Medical Association.
If pharmacists want to be full players on the health care team, then they have to make the choice. They can't at one end of the store be selling tobacco products which, when used exactly as intended, are lethal, and at the other end of the store be selling the patches and selling prescription drugs that are designed to make people well. It sends out a very mixed message.
We're not suggesting it's going to have a dramatic effect on reduced consumption, and I think that's frankly a bit of a red herring. What we are saying is that we need a comprehensive approach, and I think the government is to be commended for a comprehensive approach. What we're trying to do is reduce the social acceptability. That sends out a very mixed message when so-called health professionals are doing both.
Mr Jim Wilson (Simcoe West): I want to thank you for your presentation and the information you've provided to us over the years.
As you've rightly said, all parties agree on most aspects of this legislation and, from my point of view, as Mr McGuinty has just stated and as you know, expressed consistent concern with respect to the prohibition of the sale of tobacco products in pharmacies.
I dug out the Hansard last night, because everyone keeps quoting the college of pharmacists, and I mentioned this yesterday. On the November 29, 1993, the college of pharmacists, in a submission regarding the sexual abuse legislation, appeared before this committee and asked us to only consider their customers as patients when that person who walks into their store deals directly with the pharmacist. In other words, they were concerned that we would consider them a complete health facility and that if someone were to say something derogatory, if the clerk at the front of the store -- and I know Michael heard this argument yesterday -- were to make an inappropriate remark of a sexual nature, somehow, because they were in the pharmacy, there would be a charge against the pharmacist or the pharmacy as a result of the action of an employee.
What I took from that submission was a recognition from the college of pharmacists that indeed they are retailers and that it's a significant part of their business and that they considered only that contact with the customer, directly between the pharmacist and the customer, to be the patient-pharmacist relationship. We were told that normally occurs at the pharmacist's counter and that the rest of their operation was essentially a retail operation. As a retail operation, I think they wanted us to respect the fact that they pay retail sales tax, that they're considered a retail outlet and that they wanted, as the language is, a level playing field with all other retail outlets, including the right to sell legal products such as cigarettes.
You've had 24 hours to think of this, so I'm sure you have a great response. But I was somewhat confused because they were concerned at that time, at the end of the day, I think, that the gist of the bill ended up being that they were considered a health facility, yet the college at that time, I again stress, wanted to make sure that we knew they were also retailers selling legal products.
Mr Ronson: I'm going to turn this to Michael, but let me respond quickly to the level playing field argument. That cuts both ways. Pharmacists have a monopoly on the sale of prescription drugs. Let's not forget that. They have a monopoly in that area. So the level playing field argument cuts both ways. But I'll let Michael respond.
Mr Perley: Yes, that's part of what I was going to say. First of all, we talk about this substance as a legal product, and yes, it is a legal product. It is an anomaly. It is unique. There's no other product in the retail marketplace I know of that kills when used as intended. I have a sense that this is going to entrench if we're not careful about this issue, that the "legal product" designation is going to keep being repeated.
Rather than saying, "Well, wait a minute; yes, it's legal," if it were now proposed for use in the marketplace, it would not be allowed into the marketplace. So while we have its designation as officially legal at the moment, we all know about its effects. We all know that it has no redeeming value, and we have to treat it as an anomaly. I think that becomes even more important in the context of retailers and business people who have at the same time -- they engage in retail activity, of course, but they have an ethical responsibility, a code of conduct, they're regulated under the Health Disciplines Act. I believe the code of conduct of the Ontario college reads in part, "Pharmacists should never knowingly condone the dispensing, promoting or distributing of drugs" -- and nicotine and the materials in these cigarettes are certainly drugs, particularly nicotine -- "which lack therapeutic value for the patient."
It seems to me that if there's a substance on the market which more lacks therapeutic "value" for the "patient," I don't know what it is other than cigarettes, and particularly nicotine. So I think we have to look at this situation as an anomaly. Again, we can keep saying, "Yes, it's a legal product." Why are we here regulating this product if it's just another legal product? So we have problems with this that I've described and I think we have to look at the product in that context.
Mrs Karen Haslam (Perth): I wanted to touch briefly on the possibility of bringing in a tobacco control board -- because you mentioned it; it was raised yesterday -- and whether that would be a long-term goal of the health community to put it into a situation where it was very similar to the Liquor Control Board of Ontario. I wondered if you see that helping us achieve our policy in this area or whether we're looking at this legislation as a first step. Spitting tobacco was the other one; you said, "Ban it now." Would you look at this legislation as being the first step and coming back to some of these problems in the future over the long term or would you recommend: You've got it here; do it all now?
Mr Ronson: Certainly, on spitting tobacco, our recommendation would be do it now. The problem can be dealt with now. It hasn't, as Michael mentioned, become an epidemic. It risked becoming one as a result of role models or lack of role models like Pat Borders, who must be one of the most notorious for those of us who watch Blue Jays games.
On the question of the tobacco control board, Mrs Haslam, we do not support that, certainly at this stage. Whether we would at some future stage, I think, is hypothetical. However, as Michael mentioned, the sister agency of the liquor control board, the Liquor Licence Board of Ontario -- we would support the use of the liquor licence board mechanism to license retailers of tobacco products. Indeed, we've had preliminary discussions with the liquor licence board, and its legislation would allow it to take on the licensing function for additional products.
The Chair: I'm sorry. We're going to have to end our questioning there, but I want to thank you for your submission. As you indicated, there may be other material you want to bring to the committee's attention. Please do so. I suspect that you will be close to the hearings as we go along in any event.
Mr Perley: I have just one item quickly, a brochure we've prepared stating the full case in support of the pharmacy ban. I'll provide that to the clerk for distribution to the committee.
CANADIAN ASSOCIATION OF CHAIN DRUG STORES
The Chair: If I could then call upon the representatives from the Canadian Association of Chain Drug Stores. If you would be good enough to come forward. Welcome to the committee. Once you've had a chance to get settled, if you would introduce yourselves for the committee members as well as for the television camera. You have half an hour for the presentation.
Mr Jim Waters: Good morning, Mr Chairman, honourable members. On behalf of the Canadian Association of Chain Drug Stores, I would like to thank you for the opportunity to appear before you today and to share our views on Bill 119. My name is Jim Waters. I'm executive vice-president with Canada Safeway. We are a member of the Canadian Association of Chain Drug Stores. We also operate pharmacies in northwestern Ontario.
The Canadian Association of Chain Drug Stores was established in 1989 as a national industry association of small, medium and large drugstore chains. Our members represent almost 50% of the community pharmacies in Canada and one third of Canada's pharmacists. Together we fill almost 60% of all prescriptions in Canada.
As a national association, we are naturally concerned with provincial legislation which may have ramifications in other jurisdictions. We are here then to voice our concern over paragraph 4(2)8 of Bill 119 and to present to you some new research that bears directly upon this bill.
With me today are Rod Stamler and Mario Possamai of Lindquist, Avey, Macdonald, Baskerville. In preparing to appear here, we asked ourselves what the most useful information was that could be offered to this committee. We came to the conclusion that a definitive study on the contraband tobacco market and the impact Bill 119 would have on it would be a valuable addition to the information base on which the committee and the government will make their decisions ultimately. To gather that information, our association approached Lindquist, Avey.
Lindquist, Avey is Canada's leading forensic accounting firm. The firm's reputation was established in its work on money laundering and the drug trade in Canada and around the world. In recent years the firm has become the recognized expert on the contraband tobacco market in this country.
The study you will hear today will present to you evidence that the pharmacy tobacco sales ban does not represent a public policy gain, nor a gain for public health. We support the intent of the bill, but the study demonstrates what we all know, that banning the sale of tobacco in drugstores won't lead to one less cigarette being smoked.
I would like now to introduce you to Mr Rod Stamler, a principal and corporate investigator with Lindquist, Avey. Rod is an internationally recognized expert on the illegal drug trade and the underground economy as a whole. He will explain to the committee the results of his study and then show a brief videotape produced in conjunction with his research. We will then be delighted to hear any questions.
Mr Rod Stamler: As Jim Waters stated, I am a principal at the firm of Lindquist, Avey, Macdonald, Baskerville. We are a firm of forensic and investigative accountants and we have been investigating the contraband tobacco trade since 1990.
For 33 years I was a member of the RCMP, retiring in 1989 as assistant commissioner. In the 1980s I headed the RCMP's effort to control another illegal market; namely, illegal drugs. For a number of years I worked at the United Nations on international drug money laundering and strategies. I mention this because the problem of dealing with drug traffickers is not unlike that of trying to control the contraband tobacco market. We have just completed a comprehensive investigation of the contraband market in Ontario. This morning I want to present our findings. I want to explain why, in our view, banning tobacco sales in pharmacies will contribute to the contraband problem and why it will not reduce tobacco consumption, especially among the young people.
Let me begin by introducing a video documentary we have prepared. It summarizes our report and outlines some of the implications of Bill 119's proposed ban on tobacco sales in pharmacies. Could I ask that the video be turned on?
Video presentation.
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Mr Stamler: As you saw in the video, if you go to the Cornwall area on any given night, you will find snowmobile after snowmobile ferrying contraband cigarettes into Ontario. Police estimate that 50,000 cartons of contraband cigarettes are moved across the St Lawrence each day and they can only seize a tiny portion of that amount.
Our research indicates that Ontario consumers will easily buy illegal cigarettes from a variety of outlets. Some commonly found typical purveyors are independent corner store operators, bars, restaurants and other similar outlets. People are also selling out of their homes, their basements, their garages. As a matter of fact, this morning I spoke to one of my colleagues and he said, "I was coming through the underground system from the subway into our building and there was a man sitting there with cartons of tobacco, selling them to passersby." That was this morning, underground in downtown Toronto.
The plain fact that retailers of contraband cigarettes face little risk that their dual inventories will be detected by law enforcement spurs them on in this particular market. Even if they are detected, enforcement does not seem to be a deterrent.
For contrast, let us look at 1,400 drugstores currently selling tobacco in Ontario. They do so in an atmosphere of tight regulations and exacting internal policies and procedures. Pharmacies are less likely than other retailers to hold dual inventories of both illegal and legal tobacco products. The incidence of pharmacies being implicated in contraband sales is extremely rare. In addition, pharmacies maintain and promote strict standards with respect to prohibiting tobacco sales to underage customers.
Let me also draw your attention to a key point in the video: Young smokers have no trouble getting contraband cigarettes from a variety of outlets, but not from pharmacies. This is demonstrated in the dramatized sequence between the clerk and the underage person you just saw.
As indicated in the video, we estimate that in 1993, more than one in four cigarettes consumed in Ontario was contraband. We conservatively estimate that by 1999, if there is no change in federal-provincial taxes or in any other factors which may affect the contraband market, nearly half the cigarettes consumed in Ontario will be contraband.
What could change this scenario is if customers could no longer buy cigarettes in pharmacies. Let's look at what would happen. In doing so, four factors need to be kept in mind:
First, public opinion surveys indicate that consumers will go elsewhere to buy cigarettes.
Second, our research and that of others indicates that participating in the contraband market is tolerated by many residents of Ontario.
Third, research indicates that smokers are very price-sensitive. They seek out the best deal they can.
Fourth, a number of social studies have shown that if people believe that their neighbours are cheating the tax system, they'll also be inclined to do it themselves.
If consumers cannot buy cigarettes from drugstores, they will seek out alternative sources. Some, like independent corner stores, have commonly been found to be typical purveyors of contraband tobacco products, or they may learn through word of mouth that they can buy cheap cigarettes. That's the term that is used when people walk into a store, "I want the cheap cigarettes." Thus the possibility of coming into contact with the contraband market increases, and since smokers are extremely sensitive to lower prices, the likelihood will also increase that they will opt for the much cheaper contraband product.
In our view, the fewer number of legal retail outlets, the harder it will be for smokers to obtain cigarettes legally and the more likely it will be that they will participate in the contraband market.
What smokers will find on the market are these kinds of brands. I have here a package of regular duMaurier, which is manufactured in Canada, exported and smuggled back into Canada duty-free. No US tax, no Canadian tax is applied to that particular product. It sells for about $22 a carton average.
We also have here a package which is very similar in style called DK's and a package called Commonwealth. These two are Canadian-blend tobacco products manufactured in the United States and developed and blended to Canadian standards and tastes. They sell for about $15, $16 and $17 a carton.
We have here a package of Player's cigarettes, also manufactured in Canada, exported, smuggled into Canada, sold for $22 a carton; Putter's Light, resembling Player's, $16, $17 a carton, $22 a carton, manufactured in the United States, manufactured in Canada.
Another product, Export A, is $22 a carton on the black market. Canada Goose, again manufactured in the United States, sells for $15 or $16 and I believe it would drop to $15 and $14 a carton for these particular products if there is any change in price of the regular Canadian manufactured product.
We also have other brands, such as Raven, which is sold for $15 a carton. It's the cheapest, if you will, of the contraband cigarettes and it's manufactured in the United States, Canadian blend. Another very popular brand is Marlboros, of course, all smuggled into Canada. They sell for between $17 to $22 a carton, and are manufactured in the United States, but no US tax is applied to this particular product. So it really doesn't matter what the US price is, because at the present time the contraband dealers are not paying US tax on any of these products. They're coming into Canada tax-free, period.
In our view, by banning cigarette sales in pharmacies, Bill 119 will not further the government's objective of reducing tobacco consumption. Who will benefit? Criminals are attracted to the contraband market by high profits and relatively low risks, and this is an illegal enterprise. Not surprising, our research indicates that there is involvement in the contraband sector by many organized criminals. There are indications that some tobacco smuggling networks are also handling other illegitimate products, including alcohol, arms and illicit drugs.
This suggests that crime groups are well positioned to move into other commodities and it is a worrisome development when one considers that Prohibition in the United States created groups that went on to dominate organized crime in North America for decades.
In conclusion, let me state that in our view banning tobacco sales in pharmacies will not reduce consumption in Ontario, but it will create a new opportunity for the contraband section. Our conclusion is that banning tobacco from pharmacies will contribute to the expansion of the contraband market. Thank you very much.
Mr Jim Waters: We'd now be pleased to answer any of your questions.
The Chair: Okay, thank you very much. We are under a tight time frame so I'm going to be able to permit two questions on this round. Mr Wilson and Mrs Haslam.
Mr Ted Arnott (Wellington): Mr Waters, you're a pharmacist.
Mr Jim Waters: No, I'm not.
Mr Arnott: Are there any pharmacists here among your numbers? Do you agree that it's ethically inconsistent for pharmacists to be selling tobacco products?
Mr Jim Waters: Our position on that really is that tobacco is a legal product and will continue to be in the foreseeable future. There are special interest groups out there that think retailers should not be selling disposable diapers. Some special interest groups think we should not sell contraceptives or certain products from certain countries. The truth is, as I stated, tobacco is a legal product. As long as it remains that, we feel that it's unfair to single out one class of retailer and say, "You cannot sell it," when all other retailers who wish to, can.
Mrs Haslam: I have so many I don't know where to begin. We receive letters, and this one is from the Sudbury district health unit, talking about public policy being dictated by individual economic self-interest or by enlightened public health policy. In your brief, you talk about how you are stringently watching the sale of tobacco, whereas I come at it as an idea where I think the statistics prove that when you reduce the number of places selling tobacco and the availability, the young people won't be so prone to start.
On page 12 of your report from Lindquist Avey you say, "A common practice in the industry is that if an employee of a drug store sells tobacco to a minor that would be just cause for his or her dismissal." Do you have any statistics or can you tell me how many employees have been dismissed for doing this?
Mr Stamler: Yes, not an exact number but there have been quite a number. From the members we have contacted, there have been quite a number of those incidents, I would estimate in the range of 25 to 30 situations, where people have been either warned or disciplined or dismissed.
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Mrs Haslam: So even in a situation in your stores, there are still opportunities for young people to buy cigarettes illegally.
Mr Stamler: I'm sorry. Illegally?
Mrs Haslam: There are still opportunities for young people to have access to cigarettes.
Mr Stamler: Yes, but I must point out that by sending them elsewhere, that same young person goes to a convenience store that also sells contraband products. My question would be to myself --
Mrs Haslam: By increasing penalties within the legislation, we then may be able to address that concern at convenience stores.
Mr Stamler: It's my opinion that legislation will not control that kind of activity. It's my opinion that this is a consensual criminal activity in Canada and in Ontario, and I don't believe law enforcement can do much damage in terms of dealing with that kind of criminal activity.
The Chair: I'm sorry, but we're going to have to end there. I would just note that you have provided us with the full document of the study that you have done and members will have an opportunity to consult that as well. I thank you for coming before the committee today, for your presentation and for the video.
Mr Jim Wilson: Mr Chairman, I would like to seek some information from the parliamentary assistant at this point.
Ms Haslam just made a statement as a member of the government side. I'd like to see how it's backed up. She said that if you reduce the number of places that sell tobacco, statistics prove that it will decrease the number of young people smoking. When I pursued this matter with the minister, she was unable to produce any statistics or studies. I'm wondering if the parliamentary assistant can produce such statistics or studies, and I would request that of him.
Mrs Haslam: That's true and I would like to clarify. I meant that statistics show that when you reduce the number of places available that sell cigarettes, the number of people who smoke are reduced. I apologize if I said young people.
The Chair: Okay. I think the request stands.
Mr Jim Wilson: Young or old.
Mr Larry O'Connor (Durham-York): Thank you for that question, Mr Wilson. I'm sure that as we proceed through the committee hearings, we're going to hear from people like the Addiction Research Foundation who would be better equipped to answer that question. It's been pointed out, and I'm sure we may even hear from people like the cancer society, that if you restrict the number of access points for tobacco products, then you're going to cut out some of the sources that young people are purchasing the cigarettes from, but we'll hear more of that from the Addiction Research Foundation. I'm sure you'll want to ask them that question when they appear before the committee.
CANADIAN CANCER SOCIETY, ONTARIO DIVISION
The Chair: We now have before us the representatives of the Canadian Cancer Society, Ontario division. If you would be good enough to introduce yourselves, then please go ahead with your presentation. We have half an hour.
Dr Donald Cowan: Mr Chair, I'll introduce the members as we proceed.
First of all, may I express our appreciation to you for allowing us to appear here today. My name is Don Cowan. I'm a physician. I've practiced oncology and cared for patients with cancer since 1963, when I finished my training. I work at Sunnybrook Health Sciences Centre and the Toronto Bayview Regional Cancer Centre, I also do administrative work for the Ontario Cancer Treatment and Research Foundation, but most importantly today I am here as a volunteer of the Canadian Cancer Society.
What I propose to do is three things: say just a few words about the cancer society, tell you why we're here and give a few facts about tobacco and cancer, and then introduce three other volunteers and ultimately a fourth volunteer, who have very important personal messages to bring to you.
First, the cancer society, as I think all are aware, is a voluntary, non-profit organization. Its mission is the eradication of cancer and the enhancement of the quality of life of people who have cancer. I think our visit here today is clearly in keeping with that mission, as you will hear. There are about 130,000 volunteers in Ontario for the cancer society and somewhat over 2.5 million who support the Canadian Cancer Society of Ontario.
Why are we here? We're here to applaud the government and all parties in your collaboration on Bill 119. We clearly support the bill. We will have some suggestions, as you will hear towards the end, that we feel might improve the legislation.
The facts about tobacco use and its deleterious effects on health, with particular reference to cancer, are probably clear to everybody around this table and I almost hesitate to reiterate them. The points are clearly laid out on pages 3 and 4 of the submission, and perhaps I should just direct you to those pages and stress several of the points.
Tobacco is a major contributor to about 30% of all cancers, unequivocally so, including about 85% of lung cancer cases. Each year about 13,000 residents in Ontario and 38,000 in Canada die of tobacco-related causes. I'd like to stress point 6. More women now smoke than men and lung cancer is a leading cause of death among women. Lung cancer is a highly fatal form of cancer. Once the diagnosis is made, only about 12% of people survive to the 10-year mark. This compares to some 40% in other forms of cancer.
I haven't said anything about the effects of tobacco on non-cancerous lung disease and heart disease and I think people around the table again know that these are substantial. What I'd like to do is really just stress two points.
Twenty years ago, the consumption of tobacco began to decrease and now we are seeing a decrease or a levelling off of the incidence and mortality curve of cancer of the lung in men. In women, unfortunately, this is an entirely different situation. Young women are beginning to smoke and unfortunately, once addicted, smoke into adulthood. This year, the mortality from cancer of the lung is now just surpassing the mortality of cancer of the breast. It's an epidemic and it's a tragedy. People begin smoking when they're young, become addicted and of course continue to smoke.
I sat around with some colleagues a year or two ago and we discussed at the university what was the single most important thing we could do in terms of health care in our country. Of course, the discussion began as if there was some huge technological advance that we could bring to play.
Clearly, the most important single thing we could do would be to eliminate tobacco. We're practical enough to know that elimination is unlikely, but this legislation can have a major impact. It must proceed. Ladies and gentlemen, the issue is about saving lives, not protecting the income of individuals and corporations.
What I'd like to do now is I indicated I would introduce some of our volunteers and the first individual is Mr John Watson. Mr Watson began using tobacco when he was about 12, he tells me. He was diagnosed with cancer of the tongue and throat cancer four years ago, he's had surgery, he's had chemotherapy, he's had radiation and he continues to battle cancer. I introduce Mr Watson who will tell you his story.
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Mr John Watson: I would preface my remarks by saying that the treatment of my tobacco-induced cancer has left we with a considerable speech impediment. I will not be the least bit embarrassed if anyone should wish me to repeat what I say. I'm most appreciative of this opportunity and I thank you, ladies and gentlemen, for allowing me to be here.
I started to smoke when I was about 12 years old. My father was a very heavy smoker and I used to liberate the odd cigarette from him. I wasn't terribly interested in smoking, but I'm a very determined person, so I stayed with it until it had a hold on me. I had no trouble buying cigarettes. I'm 71 years old. When I was 12, I could buy cigarettes anywhere in Toronto, a package of five cigarettes for five cents; 10 cigarettes for 10; 25 and so on. It was no problem.
At 15 years of age, I ran away to sea. As an ordinary seaman, peer pressure took care of my smoking from then on. I was a very young person in the company of hardened sailors who all smoked a pipe, and if I was trying to be a man among men then pipe smoking was going to be my choice.
I became a very heavy pipe smoker. I was in the merchant marine, where we worked a minimum 84-hour week, so I smoked a minimum of 84 hours the hardest plug tobacco that you could find. It was part of my pay.
My wife is a nurse, my daughter is a nurse married to my oncologist, my sister is a nurse married to a radiologist, so I had certainly plenty of advice about smoking. But I had lost seven ships during the war -- I didn't lose them; I know where they are -- and I was the sole survivor from two of those ships, so I knew that cancer wasn't going to get me.
I appreciated the advice I was getting from my family, but five years ago it got me. I was diagnosed as having squamous cell carcinoma of the oral pharynx, which manifested itself in a massive tumour at the base of my tongue, so massive that when I shaved in the morning, each morning I could see this thing getting bigger.
I underwent seven weeks of simultaneous chemotherapy and radiation, the chemotherapy being cis-platinum, which is very, very strong. I would go in the morning, have my three hours of chemotherapy, nip across the hall for my four million volts of radiation, and hurry back to my daughter's place to throw up for eight or nine hours, so I could be ready to go again the next day.
My weight dropped from 184 pounds to 129 pounds in seven weeks, but at the end of seven weeks I was ready for surgery. The surgery involved cutting my jaw in half and removing the right-hand side, then removing a large portion of my tongue and fastening a new tongue from the muscle in my right forearm and part of my right thigh. I think it's the piece from my leg that makes me run off at the mouth sometimes.
I admire tremendously the task that you ladies and gentlemen have tackled. I don't want anybody ever to have to go through what I have been through. I know that the cessation of the sale of tobacco entirely would be the answer and I also know that can't happen; it never will happen. But we must, with your help, eliminate the ease of purchase of tobacco that young people have today. I am confident in my mind that if we can keep them away from that tobacco until they are really old enough to think about it, they won't do it because the need won't be there, and because nobody is doing it, there will be no peer pressure.
That's my story. I thank you very much for your time and generosity.
Dr Cowan: The next individual I would like to introduce is Ms Mabel Fraser. Ms Fraser is the widow of Paul Fraser, who died last fall, some nine months after having had the diagnosis of cancer of the lung made. He was 55 years of age. He'd been a heavy smoker most of his life, having started at age 12. Ms Fraser will tell us more about this.
Mrs Mabel Fraser: I would like to take this opportunity to thank you for the opportunity to speak to you today. My husband died October 28 last year from lung cancer after having smoked upwards of three packs of cigarettes a day for most of his adult life. In his 55 years, he accomplished much and had great success with all he attempted and was much respected and loved by his peers and family. One battle in life he lost; one thing he could not do, regardless of his many valiant efforts, was to stop smoking.
He started smoking as a child. Who knows why? Desire to be cool or to fit in is rampant among our youth, but what if the means were unavailable? What if the desire to fit in and conform were coupled with difficulty? Perhaps then the end would not be as likely.
A vending machine, for example, provides instant and easy access to even the youngest child. All the laws in the world against selling cigarettes to minors are useless if they have easy access to an impartial machine. At least with human intervention we stand a chance of keeping some children from beginning this horrible addiction. Perhaps in time we can save a few of them from suffering the slow deterioration of body and mind that will almost inevitably kill them before their time, as it did my husband.
The addictiveness of smoking is so strong. He tried several times to quit, using all the toys currently available, from hypnotism to gum, but it was all futile. His habit controlled him completely until the end. After lung cancer killed his father, who was also a lifelong smoker, he said to me then, "I will probably die the same way," but still could not quit. His brothers, two sisters and son-in-law continue to smoke today, even after being devastated by his death.
The human impulse to believe that they are immune to certain things, the "It won't happen to me" syndrome, is especially strong when combined with a severely addictive drug.
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To have cigarettes available in pharmacies must make already sceptical teens laugh. We tell them how bad cigarettes are for them and how smoking may kill them, and then make them available alongside the baby formulas, the toothpaste, the aspirin and the vitamins in pharmacies.
Before he got cancer, my husband said he wished he had never started smoking and hoped his grandchildren, nieces and nephews would never start. Making access to cigarettes harder would be a good place to begin.
In conclusion, my husband finally quit smoking four days before he died, only because his cancer had spread from the lung to the brain and he no longer knew he wanted a cigarette.
Thanks so much for your attention.
Dr Cowan: I'd next like to introduce Miss Kelly Fairchild, who is 15 years old, a high school student, and who told me that at great personal sacrifice she's missing school this morning to be at this hearing. She doesn't smoke but many of her friends do. She will, among other things, tell us how easy it is to buy cigarettes and perhaps something about the effects that advertising has on young people.
Miss Kelly Fairchild: Thank you for this opportunity to speak to you. I believe that this legislation is important, as do many of my friends. I am 15 years old and some of my friends who smoke are 13 and 14. They all started smoking because of peer pressure, yet none of them ever talk about quitting.
I've seen kids smoking almost everywhere: at bus stops, in schools and in restaurants. They don't seem to care about their future health; they only seem to care about what they think looks cool. I don't smoke because I think it's a disgusting habit. Most teenagers care a lot about their appearance. That's why I don't understand why some of them smoke. It turns your fingers and nails yellow, stains your teeth and gives you bad breath, but they still think it makes them look cool.
My mother and my sister, who is underage, both smoke, and at times I find difficult to be around them. It used to be okay with just my mom smoking, but lately, with my sister smoking too, my asthma has been getting worse. I used to buy cigarettes for my mom until I became aware of how dangerous they are, so now I refuse to buy them for her.
I took part in a compliance check last fall. It was then I realized how easy it is for someone under 15 to purchase cigarettes. I believe the legislation should make it impossible for kids to buy cigarettes, especially a single cigarette. Selling singles makes it too convenient and too affordable for kids. I also believe the cigarette manufacturers should not be allowed to advertise cigarettes in teen magazines because it gives teens the impression that it's cool and mature for them to smoke.
Another aspect of selling cigarettes that I think is stupid is that a pharmacy dispenses medicine for the benefit of your health and then it will sell you cigarettes which will eventually kill you. As this legislation stops the sale of cigarettes to kids, I believe there will be less smokers and less cancer victims in the future.
Dr Cowan: The last individual I'd like to introduce is Ms Ruth Lewkowicz, who is a volunteer and chair of the public issues committee of the Ontario division.
Ms Ruth Lewkowicz: Our previous speakers have spoken about the harsh human reality that comes with tobacco use. I'm personally, even though I know their stories, overcome. But my role here today is talk about the legislation, what's good about it and what must be done to make it even better. I'd like to do that by considering the three primary objectives of the legislation separately.
The first objective of Bill 119 is to restrict the sale and use of tobacco products by young people and by others. Access to tobacco products can be significantly reduced by making sure the ban on vending machines remains intact. As we all know from Kelly's presentation and even from our own experience, kids can be very resourceful, and if their access to cigarettes has been cut off through retail outlets, then they will seek out other sources. We cannot let them get their cigarettes from vending machines. That ban must remain intact.
The legislation must also prohibit the sale of kiddie packs. Those are small packs of less than 20 cigarettes that are sold at lower prices. Teens, as research indicates, are very price-sensitive when it comes to cigarettes and kiddie packs are an attractive purchase choice for them. Kiddie packs are already banned in Nova Scotia and British Columbia. We now have the opportunity to do that in Ontario.
The second purpose of the legislation is to reinforce the hazardous and addictive nature of tobacco. The legislation must ensure that the sale of tobacco products in pharmacies is prohibited. Pharmacists cannot continue to dispense lifesaving medications at the back of the shop while selling a lethal and addictive product at the front of the shop. By banning tobacco sales in pharmacies, you are making a clear statement that this is an addictive and deadly product.
While we're on the topic of pharmacies, the legislation must clearly define the term "pharmacy" so that tobacco products are not sold in any area directly or indirectly associated with the sale of health products. The integrity of the legislation cannot be undermined because the stipulations about physical setup, allocation of space and the placement of products are open to interpretation. These definitions must be airtight.
The legislation must also take an aggressive stand on packaging and health warnings. In addition to the strong stand on health warnings and signage, the legislation should mandate the use of plain packages. I have here for your viewing an example of a plain package: a buff background, brand name in a standard typeface. You will note the very prominence of the health warning. Compare that to your average brand pack. I challenge you to find where the warning is on this. I'd be happy to circulate them for you to look at.
The Canadian Cancer Society recently funded research that found that plain packages are more likely to deter children from starting to smoke. The very appearance of the plain package conveys the seriousness of the activity and makes the health warnings more prominent. The research also found that the imagery associated with tobacco products, that it's such a turn-on and so appealing and attractive to teens, is equally a turn-off when they see a plain package.
The third objective of the legislation is to ensure compliance with the law. The law, any law, is only as good as the enforcement. Bill 119 approaches enforcement through statutory prohibition. The Canadian Cancer Society does not believe that's an effective approach. What this means is that the resources to enforce the act through the public's tax dollars will likely come at the expense of enforcement in some other area. This will result in a constant juggling act to determine priorities. Where do you think police officers will place their efforts, in stopping street crime or in policing retailers?
The only effective enforcement approach is through a self-funding licensing system. A recent study in the United States found that sales rates to minors decreased from 70% to less than 5% in 18 months after the imposition of a retail licensing system. This study also found that smoking rates among adolescents were reduced by more than 50%. That, ladies and gentlemen, is what we're all about here today.
In conclusion, the committee faces a critical task that has enormous implications for the health of Ontario residents. I hope that the recommendations provided in the Canadian Cancer Society brief and highlighted here today will help the government make a major legislative step towards eliminating tobacco-related disease in our province. With this legislation and the proposed amendments, the government can feel confident that it will reach its tobacco reduction targets.
On a final note, the Canadian Cancer Society would like to praise the Minister of Health, Ruth Grier, and the Minister of Finance, Floyd Laughren, for their opposition to the reduction of tobacco taxes. We commend them for their strong commitment and leadership on this matter. None of what we are here talking about today means anything if the taxes on tobacco are lowered, because this action will only serve to put more cigarettes in the hands of more children. This government, any government, cannot and should not compete on the basis of price with smugglers.
Bill 119 should be the most effective law in the country. It should be proclaimed as soon as possible and the penalties should be the strongest of anywhere in the world.
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The Chair: I apologize; we're tight for time, if members could keep their questions succinct.
Mr McGuinty: Thank you very much, all of you, for a very compelling presentation. Mr Watson, I for one would be very interested in reading your memoirs about your time in the navy and I hope to see that shortly. Mrs Fraser, I know it was difficult for you, but rest assured that your message has not gone unheard.
Kelly, I want to focus in on you. The primary purpose of this legislation is to make it harder for kids to start smoking. One of the things that it proposes to do is to ban sales outright in pharmacies. I want to know, when you think of your friends who smoke or your sister, how will this ban in pharmacies affect those kids? Will they stop smoking? Will they look elsewhere?
Miss Fairchild: It's more convenient in pharmacies but they probably will look elsewhere. Some of them will probably stop if it's more inconvenient in pharmacies.
Mr Jim Wilson: I too want to thank you on behalf of our caucus for a compelling presentation. On page 7 of your written submission, the last line of the second paragraph that deals with section 9 is a very disturbing sentence. It says, "As the legislation is now written, it would appear to permit the use of tobacco products on the grounds of each of the places cited; in the case of schools and day nurseries, it would permit children and adult role models to consume tobacco products on the property."
I want you to expand on that because certainly the intent of the legislation is to ensure that people can't smoke in day nurseries or on school property.
Ms Lewkowicz: What we're trying to ensure here is that this possibility doesn't exist, that the definitions in the legislation are clear and precise in terms that we're talking inside the building as well as on the grounds.
Right now, in my work, I have the opportunity to go into a school from time to time and I'm appalled by the number of teens Kelly's age and even younger who are loitering around the doorways smoking. We know that in certain day care centres, when the staff are not permitted to smoke in the presence of children, they will just go outside the main entrance and smoke. So what we want to do is eliminate the presence of tobacco from anywhere near where there are children. That's inside and outside.
Mr Paul Wessenger (Simcoe Centre): Thank you very much for your presentation. You certainly impressed us with the need to have the most effective legislation we can in this area. I'm just going to focus in on one area and that is your recommendation with respect to banning smoking in public places. I think this is very important obviously, first of all because of the second-hand smoke aspect, and secondly the more places people cannot smoke, I would suggest that perhaps it has an impact on reducing the smoking level.
What I'd like to know is specifically how you would define what public places where you would prohibit smoking, what you mean by "public places." Do you mean interior spaces, or in some cases you obviously mean interior and exterior, as in the day care situation, and also do we mean by "public places" places the public has access to or do you mean "public" in the sense of municipal property, provincial property, school board property? I wonder if you could elaborate.
Ms Lewkowicz: Go on; that sounds very good.
Mr Wessenger: I'd like to know. I'm looking for something more concrete because I will be quite frank with you: I would like to strengthen this section in the act and I'd like something specific.
Mr Drummond White (Durham Centre): Don't give up.
Ms Lewkowicz: Thank you very much, Mr White. I think what we're after here is that we'd like to define all public places as areas where the public has the opportunity to congregate, both indoor and outdoor. For example, it's not good enough to ban smoking in covered arenas; we also want to prohibit smoking in open-air arenas, places where even though there is fresh air around, the sidestream smoke will affect people sitting next to you or behind the smoker. I think we have to be as all-inclusive as we possibly can.
Mr Wessenger: Thank you very much. I appreciate that.
The Chair: On behalf of the committee, in particular to Mr Watson and Ms Fraser, we know it is not always easy to relate personal experience and we really appreciate the fact that you were part of the delegation today and shared that with us. I'm just sorry that time has run out. Thank you for coming today and for your presentation.
ONTARIO PUBLIC HEALTH ASSOCIATION
The Chair: I call upon the representatives of the Ontario Public Health Association, if they would come forward, please. Welcome to the committee. Once you're settled, please introduce yourselves and go ahead. We'll just let people move out of the room so you will have our undivided attention.
I think some peace has returned, if you would please go ahead with your presentation.
Ms Jane Underwood: My name is Jane Underwood. I'm the president of the Ontario Public Health Association. Anne Lessio is a volunteer member of our organization, and Peter Elson is the executive director of the Ontario Public Health Association.
We are a 3,000-member charitable organization that works to strengthen the impact of people who are active in community and public health throughout Ontario. Our members are drawn from every community health discipline and location within the province, from Windsor to Thunder Bay. They include people from community health centres, public health units, universities and community agencies.
The Ontario Public Health Association is no stranger to tobacco legislation. It was OPHA that called on the Minister of Health to develop a comprehensive tobacco strategy for Ontario. It was our organization that called for effective protection of workers from environmental tobacco smoke. It is public health workers who most often propose and enforce municipal smoking bylaws. OPHA comes to you today to add our voice to the others who see tobacco for what it really is, the leading cause of preventable death in Ontario.
The Ontario Public Health Association strongly supports the introduction of legislation which will restrict access to young people and will protect non-users from environmental tobacco smoke. Enforced legislation is crucial in the overall strategy against tobacco industry products, as is public education and societal support for healthy children.
We want to express our appreciation to the government for taking a leadership role in the tobacco fight by introducing Bill 119. We also want to take this opportunity to acknowledge the support of the opposition parties in making tobacco use a non-partisan matter and supporting the bill throughout the legislative procedure.
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Bill 119 aims to prevent the provision of tobacco to young persons and to regulate its sale and use by others. OPHA strongly supports this intent. There are, however, a few comments we would like to make for your consideration.
OPHA commends the government for the provisions in Bill 119 that restrict access by raising the legal age of purchase to 19 and requiring proof of age as important steps to achieving the goal. The onus must be on tobacco retailers to operate legally. Research has indicated that these measures prove very effective in reducing youth access to tobacco industry products.
Minors have little difficulty in purchasing tobacco, as you've already heard this morning. OPHA and others have conducted surveys in stores in Toronto, and in 92% to 95% of cases, young people, some as young as 12 or 14, could have purchased cigarettes without question.
According to the 1991 Statistics Canada General Social Survey, 16% of teenagers between the ages of 15 and 19 are daily smokers. It is estimated that Canadians under the age of 19 consume over two billion cigarettes per year, representing an annual market of over $400 million for the tobacco industry. We are putting a higher price on the value of tobacco profits than we are on the lives of our young people. OPHA is here to tell you that our members value the lives of our young people as the single most valuable resource any society will ever have.
Mr Peter Elson: Recent research indicates that three elements are key in legislation to prevent tobacco sales to minors: vendor licensing, active compliance and penalties. This study showed that temporary suspension of a licence had a greater impact than a monetary fine, because so much of the store's profit was made through cigarette sales.
Studies in two US communities found a direct link between enforced restrictions on sales to minors and reductions in youth smoking. Youth smoking rates plunged by 30% to 70% in those two communities, showing that tobacco-access laws do accomplish their objective, especially when they are enforced.
Therefore, OPHA recommends the implementation of a self-financing licensing system for tobacco retailers and establishing an enforcement system, complete with a schedule of penalties, including a licence suspension and monetary fines.
OPHA is particularly pleased with the provision of Bill 119 which prohibits the sale of tobacco industry products in all health care facilities, including pharmacies and any retail establishment that houses a pharmacy.
It is crucial to establish tobacco industry products as the health hazard they are: lethal when used as directed. These products cannot be associated with health facilities nor licensed health professionals. The major benefit of the termination of cigarette sales in pharmacies is the elimination of conflicting messages about the risks of tobacco products being sent to people of all ages, but especially to the young.
The Ontario College of Pharmacists asked the province for legislation to ban the sale of tobacco industry products in pharmacies in June 1991 when it was apparent that many large drugstore chains would not cooperate with a voluntary sales ban being advocated by the college. The pharmacies in this province have been aware of the college's request and have had ample time to prepare for terminating their tobacco sales. Therefore, OPHA strongly recommends that the pharmacy ban become effective 90 days after the legislation comes into force.
We're also pleased to see that Bill 119 requires that signs displaying health warnings and other pertinent information be posted at all retail locations. We urge the committee to recommend that plain packaging requirements and strong health warnings information be mandated under the packaging regulations. OPHA strongly supports the banning of cigarette vending machines. As you heard earlier in the other testimony, they represent a means of uncontrolled access to this addictive and lethal product.
Ms Underwood: OPHA supports Bill 119 in the prohibition of smoking-designated public places, including schools, day cares, retail establishments and others. However, we see opportunities to improve in the protection against the health hazards of environmental tobacco smoke.
Environmental tobacco smoke is classified as a group A carcinogen by the US Environmental Protection Agency. This places environmental tobacco smoke in the same category as the most deadly known human carcinogens such as arsenic, asbestos and benzene. There is no safe level of exposure to environmental tobacco smoke.
The US Environmental Protection Agency and other authorities recommend two, and only two, solutions to the environmental tobacco smoke problem: Either smoking must be prohibited in indoor environments, or if smoking is permitted, it must be confined to enclosed areas under negative pressure, separately ventilated and exhausted directly to the out of doors.
The current provisions of Bill 119 leave a large number of public places where smoking is permitted, such as entertainment facilities, sports and recreation facilities, restaurants and bars and bingo halls. Environmental tobacco smoke will continue to be a serious public health problem.
We strongly support the government's target to increase to 100% the proportion of schools, workplaces and public places that are smoke-free by 1995.
In order to reach this goal, the Ontario Public Health Association strongly recommends that the public places included in the legislation be broadened to include all public places and that a total smoking ban be imposed. A strong and consistent message about the health risks of smoking and environmental tobacco smoke needs to be sent to the public.
The Ontario Public Health Association recommends that this section be revised to include the principle of reverse onus. Reverse onus would prohibit smoking in all public places except where permitted by regulation, thus reversing the onus to defining the places where smoking would be allowed by exception rather than legislating all non-smoking areas. The reverse onus principle establishes non-smoking as the legislative and social norm. Only areas where smoking is permitted will need to be signed. All other areas will automatically be recognized as smoke-free.
We also recommend the province strengthen the Smoking in the Workplace Act to effectively eliminate exposure to environmental tobacco smoke in the workplace by either establishing a total ban on smoking or by legislating designated smoking areas which are under negative pressure and separately ventilated to the out of doors. This provision will protect all non-smoking employees throughout the province from exposure to environmental tobacco smoke.
Penalties for breaking the law need to be deterrents in themselves. We are pleased to support the schedule of monetary fines.
To date the means of enforcement has not been outlined. Enforcement is a critical piece of the legislation. If the laws are not enforced, they will be ignored. We await the province's strategy for proper enforcement of this precedent-setting piece of legislation.
OPHA views Bill 119 as a progressive step forward in the enhancement of public health. Its passing will reflect our desire to provide our young people with the support they need to say no to addiction and no to premature death.
In summary, our recommendations are:
The implementation of a self-financing licensing system for tobacco retailers and establishing an enforcement system complete with a schedule of penalties, including a licence suspension and monetary fines.
We recommend that the pharmacy ban become effective 90 days after the legislation comes into force.
The Ontario Public Health Association recommends that public places included in the legislation be broadened to include all public places and that a total smoking ban be imposed.
Our association recommends that the government strengthen the Smoking in the Workplace Act to effectively eliminate exposure to environmental tobacco smoke in the workplace by either establishing a total ban on smoking or by legislating designated smoking areas which are under negative pressure and separately ventilated.
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Mr Arnott: Thank you very much for your presentation. You've said you support the bill in principle, and with your recommendations you're suggesting to the government it go far farther than it has with this bill. "To include all public places and a total smoking ban to be imposed" is what you've suggested to them, which in my view goes considerably farther than what they've suggested.
My concern with one part of the bill is that it doesn't specify absolutely the number of places at the present time where smoking will be banned. In section 9, there's a clause right at the end that says "or a prescribed place," which doesn't give us a full understanding of what the government's thinking is in terms of which areas it wants to ban at the present time versus what it might do in the future. We've expressed the concern that we should know where the government's going on this, that in terms of legislation, it's better to have these additional prescribed places discussed in the House, as opposed to having it done by regulation by the government behind closed doors.
Would you agree with that concern, that those places should be spelled out, out in the open, up front, so that everybody knows about it?
Mr Elson: Part of your question, obviously, is for the government. The other part is that what we're saying is that the debate should not revolve around where smoking should not take place, but where it should take place, where in fact the government would be prepared to allow people to be exposed to environmental smoke. We are saying there shouldn't be a place in the province where anyone is exposed to environmental tobacco smoke, and others would say that the debate should be around where it is permitted for this health hazard to occur, as opposed to where it should not occur. It reflects to our recommendation about the reverse onus, that the discussion should be on the other part of the ledger.
Mr Arnott: Your suggestion is, though, that smoking be prohibited outside of, I assume, people's private residences and perhaps their cars.
Mr Elson: Yes.
Ms Underwood: Yes, we're talking about all public places.
Mr O'Connor: Thank you for your presentation and brief. The question I have for you would be on the licensing. What do you think could be accomplished that can't be accomplished through the legislation by going into a licensing system and creating another bureaucracy? Maybe you can point out some areas that you think can't be accomplished presently within the realm of the current bill. You pointed out that you think there should be licensing. Why would you like to go to licensing? What would you hope to achieve through licensing that can't be achieved through the present bill?
Mr Elson: I'm not sure what exactly is the point of the questions.
Mr O'Connor: Okay. In the summary of your recommendations, your first recommendation was "a self-financing licensing system for tobacco retailers and establishing an enforcement system complete with a schedule of penalties...licence suspension," which sounds like the ban, "and monetary fines." I just wondered what would be accomplished by going to a licensing system that can't be accomplished through the legislation that we have before us.
Mr Elson: My response to that is with respect to the actual financing of the enforcement aspect of the legislation. In many cases at the municipal level there are limited resources to enforce this, through public health inspection or otherwise, so that's why we're calling for the people who are in the business of making the profits, the retailers and others, to contribute to the self-financing aspect of that system.
Simply having the legislation or the licensing system in place -- now, for example, it is against the law to sell tobacco products to minors who are younger than 18, and yet there are very limited means at this point financially to enforce that system on any kind of systematic basis.
Research has shown that when there is a provision for it to be enforced, there is a dramatic impact. The system needs to be self-financing, and that's why the licensing would provide the means for that financing, for the self-payment of that licensing system.
Mr McGuinty: Thank you very much for your presentation. I'm sure that you are not without some sympathy for people who are in the grip of the powerful addiction of cigarettes.
You want to ban smoking in all public places, save and except those which are listed as exceptions. We've just heard from the presenters before us. I'm sure that Mrs Fraser loved her husband very, very much, and that when he was alive maybe they would like to go out to a restaurant, maybe they'd like to go out and play some bingo. This man was smoking three packs a day. He would feel a tremendous urge, his body would crave a nicotine fix.
Our government has profited from cigarette smoking over the years. We've built up industries around it. We've employed people. What do we do with these people? They can't go out of their homes now to smoke?
Ms Underwood: I guess there's a way of turning that question around. I agree it's a very, very difficult situation. He also was putting her at risk every time they went out.
Mr McGuinty: She consented to that.
Ms Underwood: He was consenting too, wasn't he? It's a difficult choice to make. I'm not sure that she really did have that much freedom. As you say, she loves him very much.
Mr McGuinty: The point I'm simply trying to make is that we get into difficulties when we stop focusing on making it harder for kids to start, when we go and focus on those who are already hooked on a highly addictive legal product. It's not easy.
Mr Elson: That certainly too is one of the reasons why OPHA, at the very outset, called on the government at the time to look at tobacco in a comprehensive fashion. When it comes to alcohol addiction, we do not leave people who are addicted to that substance abandoned, and neither should we as far as tobacco is concerned. If we recognize it, then the programs to support people who are addicted and who choose not to smoke need to be in place and accessible in a way that, if they make the choice, in fact they are.
Although we're talking about the particular circumstance of what was presented earlier, in fact young people too are particularly vulnerable in that regard. In many cases they cannot advocate for a change. In some cases they can, but in other cases they can't, in terms of parents who smoke, as an example.
The Chair: Did you want to add something?
Ms Underwood: I was just going to emphasize the point that the young woman made here earlier and that you heard in the earlier presentation that in day cares and schools children are exposed to seeing people smoking all the time. So we're setting a tremendous example of smoking being okay in our society today.
The Chair: Thank you very much for coming before the committee this morning. We appreciate it.
The committee will now stand adjourned until 2 o'clock this afternoon.
The committee recessed from 1159 to 1403.
The Vice-Chair (Mr Ron Eddy): Ladies and gentlemen, the standing committee on social development is now in session and continuing hearings on Bill 119, An Act to prevent the Provision of Tobacco to Young Persons and to Regulate its Sale and Use by Others.
ONTARIO DISCOUNT DRUG ASSOCIATION
The Vice-Chair: The first presentation this afternoon will be by representatives of the Ontario Discount Drug Association. Please introduce yourselves and proceed with your presentation. We have one half-hour for presentation and questions at the end, if there is time.
Mr Zel Goldstein: My name is Zel Goldstein. I'm the CEO of Hy and Zel's. To my left is Marvyn Lubek, director of pharmacy operations for our chain. This brief was originally presented by Marvin Turk of the ODDA. Unfortunately, Mr Turk could not be here today, so we're filling in for him.
I believe that all of you have a brief in front of you that was presented by Mr Turk. If need be, I would ask Mr Lubek to read this again to you, or if not, if you want to save some time, we could just open up the floor to questions.
The Vice-Chair: It's as you wish, but if you would make a presentation regarding it, either in full or part, the presentation is entitled Pay Less Drug Emporium Ltd. That's across the top for members. Proceed, please.
Mr Marvyn Lubek: "Dear Sir:
"I am writing to you today on behalf of the ODDA (Ontario Discount Drug Association) to express the views of the members of our association toward the tobacco prevention act.
"Our association is made up of Hy and Zel, Herbies Drug Warehouse and Pay Less Drug Emporium Ltd. Between our members, we have 25 stores, approximately 75 to 100 pharmacists, full- and part-time, and between 2,500 and 3,000 employees. Our stores are all larger than 15,000 square feet and in fact average 30,000 square feet. The association stores average between 150 to 200 prescriptions per day on a seven-day week, which in fact would certainly put our stores in the top 10% dispensing stores in the province if taken as a unit.
"When the stores were originally planned and the pro formas produced, the composite involved the coming together of many departments, including a comprehensive tobacco department.
"The position of the ODDA is clear on the new proposed Tobacco Control Act. We will lose gross profit dollars which we are now applying to the professional part of the business, thus allowing our dispensing fees to be amongst the lowest in the country. As well, there will be a loss of a minimum of 100 jobs as these are the clerks and receivers that are involved with the total sell-through of tobacco products. Obviously, if the restriction of tobacco sales has the anticipated impact of decreasing our traffic flow, then we run the risk of losing many more jobs, and in fact face the spectre of bankruptcies. There are very few drugstores in Ontario today that will be able to withstand the traffic loss that is imminent if tobacco products are restricted from sale.
"Since most of the data that concerns the Tobacco Control Act is being reported by subjective surveys, the ODDA has done some of our own. Here are the results.
"From 100 customers noted purchasing tobacco from six assorted Hy and Zel and Pay Less Drug Emporium stores, 93 purchased other merchandise as well. Sometimes it was something as simple as a newspaper and/or a chocolate bar, but they did purchase something else. The average sale of the person purchasing the tobacco product plus the other goods was, including the tobacco, $21.72. Our average sale between the two companies is in the $16 range. Obviously then the gross profit dollars generated by these customers is significant and vital to our viability. Although it may be possible that these customers would have come into the store and purchased these items in any case, is there anyone in retail that would want to take that chance?
"Obviously, tobacco is a product that produces and encourages impulse sales.
"In another random sampling in the same six Hy and Zel and Pay Less Drug Emporium stores, we asked the customers the question (different customers from the first survey) `Do you think tobacco products should be sold in drugstores?' To our surprise 26 out of the 100 replied that they thought tobacco products should not be sold in drugstores, 57 thought they should and 17 had no comment. It should be emphasized that none of these people had made a tobacco purchase.
"When the same question was asked again of these people but was suffixed with `if there was a possibility that some people could lose their jobs' the sample changed rather dramatically.
"Now only 10 people of the 100 were for the tobacco sale restriction, 77 thought it was acceptable and 13 had no comment. Then we raised a third point to this question, which I believe speaks volumes on the subject. When we said, `Do you think tobacco products should be sold in drugstores, notwithstanding the fact that there was a possibility that some people could lose their jobs and given the fact that there would be no appreciable decrease in the total amount of tobacco consumed or in the number of people smoking,' the response was startling.
"One person of the 100 suggested we should still not sell the tobacco products, 93 felt that under those circumstances we should and six people still had no comment.
"The result is incontrovertible. When people are given the choice on the one hand of a philosophical question which seems reasonable, after all it does seem on the surface inappropriate to be dispensing medication at one end of the store and a health damaging product at the other end, and the reality of lost jobs, they will invariably vote for the option that maintains jobs.
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"Integrated into the mix, of course, is the incredibility of most people when you tell them that tobacco products will still be legal for sale at convenience stores or at the gas bars or at Canadian Tire etc. At this crisis point in our economic life in Ontario, the last thing any retailer needs is further restrictions on his ability to sell a legal product. It seems if there was even a case for going to court on a restraint of trade and commerce, this would be the issue. Of course, added to the latter statement is the fact that it doesn't seem reasonable for any government to morally change the rules of the game in the middle of the game with no benefit whatsoever accruing to the public.
"It is interesting to note that Nghia Truong, who was the president of the Ontario College of Pharmacists when the college voted to ban tobacco sales, and who was in his words `booted out over his stand on tobacco,' says, `Somebody has to have the guts to ban tobacco rules.' I wonder if he was in a position to lose his livelihood or his job if tobacco sales were terminated in drugstores, would he express such bravado or superfluous courage. The fact that he removed tobacco from sale in his drugstore is absolutely irrelevant to the issue. Obviously tobacco was never a significant component of his profit or he never priced it competitively enough for it to become significant. It is reprehensible that someone of his reputation is conceding the loss of someone else's job. Absolutely unbelievable.
"In terms of the comments made by various pharmacists who are members of Pharmacists in Support of Bill 119, these pharmacists are speaking of a department that was never relevant in terms of the total profitability of their own stores. As well, they are speaking about their own specific situations, which obviously is totally unrelated to large stores such as those in the ODDA.
"It is true that pharmacy is my profession, but my vocation is business, and that business is the drugstore business.
"As long as I speak for over 100 pharmacists and 3,000 employees, I feel that any committee should listen very carefully to our point of view.
"It is also interesting to note that in a survey of pharmacy practice, 60% of independent pharmacists who responded said they are against tobacco sales versus just under 50% of chain pharmacists. In our survey 30% of our pharmacists also reported that they are against tobacco sales, but when it was stated that we might go out of business because of the loss of gross profit dollars and/or the ensuing traffic, only 8% were then against the sale. It is obviously a function of one's personal potential downside as to how they will decide to vote on this issue.
"In summary, it is the position of the ODDA that drugstores should continue to be allowed to sell tobacco as long as it is legal tender everywhere.
"We would also like to recommend the continuation of the province's wide advertising against smoking as it is poignant, precise and quite frightening.
"It is our belief that through increased education and communication, not arbitrary selection of sale venues, will we as a province be able to meaningfully reduce tobacco consumption and the number of smokers in this province.
"Yours truly,
"M. Turk, president and chief executive officer of Pay Less Drug Emporium Ltd and the Ontario Discount Drug Association."
Mrs Haslam: Do you counsel your clients to stop smoking?
Mr Goldstein: When the pharmacist has the opportunity to do that, if he's asked that particular question, yes, he does.
Mrs Haslam: Are your cigarettes sold at the front or the back of your store?
Mr Goldstein: The cigarettes are sold at the front of the store.
Mrs Haslam: Do you know, on average, how many times you would counsel some of your patrons to not smoke?
Mr Goldstein: No, I couldn't quantify it or anything like that, but then again, I say that if the pharmacist himself was to be asked that particular question, he would give the answer that would be appropriate at the particular time, and that is that we are concerned about the health issue and I think that he would answer accordingly at that particular time.
Mrs Haslam: On page 2, you say, "given the fact that there would be no appreciable decrease in the total amount of tobacco consumed." On what study do you base that?
Mr Goldstein: We base it on the fact that if it's not available in the drugstores then it certainly would be available in the variety stores, the gas bars.
Mrs Haslam: But there would be less availability if it were not in pharmacies?
Mr Goldstein: No, I don't believe that would be the case. I think the tobacco consumption would be exactly the same. All you would be doing is sort of moving it around a little bit.
Mrs Haslam: There have been other submissions, and I maybe would just ask for a couple of comments. The Canadian Cancer Society has recommended "to reinforce the hazardous and addictive nature of tobacco products." "The legislation must ensure" that the section concerning the ban on the sale of tobacco products in pharmacies remains intact. They look at this as a health issue and that therefore, as a practitioner, as a health facility, it is giving mixed messages when you sell tobacco in the same facility. I wondered if you had a comment on that.
Mr Goldstein: Like I said before, we are as concerned with the health issue as anybody else is, but basically all you would be doing is diverting the problem from the drugstore into the variety store. I think the results would be the same, the consumption would be the same, but the harm done to pharmacy at that particular time would be irreparable. I think you face the option of certain pharmacies going out of business. You face the potential loss of jobs, and I don't think that really is the intent of this particular legislation.
Mrs Haslam: One of the other groups that came forward -- and I apologize because I've been looking for it and I'm usually an organized person and can find it, but I can't -- did studies that showed there wasn't an appreciable closing of businesses when pharmacies decided to not sell tobacco in their facilities.
Mr Goldstein: If you took some of the drugstores today, I would say that potentially the average would be 15% to 20% tobacco, total sales, in these particular stores. If you took that 15% to 20% out of there, there isn't too much left, and when you factor in the effect that these people do not come into the store any more, then you face a loss of other particular sales, as we've alluded to in this particular brief. A customer who would come in and buy a package of cigarettes would buy something else, and if that were not available -- in other words, if they would go into another store and pick their cigarettes up, they would certainly get what they needed someplace else.
Mrs Haslam: That would seem to contradict what the Ontario Chamber of Commerce letter says, because they said "undue economic burden on merchants who rely on the sale of tobacco products for a significant portion of their sales." It's my understanding that the markup on cigarettes is not a profitable business, that you're talking about a spinoff, whereas if you replace those products like tobacco with other products, the business is still in your pharmacy.
Mr Goldstein: You'll find that the consumer today really doesn't want to go into two or three different places to obtain all their products. In other words, if they did go for their tobacco someplace else, they would look to get everything else in that particular place.
Mrs Haslam: I understand those concerns. My concern is health facilities, health issues, and as pharmacists you deal in --
Mr Goldstein: Yes, but shouldn't a variety store be as --
Mrs Haslam: Well, are you a variety store or are you a health professional as a pharmacist? You are CEO and you're looking at the business aspect and I understand that. What I'm looking at is you're a pharmacy that has a monopoly on selling drugs. In your presentation on page 3, you talk about Canadian Tire and other facilities that do not have that ability or do not have within their facilities the pharmacist. I think the question is, as a health facility, should we be giving a mixed message that at one side you can buy products that only you sell, and at the same time you're selling a poisonous product in your store?
Mr Lubek: I'd like to add that if one is so concerned about the health situation, why is tobacco legal in the first place?
Mrs Haslam: Would you recommend we do something stronger in the legislation?
Mr Lubek: If you're not going to allow the sale of tobacco in pharmacies, then it should be illegalized in the first place.
Mr McGuinty: Thank you, gentlemen, for your presentation. I have difficulty conceptually divorcing one side from the other in a drugstore. I think it's both a health care centre to some extent and a retail business. It's a small business. I haven't done a great deal of research on this, but I suspect that over the years governments have induced you, whether you wanted to or not, to look more to the front of the store for your returns. I don't know whether you can operate a pharmacy profitably today solely on the basis of prescriptions, for instance.
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Mr Lubek: Not at today's dispensing fees.
Mr McGuinty: Can you tell me a bit about the percentage of sales -- I'm not sure if you referred to that specifically in here -- in the store that are tobacco-related?
Mr Goldstein: I can only comment on our particular stores. The percentage of sales varies anywhere between 4% to 6%.
Mr McGuinty: For me, the crux of the matter here is that we all want to ensure that we can reduce overall tobacco usage. I understand there are 1,400 pharmacies in the province that sell tobacco; that's out of 120,000 stores. That means we're going to reduce the availability by 1%. There'll be 119,000, whatever, stores still present in the province where somebody can buy tobacco.
I think the argument that somehow we're going to reduce availability really doesn't hold a great deal of water and I think the impact will be negligible. So what we're really talking about here is the symbolism and I think most people are prepared to admit that. We're talking about reducing the social acceptability. How do you comment on that?
Mr Goldstein: Are you prepared to take a gamble where you would ban tobacco sales in a drugstore and potentially have hundreds of drugstores closing up? In other words, you don't seem to know. You don't seem to have an idea of what impact this is going to have. I'm telling you that as a retailer -- and I've been a retailer for 45 years of my life -- in the retail business basically you try to provide everything you can for the consumer.
Tobacco has been something that has been in drugstores ever since I can remember. I remember going into a drugstore when I was 10 years old and the pharmacist himself was smoking. What I'm trying to get at here is that you just can't zero in on the drugstore and say because you are selling a health product, you can't sell something that is going to go against your health.
I think you're going to redirect all the tobacco sales. The consumption will be the same and you're not going to do away with the problem. The problem is having something that is considered to be legal, but illegal in a drugstore. That to me doesn't seem to make any particular sense at all.
Mr Lubek: I would like to add that if you'd like to make this a health issue only, I think it would be more prudent to make it illegal to sell tobacco in any other store except a drugstore and allow the pharmacist to counsel on the use of tobacco. I would also do that with alcohol. Alcohol is a drug; tobacco is a drug. It should be sold in drugstores, not anywhere else. Therefore, we could counsel on the health concept.
Mr Jim Wilson: Thank you very much, gentlemen, for your presentation. The letter from Mr Turk, I think, goes right to the crux of the disagreement we're having over this legislation with the government.
As you've heard in the questioning and in previous presenters, we're just having a very difficult time getting the government to wrap its mind around this jobs issue. While the Premier has spent the last couple of months trying to convince the province that jobs are important, we've seen a number of initiatives, including this one, that could very well affect the number of people who are currently employed. It will put more of them on the unemployment lines.
I sense, though, in my dealings with this issue and my dealings with the government that either it doesn't care about that or, secondly, it doesn't believe you. They think it's a false threat that people will lose jobs in the pharmacy sector as a result of Bill 119. Would you like to comment on that further?
Mr Goldstein: The government didn't believe that stores had to be open seven days a week either. With all due respect to everybody here, I don't know whether anybody really is in the position to say, "This is what's going to happen." Basically, I can tell you, with 45 years of experience in the retail business, when we were closed on Sunday we didn't do as much business as we did in the seven days.
I'm telling you today again that if you took tobacco out of drugstores, I'm not saying every drugstore would go out of business, but I'm certainly saying that a percentage of these drugstores that are currently open, providing a living for the independent pharmacist, would close up and there would be lots of people out of business. There would be families destroyed because here's a pharmacist who is making maybe $50,000 or $60,000 a year who could not be able to ply his trade any more. This really is not the intent of this particular law.
I think what you're trying to do is counsel the people as to what to do. I think Karen Haslam raised this point before and I believe Mr Lubek answered it quite adequately when he said, "I think pharmacy probably is in the best position to counsel." You go into a variety store, they're not going to tell you anything. If a 16-year-old went in there, they would probably sell him a package.
Mr Jim Wilson: Plus the clerk in the variety store isn't going to lose his pharmacy licence for breaching any of these laws.
Mr Lubek: I don't think the clerk in the variety store would know the effect of tobacco on the body in the first place.
Mr Jim Wilson: That's a good point. The law talked about morality and it's mentioned on page 3 of your presentation. For some reason, the moral high ground from the government's point of view seems to be that it's okay to take the chance that people might lose their jobs because, even though the minister admitted in the initial press conference that it was simply optics in terms of banning the sale of tobacco products -- she couldn't say whether it would have any effect in terms of declining consumption by young people or anyone else -- none the less, for some philosophical reason, they think it's a good idea. Is it morally right that government even take the risk to put your people out of work?
Mr Goldstein: Definitely not, if you're asking me. I wouldn't want to sit in judgement and potentially pass a law or have something to do with some kind of legislation that's going to put people out of business and people out of work.
Mr Lubek: Is it morally correct for somebody to collect taxes on something that is a health hazard?
Mr Arnott: That's a good question. How many pharmacies do you think a town of 2,000 could support, a small town?
Mr Goldstein: Two thousand people? I don't know, I really haven't got a clue.
Mr Arnott: In the village of Arthur where I live there are two pharmacies for 2,000 people and about 2,000 people perhaps do their shopping in Arthur, so you may be looking at 4,000 people in total. Two pharmacies and neither one of them sells tobacco. I want to read to you a brief excerpt from an article which appeared in the Arthur Enterprise News last week:
"John Walsh, owner of Walsh's Pharmacy in Arthur, made his decision to get out of the tobacco business about eight years ago. Expanding his store, he replaced the display shelf and space with a display of picture frames and film. John Walsh says, `You're contradicting yourself, trying to promote health in the back of the store and tobacco in the front.' He thinks the public is now at the point where they expect responsibility from health care services. He suspects that much of the uproar from pharmacists is due to the government's intervention in many of the other pharmacy-related issues."
To me -- two pharmacies in a small town, neither one of them selling tobacco.
Mr Goldstein: Again, I think this is a personal decision that Mr Walsh made and probably in his particular store it turned out to be okay, but I don't think, if you look province-wide, that this thing is going to be okay. I think you're going to have some casualties along the way and I don't think this particular government that really is pro-jobs would want to have any part of any legislation that is going to put people out of work.
Mr Lubek: I'd also like to ask the question, do you know how many people in Arthur are not smoking because Mr Walsh hasn't been selling tobacco, or have they been able to buy it somewhere else, when they stop for gas?
Mr Arnott: A valid point. There are other places to buy tobacco in Arthur.
Mr Lubek: So if the product is available and nobody is getting counselling as to the use of tobacco, I will reiterate that the only place it should be sold is in pharmacies, where they can get proper counselling. Again, we'd also like to have alcohol, so we can counsel on its use.
Mr O'Connor: One brief question: In your marketing, because you're looking at this from a marketing point of view, and hearing your discussion around the counselling element, have you found then -- because retail, quite a bit of it is marketing -- that if pharmacists were to sell the tobacco product, you would actually increase your trade by having every person who wanted to purchase tobacco stop for that counselling? That would be a way of maybe increasing your trade. All pharmacists then have to counsel?
Mr Lubek: Are you recommending we do that? Because that's certainly a good marketing tool.
Interjection.
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Mr Lubek: Would we bring it to the back instead of having it at the front? I would certainly think that would be an acceptable situation. As far as the health situation is concerned and what we're looking at here, it would be more appropriate than saying, "Don't sell tobacco at all," and allowing it to be sold at a gas station or at a Canadian Tire store where nobody could help the consumer.
Mr O'Connor: So you think it actually would make sense for the pharmacist then to spend 10 minutes counselling, which is a good idea, counselling people about the use of the tobacco, this lethal product, and as a marketing tool it would be a good tool?
Mr Lubek: Absolutely.
Mr O'Connor: Interesting. Thank you.
The Vice-Chair: Thank you for your presentation. We appreciate it.
ONTARIO MEDICAL ASSOCIATION
The Vice-Chair: The next presentation will be made by representatives of the Ontario Medical Association. Would the representatives please come forward, introduce yourselves and proceed with the presentation. Hopefully, there'll be time for questions at the end. We have one half-hour.
Dr Tom Dickson: Thank you, Mr Chairman. I'd like to introduce Dr Verna Mai, who's chairman of our section of public health, and Dr Ted Boadway, who's the director of our health policy department at the Ontario Medical Association. I'm Dr Tom Dickson, president of the Ontario Medical Association. Dr Mai will present first, then myself, and we hope to leave some time for questions.
Dr Verna Mai: Honourable Vice-Chair, members of the committee, I would like to thank you for the opportunity to speak on a subject of vital importance to the 22,000 members of the Ontario Medical Association. We applaud you for proposing some of the toughest anti-tobacco legislation in the world. Finally, we have a Tobacco Control Act on the legislative agenda. You are to be congratulated for bringing this act forward and for encouraging public input. Bill 119 is an excellent step towards passing comprehensive tobacco legislation.
The Ontario Medical Association has been deeply concerned about the effects of tobacco use on the population for decades. We see the effects on an individual basis every day and we know the collective costs. The evidence against tobacco use is enormous; the human toll is sickening. Yet the frustrating part is that the death and disease caused by tobacco can be prevented.
The fact that millions of people continue to smoke and thousands of children take up the habit every month in Ontario proves just how powerful and addictive tobacco is. Don't for a moment allow yourself to think that smoking is simply a bad, smelly habit. Tobacco kills 13,000 people a year in this province, and the numbers keep growing. New, still healthy converts are taking up the habit. Each month it's estimated that more than 3,000 children start smoking.
If we thought of tobacco as the poison it is, we would realize that we have a major epidemic on our hands. Sadly, still too many believe tobacco use is just a matter of personal choice. It isn't. The tobacco industry must be condemned for causing this epidemic and, as with any other major epidemic, we not only need to educate the public about the risks, but we must also not hesitate to pass protective, tough legislation and generate a concerted public effort to combat the agent, in this case tobacco use, in our society. It won't go away on its own.
We know this government has come in for much criticism from the tobacco industry, tobacco product retailers and defenders of free speech and civil liberties. They've criticized the proposed legislation as draconian and anti-democratic. They've trotted out the old scare tactics about lost jobs and lost revenues. Sadly too, other governments seem to agree with this point of view. But what about the losses in health and life of our citizens addicted to tobacco? Don't be deterred, don't give up the fight and please don't give in.
If you will permit, a little history at this point is in order. We've been here before. There are dozens of examples of groups having opposed similar public health measures this century. The medical profession, among others, fought for the pasteurization of milk, for the chlorination and fluoridation of water, for asbestos removal from our buildings, for the vaccination of all school children in Ontario and for seatbelt legislation. Do you remember the furore over forcing people to buckle up for their safety? The list goes on and on.
These laws were also fraught with political hesitancy and heated debate, but they too were based on solid evidence. History has shown the effectiveness of enacting public policy on the basis of evidence. It's time we let everyone know that this government intends to protect the public and is dedicated to preventing yet another generation of children from becoming addicted to this lethal substance. But we do know that you need help and public support, and the Ontario Medical Association is firmly behind you.
The general public must also get involved in this battle for the hearts and the lungs of our youth. Effective health promotion requires more than just health counselling and health education. We need parents and strong role models to lead the way. We need wide public support to allow our children to grow up in a smoke-free environment. No-one should be subjected to secondhand smoke, especially children, who are most vulnerable to toxins and poisons. We need to create an environment that promotes a healthy lifestyle. We need to make it easy for people not to smoke. This keeps the environment in which children grow up consistent with the health education messages we give them in our schools.
It's an uphill battle, and we need as much help as possible to counter the tobacco industry's huge marketing machine. According to a report by the Canadian Council on Smoking and Health, people in the Ottawa-Hull area are exposed to tobacco company's sponsorship ads at least 295 million times per year. We need plain packaging to break the link between the packages and the sponsorship ads. Banning vending machines and preventing the sale of tobacco products in pharmacies would also break another major link in the tobacco industry's supply chain.
Of course, there's always more we can do as well, but this legislation is an important step in bringing our dream of a tobacco-free society a little closer to reality. Again, you're to be applauded for having the vision and the courage to make this happen.
Now I would like to introduce Tom Dickson, our OMA president.
Dr Dickson: Thank you, Verna. I too wish to commend this government for enacting legislation to reduce tobacco use and, most important, to prevent children and teens from ever lighting up or chewing tobacco.
We see the tobacco industry as public health enemy number one. This might strike you as an exaggeration, but it's not, and we mean it. There is no doubt about it: Tobacco is a poison. It should be treated and marketed and displayed as a poison.
We've made significant gains over the years, and this legislation will help, but we still have a long way to go towards a smoke-free society. Since we addressed the standing committee on social development last March, 11,000 people in Ontario died from tobacco-related diseases, and 3,000 Ontario children aged 11 to 15 take up the habit each month. Tobacco use is the leading cause of preventable disease, disability and death today, so we urge this government to make the reduction of tobacco use among its youth its number one health policy goal.
More people die from tobacco poisoning each year than from exposure to asbestos, yet the handling of removal of asbestos is more highly regulated than tobacco. We've banned the use of asbestos and evacuate entire buildings if even a trace is found. We force people to wear space suits when removing asbestos. Yet we allow children to breath in tobacco fumes in restaurants and other public places. Tobacco is still treated in many circles as nothing more than a nuisance, a bad habit, instead of a killer. Would any of us allow our children to come within even a mile of asbestos? Not a chance. For historical reasons, tobacco has been treated differently, but that is ancient history. We know that tobacco is a killer.
There are more women than men smokers overall, and the smoking rates for young girls are higher than for young boys. Young girls are the future of the tobacco industry, and how does the tobacco industry thank them? By addicting them to a health hazard worse than AIDS or suicide when measured in death and disability. Last year lung cancer overtook breast cancer as the leading killer of Canadian women. It is our duty to prevent our children, our girls and our boys, from taking up a deadly habit. We know that smokers rarely take up the habit after age 20.
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As doctors, we've heard it all before. At first they'll tell you they were only curious, maybe imitating a parent or a role model who smokes, or they'll tell you it was because of peer pressure. They tell you not to worry because they only smoke to be sociable, that it's only a passing fad, a stage in their lives. Others will tell you that smoking is a way of exercising their independence, but then they become dependent and they come to us because they're hooked.
It is the most difficult part of my job, watching a patient slowly suffocate to death over 10 or 20 years because of emphysema. It's not a very glamorous way to go out, sitting in a chair for the rest of your days, not able to even walk to the bathroom on your own. A smoker's last years of life are often out of the public view, restricted to their homes and too short of breath often to do anything but sit in a chair, unable even to walk across the room to pick up their grandchild.
We see it daily and we're angry. We want action and prevention is the only way to go. We must drive home the message that today's teen smoker is tomorrow's statistic. Teens live in the present. They refuse or can't imagine that the decades of abuse will ever catch up to them. Teens are not invincible. The effects of decades of smoking will eventually catch up.
In the case of smoking, a harmless curiosity becomes an addiction. Most of today's smokers will die from smoking-related diseases. Let's not give our youth a chance to get hooked. There is nothing glamorous about smoking. For a group that is so concerned with physical appearance, smoking is probably the most gross of all habits, but it's far worse than just smelling bad or having yellow teeth. Nicotine is the most addictive drug of all, and we know it's not just a high school thing. According to one US study, only 5% of high school seniors who smoked believed that they'd be smoking five years after graduation, yet on average 73% were still smokers eight years later. So what can we do?
Let's face it, tobacco products are toxic and they kill, but look at how tobacco products are sold and advertised. They're packaged like candy or ice cream in bright, eye-catching colours. Let's show youth that there is something different about tobacco products. We support plain packaging. It is deadly, it should look deadly. It would be easy to condemn pharmacies, but the medical profession knows all too well the power of the tobacco industry. When it gets you, it never lets go.
Tobacco manufacturers were once welcomed at medical conventions. We even allowed them to pass out products by the carton to our members. We used to get our smokes for free and we snapped them up like candy. Tobacco manufacturers loved doctors because our silence was an endorsement of their product. They even used doctors as spokesmen. It was in their interest to associate cigarettes with health providers and health facilities.
We made mistakes but we broke the habit and pharmacies can too. We wholly support the move to ban tobacco products from pharmacies. Health care providers cannot on the one hand condemn the use of an addictive and deadly product and on the other hand profit from it. What are we telling our youth by allowing pharmacies to sell instruments of death side by side with products that cure you? This paradox is not lost on youth. They see the contradiction, and so with me. Pharmacies are the tobacco industry's last link to the health care system. Let's break it once and for all.
Members of the committee, we must not, and I repeat, we must not, trade the lives of our future generations for profits from tobacco. The law prohibiting the sale of tobacco products to minors needs real, meaningful enforcement; otherwise it simply won't work or make a difference. Kids will tell you buying cigarettes is as easy as buying a bag of chips. They're sold on the street and in school yards, they're sold under the counter in restaurants and convenience stores for as little as $3 a pack. They're smuggled in trucks and in cars. Single smokes sell for 40 cents in corner stores, at least my children tell me that.
It is important for tobacco retailers to become an integral part of eliminating tobacco sales to minors. If you are to meet your stated goal of reducing tobacco use among teens by 10% by the year 2000, then we urge you to follow through on some of your original proposals and goals: Prohibit smoking in all public places except where exempt by regulation; consider licensing of tobacco retailers if the statutory prohibition has not worked after one year; ban kiddie packs by way of additional regulation; ban chewing tobacco.
The government is seeking to devote more emphasis to illness prevention, health promotion and community care to promote a higher level of health and wellbeing and as a means to curb health care costs. Let's get tough with the people who cause millions of dollars in tobacco-related health care costs and seek to hook our children while still minors. Thank you.
Mr Arnott: Thank you very much. Your presentation is very blunt and direct and we appreciate that. Like you, I think there should be generic packaging on cigarettes. I'd like to see the package in black and I'd like to see a very, very blunt, direct warning. This bill seems to include provision for that possibly happening by regulation, but it's not there in the legislation. Do you think it should be?
Dr Dickson: Absolutely. Plain packaging, we know that the single appearance of a brightly coloured cigarette package on a table, in a school yard, wherever, is a constant source of promoting the product. The colours themselves promote the product. We think that plain packaging should be used as a way of discouraging and showing that in fact tobacco products are not a glamorous thing, that they're a dangerous product and should not be promoted.
Mr Arnott: Like you, I think it's extremely inconsistent as well as probably ethically indefensible for pharmacists to be selling tobacco, although their argument I think is valid when they say, "If you take away our right to sell tobacco, it's not going to, in a large way, limit the access." I think they're correct in that. Do you have any comment on that?
Dr Dickson: Yes, they are correct. It will not limit the access in the short term. But let's face it, we'd like to see reduction of current smokers and see people quit, and you continue all of those measures if you can. But most important, we have to stop people from becoming addicted to tobacco products in the first place. We know that people usually don't start after age 20, so you have to target children and teenagers.
If preventing them and cutting that link between pharmacies and it's a health product and tobacco's okay because they're sold together, if that somehow can cut down on addiction of our children to tobacco, we'll have a whole generation of non-users in the future, it'll save us a fortune and it certainly will be good for the health of this province.
Dr Ted Boadway: If I could add, I think we do well to remember that with kids, you or I giving them a lecture doesn't work very well when they're 16, 14, whatever. They're at the age where they're refractory to that, at least my kids are for me. That doesn't work. They're at the age when they're at their maximum resistance to education. They're at an age where image and association is the method of aspiring and the method of learning.
Image and association is what the tobacco industry's linkage of tobacco and the health industry is all about. If it's important to the tobacco industry to have that linkage, then by gosh it's important to us for exactly the opposite reason.
Mr Arnott: You've suggested we take away Pat Borders's chewing tobacco. I guess he's going to ask to be traded and maybe half the other Blue Jays too, so that's politically dicey.
Is there as direct a link or as clear a link between chewing tobacco and cancer as we see through smoking tobacco and cancer?
Dr Dickson: Absolutely. I can speak personally on this. I am an ear, nose and throat surgeon by training, and there's no doubt that the incidence of cancer in the oral cavity, tongue and the side of the buccal mucosa where they hold their pouch, is seen essentially only in people who chew tobaccy -- you will see it in other tobacco products but that particular cancer in the side of the mouth, and it's actually right in the very spot where they hold their chaw, so to speak. So the link is very strong.
Mrs Haslam: Who is Pat Borders?
Interjections.
Mrs Haslam: I come from Perth. Just because I live here four days a week doesn't mean I watch ball all the time. A pleasure to see you, Dr Boadway and Dr Dickson.
I wanted to ask you a question because I read a lot of things that come to this committee and a couple of very interesting letters have come my way. This one brings up a particular issue, and I know that Mr White has a question around some other issues, so I'll ask one quick question.
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This came from the Sunnybrook Health Science Centre. They were concerned about veteran residents of facilities such as Sunnybrook Health Science Centre because of their inability to walk and their mobility difficulties. They were concerned about putting an exemption in place to purchase cigarettes on site, and to expect physically and cognitively challenged smoking residents to access cigarettes outside the facility would pose a major risk management issue.
I just wondered if you had a comment on that, because I asked whether this might be an exemption case and I just want the Ontario Medical Association's comments on this particular issue.
Dr Boadway: Geriatrics was the field in which I worked when I was in practice, and I must say that this argument tears at me a little bit. First of all, you have to recognize that the reason a lot of those veterans are limited and can't walk is because they smoke. This is absolutely astonishing. People whose lives are just about over because of their addiction still have a compelling need to find the product. As a non-addict, I always have difficulty with that.
In nursing homes we've had the prohibition for years of not being able to smoke in the residents' rooms. In my own nursing home we had some deaths due to fires due to smoking in bed -- it's a terrible tragedy -- before the ban was brought in. We in the nursing home industry supported the ban of smoking in residents' rooms completely. It was hard on some of the residents because some of the residents had such bad emphysema they could hardly walk from their bed to the smoking room. But did you want them to burn to death, or what?
As a matter of fact, one of my patients who was so sick she couldn't get to the smoking room finally got well enough, because she was prohibited to smoke, that she was able to get to the smoking room. She smoked, it fell on her clothes, she was burned, and as she was carried out she said, "Dr Boadway said my cigarettes would get me one way or the other." She had a sense of humour. She died from her burns.
Mrs Haslam: So you feel that there should be no exemption for this particular issue and case.
Dr Boadway: I am afraid that, having lived fairly close to it, I have difficulty thinking there should be exemptions.
Mr White: I wanted to get back to the issue that you brought up, Dr Dickson, in regard to the free cigarettes, the enticement of doctors, as health professionals, to smoke that was pretty insidious and pretty effective in the past.
I can certainly remember advertisements from an American company that one out of 10 doctors smokes Camels, or whatever the heck it might have been. The idea is that if a medical or health professional such as yourself is smoking Camels, or whatever brand it might be, then clearly these are good cigarettes, they're healthy.
You, as an association, are clearly saying it's not a good idea and you are clearly, as an association and as a profession, indicating that a poisonous and toxic substance such as this should have no part in the dialogue between a patient and yourselves. Yet we have still that one conflict in our community with the pharmacists, who are a regulated health profession, the only place where you can buy drugs. It seems such an obvious conclusion that that should not occur. I'm wondering what your experience is with pharmacists who have spoken to you on this issue.
Dr Dickson: Firstly, we know that it has been a direct tactic and a strategy adopted by the tobacco industry in the past to get health care providers to, in effect, endorse its product and be spokespeople for its product. That was seen back in the 1940 and the 1950s, and they targeted physicians. Ten per cent of the doctors in this country now are smokers. We've reduced it rather dramatically. We were one of the heaviest users and now we're one of the lightest, if not the lightest, users. We've banned tobacco use at all our meetings and in all our association offices. Failing physicians being the obvious link, the last link in that chain now that remains is in fact the pharmacy. That's the only health care provider facility that's involved in the dispensing of tobacco products or promoting them, not necessarily actively but tacitly. They're in the same room, they're in the same area, and the linkage is quite obvious. We simply can't support that. It's just an insupportable activity on the part of pharmacists, we believe. It simply should stop.
Mr White: Wouldn't making this message very clear, that no health profession is involved, implicitly or explicitly, in the sale of tobacco, in the sale of a toxic substance such as this, make it clear throughout our province that there is no association whatsoever between this product and anxiety reduction or any other excuse for smoking?
Dr Dickson: Yes, absolutely.
Mr McGuinty: Thank you very much for your presentation. I'm sure we all agree with at least 90% of what you said. The issue of course that recurs and that I find troublesome -- you know, I'd like to phase out smoking in the province over time, and I guess we have different ideas on how best to accomplish that.
You have a certain luxury, of course, that I don't have, and I mean that sincerely, in terms of being able to advance only one particular cause, so to speak, and that's the health cause. We as politicians have to be concerned with all the other kinds of concerns that are advanced by the various interest groups, things like jobs and what this means to the economy.
I just want to focus on one issue again; that's the pharmacy issue. I understand the argument that's made for having this in here is the symbolic value; it represents a social acceptability. I'm just wondering if anybody has ever obtained any empirical data as to what -- do people, kids in particular, believe that it presents as some kind of an anachronism, some kind of a paradox? "They're caring for my health and they're selling me cigarettes." By the way, I don't buy into the argument at all that pharmacists can counsel you against smoking while at the same time selling the darned stuff.
Give me something to hang on to, because what's going to happen at the end of the day here is that we're going to vote on this stuff. On the one side there's a symbolic merit, and on the other side we're going to hear from some people who are going to say there are going to be some job losses. We have to weigh that. What have you got for me?
Dr Dickson: Let me start off by saying that about a month ago, almost to the day, this government passed legislation, the health professions amendment act, which in fact treated and accorded to pharmacists professional status, in effect. They were treated as all other 25 professions were. They were given a monopoly over the dispensing of pharmaceutical products in this province. They were treated as professional health practitioners, not as retailers.
Now the argument has flip-flopped; in fact they're using the reverse economic argument to protect a certain part of their practice, if you will, when in fact under the RHPA they were treated as health professionals. We believe there's an inconsistency there. The argument was that they were health care providers like everyone else. Now it's that they're retailers like everyone else. You can't have it both ways.
I understand the concern about job loss; it's a serious one. But as I mentioned in my earlier comments, I do not believe that we can in all conscience trade off economic benefits for the lives of a future generation of our children. I know it's a difficult choice, but it's a profound one and I just cannot agree with it.
Mr McGuinty: What I keep coming back to, though, and everybody agrees, is that it's not going to reduce tobacco usage. So it's a symbolic element.
Dr Dickson: Just a very quick one: It won't prevent tobacco usage right today. What we want to do is stop a whole generation from becoming addicted and cut the link with the health care facility. I made that comment earlier and I believe that by breaking that link, it's much less likely. It's one of the links in the chain to prevent our teenagers from becoming addicted.
Dr Boadway: If you've ever had a child with an earache, you know that child suffers intensely with the earache. You take the child with the earache to the pharmacy, where they learn to understand that they can have medication which will deliver them from this raging pain. That's a high-impact event for a kid. Then when you take it to the front to pay for it, behind the counter are tobacco products. Kids do not have their eyes shut. Kids make associations. They make associations more strongly than they take lessons. So I would suggest that is a very powerful image for that kid at a time when they're maximally vulnerable with their raging earache.
Dr Mai: We may think that it's only symbolic at this stage, but if we don't start somewhere, we're never going to move towards a tobacco-free society. If we hedge every time we make a move and say, "Gee, we're not going to have a major impact; there will still be smoking; we'd better not do it," then we're not going to move along.
Mr O'Connor: I just wanted to maybe add a little point to this conversation that just took place, because I was actually going to ask a very similar question. I think that as we went through the Regulated Health Professions Act, and just before Christmas there was another health piece of legislation, the college was there and I appreciate that. It wasn't symbolic. It was something tangible, was it not? And I think the college of pharmacy was there because they wanted to be recognized as health care professions and participate in that. Is that not the sense that you feel, that the college really want to be health care professionals and not just another brand of retailers out there?
Dr Boadway: I'm one of the very few people who can claim to be a veteran of the entire HPLR process, okay?
Mrs Haslam: There are others.
Dr Boadway: There are a few of us who are equally nuts, but I'm one of them. I was in it for the full 11 years and I was here at the hearings with some of you. Never, during that entire process, did my colleagues the pharmacists claim they wanted to be anything other than full health care professionals. I'm glad that's what they wanted. We accept them that way. They're welcome partners in our health care spectrum; we couldn't do without them. But that's what they are.
The Vice-Chair: Thank you for your presentation.
SOCIETY OF INDEPENDENT COMMUNITY PHARMACISTS OF ONTARIO
The Vice-Chair: The next presentation will be made by a representative of the Society of Independent Community Pharmacists of Ontario. Please have a seat, introduce yourself and proceed with your presentation when you're ready. Hopefully, there will be time for questions towards the end of the time allotted, that being one half-hour.
Mr Jerry Taciuk: While I'm getting ready, my name is Jerry Taciuk. I sit on the Etobicoke board of health. The city council yesterday made a monumental decision with respect to the tobacco act. At the board of health, it was passed 6 to 4 in support of Bill 119. It went before the council yesterday and I would like you to hear just one small comment, a very prominent politician and what he said after reviewing all the material.
Audio presentation.
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Mr Taciuk: That's sufficient to give you an idea of what has happened. So I put out a motion to them at city council and I advised them that I'd file a motion in Ontario Court (General Division) to overturn the decision of the board of health because of misinformation that was presented to the board in making this decision with respect to Bill 119. There was a pile of information on 119 pro, but very little against. I'd say the pump was primed one way. I told them that in the event that anybody put a motion forward to the Ontario Court (General Division), they'd win automatically because of the way it was structured.
Basically, I come here with a double whammy. I'm a stroke victim from tobacco. I smoked for 25 years, two, two and a half packs a day. I've got no feeling in my hand, so I would like some water that I could put on to turn the pages. So I know from both ends what it's like. Notwithstanding that fact, my siding with the OMA -- I agree with them, I agree in principle with them, but I don't agree with the methodology. I don't think -- Dr Kaplan or Sadock have prepared psychiatric textbooks. It's an addiction. We'll now come to that in a little while.
Basically, I'm with the Society of Independent Community Pharmacists. I was a founding director back 10 years ago. I was asked to do this, and Mr Musial sends his apologies; he's in Aruba lying on the beach. He leaves me with this.
But my experience at this committee -- the reason I came back was, after Bill 100 with respect to sexual abuse, I had so much fun with that one and I was very discouraged that it would appear that the Legislature had had frontal lobotomies when it came to the legislation, because Premier Rae tabled this legislation without the minutes of Hansard being released. I contacted the Premier's office and told him, "How can you allow the members of the Legislature to make an informed decision when there are no minutes yet?" I got a call back. This precipitated three calls from the Premier's office that one day. They said, "Well, there's Instant Hansard." Then I called the Clerk of the House and I found out Instant Hansard is only distributed to you people here, not to the Legislature. So after that, and after seeing what has been going on with this Bill 119, I decided -- I heard that the chief medical officer of health may try to establish a correlation between sexual abuse and tobacco, so I decided I should come here.
You'll find out later what this stands for.
There is concern of what has gone on in the past. As I stated, I am disabled, and proof from the tobacco aspect. I'm under Canada pension. It says I'm not able to go back to work as a pharmacist. Counselling is now recommended because I can't work as a pharmacist. I have "problems with complex problem-solving, attention, concentration, mental flexibility, abstract reasoning." But I love this one. It says that, "The patient is alert and well-orientated...above-average intelligence." This is after my stroke. Boy, I would have been good before the stroke; I would have torn you apart.
But anyway, I have problems with the memory, I really do, and I have the numbness. I'll tell you, if you have a stroke, there's no feeling to -- you can't describe it. I was sitting on the veranda doing what I did best, smoking, and I looked down and my hand was paralysed. My face was drooped. I tried to get into my house. I tried to open the screen door and I didn't know -- we'd lived there 20 years and I didn't know there was a button on the door. I was shaking the door and finally got it open. I got into the house and couldn't find my way around. I didn't even know where I was. I'd lived there 25 years. I finally found my wife, and she said, "Well, you've probably got some circulation -- go put water on it." I reached for the taps. The taps were here, my hands were here, trying to turn a tap that wasn't there. So try that. I'll show anybody these reports and ask you to bear with me, because I do have a problem with correlating. I lose papers left, right and centre. I'll probably lose my keys before I get out of here.
What the concern is: Bill 119. What are we here for? Well, I can tell you why we're here. The Ontario College of Pharmacists has the power under the Health Disciplines Act to initiate regulations to do that which they want it to do, but the government wouldn't get the joy, and blowing -- I don't know how much these committee hearings are going to cost us, but we're paying for them. So when the college says to me, "We came. We wanted an act," of course, I'd want an act, too. It's easier. You don't take the heat.
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Now, with respect to the college and their power, you look at the letter from Dr Truong, who is here. There's a list of people in this, pharmacists who support Bill 119. If you look at them, they're all educators, okay? Educators, not retailers. That's very important. Number two: Their letterhead misleads the people looking at the letterhead into thinking they're in a different position. Past-president means you've been president; but you are still on the executive and you are still making executive decisions. These people are so far past that they're in history, but the people at my board of health were of the opinion that they're all past presidents. They say, "How can you have five past presidents running at the same time?" This bothers me.
Dr Truong indicated that he ran for election in 1992 and he was defeated. This is from the pharmacy publication, "Truong nearly lost his seat on OCP. He believes it should be booted on the tobacco stand."
What that tells you is, the support is not there. Had there been support, Dr Truong would still be at the college, so the issue on the tobacco is not what we think it is.
Also, there was another issue at the college at that time. Premier Peterson wrote to us and I've got the letter here. I can show you. Here it is:
"Dear Mr Taciuk:
"Thank you for your letter. I understand that the staff of my office and the Honourable Elinor Caplan met with you. We are aware the governance of health professions needs improvement."
There were problems at our college a long time ago, probably 50 years ago, and a former minister of this Legislature, the Honourable Mr Leluk at that time, had written a thesis on this -- all the problems at the college, so it's nothing new. There were problems. Tobacco is not one of the problems and it's not going to solve the problem for them.
My contention is -- okay, let's put it where it is -- here's another example: The chief medical officer of health; I believe his name is Dr Schabas. It is my respectful submission that Dr Schabas is one of the chief lobbyists on Bill 119 this province has ever seen. He openly comes out and lobbies. He sent a letter to medical officers of health in the province stating that if any pharmacy group comes to you about the sale of tobacco, contact me and I'll provide you the information. Isn't that amazing? Here's our chief medical officer -- you know what that tells me? This legislation's going right through that Legislature and everybody's going to be lobotomized and it's going through, because if Dr Schabas is involved, turning the screws and providing false information, what else is going to happen?
I contacted Dr Schabas. He stated in his letter to all the medical officers -- I have a copy of that -- tobacco kills 13,000 people a year. Isn't that amazing? That's a lot of people. He said he's going to stop that. We won't have people dying from tobacco. Great.
I said to him, "Is that what your primary motives are?" He said, "Yes, and if we get it out of pharmacies, that's going to help." I said to him: "You're so concerned about the life of the province. Not that I'm a pro-lifer or in favour of abortion, but why are you allowing 43,000 babies, unborn fetuses, to die -- because you told me, 13,000 die from tobacco and you're concerned about that. Let's turn it right back." So his argument does not hold any water at all. His purpose does not hold any water.
I would respectfully suggest that this legislation has nothing to do with tobacco and utilization. My contention is, there's a battle between a major tobacco producer and a major pharmacy chain. The chain's got nothing to do with it; neither has the tobacco. But why would Dr Schabas get himself involved?
Another example: ALOHA is an association of health organizations, right? Dr Jaczck will be here today. The question to ask her is -- it states here: "The promised tobacco act is intended to prevent this from continuing to be the death of the next generation." What about the babies? Let's ask that.
"We call on the members of the Legislature to ensure that this legislation is brought forward and passed." You know what she did? She sent out and got every medical officer of health of this province -- why've I got this? Because I'm on the board of health. Look, they all signed. They supported it. You know what? The legislation to my knowledge wasn't released yet. Isn't that great? No legislation, but they signed.
I brought it up at our board of health. You know where it is? They didn't put it in the minutes. It's not in the minutes for the meeting that we went to on this one.
Here's a beautiful one to Dr Jaczck from campaign on tobacco -- one part. "Prior to the act's introduction many of you wrote and telephoned." It said that "the NDP deserve a pat on the back on this legislation." You don't pat until you're finished, unless we're going to be driving right through without even having any problem. I don't know.
Okay, the next one is -- I was very pleased to see this brochure here, because that tells me that the government is now concerned the legislation may have some rough running through the Legislature.
Interjection.
Mr Taciuk: This is the one here -- through the Star. It's a beautiful thing about children: how we deal with them, how we do this. But you know, this thing here is not consistent with the textbook on psychiatry. The ministry -- the way they designed it, it's nice. But one thing the government did admit -- and it's at the very end, about the addiction properties -- is that it's highly addictive. It's worse than heroin for addiction and you want to take it out of the pharmacy. That's going to really solve the problem, isn't it?
I'll tell you what. I went to Europe. I was a smoker then. You had to go to a tobacconist's shop. I remember driving all over the place and I'd kill anybody if I could get a cigarette. That's how bad it is.
The way we brought it up at our board of health is, our chairman has a plaza near his home with about 10 stores: one store's a pharmacy; two doors away is a variety store and two doors from that is the little grocery store. So he looked at it and he says, "Well, if they take it out of the pharmacy, I can still go two doors away or there." But then he says that if this fellow leaves -- it's all senior citizens in the area; they walk to that pharmacy to get their prescriptions; walk. The chairman, that's how he changed his mind on this bill. He was supporting it until I said: "Go down there; you live in the area; go look it out. Don't even talk to the pharmacist; just look it over."
Another thing that bothered me -- I'm totally against tobacco, but I am against control and treating people like kids. We will make the informed choice. I made the informed choice to die. For some reason I didn't die; I had a stroke. Next time I'll die. But we make the informed choice. The government is not going to be my keeper. They may think they are and they're going to legislate me to death, but it's not going to do any good.
This is the kind of stuff that's coming out -- running down -- shoppers this and shoppers that. But you know what the issue -- Mahood has not talked about how it's going to reduce tobacco utilization. Everything I got from our board of health that was put on our plate is criticism, criticism: These people are married to these people. These people are sleeping with those people. Who cares? Tell me how the legislation's going to benefit the public of this province. Tell me that. You won't find anything.
Mr Mahood brings out in the paper, when they're talking about the reduction in tax on the tobacco -- I love his comment that it would lead to revenue loss of hundreds of millions of dollars which will have to be replaced with something else. I thought he was concerned about smoking and health. He's telling about taxes and bucks now. I don't know. That's another one.
I better put this down because this is the society's view. "The society is supportive of curtailing the use of cigarettes" -- this is a letter that they sent to the mayor of Etobicoke and it gives their position -- "and their distribution. We are also supportive of any program or legislation that will deter our young persons away from smoking. However, the government's proposed legislation does not address any of these problems whatsoever. The legislation merely removes pharmacy as one of the links in the distribution chain for tobacco in Ontario. It is the government's ultimate goal that by removing pharmacy as one of the links in the tobacco distribution chain it would show somehow curtailing of distribution; there's ample evidence that this will not occur."
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That's the position of the society. I read you Dr Schabas's thing.
Here's another non-smoker's letter, to a councillor in Etobicoke, not saying how the legislation's going to benefit. He says, "I believe the committee of independent pharmacists is a front for the tobacco industry." What's he talking about? Hasn't he got anything positive to say about the legislation? Anybody can go and personalize and attack people.
This is signed by Gar Mahood, and then at the bottom he says, "I do regret I am unable to appear personally at council." He takes a shot and then he runs.
Then here's another one: "We believe the committee of so-called independent pharmacists is either a front for a group of chain stores or Shoppers Drug Mart." No proof. Won't come to the meeting, though.
I think I'll just move to the last part. The college thing is very important; I can give you the regulations of what it is. But they had the opportunity. They could have done it, but they didn't do it, and it is my firm belief that all we're doing is going through the motions to give the government a big pooh-hoo when it pulls this legislation off. It will be another Bill 100. Then they're going to turn around and say, "Oh, colleagues, you make the regulations for this." There will be no act.
This is where I differ from the medical association. As I said, it's a very, very addictive drug and the idea about teenagers -- they don't take that, in this book, to be full gospel. Just one second.
Another thing, if you're so concerned about tobacco, do you know that you've got the same problem with caffeine? It's a highly addictive substance, and here it outlines what the problems with caffeine are. But the tobacco issue -- "Tobacco dependence is defined as persistent tobacco use, despite the person's psychological distress at the need of repeated use."
What causes it? They say that a kid grows, he's going to automatically become -- here they don't say that, but what they do say is, "Causes: The initiation of tobacco use seems to occur predominantly through social reinforcements." That's where it starts, and it doesn't matter on age.
Tobacco dependence, I don't know if you knew what some of the effects are: anxiety, guilt, shame, anger, counterattacking people. But on the withdrawal, it's really bad. The most common symptoms are irritability, restlessness, sleep disturbances, headache, impaired concentration, memory anxiety. Would you like these people driving a car?
The college is saying, "Take it out of here; we don't want it." You know what? They should be saying: "We want to counsel these people. It's a psychiatric problem. It's serious." Why the hell, excuse my French, do you want to give it away and send it away? Is that what we do in pharmacy? Send their problems to somebody else? The OMA is saying the same. Why is the OMA? The government has given them the right to incorporate.
Also, in this book they turn around and state --
Ms Sharon Murdock (Sudbury): Could you give us the correct title of that book and the year it was published, please?
Mr Taciuk: As I come near the end, okay? The concern is that physicians are now coming out of the woodwork and saying, "Hey, we've got a real problem; we're going to really fix this up," right? But you know what it says in here? "Most cigarette smokers state that they have never been advised by a physician to discontinue." I checked out 50 people I talked to who smoked and I said, "Did your doctor ever tell you to stop smoking?" "No." But the ones who quit, they went to their doctor to quit.
Another reason would be, a doctor is like me. He's a businessman. You don't chase the customer away by giving him what he doesn't want.
If the physicians were so concerned about this, they should also -- as he says in here, "Let's start counselling." It's an addiction. Don't go and throw it down the tubes and pass it on to somebody else. You start telling every patient who walks into your office. The pharmacy -- it's not going to do nothing in here, absolutely nothing.
The treatment here, they say, as a supportive approach is the only way to go. You have to be supportive. Who can be the most supportive? The pharmacist.
The most important aspect, I forgot to mention, is the effect of the drugs on this. Any person using medications -- tobacco has a drug metabolizing effect, so people using psychiatric drugs, chlorpromazine, anti-depressants, their dosages will have to be regulated. What are you going to get: Becker's, Mac's Milk, the corner store? They can't do it. Why is my college saying, "Don't sell tobacco in here"? As long as you've got those people coming in, you're going to be able to talk to them. We have to realign our thinking in pharmacy to the patient and not throw the baby out with the bath water. There's a serious problem with tobacco, and I agree. The pharmacy has to be regulated to take part in this. I think that's all I can give you on that.
The name of the book is Modern Synopsis of Comprehensive Textbook of Psychiatry/III, by Harold Kaplan, MD, and Benjamin Sadock. I will leave one copy of documents with the Vice-Chair and you can distribute them as you can.
But I would implore you not to allow this to be used by government or anybody as a means to change the system. As Councillor O'Rourke said, you don't move into somebody's turf like that without knowing what you're doing. Basically, that's what he's trying to say. I hope this Legislature will do the same and tell pharmacy they have to keep tobacco and you're going to start counselling everybody, even if you have to put the tobacco right in the dispensary. I thank you.
The Vice-Chair: We're almost out of time, but are there any questions?
Ms Murdock: Just one; more of a comment, I guess. In my riding of Sudbury we have a pharmacist in Copper Cliff, part of my riding, who upon graduation as a pharmacist never sold any tobacco in his store. Many of my pharmacists -- in fact, almost all of them -- have agreed with the recommendation that came out from the college of pharmacists two years ago to voluntarily remove tobacco products from their stores. So I am sort of surprised by your presentation today in the sense that I'm wondering who you represent.
Mr Taciuk: I forgot to tell you. I started consulting probably the time McDonald's started. In 1969 we were written up in the British Pharmaceutical Journal for the first pharmacy that had been consulting -- we had no front shop. We were written up in the Canadian Pharmaceutical Journal. We have been in the world bulletins for what we have done. But I see it differently. I see it as an opportunity, with an addiction -- and another reason, too, which you brought up: If you are in a clinic, the only thing you want is that piece of paper, that prescription. I had clinic operations. I had two of them. I didn't need tobacco. I didn't need drawing cards. My drawing card was the doctors upstairs, and I got the piece of paper downstairs. They didn't send them to me, but they had to come down the stairs, and to get out the door they had to walk by me. So you have a different philosophy.
Ms Murdock: So you represent consultants to pharmacists but not pharmacists.
Mr Taciuk: No, I don't represent -- I started the Society of Independent -- now, that group, the other group that sent things around --
Ms Murdock: Who is your membership? That's what I want to know.
Mr Taciuk: The membership is pharmacists around Ontario. It's a very small group and we're not associated with any group that represents -- called the committee of independent pharmacists. The society of independent pharmacists was formed at the time of Murray Elston during Bill 54, Bill 55, and the Senate bill 92 when we appeared in the Senate. It was formed as a cohesive group that had likewise philosophy. As I state, numbers don't mean anything. If you want to talk numbers, we're talking philosophy. We're talking, will legislation work? If one person can bring out a point in legislation, if you've got 1,000 -- like I showed you, the college: Now, Mr Truong, if his group represented as much as they did, he would have got re-elected. So numbers don't count is my opinion.
The Vice-Chair: Thank you for your presentation.
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PHARMACISTS IN SUPPORT OF BILL 119
The Vice-Chair: The next presentation will be made by representatives of the Pharmacists in Support of Bill 119. Would you come forward please, introduce yourselves and proceed with the presentation. Hopefully, there will be time for a few questions when you've completed your presentation. Good afternoon and welcome.
Mr Jim Semchism: Good afternoon. My name is Jim Semchism. I'm a pharmacist-owner from London, a past president of the Ontario Pharmacists' Association -- that's the voluntary body for pharmacy in the province -- and co-chair of the group known as Pharmacists in Support of Bill 119.
I am joined by my co-chair, pharmacist Nghia Truong from Ottawa. Nghia is a past president of the Ontario College of Pharmacists -- that's the regulatory body -- and played a key role in the development of Bill 119, the Tobacco Control Act, which proposes to ban tobacco sales in pharmacies in Ontario. I am also joined by Margaret Frankovich, a pharmacist-owner from Whitby. Margaret is one of our founding members. She appeared with Nghia and myself at our opening news conference at Queen's Park in December.
On behalf of our group, we would like to formally congratulate the government for forwarding the Tobacco Control Act. We support all of its major initiatives and urge the Legislature to pass Bill 119. We are especially pleased that the province has chosen to respond positively to the request from our own licensing body, the Ontario College of Pharmacists, to suspend the sale of tobacco products in pharmacies.
The founders of Pharmacists in Support of Bill 119 include three former presidents of the Ontario College of Pharmacists, two former presidents of the Ontario Pharmacists' Association, the executive director of the Canadian Pharmaceutical Association, the dean and acting dean of the faculty of pharmacy here at the University of Toronto, a former registrar of the Ontario College of Pharmacists and several other prominent community and hospital pharmacists.
Our group has four basic objectives:
(1) To support the 1991 request from the Ontario College of Pharmacists for legislation to terminate the sale of tobacco products in Ontario pharmacies;
(2) To support the passage of Bill 119, the Tobacco Control Act;
(3) To inform the public that many Ontario pharmacies have already removed tobacco products from their stores, some in response to a series of requests from the Ontario College of Pharmacists dating back to 1989, and that others have never sold tobacco products;
(4) To educate the public about the incompatibility of pharmacy as a health profession being involved with the sale of tobacco products.
Margaret, Nghia and I own pharmacies where tobacco was sold. We removed tobacco products from our stores during the 1980s and have remained successful health professionals. The discontinuation of tobacco sales in our stores did not lead to our demise. Unfortunately, voluntary removal of tobacco, as endorsed by the Ontario Pharmacists' Association, has not occurred in all pharmacies.
Since our initial news conference here at Queen's Park on December 10, 1993, our group has prepared and sent a letter of introduction, a membership form and a survey to every pharmacist in Ontario. Most of our colleagues have just recently received this correspondence, and we hope to share with the committee our membership numbers and survey results at either the hearing in London or in Ottawa. A copy of the survey is attached to our documentation. Our activities are funded entirely by the generous donations of pharmacists who support our objectives.
We have been active for the past two months meeting with our allies in the health advocacy field. Our efforts have been endorsed by many organizations, such as district health councils, public health units, medical officers of health, local chapters of the cancer society and the lung association, the Canadian Pharmaceutical Association, the Non-Smokers' Rights Association and the Ontario Campaign for Action on Tobacco. We are grateful to all these organizations for their support and advice.
In response to correspondence sent to over 500 Ontario municipalities by the Committee of Independent Pharmacists, CIP, we have written over 130 municipalities in the province urging them to support the proposed ban. In its letter to each municipality, the CIP claims to "represent 1,420 pharmacist-owners in Ontario who sell tobacco products." In reality, there are only three members. In an interview in the January edition of the Pharmacy Post the following paragraph is printed, and I quote: "`Just the three of us are the committee,' Rosen admits, adding they felt any independent pharmacists who currently sell tobacco products `would support us.'"
They also told in the letter to the municipalities that, "Approximately 300 pharmacies will have to close, up to 10,000 jobs will be lost and the remaining pharmacies will have to downsize....As time goes on, the commercial tax base of your community will be adversely affected."
There is no rational basis for this preposterous assumption.
In response to the CIP's unfounded projections, several town councils passed motions against the proposed ban before receiving our letter on the subject. Most groups passing motions of support were from small towns, counties or townships with the exception of Sault Ste Marie, Niagara Falls and Brockville. Rather than catalogue each of the councils in opposition to our cause, I would like to highlight two interesting cases.
In southwestern Ontario, the town councils in Mitchell and Petrolia passed motions decrying the pharmacy tobacco sales ban. In Mitchell, the only pharmacy in town does not sell tobacco. The pharmacist-owner was not contacted by a single councillor before the motion was made. In Petrolia, there are two pharmacies, a small clinic dispensary that does not sell tobacco products and a large chain pharmacy that does. Neither store was contacted before the motion appeared at council. In response to press coverage, the manager of the chain store wrote the local newspaper to outline his personal support of Bill 119 and that of his company. Neither pharmacist was contacted by Petrolia's councillors. One of the councillors in Petrolia told the clinic pharmacist that he assumed that the Committee of Independent Pharmacists was really the Ontario Pharmacists' Association, based on their claim of who they represented. It is essential that the social development committee does not fall into the same trap.
Attached to this presentation are copies of the Committee of Independent Pharmacists' letter and our response. You will note that their predictions of job loss, pharmacy closings and the loss of municipal tax base are without substance. We challenge them to show the committee how they arrived at these numbers and conclusions. Hundreds of pharmacies in Ontario have stopped selling tobacco products without serious economic consequences. The Canadian Pharmaceutical Association study in 1992 also confirms the fact that many pharmacies removed tobacco without serious economic consequences.
In our own pharmacies there were no job losses, no downsizings and certainly no pharmacy closings associated with the discontinuation of tobacco sales. The CPhA study results reaffirm our premise that the economic impact on pharmacies is minimal. I believe that the committee will also be receiving the results of a Coopers and Lybrand survey commissioned by our opponents. It is my understanding that this study will predict job losses in pharmacies of 2,700 and pharmacy closings of about 130. This survey defies the experience of hundreds of independent pharmacies who voluntarily discontinued tobacco sales in the last 10 years.
The CPhA study of 56 real cases of pharmacies discontinuing tobacco sales does not support the Coopers and Lybrand speculations. Even if the Coopers and Lybrand figures were accurate, the three pharmacists claiming to be the Committee of Independent Pharmacists grossly overestimated the impact by factors of two or three. Unfortunately, municipalities appear to have accepted misleading, unscientific data. It is truly unfortunate that many municipalities responded to the CIP's propaganda. Again we urge the committee to view the issue from a more informed perspective.
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The Committee of Independent Pharmacists does not represent independent pharmacy in Ontario. Hundreds of independent pharmacies have voluntarily stopped selling tobacco products in the last 10 years. Hundreds of independent pharmacies in Ontario have never sold tobacco products. I believe that hundreds of independent pharmacist-owners currently selling tobacco in Ontario are in favour of the legislation, Bill 119. Many have stated that they will gladly discontinue selling tobacco when a level playing field is created by the province. The president of Ontario's second-largest pharmacy chain, Big V Pharmacies Ltd, Mr Norm Puhl, made the same comment to the media in November. He stated that his 125-store chain was in favour of the pharmacy tobacco ban, that they supported Bill 119 and that they looked forward to the creation of a level playing field.
Let me state once again for the record that pharmacy does not need tobacco sales to survive.
Any reasonable pharmacist readily admits that the health of Ontario's citizens will improve if tobacco use is curtailed. Removing tobacco from pharmacies eliminates a conflicting message and continues a very rational move towards a smoke-free Ontario. Those who promote this myth are not using logic. First, pharmacies are health facilities. Pharmacists are health professionals, educated to promote health and prevent disease. Pharmacists should want everyone in Ontario to stop smoking. Our opponents appear to believe that if this occurred, pharmacy could not survive.
Smoking is the single most significant cause of preventable illness and premature death in the province. Why would any health professional want to be involved with the sale of a product known to increase the patient's risk of stroke, cancer of the mouth, cancer of the larynx, cancer of the oesophagus and cancer of the lungs? Smoking leads to ischaemic heart disease and circulatory diseases. Smoking contributes to bronchitis and emphysema. Smokers are more vulnerable to gastric and duodenal ulcers, as well as to bladder and kidney cancer. Smoking during pregnancy increases the risk of spontaneous abortion and low-birth-weight babies.
These are all well-known facts. It is clear why our licensing body called for a ban on tobacco sales in pharmacies. How can pharmacists who call themselves health professionals appear before this committee and argue against our college's rational request for legislation to ban the sale of tobacco in pharmacies?
Pharmacy loses credibility when pharmacists try to defend the sale of tobacco on legal and economic grounds. Pharmacy survives throughout Europe without the stigma of tobacco sales. It is time for North America to wake up. Our members applaud our licensing body and the government of Ontario for developing legislation that will remove tobacco products from all pharmacies in this province. This is precedent-setting legislation for North America and will be duplicated across the continent.
Late last Saturday evening, I received an after-hours request to open my pharmacy to fill a prescription for a two-year-old asthmatic girl. The girl's father brought me a prescription written in a local hospital's emergency room for a steroid inhaler. He told me his wife was also asthmatic and that she had used a similar inhaler. While counselling him on how to use the device, I asked him about tobacco smoke in his home as a possible irritant to his family's asthma. He admitted to being a heavy smoker. He was coughing and complaining about the cold air outside. How would a pharmacist who sold tobacco have resolved the ethical dilemma that they would have to face? Profit from the sale of tobacco, profit from the sale of medication used to treat the adverse effects of tobacco consumption: clearly a conflict of interest. How often are health professionals confronted with smokers seeking medical attention for conditions caused by or exacerbated by tobacco smoke? No health professional's income should be dependent on the sale of this deadly product.
I would now like to call on Nghia Truong to describe the efforts of the Ontario College of Pharmacists over the past several years to remove tobacco products from pharmacies.
Mr Nghia Truong: Good afternoon, ladies and gentlemen. Let me first thank all the members of the committee to give this group a chance to talk with you. Let me make one thing clear right from the start. Maybe you have heard my name about being the president of the college; it's the past. I'm no longer on council. I speak of what happened at the college when the genesis of the pharmacy part of this bill came about.
I have to go back to when I first came to Canada. I was trained in Europe as a pharmacist -- in France, to be exact. As all of you know, you can walk into any pharmacy in Europe and you will never find tobacco. You can walk into a pharmacy in Asia, in countries that we call developing countries, and you would never find tobacco in a pharmacy. So I was quite shocked when I first came to Ontario.
The only thing people told me you can do is for you to be inside the process. You can scream from the outside and it will never happen. That's when I became a member of the Ontario College of Pharmacists in 1984. Back in those days selling tobacco was quite natural, and of course pharmacies and drugstores in a North American setting carry everything from soup to nuts.
When I put the question of tobacco to my colleagues on council, I got the answer: "This is a legal product. So it's all right; don't worry about it." But I cannot say I don't worry about it. My training as a health care professional would prevent me from saying that.
I kept on plugging with the college and I made a personal decision which I will tell you when you will be in Ottawa, in taking out tobacco in all my pharmacies. Contrary to what you may have heard, I used to have a large store, a 5,000-square-foot store, not a small store. We carried tobacco and it's a large amount of revenue which I lost; it's not a small amount. So whatever you heard this afternoon may not be correct but I won't go into details.
I took tobacco out of my stores. I used to have four stores, by the way. My wife's own pharmacy -- she's a pharmacist also -- never carried tobacco, so that's the end of the story there. She's smart, I think.
Mrs Haslam: We usually are.
Mr Truong: I quite agree with you, Ms Haslam. I'm told that women are very smart, and I have no problem about that.
In 1989 the college, due to certain pressures from some councillors, made a statement of disapproval. They couldn't go further than that. I won't take any credit but at least we had the tobacco issue on the agenda.
My chance came in 1990, when I became president of the college. By pure luck, if I could say, tobacco is on the agenda thanks to the cancer society and the Non-Smokers' Rights Association. It just dropped in the council's lap. I can say it now because I'm outside council now.
We had a vigorous debate that afternoon and to my deepest satisfaction council passed a resolution to ban tobacco sales in Ontario pharmacies. I could not believe my dream was there. I was thinking if I could ask the college to think about it. Now the council voted to take tobacco out. I could not believe it but it was there.
I was asked, as the president, to strike a task force to find ways to implement this council's decision. It was chaired by a layperson on the council, Ms Jane Chamberlain. I will give you those names because they are significant.
We have asked four people to sit on the task force. I was quite fair in a way that, being president, I would not want to be involved in it. The four members are two members of council, Ms Midge Monaghan from Hamilton and Dean Don Perrier from the faculty of pharmacy. We went outside the council to get two more members, Mr John Connor, an independent pharmacist from the Ottawa area, and Mr Norm Puhl. You may have heard the name already. He's the president of the second-largest chain of pharmacies in Ontario.
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Why are those names significant? You will hear all of them in the next few weeks. Ms Chamberlain will be here to speak to the committee; Ms Monaghan is presently the president of the College of Pharmacists. I don't think Dean Perrier will be on the list. Mr Connor will be speaking as the president of the Ontario Pharmacists' Association and I don't think Mr Puhl appears on the list.
Going back to the task force, the task force took almost a year to listen to hearings and read submissions and listen to everybody. We wanted not to make the same mistake as our colleagues in Quebec because over there the College of Pharmacists made a very quick decision to ban tobacco without properly having hearings from the community, meaning all the people involved. So the task force heard over 200 submissions and in June 1991 brought its final report, which council passed after vigorous debate and which forms, ladies and gentlemen, the pharmacy part of this Bill 119.
I speak with emotion because I could never believe it would be here today. When I left council in 1990 for reasons that people think -- it doesn't matter whether I was defeated by a candidate who offered tobacco. I keep on reminding my colleague pharmacists that being a member of the Ontario College of Pharmacists, you are there to represent the public of Ontario; you are not there to represent the pharmacists. So whether I was defeated by my colleague does not matter. The matter for me is for the public health of Ontario.
It took two years for this bill to be here today and I beg you to realize this bill comes from our own governing body, the College of Pharmacists. They will be here in the next few days to talk with you. Would you imagine if for some tragic reasons this pharmacy part of the bill is deleted or lost in the debate? This committee and this government would send a very mixed message to all colleges; ie, on January 1 of this year, with the Regulated Health Professions Act, there are about 23 new health professions and it will send a chilling message to all councils of those colleges that if they send something and ask the government to pass a bill to help the public of Ontario and they get defeated, what is the message that this government and this committee would tell the public of Ontario? Please think of that. That's all I ask of you.
Many of us have spent a lot of time and effort. I have spent a lot time talking to my two MPPs in our area and I thank you for the time. Publicly I thank Mrs O'Neill and Mr McGuinty for giving me the time to speak to them. They gave me some insight as to how to do it properly and I thank them for that. I would like to take this time to thank the government and all members of this committee, the previous five or six Health ministers who had to deal with this tobacco issue and didn't have a chance to do it.
This is a time that we in Ontario have to present ourselves as leaders. Leadership is difficult sometimes because we have to make difficult decisions. Am I quoting Brian Mulroney? Forget it. Don't say that. Sorry about that; I'm just joking there. The world is looking at Ontario -- the small world of other provinces. Many colleges of pharmacy in other provinces told me personally when I was the president that they look at Ontario. If Ontario passes it, they will do it. North America, meaning the US, is looking upon us.
When I visit my fifth-year students in France -- I still go there and give some lectures in international jurisprudence and pharmacy as a guest lecturer -- we bring up this question of tobacco in Canada. They are amazed that this thing has dragged on so long. But I told them, in Europe, you could be very dogmatic. The college could do things that in Canada we can't because we're supposed to be a democratic country. We let everybody discuss the thing. We cannot go and pass a law. So they are amazed.
My professors, my mentors, keep on telling me: "If you're doing the right things, don't worry about the consequences. Later on, history will tell you that you were doing the right things." I'm asking you, history is looking at Ontario now. Please do the right thing. Pass the bill pertaining to pharmacy as it is.
Pharmacists in Ontario have already had four or five years to get ready, from 1990. If they're not ready by now, they will never get ready. So if they come and beg you for one year and two years and three years, it's all in the task force, 1991. It gave them two years to get ready. If they haven't got ready by now, they will never get ready, ladies and gentlemen. Thank you.
Mr Semchism: Thank you, Nghia. I would like to call on Margaret Frankovich to share her views and experience on removing tobacco from her pharmacy.
Ms Margaret Frankovich: I'm here to show my strong support for Bill 119 and to applaud the government for taking a decisive stand on a serious issue. I fully support this legislation, not just as a citizen but also as a pharmacist and a founding member of the group Pharmacists in Support of Bill 119.
I'm a third-generation pharmacist who is an owner of a community pharmacy in Brooklyn, Ontario. I've been an active, practising pharmacist for 22 years, and during this time I've had an opportunity to be exposed to a wide variety of pharmacy practice in Ontario.
I've worked with the Addiction Research Foundation in northeastern Ontario; been president of the Porcupine Pharmacists Association; been on the council of the Ontario College of Pharmacists; worked at the faculty of pharmacy, University of Toronto; and I am presently coordinator of continuing education for the Durham Region Pharmacists Association. I am a pharmacist who is absolutely committed to pharmacy as a health care profession and to pharmacists as members of the health care team.
In the past, perhaps none of us knew the full story of the health risks involved with tobacco use, but during these hearings, this committee will be made very much aware of these risks and the resultant costs to the people of Ontario. Pharmacists are aware of these risks and because of this should not be involved in the promotion or sale of tobacco products. Pharmacies, which are health care facilities, are not suitable sites for tobacco sales.
How can I, as a health care professional committed to pharmaceutical health care and receiving fees from the Ontario Ministry of Health for pharmacy services, be involved in the sale of a product which is known to cause such morbidity and mortality to the people of Ontario? For our pharmacy and our pharmacists, the answer is that we cannot be involved. We have not sold tobacco products since 1983.
During these hearings, you will hear arguments which predict job losses and the economic demise of pharmacies which are forced to give up the sale of tobacco products. Our pharmacy has not sold tobacco products for 10 years and yet we are still a viable pharmacy, and not one person lost their job as a result of this action.
In my opinion, the reason we were able to do this was that after ceasing the sale of tobacco, we were able to focus our attention on health care, which is the primary reason for our existence. It is for these reasons that I have chosen to strongly support this legislation and to urge its enactment. I thank the committee for allowing me the opportunity to present my views.
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The Vice-Chair: We have time for one short question only. Mr White had indicated he wished to ask a question some time ago.
Mr White: Ms Frankovich, you spoke of your pharmacy's efforts. You stopped selling cigarettes some 10 years ago. Not unlike Mr Truong, you experienced some loss of revenue. Did you experience some loss of revenue as a result?
Ms Frankovich: No. I'm going to be appearing before the committee again and when I do so I will be showing my financial statements that show my sales continued to increase. I will also show you my financial statements for 1992.
Mr White: So not only did you not lose money as a result of this, you were able to maintain your integrity as a health care professional without ending up in the poor house or your pharmacy closing down.
Ms Frankovich: That's correct.
The Vice-Chair: Thank you for your presentation. We do appreciate it.
Mr Jim Wilson: Mr Chairman, I should caution the witness not to show any profit or the NDP will have her before the finance committee.
The Vice-Chair: That's not a permitted comment. Again, thank you for coming forward.
ASSOCIATION OF LOCAL OFFICIAL HEALTH AGENCIES
The Vice-Chair: The next presentation will be made by representatives of the Association of Local Official Health Agencies. I would ask the representatives to come forward, introduce themselves and proceed with their presentation. Hopefully, there will be questions.
While the representatives are being seated, I will confess to the committee to being a director of this particular association in a former life. Welcome.
Mr Richard Cantin: My name is Richard Cantin and I'm a vice-president with the Association of Local Official Health Agencies, ALOHA. I'm also chair of the health committee in Ottawa-Carleton. David Butler-Jones is a medical officer of health for Simcoe county and a member of ALOHA, and a person who originally wasn't planning to be here -- she's along for moral support -- is our president, Helena Jaczek, who also happens to be the medical officer of health for York region.
ALOHA is the collective voice of Ontario's 42 health units and boards of health. I'm not going to bore you by reading verbatim. That's probably the only thing verbatim I'm going to read in the whole brief.
The Health Protection and Promotion Act defines the mandate and responsibilities for boards of health and medical officers of health in key areas that make a difference to Ontario's health. Ontario's government faces a very difficult issue with Bill 119, that of possible loss in tax revenue due to reduced sales and possible loss of jobs in the tobacco industry proper.
ALOHA wishes to congratulate the government on the introduction of legislation to reduce the number of young people who become addicted to tobacco. Much like one of your past presenters, we feel that with people my age, you may as well give up. Once they're addicted, they're lost. But if you can hit somebody before they're 19, it's a much easier sell to keep them off.
We have enclosed in the package some recent resolutions from our annual general meetings which touch on the subject and indeed support the government's position.
Dr David Butler-Jones: We're not going to repeat the mountains of evidence that really identify tobacco as our number one preventable killer in Ontario, and actually most of the developed world. If we're going to have any real success in challenging this epidemic, then we really have to focus on preventing addiction.
This century has seen some remarkable improvements in health, and in fact,if you look at each day of the century, average life expectancy has increased by about eight hours. Unfortunately, most of that's been wasted in terms of the life expectancy of tobacco smokers, and we really have to get at it early.
In that context, tobacco use prevention is our most important public health problem. Potentially, this legislation that you're dealing with could prove to be the most important piece of health legislation in this decade.
Mr Cantin: Evidence will show you that there are 13,000 deaths due to cigarettes in Ontario every year. That's equivalent to having an A300 Airbus scheduled to crash-land at Pearson International Airport every week of the year. That's 52 Airbuses, 13,000 people, passengers and crew.
Therefore, we are supportive of licensing restrictions with stronger measures to prevent sales to minors, the elimination of vending machines, the removal of the anachronism of tobacco sales by pharmacists who profit from ill health caused by tobacco, and these are to be commended.
I'd like to piggyback on a statement made by a pharmacist earlier. I live in a community east of Ottawa called Orleans, and recently a chain of pharmacists from Quebec moved into the neighbourhood. An independent pharmacy hooked on to this chain and invited me to the ribbon cutting, which I refused to attend because as chair of the health committee I could not go to the ribbon cutting of a pharmacy that sold cigarettes. He found that unfortunate, especially when I told him that I would cease to be a customer, because I had been a long-time customer of his. He found that very unfortunate, did back flips and everything to entice me to go, and I refused to go.
The nice thing about this story, the nice ending, is that two months later he called me back. He'd been in intensive negotiations with the president of the chain and for the two months that he had to sell cigarettes they were not visible. They were under the counter. You had to request cigarettes if you were going to have any. The beauty of it is that he called me after two months of intensive negotiations to tell me that he no longer had to sell cigarettes in his store. His profit numbers have gone up from the independent dispensary, to the chain, to the chain without the cigarettes. In fact, he makes a big to-do about the fact that he doesn't have to sell cigarettes, and he doesn't have them. Of course, our local board of health has stickers that say, "This is a smoke-free pharmacy," which kind of reinforces it.
We're told that there's a study about to come out by the tobacco manufacturers that own pharmacies that jobs will be lost; not true. The story you heard earlier is replicated many times over in Ottawa-Carleton. What we like about the legislation is that it hits the root of the problem. It proposes to have some fines for not only the retailers, but people who might be buying to resell to kids, especially in high school. I've got a 14-year-old who was offered cigarettes in his high school. I'd like to see that person hit. So let's make sure that what we do, the decisions that come out and the recommendations that go to the Legislature are those which make it very difficult and very uneasy for the person who does in fact sell to the underaged.
Price and availability are key determinants in acquiring addictions. It's a fact which drives tobacco lobbies to call for reduced taxes. The temptation to accept this quick fix must be challenged. The only outcome of lower taxes will be thousands more addicted teens and premature deaths.
Smuggling of Canadian cigarettes back into Canada should be fought through law enforcement and appropriate distinctive packaging. We've been talking about plain packaging for all companies, not through the surrendering of the next generation. ALOHA also supports a reintroduction of the export tax by the federal government.
We've said it and everybody will tell you that if you can stop someone less than 19 from smoking, you will increase the chance that they will not be a lifetime smoker. We feel that not only should the legal age be up to 19 years to smoke, but for the person who sells the cigarettes it should be 19 years as well.
Dr Butler-Jones: Just to elaborate a little bit on plain packaging and health warnings, not very much, basically our request is simple. It's been shown that plain packaging is a disincentive to young, new smokers and yet has little effect on the established smoker.
The other thing is that basically the only thing we want on cigarette packages, other than the basic identification that this is a Rothmans or a cigarette, should be the health warning, and that also will make it much easier to identify cigarettes that originated elsewhere.
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Mr Cantin: We hear that some pharmacies are crying foul, that they're not being treated the same as retailers. Maybe the pharmacies have to make a decision. Do they want to be pharmacists or health care professionals, or do they want to be retailers? There are enough corner stores that can sell the weed. We don't need to have the pharmacies selling them as well. If the pharmacies really feel they're being dealt a hard blow as retailers, maybe we should go the route of the LCBO-type dispensation; you have to have a very controlled atmosphere in order to sell through that kind of venue.
Dr Butler-Jones: The final point we want to raise before the committee is a key public health issue, and that's involuntary smoking. When it comes to smoking in public buildings, we really hope that the government will introduce strong regulations that will limit smoking in public places. It really is essential to avoid dangerous, secondhand tobacco smoke. Innocent bystanders are particularly the issue here, there's no question.
Just to give you a sense of the day-to-day impact, from time to time I do my turn in an after-hours clinic, and at this time of year with literally half the kids I see, the only reason they are there is because of tobacco smoke in the house. The bottom line for all of this is that the opportunity is now to save the next generation and we must act so that tobacco addiction will die a natural death. Finally, a reference in history, and if I might say, from a personal standpoint: I really don't want a generation from now having to be dealing with the suffering and the pain and the needless cost of inaction today.
Mr Cantin: We thank you for your attention. All three of us are available for questions if you have any.
The Vice-Chair: Mr McGuinty.
Mr Jim Wilson: Are we going in any sort of order here?
The Vice-Chair: Yes, I was trying to go in order.
Mr McGuinty: Thank you for your presentation. Richard, it's good to see you, and I'll take the opportunity to congratulate you on your involvement in health-related issues. Mr Cantin and I are involved at present in an effort to make CPR mandatory in our Ottawa-Carleton high schools. It's a four-hour course some time in grade 11 or 12 and we're looking forward to some positive results.
Mrs Haslam: Have you got flyers?
Mr McGuinty: I'll be signing things outside later.
One of the things I wanted to mention was that this issue of plain packaging is interesting. I read about a study that was done in the States where adults were offered Marlboro cigarettes at a substantially reduced price if they were to be sold in a plain package, but they were so hooked on the aura and the mystique as a result of a very expensive and effective advertising campaign that they just had to have that packaging. So I think even so far as adults are concerned, plain packaging would have some impact.
I really don't have a question for you. I thought your brief was good and I appreciated it.
Mr Jim Wilson: Thank you very much for your presentation, and it's nice to see Dr David Butler-Jones from our county, Simcoe county. I know that in the time I've been elected and prior to that as an assistant, I've read many of your articles in the local papers and that you've sent to us regarding smoking and other issues, and I just want to say publicly that I think you're doing an excellent job.
Like Mr McGuinty, I agree with most of the brief; in fact, it's one of the few briefs that mentions pharmacies that I think I can agree with -- the point of purchase, the point you make on page 3. I'd be interested to know whether anyone has actually seriously pursued this, and that is to restrict the sale of tobacco products in premises like LCBO and Brewers Retail. I would say it would be the ultimate level playing field for all those retailers out there. Frankly, I can see that happening at some point in my lifetime, I expect. If the trend continues and the public continues to get fed up with smokers, which they clearly are, then we may see it into restricted licensed premises like that.
Has anyone seriously pursued that, that you're aware of?
Dr Butler-Jones: In terms of jurisdictions, not that I'm aware of. Obviously, there is the ease where you already have a licensed premise. You have the situation where people under that age aren't able to walk in and purchase. You have ID cards. It fits very neatly.
The thing that we experience, and it's not unique to Simcoe county, is that people walk into pharmacies, kids of 14 and 15, they're unchallenged, they buy a couple of packs of cigarettes and they walk out; no big deal. That's much harder to do in a Brewers Retail.
Mr Jim Wilson: That's true.
Mr Cantin: It's especially true when the cartons of cigarettes are right there at the cash at the door. If they're on open display, it seems as if there's a blessing by the health care community for cigarettes, that it's really not going to harm you, no matter that commercial with Joan or Joanne, where she huffs and puffs in the bathroom and ends up dying by the end of the 30-second clip. No matter how effective that public service announcement is, if you walk into a pharmacy and you can associate cigarettes with health: "My parents are kidding around. They're not serious. It can't be that bad. We know people who smoked till they were 83." But they don't talk about all the other victims along the way who might have had asthma, who might have had allergies.
I'll tell you a very short but personal story. I was a corporate trainer with Canada Post for many years and didn't drink at all in those days. After a full day --
Ms Murdock: But he does now.
Mr Cantin: Things have changed. When you become a politician, you take on other things.
The odd thing is that I'd wake up following a training session out of town and I'd have the worst headache, similar to a hangover. I'd come back from my trip, a day back at the office and it was gone, but for the week I was away, I was suffering. My eyes were puffy and I didn't sleep well.
I went to see my GP and he suggested: "Maybe it's your training sessions. Do people smoke in the room?" "Yes." "Well, try one of two things: Have them leave the room during the training session or you're one of these guys who's used to being outside all the time and maybe you could open the window and offer a people the choice, `We work with the window open or you leave the room if you want to smoke.'" I did the open window thing for a while and never got a hangover all week. So there are people who are affected very tremendously by the effects of secondhand smoke.
Mr Jim Wilson: Yes, I know some.
Mr Wessenger: I have a question. I'd like to explore your comments with respect to involuntary smoking and the question of smoking in public places. I have two questions, first of all. One is that we had some representation by the restaurant association suggesting that they could, by certain ventilation measures, protect patrons against secondhand smoke and I'd like your comment on that.
Dr Butler-Jones: It is conceivable. For a room this size, though, my understanding from the engineers is that you'd need a fan the size of half that wall to actually ventilate it adequately. You'd need to have segregated dining areas basically with separate air flow, and the same for other buildings. If you have a totally segregated area with a different air source and venting to the outside, that's quite possible. You could have that.
My concern would be how it would be applied. For example, recently at a lunch that I had with a local MPP, the smoking section was about six inches from the non-smoking section, sort of meeting the law but not quite meeting the intent of the law.
Mr Wessenger: Just to add, do you have anything we could look at as a guideline in determining where smoking should be restricted in public places? Are there any bylaws you've seen that have been particularly good or as a guide?
Dr Butler-Jones: Toronto's is probably the most active in that area. I think what ALOHA in the past has talked about is basically any public space, so you're looking at arenas, at restaurants, office buildings, unless you have a designated smoking area. The focus should not be carving out small areas where non-smokers can go and be protected. It's a matter of providing a separate space for smoking for those who need to do that, or outside.
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Ms Murdock: I noticed that the last resolution, for the East York Board of Health, was suggesting under one part of the resolution including taxis as covering an area for no smoking, just to follow up on Paul's question.
The question I want to ask is on your plain packaging and health warnings because the OMA made it very clear about calling tobacco a poison. When they said it, and they said it so strongly, I thought to myself, "Gee, it's a wonder it doesn't have the hazardous signage" --
Dr Butler-Jones: Skull and crossbones.
Ms Murdock: -- "that they have under the Health and Safety Act." I was wondering what your views on that were. With respect to plain packaging, the point has already been made, but if you had a skull and crossbones across the front of it, I'm wondering how effective that would be.
Mr Cantin: I'd like to draw on personal history again. I've got a father who's about to turn 84 years old. I was playing midget hockey, and Dalton McGuinty will remember and maybe Ms O'Neill will remember, at the old YMCA auditorium in Ottawa. That's where I played, so it was a few years ago. My father couldn't skate the length of that hockey rink when we went for practice.
Today at 83, about to be 84, he skates a length of the Rideau Canal, four and a half miles, and back. He hasn't smoked since the age of 53. He's been without smoke for 30 years and the reason he quit smoking was that one night he went into a coughing fit. This was a man who smoked three decks a day, 75 cigarettes a day. He quit overnight, he was so afraid to die. That's what it took.
Dr Butler-Jones: In terms of the question, I think we'd want to go to the literature more and actually do some market testing. My guess is that actually a skull and crossbones might be more attractive. From the studies I'm aware of, the simplest thing is a very simple message that makes the package look unattractive, but the only thing you see is, "Smoking causes death due to" or whatever, as opposed to a skull and crossbones, which may actually be a cult identity. You'd want to market-test that kind image.
Interjections.
Dr Butler-Jones: Yes, that's right.
Ms Murdock: You mentioned Toronto, but I want to get on the record that Sudbury had a big controversy when it passed its resolution -- I'm sure your district health council would probably have advised you of it -- where it made all public buildings in the city non-smoking. Even though the university rents out the great hall to weddings and so on, there is absolutely no smoking on the premises.
They did it at the arena as well, and the controversy came over the bar in the arena and whether or not a portion of it could be designated non-smoking. The council voted against smoking being allowed. They said, "No, it will not be allowed." There was a big controversy again. They revisited the issue and voted again and, proudly I guess I can say, they voted that there will be absolutely no smoking anywhere in any of the public buildings in the city.
The rest of the municipalities around the city of Sudbury haven't done that yet, so regionally we aren't covered, but municipally we are. It's slowly coming on a voluntary basis.
Dr Butler-Jones: It really is a patchwork and that's the difficulty.
Ms Murdock: Yes.
Dr Butler-Jones: Places like arenas often are ones that in the past have challenged it the most. I've seen many kids who would wheeze every time they play hockey until you can get the smoke out of the arena.
Mr O'Connor: Thank you for appearing before the committee. We're hearing from a group called the Committee of Independent Pharmacists and they've asked municipalities right across the province for endorsement of the bill other than the ban on pharmacies. I just wonder whether you would have been requested -- Dr Jaczek would perhaps have been approached -- by the local municipality for some response in preparing a resolution either yea or nay for this.
I've seen one of my local municipalities that has responded to it. I don't think they approached the pharmacists, because I know of two; one sells and one doesn't. I wonder whether you have been asked for advice by any municipality on whether or not it should be endorsing such a resolution?
Dr Helena Jaczek: In relation to York region specifically, of course I did receive the resolution and the suggestion that I forward it to our regional chairman, who also had his own copy. Each of the nine municipalities also have their own copies. You can be sure that unless I'm specifically directed to even popularize this, I would not do so.
The pharmacists' association has spoken very clearly: They are health professionals. It simply, in my view, is entirely inappropriate in terms of what they're circulating to municipalities. I feel fairly confident in our own region that there will be absolutely minimal interest.
One point I'd like to make is simply that the reason why I think Bill 119 is so important and why we are having legislation now is specifically because all the efforts made to date have not been sufficient in terms of the epidemic of new smokers that we're seeing, especially the young female smokers. The public health messages, the municipal bylaws -- in our own region we have some excellent municipal bylaws -- are still not sufficient. It needs to be a total package such as this particular piece of legislation encompasses, and this is the appropriate way of handling this problem at this time.
Mr Cantin: With our region being a border region with Quebec, and our knowledge that Quebeckers are just about born with a cigarette in their hands, it's more difficult for one municipality to go ahead. Ottawa has tried to spearhead things. I think they went about it the wrong way. They tried to exclude some of their facilities and include some of the other ones, and you've got to have the same treatment for everyone.
To me, the only way to go is to have a province-wide regulation which touches pharmacies, a province-wide regulation when it comes to sports arenas or stadiums or things like that. You certainly can't have situations like one I'm aware of at the SkyDome, and the SkyDome is a smoke-free situation. There was a health fund-raising organization that had a special event there, and there in fact was a smoking area and the Metro police looked the other way. They were not enforcing their own bylaws. So there's a need to do things the right way.
We in Gloucester -- I represent the city of Gloucester at regional council -- have taken the approach that if the customer walks into a restaurant and is bothered by the smoke, all he has to do is walk out. Do that a couple of times and the owner will realize what it is. As a result of that, most of the restaurants that I frequent have over 75% of their seats as smoke-free. You're really a second-class citizen if you walk into those restaurants and you're a smoker.
Dr Butler-Jones: I'm not sure whether it's been raised yet with the committee, but one of the things I often hear around smoking in restaurants is that business falls. They give examples of the local doughnut shop that went out of business after it went non-smoking. Really, the reality is that's an issue of marketing. The doughnut shops I'm aware of that have gone non-smoking but didn't tell anybody have gone out of business, because the smokers leave but the non-smokers who have quit going to donut shops don't come out, whereas the ones that advertised are bursting at the seams. It's the same with Taco Bell and other restaurants. It's an issue of marketing.
The advantage of making it the same for everybody is that then it's no longer an issue, and jurisdictions that have done that actually have found more people eating out and going to restaurants, people who had given up going out to restaurants because they can't stand smoke, even with non-smoking sections. It's just too much for them.
The Vice-Chair: Thank you very much for your presentation. It's very helpful. We appreciate it.
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CANADIAN ONCOLOGY SOCIETY
The Vice-Chair: The next presentation will be by a representative of the Canadian Oncology Society. Please come forward, introduce yourself and proceed with your presentation.
Dr Michael Goodyear: Good afternoon and thank you very much for the opportunity to come and speak to you today, and thank you for your patience for lasting through the day so far.
Congratulations, ladies and gentlemen. You are at a historic moment in the history of public health in Ontario and you have enormous potential to do good today and in the coming days.
I have a sort of sense of déjà vu, because on Wednesday April 19, 1989, I was sitting here in this room addressing the same committee. Reading through my presentation to that committee, I decided it was so good I didn't really need to repeat it again. Maybe the clerk could provide members of the committee with it. We made all the points there and five years later we're here to see whether you're actually prepared to implement them.
Actually, it's interesting to see how many people are still on the committee from then. A few of them seem to have escaped for the day, like Mr Sterling or Dianne Cunningham, but I recognize Yvonne O'Neill over there. I'm very delighted to see Ron Eddy, my next door neighbour. Many of my patients come from his constituency and many of them have discussed the issues with me and I will come to that in more detail in a little while.
I am going to apologize and crave the indulgence of the members since I basically gave up working on this brief at 2:30 this morning. Some of you may have read the Globe and Mail this morning and noticed that a number of us have been rather busy over the last few days. I think, in baseball parlance, we were thrown a curve ball by the tobacco industry a few days ago. Many of us had to drop all the efforts in working on this bill and devote ourselves to this insane rollback of tobacco taxes, which I don't think was coincidental. I think this bill represents a major threat to the tobacco industry and its $100 million in profits per year.
However, what you actually have in your hands, in terms of a brief, is a bit of a rehash of what was given to Karen Haslam back in March, but it does provide you with some background information. What I will do is just leave a rough draft of my comments this afternoon with the clerk.
I believe I have until the 18th to get a very thorough, carefully documented brief to you. I know how much you love going through clause-by-clause so it will contain every suggestion in the form of drafted amendments to save you all lots of time and work. A lot of them are technical amendments and we won't take up too much of your time with those today.
What you actually have, or should have, in front of you today should be, if I can find the right document, something called Stepping Forward -- I've just discovered page 3 is missing but don't worry -- and a whole lot of background material.
I believe my secretary actually bound in a separate document and didn't include it -- probably because her stapler wasn't big enough -- which is actually the most important document. It's one that is a comprehensive strategy. It's a conceptual framework in which you can relate all the things we're discussing. In my brief, I will make numerical references to those points.
Who am I? You're probably going to ask as you've asked a lot of people here today. My mind is taken back again to 1989 when our colleague Richard Allen -- I'm sure he'd love to be here today because I know he's spoken passionately on this subject in the House on many occasions but is in a warmer climate in South Africa today -- asked me why did I come here today to talk to you. I think what I said then is still valid.
Technically, I'm here representing the Canadian Oncology Society. At the last page of your brief, at the back of that proposed strategy, for some peculiar reason, is a sort of mission statement of the Canadian Oncology Society. Suffice it to say that we represent all cancer specialists in all walks of medicine right across Canada, whether they be involved in radiation or be surgeons or paediatricians or gynaecologists.
In a way, I'm not really representing those. What I'm representing is, I regret to say, thousands of patients I've treated over the last 20 years that I've been practising cancer medicine who, for obvious reasons, cannot be here today but who, in their dying breaths, expressed extreme sadness and anger at a system that allowed them to become addicted to nicotine as children before they could spell either word and which they struggled with through all their lives and they died from.
I'm also here representing their widows, widowers and their children, many of whom have written to me and asked me to do something about it. It usually starts off like, "Why doesn't the government...?" For a long time I said, "Call your local MPP and tell him what you think about it." Then I decided maybe I should do something about it too. That's why I'm here today and that's what the organization I represent -- we feel passionately about this subject.
You've heard a lot about jobs today. Here am I trying to put myself out of a job. I should delighted if I can go and do something more effective if you do your job this month.
This, I'm afraid, is a sort of war. You may have heard expressions like that before. It's a global war. It's one that's coordinated from our side, if you like, by the World Health Organization. On the other side, the enemy is a series of transnational companies that of course will be scrutinizing your every move over the next few weeks. I don't want you to underestimate what the potential power of Bill 119 is in terms of global health. Everything that is in this bill will be rapidly transmitted to other countries where this war will have to be fought many other times. Of course, all the other provinces in Canada are also watching the deliberations of this committee.
You're not alone. I know politicians like to be congratulated for being leaders and you are leaders in many ways in this bill but, of course, you're in good company because legislation like this is popping up all over the place in Canada. There are committees like this sitting and discussing very similar legislation to this one. As it happens, there was just a recent one in Newfoundland. We can come back to that. There is an enormous momentum out there across the provinces in terms of provincial legislation in terms of tobacco control.
It's rather interesting that we're sitting here discussing this now, 44 years after the first major scientific studies appeared on both sides of the Atlantic linking lung cancer and smoking. I don't want to be sitting here discussing this -- well, I probably won't be sitting here discussing this 44 years later, but that's why I'm relying on you to do your job. I'm going to take a quotation from Mr Paul Martin, the Minister of Finance, who was in Toronto the other day and sat down at an economic conference and said, "We're not here to fiddle."
There has been a minimalist approach to this problem for many years and I hope this is going to be your opportunity to actually make a difference. We're not going to achieve any of the goals in this Ontario tobacco strategy if we take a minimalist approach. This is not Band-Aid legislation, this is a chance -- and maybe I'm revealing political biases -- that the current administration should delight in, in being able to take on one of the most incredible examples of corporate greed and predatory industrial practices in the world and to actually translate that into some social good.
I also congratulate all parties in the House. I've read the Hansard debates and I'm impressed with the civility and teamwork with which all parties are approaching this and, of course, this is a partnership between yourselves and us.
I want you also to keep very closely in mind, and I'm sure you've studied all these documents, the goals of the Ontario tobacco strategy, particularly those due in 1995, which I remind you is only 11 months away, so we really have to get on with this.
Obviously, you will guess from my profession that we are in general support of all the measures in this bill, although we think there are a lot of areas that need considerable strengthening. I apologize to all the people in this room who worked extremely hard on this bill when I say there's a long list of technical amendments, but I'm sure they will bear with us.
I'm not here to tell you about the problem. You've heard quite a bit about the problem here today. You're supposed to know what the problem is as opinion leaders in this country and you're going to be hearing all about it. As I said, I could send you several filing cabinets of papers about the effect that tobacco has on the world. There is quite a bit of information in the backgrounder that was circulated a little bit earlier. I think as politicians you want to hear about solutions, so let's talk about the solutions.
I also know that, as politicians, you're also interested in public opinion. I will be depositing with the clerk a tabulation I prepared of public opinion polls over the last few years which basically show support running for most of the items in Bill 119 at about 80% to 90%. I think that this, despite some of the opposition you've heard from certain quarters, is something that is going to get you a lot of public support.
You're not going to hear from the tobacco industry. I did notice a member of the board of directors of Imasco sitting in the back of the room earlier on in the large crowd. They're not going to appear and argue about the things in this bill, they're too close to motherhood, but you will hear from some of their friends, those people who have become economically dependent on them who will be pushing their particular thoughts.
For Mr Eddy's sake, I noticed in the Hansard reports that there was some discussion about the effects of this legislation on a certain sector of the Ontario economy. In fact, I spent quite a lot of time over the last year working in municipalities along the north shore of Lake Erie, and I actually spent one day with Peter North in his riding, talking to the farmers down there. I don't know if they're wanting to come here, but I will say that, just remember, if you completely stop all tobacco usage in Ontario tonight, you will only shrink the demand for Ontario tobacco by 16%.
We live in a market economy. It is driven by changing needs. Our demand for various consumer products is changing all the time and I think this is an economy that is adapting. There are special economic needs in the area that need to be addressed, just like they do in many other parts of the economy, but I do not think you should stay your hands on this legislation because you think we should be promoting the economy in southwestern Ontario. I think those are two totally separate issues and I think the people down there know that only too well.
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The major areas we would want to address really are in the labelling of the product and you've heard something about that today; the regulation of sales and I notice you're very interested in that; and basically the protection of the general public from the combustion products of tobacco.
We've also heard a little phrase that seems to slip off the lips rather easily today about, "This is a legal substance." Actually, rather interestingly, it's not strictly speaking a legal substance. It's very difficult to define what a legal substance is. For your interest, it's actually a controlled product under the meaning of the Hazardous Products Act, a federal piece of legislation which basically classifies toxic substances as either being completely prohibited, which clearly it's not, or as being controlled. In many circumstances tobacco is an illicit drug.
One question that always comes up at these sort of committee meetings is, "Do you think we should prohibit this?" I think in my heart I would say yes to that, but I think that many of you remember, and we saw a fascinating video about this. We also heard a lot about gun-running and various other irrelevant subjects. We saw the stills of the Prohibition era. We know that an unbalanced strategy, one that merely seeks to block access and supply, is unlikely to work, and we also know the craving for nicotine is even more powerful than it was for alcohol in the time of Prohibition.
With 5.4 million Canadians being regular smokers at the moment, prohibition isn't the answer today. It may come when that number is considerably shrunk by the efforts of yourselves over the next few weeks. We need a somewhat more sophisticated approach to the social change that I believe, from your comments today, you all desire.
However, there are many tobacco products on the market, and I want to draw your attention to one particular one. I think there has been some reference to it today. I'm just going to pull out here a magazine that is widely circulated in Ontario schools. It's called Sports Illustrated, and no, it's not the swimsuit edition, about which the least said the better. Here is a full-page spread for Skol. This is smokeless tobacco, chewing tobacco, spitting tobacco, snuff, whatever you call it.
I think you know the sort of kids who read this. This is very much oriented to adolescent males. Many of the athletes pictured in its pages have this sort of peculiar bulge in the side of their cheek, which I'm told is not cancer but tobacco, and I'll return to that.
Mary there and I had the pleasure of visiting a school in Hamilton a few weeks ago. You've seen the advertisements that are on television here and you think maybe we're doing a good job trying to preach to the children of this province about the problems with tobacco.
Basically they said: "Who's telling the truth here? We've got these magazines" -- I didn't bring things like Cosmopolitan and that along -- "American magazines, imported publications, and here are all these glamorous people" -- there are plenty of those in here -- "all having fun, and they're obviously all having fun, because they're riding horses or they're surfing. They're enjoying themselves because they're smoking, and yet you're telling us that it hoards all these terrible things."
Of course you know this fellow here, don't you, Joe Camel. He's more well known than Mickey Mouse, according to a recent survey of American kids. These children are exposed to a lot of influences from advertising. You thought advertising was banned in Canada, but we allow imported publications.
It's rather interesting that Sports Illustrated actually brought out a Canadian edition in November of last year: no tobacco ads in it at all. Unfortunately, due to protests from Canadian publishers, this was then banned by the federal government and we had to go back to getting the American version with all the tobacco ads in it again for the children. Unfortunately, sometimes social policy has undesirable side-effects that one hadn't really thought of. However, in my brief I will address that there is something you can do about that.
The main thrust I'm making here is that while smokeless tobacco, spitting tobacco, is increasing at an alarming rate in the United States and is increasing at an alarming rate among native children in Canada, this is one product that I think we can nip in the bud before it gets any worse. Many jurisdictions throughout the world have already prohibited the use of smokeless tobacco.
It's very interesting that this particular ad tells you that this is the one tobacco product you can use where you can't light up. In other words, they see what is happening to our society, that smoking in public places is decreasing, so here is the chance to replace it with another form of tobacco, and we're back where we started again. I would urge you to think about that.
As you well know, advertising and promotion is controlled by federal legislation, the federal hazardous products control act. This is the subject of Supreme Court of Canada hearings that will be going on this year. Preliminary hearings have already taken place. There is the possibility that due to a technicality, that legislation could be struck down as being invalid some time this year.
The tobacco industry has actually spent, through many court cases leading up to the Supreme Court case, years of arguing that this is provincial jurisdiction and not federal jurisdiction. Therefore, it is vitally important that Ontario follow the example of British Columbia and incorporate what is in the federal jurisdiction into the Ontario legislation, because otherwise you might suddenly find overnight, in a few months' time, that it's open season again on Ontario school children and that we can promote and give away free tobacco samples and have billboards. If you put that into the Ontario legislation -- the industry can't possibly oppose it when it spent all that money arguing that it is your responsibility -- I think we will get a lot further.
If we learn from the experiences of the federal legislation, where there are loopholes that allowed you to see these huge, great billboards for du Maurier and Player's cigarettes and racing cars and tennis, we can get rid of those loopholes -- I will explain that in our brief -- we can get rid of advertising and we can get rid of the link that associates the product, the packet -- you've seen many examples of that today -- with the advertising, and break that essential connection.
Which of course brings me to the next subject, which is packaging, and I think you've heard much about that today. There is obviously a spectrum from just having a little health warning on the corner of the packet all the way to what they call generic packaging, which is basically that you go to your Loblaws and get a packet which would just say "cigarettes" on it. Plain packaging is somewhere in between where the manufacturer would at least be able to put his particular name on it.
We completely endorse that. We know from the market research studies that this turns kids off. We know that a lot of the allure of the product, and there is a background paper on this in your package, is very much the cult. I'm told by school teachers that what is very in at the moment is red. If you have a red packet in your pocket up here, you're in the in crowd. If it was some beige colour, presumably this wouldn't work so well.
What I've heard more about today is actually probably about sales: How are we going to control sales? The way I see it, there are basically three sorts of models that have been looked at or used or discussed or debated throughout this jurisdiction and other jurisdictions. The first is what is called statutory prohibition, which is what you're aiming for here in this legislation. The second you've heard a fair bit about today is called licensing. The third of course is the control board operation. I'm making absolutely no bones about it that our organization is advocating completely unequivocally that tobacco should only be sold through a control board and that it is the only solution that's going to work.
It's very interesting that one of the goals of the strategy is not the reduction of sales to minors, it's the elimination by 1995. Brenda and I have had some interesting discussions whether that actually means one minute past midnight on January 1 or one minute before midnight on December 31. I'm prepared to give her a little leeway, because I know she works very hard on this issue.
Anyway, you're not going to get away with a minimalist approach to this one. You're going to have to be darned sure that you choose an approach that is 100% absolutely foolproof, and that is why our organization is advocating the control board setup.
We don't need a separate tobacco control board. That's a lot of extra administration, bureaucracy and finance. The LCBO, as I understand it, is not in principle opposed to the idea of using its facilities. When I've given a number of talks to police services boards around the community, there's no doubt the chiefs of police have been very much in favour of it. They can't and you can't possibly make this work with the current setup.
Do you actually know how many outlets are out there? You don't. The reason you don't is because we don't have licensing in this province, unlike a number of other provinces.
In Hamilton, if I can share some experience with you, we went for a licensing bylaw. We now know, in a city of 300,000, that there are 700 outlets. We know where they are. We know what sort of store they are. We now can develop some strategies to target those stores, to survey them, to prosecute them, if necessary. We can start to get things under way. Licensing has taken us a long way to understanding the problem, let alone doing something about it.
We've heard a lot about pharmacies today. I'm not going to say much about pharmacies. I think it's a very straightforward problem. We support the pharmacists in this issue. That's one area.
I was talking to Evelyn Gigantes about this when she was Minister of Health and we were discussing Hitchcock's film The Birds. I don't know whether you remember the final scene there. Somebody lights a cigarette in a gasoline station and that's basically the end of the birds and the end of a lot of other things too. She said: "You're right. Why on earth did we let people sell tobacco in gasoline stations?" Actually, nobody ever let anybody sell it. It's an unlicensed product in a lot of Ontario.
You may remember in the last century, or probably most of you don't remember in the last century, that tobacco was basically sold in tobacconists' stores, specialty stores. They weren't really places where kids went, let alone purchased. But as cheap cigarettes were mass-produced, they spread through society and we saw the lung cancer rates starting to rise off the floor in men and reaching a peak which we've reached now, and then women now catching up, crossing breast cancer rates this year, as we've also heard, and still heading up.
1650
Of course, if you do allow Ontario to roll back taxes like the federal government, these projections that I've made to the year 2010 are useless. These figures will just go off the roof. But anyway, since cheap cigarettes became widely available, virtually everybody out there is selling them from pharmacies to pizzerias to gasoline stations; you name it. It's an impossible situation to enforce, the police say. They're well-meaning. They're stretched to the limit. They say, for instance, that when school breaks up they can police a few liquor outlets, but as far as the tobacco outlets are concerned, it's a hopeless situation, so I think the control board is really the only solution. Licensing has quite a bit to say for itself and we can address that in more detail in the written brief.
An interesting aspect of the sales of tobacco to minors is the question of possession. It's currently in federal legislation. That federal legislation may go by the board because it's technically repealed by an act that has been assented to but has not been proclaimed.
Reading through the committee proceedings from Newfoundland, there were a lot of people like myself addressing that committee and they were listened to very politely. What really made them sit up was this day when all the children came along to speak to the committee. We've had one child here today. I was fascinated that a lot of the children there said that they thought any legislation that addressed the subject of sales to minors wouldn't work unless it was illegal for a child to possess tobacco.
The federal legislation actually allows anyone to seize the tobacco and to confiscate it, which I guess is making the punishment fit the crime. I've talked to quite a lot of kids in schools in our area and they're all saying the same thing, so I think that's something I'd like to leave with you, as to whether you should allow at least some provision for making possession an offence.
The final area in the short time that we have here this afternoon is the question of environmental tobacco smoke. Some of you may have read a column by myself in the Globe and Mail a few weeks ago and some of the correspondence emanating from it. I was actually startled to read in today's Sun, in two different places, that the minister yesterday announced legislation that would create a totally smoke-free workplace and public place. I think they misread the legislation, but I'm delighted to see that this is now what the minister's now going to do and I'm sure you'll just simply put it into practice, because that frankly is what we are advocating.
Once again, let me draw your attention to the goals of the Ontario tobacco strategy: a completely smoke-free workplace and public place by 1995. This legislation isn't going to do that.
We are advocating a 100% smoke-free workplace, which reminds me that back in 1989 we sat here addressing a House of a slightly different political mix, and that's where I made a lot of close friends of the NDP front bench. We discussed at great length, in the House and in committee, the question of smoking in the workplace and I think we were all in agreement about it. I know you politicians have been very busy in the last few years and some haven't quite got around to actually doing all the things you said you were going to do in 1989, so this is your golden chance to actually do this.
I was interested to see a study from the city of Toronto health department the other day. They just surveyed all their workplaces to see how their municipal bylaws were getting on. They now have 88% of workplaces in the city of Toronto 100% completely smoke-free. Unfortunately ,for those workplaces that decided to go for the other option, that of having a designated smoking area with separate ventilation under negative pressure to the outside, they found that 54% had got it wrong. They didn't understand the legislation. It was in the wrong place. It wasn't ventilated.
I think that's a very good illustration of why partial solutions don't work. As far as drafting legislation goes, wouldn't you agree that it would be the easiest thing possible to simply create a smoke-free workplace? It's an occupational health and safety issue, it has tremendous public support and those people who work in smoke-free environments have really benefited from them.
The other interesting thing, coming back to the smuggling issue, is that if there's one issue in a tobacco strategy that's going to do something about smuggling, it's something that almost immediately decreases demand.
Studies both in Canada and in other jurisdictions have shown that when you introduce a completely smoke-free workplace, a lot of people make up for it outside, in the car and maybe at home, unfortunately for their children, and that actually the individual's tobacco consumption over a 24-hour period falls by 25%. So you can actually smack a 25% reduction in Ontario tobacco consumption by going for a completely smoke-free workplace. If you also go for a completely smoke-free public place you can probably smack an even bigger reduction in tobacco consumption in Ontario.
You can smuggle as many cigarettes across the St Lawrence River as you like, but if nobody wants them on the other side you're going to be taking them all back again the next day.
I heard a question around here about how you define a public place. Don't look now, but in your package there is model municipal legislation that was presented to the city of Hamilton. In it, it defines "public places." The key thing there is, don't start with a list and start adding on and adding on, "Let's have beauty parlours here and barber shops." Let's have a smoke-free public place. We may need to define for greater clarification. You heard about the reverse onus principle. We have a smoke-free public place and we can define a "public premise" quite easily and I've defined it in that legislation.
Let me try something on you that I tried in 1989 that was very effective that maybe the years have passed by. How many people around here had a home that had urea formaldehyde in it? Nobody? I guess you've all moved houses since then. That afternoon at least half the committee put up their hands, particularly when I said, who had it ripped out? Then the interesting thing is that I asked how many of those people allow people to smoke in their homes. Then I asked how many of those people know that there's more formaldehyde in environmental tobacco smoke than there ever was in urea formaldehyde.
I think I heard reference to asbestos this afternoon. How many people would take your kids out of school if you heard that there was asbestos lagging on the pipes? Yet how many people around here know that asbestos was in the filters that were in the cigarettes for many years?
I think I saw on the agenda that there's going to be a presentation, or has been, from the Ontario Restaurant Association.
Mr White: There was.
Dr Goodyear: I don't know what they said. I'll be interested to find out. But clearly, worldwide there's a lot of concern in the restaurant association. The American Restaurant Association, which recently did a survey and found that far more people would go to a completely smoke-free restaurant than wouldn't go to it, sent out an advisory to all its members, pointing out that there is an alarming number of cases coming through the courts at the moment, from their employees and from their customers, basically claiming damages to their health from eating in a place where smoking is allowed. Clearly, it's going to be in the restaurateurs' interests to go along with a completely smoke-free public place.
I'm going to stop there basically because I love answering questions. I could go on on this subject, as Larry well knows, for several weeks. I'm coming back later.
The Vice-Chair: Good. Are there some questions at this particular time? Mr Wilson, it's your turn to go first if you'd like to.
Mr Jim Wilson: I'll notify you when I have a question. Thank you.
The Vice-Chair: Someone over here.
Dr Goodyear: I told you I was passionate on this subject.
Mrs Haslam: I want to cover a couple of other things that you had in your A Provincial Tobacco Control Strategy for Ontario. A couple of them concerned me and I wondered if it could really happen.
One was the production. "A definite date needs to be set for the phasing out of tobacco production in Ontario, and the redirection of those resources currently involved in the production of this drug." You talked about prohibition and the difficulty when we see prohibition doesn't work, and will it work in the elimination of tobacco production in Ontario? I wondered if you had some time lines involved in that.
I had one other question. I'm going to put my two together because Ms Murdock may have a question. Your "Access by Minors," point 2.6 on page 6 of your brief, indicated that you wanted the age of majority to go from 19 to 21. When we talk about changing norms, we see younger and younger children smoking, and I wonder whether actually raising the age from 19 to 21 would have any effect on that because we're looking at changing norms in a society that's changing. I wonder if you have a comment on those two things.
Dr Goodyear: I'll answer the second one first because that's the easier one. The age of majority for alcohol consumption has basically been going up and down in our society. It went down a little while ago from 21 back into the teens, and in a lot of the adjoining jurisdictions, particularly across the border in the United States, for instance, in Michigan, it is 21. Some of you may have seen an article in the paper recently showing that a lot of their kids come over here to get drunk and then go back again and get arrested across the border. There was a disastrous accident involving children and alcohol in Caledonia last year. There was a tremendous burst of public support for raising the alcohol age to 21. There were all sorts of letters to the newspapers.
One of the reasons why the age of 19 was chosen for this legislation and in many other provinces which have raised their ages recently was, of course, that it makes a lot more sense to have a consolidated age of majority for substance abuse. You would have exactly the same proof of age required, the same card. It's very easy to administer and it's sort of logical. I just want people to keep in mind that the two should go up and down together and that if there is a lot of public pressure, as there was last year, for raising the drinking age back again, then it would be logical.
Would it make a difference, Ms Haslam says. I think it would. Obviously, it's a lot easier for a 13-year-old to pretend they're 16 than it is to pretend they're 21, and also we are taking out the top of that curve. I'm sure a number of you have seen how there are a portion of children who eventually will end up as smokers and it rises steeply through the teens, through the high school years and then flattens out. It just gets into that area. That would be a much more complete solution, but I'm not necessarily saying that's something we have to do today. I would certainly suggest that you make the act say "19 or such greater age as the regulations will prescribe."
As far as the agricultural side goes, obviously the agricultural community has seen this coming for a long time. It's a bit unique in Ontario, where most of the tobacco production now is; most of the other provinces have abandoned this. It has been a self-perpetuating problem. Production actually went up again last year to accommodate all this smuggling. We have progressively and are progressively withdrawing direct financial support, which was keeping the industry going and perpetuating the problem.
There is some support being given to the marketing boards and of course we're peddling this stuff in eastern Europe. As the World Health Organization recently said, the problem with Canada is it's not solving its problem; it's shifting it into somebody else's backyard. That's a point that is taken.
The official position of the Royal College of Physicians and Surgeons of Canada, of which we are an affiliate specialist society, has certainly been that tobacco production should cease in Canada. The bulk of it is actually going outside Canada. It's been rising steadily and now over 50% of the raw tobacco leaf is being exported out of the country. A lot of that is going to Third World countries. It's a problem they don't need and it's a problem about which I get sort of kicked in the ankle under the table when I go to international medical conferences because they say: "You're from Ontario. You're the source of our problem."
Yes, I think we should be trying to diversify the economy down there, and as I said, I spent a lot of time talking to farmers down there about it and I've seen the success that some have. There's no cash crop like tobacco, but I think that has been a pipe dream. It's been a very false sort of economy. I think we do have to progressively phase out tobacco production and use that soil for something else.
The Vice-Chair: Thank you for your very helpful presentation.
Dr Goodyear: You have my phone number. Call me.
The Vice-Chair: The committee stands adjourned until 10 am tomorrow morning.
The committee adjourned at 1703.