TOBACCO CONTROL ACT, 1993 / LOI DE 1993 SUR LA RÉGLEMENTATION DE L'USAGE DU TABAC
CITY OF TORONTO DEPARTMENT OF PUBLIC HEALTH
MEDICAL OFFICERS OF HEALTH OF THE GREATER TORONTO AREA
MEDIS HEALTH AND PHARMACEUTICAL SERVICES
METROPOLITAN TORONTO PHARMACISTS ASSOCIATION
HAMILTON-WENTWORTH HEALTH AND SOCIAL SERVICES COMMITTEE
ONTARIO NATUROPATHIC ASSOCIATION
COUNCIL FOR A TOBACCO-FREE YORK REGION
UNIVERSITY OF TORONTO, FACULTY OF PHARMACY, CLASS OF 1994
CONTENTS
Thursday 3 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
City of Toronto, department of public health
Dr Perry Kendall, medical officer of health
Medical officers of health for the greater Toronto area
Dr Jim Mitchell, medical officer of health, city of York
Dr A.M. Egbert, medical officer of health, city of Etobicoke
Royal Canadian Legion
Jack Currie, veterans' service officer, Metropolitan Toronto
Pharma Plus Drugmarts Ltd
Rochelle Stenzler, president and general manager
Tim Carter, public affairs manager
Addiction Research Foundation
Mark Taylor, president
Dr Roberta Ferrence, senior scientist and director, Ontario tobacco research unit
Medis Health and Pharmaceutical Services
Frank Goodman, Ontario regional vice-president
Samuel Hirsch, past president
Ruth Mallon, president
Karen Graham
A&P Drug Mart Ltd
Phil Rosenberg, director and general manager
Regional municipality of Hamilton-Wentworth
Dominic Agostino, chairman
Barry Phillips
Ontario Naturopathic Association
Patricia Wales, executive director
Richard Stein
Council for a Tobacco-Free York Region
Joanne Kaashoek, chair
Tania Gabrielle, high-school student
Linda Pugilese, high-school student
Fady Samaha, high-school student
Frank Casicaro, high-school student
Frederic Bass
Carmen Paquin
University of Toronto, faculty of pharmacy, class of 1994
Mona Sabharwal, vice-president
Tony Antoniou, president
Arima Ventin, secretary-treasurer
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
Duignan, Noel (Halton North/-Nord ND) for Mr Hope
Haslam, Karen (Perth ND) for Ms Carter
Perruzza, Anthony (Downsview 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 1007 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): Welcome to our fourth day of hearings of the social development committee on Bill 119.
Just before calling our first witness, I would like to get direction from the committee. As you recall, the House leaders have given us permission to use one of the clause-by-clause days for public hearings so that we will, in fact, be able to hear from everyone who has asked to present. The two days that were to be considered were February 23 and February 24.
Is February 24 acceptable to everyone?
Mr Dalton McGuinty (Ottawa South): Yes, it is.
Mr Jim Wilson (Simcoe West): Yes, it is.
The Chair: Okay. For the clerk's benefit then, we sit on February 24, and we'll let you know a little later in terms of numbers and the hour of sittings.
The second issue was for clause-by-clause, which is the week of March 7. What I would propose is beginning Monday, March 7 at 1 o'clock and then having the Tuesday and Wednesday as the other two days that would be there if needed. Is that acceptable to all parties?
Mr McGuinty: That sounds most acceptable.
Mr Jim Wilson: Agreed.
CITY OF TORONTO DEPARTMENT OF PUBLIC HEALTH
The Chair: With that out of the way, I'll then call on the representative from the city of Toronto, department of public health. If he would be good enough to come forward, and please identify yourself for Hansard. We have a copy of your submission. It's healthy Toronto water.
Mr Jim Wilson: Should have been York region.
The Chair: Yes, via Lake Simcoe.
Dr Perry Kendall: Actually, it's not true that Toronto drinks its own bath water; it only thinks it does.
My name is Perry Kendall. I'm the medical officer of health for the city of Toronto, department of public health. Good morning and thank you for the opportunity to be here to present today.
I'd like to congratulate the government for bringing the bill forward and the opposition parties for supporting it.
The health community has been fighting for this kind of legislation for a long time, and the department of public health in Toronto is a member of the Ontario Campaign for Action on Tobacco with all major Ontario health organizations.
As a member of that organization, we support the recommendations in the brief presented to you earlier this week. My remarks today are intended to support those recommendations and to elaborate on our most important concerns.
I'd like to start by saying that the real beneficiaries of this legislation will be the children: the children who don't start smoking because of it; the children who won't grow up to develop heart disease or cancer because this government, supported by the opposition, had the political will to pass this piece of legislation. Tobacco does exactly what the Ministry of Health's powerful new anti-smoking commercials say it does: It sucks the life right out of you. It is the number one health issue in Canada.
Dr Richard Schabas, the province's chief medical officer of health, has said that tobacco kills more than 13,000 Ontarians every year, 6,000 of them from ischemic heart disease. It contributes to many cancers. It causes lung cancer, strokes, emphysema, chronic bronchitis and low birth weight in children of mothers who smoke.
The Environmental Protection Agency in the United States has classified environmental tobacco smoke as a group A carcinogen, and there are only 15 other substances in this category, which include radon, benzene and asbestos, a substance we believe so dangerous when it's in the atmosphere that we remove it from our homes and offices.
Yet one of the major problems we have getting kids not to start using cigarettes is their easy availability. Another reason is the obvious gap between the reality of what tobacco does to our bodies and the massive promotion of it by the industry. The tobacco industry has funnelled millions of dollars into promoting this toxic product. Manufacturers have dressed cigarettes up in fancy wrapping, they've promoted them to vulnerable and impressionable youth and they've said there is still no hard evidence that tobacco kills. George Orwell couldn't have done a better job at doublespeak.
The industry would have you believe it isn't targeting youth and women, and that those thinly disguised cigarette ads promoting the Matinee Ltd Fashion Foundation have nothing to do with tobacco. If you watched the reporters from CTV or CBC when they went out in the TTC and they asked teenage girls what the adverts were promoting, it was very clear. They just said: "Tobacco, of course. Cigarettes."
When you're debating this bill, when you're considering the amendments suggested by the Ontario Campaign for Action on Tobacco, I'd ask you to weed out the doublespeak and look at the reality of what is happening, because the reality is that the health care system cannot afford for you not to pass this bill. Bill 119 is essential for health reasons, it's essential for ethical reasons and it's essential for economic reasons.
When Toronto studied the economic impact of smoking in 1991, we found that it cost the city $193 million a year in costs related to direct health care and income losses due to absenteeism and premature death. That study didn't even look at the costs related to harm caused by secondhand smoke, which include the increased risk of leukaemia, asthma and respiratory problems, including sudden infant death syndrome, in the children of smokers.
The study found that a 30% reduction in the number of people who start smoking would lead to a 30% reduction in deaths caused by smoking. A 50% reduction in smoking would lead to a commensurate 50% reduction in deaths.
The key to reducing health costs related to smoking is to stop kids from ever starting, because studies clearly show that if you haven't started smoking by age 19 you're not likely to, and some 3,000 Ontario children start smoking every month. This is an important reason for raising the age of purchase to 19 and for requiring photo identification for buyers and licensing for sellers. We support these provisions in the bill.
The tobacco industry has used some powerful and successful techniques to seduce new smokers to replace those who quit or die, and the health effects are showing. I'll give you one example: Thirty years ago, lung cancer was virtually unknown in women. Last year, more than 5,000 women in Canada died of it. This represents a five-fold increase since the Second World War, when women took up smoking in large numbers. Soon, more women will die of lung cancer than of breast cancer, and there is some indication that already the lines have crossed.
If we look at the women's health lobby for more funding and research into breast cancer, and if we try and imagine there was a product on the market that caused breast cancer with the same certainty that cigarettes cause lung cancer, I just cannot imagine that, given the strength of that lobby, that product would be on the shelves in six weeks from the time the lobby started; a sad epitaph for all those women who breathed in the contents of those elegantly packaged Virginia Slims with the tag line that, "You've come a long way, baby."
Teenage girls in Canada now smoke more than teenage boys; 20% compared to 12%, according to Health Canada's 1991 general social survey. If we don't take strong action to stop this epidemic it will be too late. These youth and thousands like them who turn to cigarettes to deal with such problems as stress, body image and poor self-esteem will be gasping their way to the grave. They'll get hooked, and they're really hooked. The Addiction Research Foundation says that nicotine is as addictive as heroin, and it's borne out in this by the US Surgeon General's report of 1989.
But if we tell kids not to start, not to open the door to addiction and poor health, we have to back our words up with real action. If we say that smoking kills, we have to show that we believe it. We cannot persist in double messages and double standards. We have to show that we mean what we say. We have to do something to stop the malaise and disillusionment our youth have with the leaders in our society, leaders who sometimes appear to say one thing and do a completely other thing.
The provisions in Bill 119 for plain packaging, provincial health warnings, improved control over cigarette sales and the banning of vending machines are important ways to reduce attractiveness and access to youth. They're also an important statement on health.
One of the most disheartening double messages in the tobacco business is the percentage of sales in pharmacies. Twenty-three percent of all tobacco sold in Canada is sold in pharmacies. What message does a teen get, what message does an adolescent get, what message does anyone get when a health outlet sells cigarettes?
Shoppers Drug Mart, owned by the same people who own Imperial Tobacco, want to keep profits up by selling a product that kills. Such sales show a blatant disregard of the most fundamental health issue of our time. You cannot be a health professional and sell cigarettes. The two activities are ethically incompatible, especially when you're in the position of then selling the remedies to palliate the harm done by the cigarettes you sold in the first place. Canada and the United States are the only nations in the industrial world where pharmacies also sell tobacco.
The pharmacists' professional regulatory body, the Ontario College of Pharmacists, supports this bill and asks for a prohibition on sale in pharmacies. I urge the government to reject the arguments of the tobacco lobby and to send a strong message to our youth that their health is more important than the powerful tobacco lobby. I ask you to bring the ban of sales in pharmacies into force within 90 days of royal assent, and to clarify the definition of "pharmacy" to ensure that tobacco products cannot be sold in any contiguous retail space.
I'd like to comment briefly on the issue of environmental or secondhand smoke. It wasn't too long ago that public hearings on important health issues such as this would have posed a threat to the health of everybody in the room. People with chronic illnesses such as asthma and heart disease would have had to sit through a haze of smoke in order to attend meetings on important social issues. We've come a long way in protecting people from secondhand smoke, but we still have a long way to go.
Section 9 of this bill will increase public protection, but it needs to be expanded to include all public places, such as recreation centres, shopping malls, theatres, restaurants and fast-food outlets. Bylaws controlling secondhand smoke are springing up all over the province, with various degrees of restriction. It's becoming confusing to the public and, in some ways, I think, unfair to merchants and restaurateurs, and poor health policy. Cancer and lung disease will not adhere to municipal borders. An amendment proscribing smoking in all public places except where specifically permitted, the reverse onus position, would provide increased protection from a known and severe health hazard.
The city of Toronto has been a leader in trying to eliminate secondhand smoke in workplaces and public areas, but municipalities cannot do it alone. In responding to individual municipal strictures, the Ontario Restaurant Association calls for a level playing field. I submit that the provincial government could provide that. In fact, I submit that the province must bring uniformity to this issue.
Smoking in the workplace is another issue which is not addressed in this bill, and it is a major omission. The workplace restrictions under the present provincial act are really grossly inadequate. To be effective, the act needs significant amendments that would enshrine the right to a smoke-free workplace. It would be an important statement if the government moved quickly to support this bill by also amending the Smoking in the Workplace Act.
The brief you have from the Ontario Campaign for Action on Tobacco deals with problems around the issue of packaging, health warnings and signs, as well as issues around point-of-purchase tobacco displays, tobacco paraphernalia, kiddie packs, spitting tobacco and licensing.
I won't take any more of your time to address these issues, except to ask you to bring in a clear ban on chewing or spitting tobacco. This product can lead to cancers of the lip and oral cavity and pharynx as well as to non-cancerous oral conditions, nicotine addiction and dependence. Spitting tobacco is being used by baseball players, who are important role models for our children, and has the potential to become a major health problem. You have the opportunity now to put a halt to its spread in Canada, the opportunity to further protect our children.
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In closing, I will ask you to reject the arguments of the tobacco lobby, and I will ask you to support health, to strengthen this bill and give it a speedy passage.
Environics polls show clear, majority support from smokers and non-smokers alike for further control of access to tobacco. The only significant opposition comes from the tobacco industry or its agents. You cannot let that industry lobby delay or water down this critical bill. To do so would be to abdicate responsibility and to count the cost in preventable deaths, disease and disability. I thank you for your time.
The Chair: Thank you very much, Dr Kendall. We'll move to questions, beginning with Mr Wilson.
Mr Jim Wilson: Thank you, Dr Kendall. Towards the end of your brief, you make a very good point about the fact that smoking in the workplace is not addressed in this act. I must admit, because it isn't addressed in the act, it's been a while since I've looked at that piece of legislation. I was wondering if you had comments on the current Smoking in the Workplace Act. I also would ask either the parliamentary assistant or legal counsel to give us some highlights of that act, and perhaps the parliamentary assistant could explain any discussions they had as to why workplace legislation isn't included in the Tobacco Control Act. Any order.
The Chair: If you want to make some comments, Dr Kendall, and then I'll ask the parliamentary assistant to comment.
Dr Kendall: The only way of protecting non-smokers in a workplace is essentially to have a smoke-free workplace. One could permit smoking in an area which is physically enclosed, separated and ventilated to the outside to accommodate smokers.
The current provincial workplace act doesn't do that. Essentially, my desk could be a smoking area, and your desk would be a non-smoking area. The fact that tobacco smoke obeys the laws of physics and not the policies of the workplace has been pointed out in the past. It's a little bit like saying, "Your part of the swimming pool isn't chlorinated, but my part is." It just doesn't work for that reason.
Mr Jim Wilson: Just facetiously, today we have chlorine in the pool; yesterday Mr McGuinty had something else in the swimming pool.
Dr Kendall: Yes.
Mr Jim Wilson: That's essentially all that act does, if I could ask the parliamentary assistant?
Mr Larry O'Connor (Durham-York): The Smoking in the Workplace Act, which came out I believe in 1989, designated 25% of the workplace as a smoking area. The way that was to be established was a joint committee between representatives of the employers and the employees. At that time it was a significant piece of legislation. There certainly is a strong argument for moving forward with something else. That has to be dealt with by the Ministry of Labour.
In our discussions a year ago in trying to work through the tobacco strategy, it was felt that we move forward as quickly as we can with the Tobacco Control Act, to regulate the provisions of sales to young people. The key here right now is "to young people," and if we can focus our attention on that, the other element, yes, does need to dealt with at some time.
I don't think that anybody would come to the committee and advocate for what we're doing now to be slowed down so that we can broaden the debate to include workplace avenues. It does need to be talked about, but it would definitely slow this process today if we were to try to include that in it.
Mr Jim Wilson: Really, this is just for information. Do you know whether your ministry or the Ministry of Labour has done any follow-up with respect to compliance or effectiveness of the 1989 workplace act? I'd be interested really just in any papers on it, because it comes up in a number of the presentations and I just can't get my mind on it.
Mr O'Connor: At this point I can't. I cannot offer you any, other than that I know the Ministry of Labour responds to complaints by employees, which is how it's dealt with today.
The Chair: Perhaps we could just make a request that if there is any information, any kind of a report or anything, there may be something there that would be useful. I think that would be an interesting thing to know.
Mr Jim Wilson: Yes, I'd be interested to read it.
Mr McGuinty: Doctor, thank you for your presentation. You have mentioned something in here which a number of other presenters have as well, and that is this business of a reverse onus provision that comes to smoking in a public place. It's something that I've been trying to get hold of and I think that holds a certain amount of appeal. But what criteria would you have to meet in order to qualify for an exemption? I'll give you a couple of examples: Legion halls and bingo halls.
Dr Kendall: I think Legion halls would make a case for qualifying under the exemption on the grounds that a number of their members smoked, were unlikely to quit smoking, but the grounds for the exemption would be that they would have to provide a separately ventilated, physically enclosed space so that non-smokers were not exposed to environmental tobacco smoke. I think you can make the same case for bingo halls, that you first would have to apply and then you would have to be prepared to make a separately enclosed space. The law essentially will protect non-smokers from smokers, so the commitment would be that your smokers have a place where they can smoke but it has to be physically separated and ventilated to the outside and preferably under negative pressure.
Mr O'Connor: Knowing that Toronto has very active bylaws, I just wondered if you could offer us any advice. We've heard people coming before the committee suggesting that we go with a licensing scheme and I think that we've got enforcement mechanisms in the legislation that would be very effective without going to a licensing scheme. I wondered if you could comment on the enforcement mechanisms that Toronto uses and if you have any suggestions of how we could model something after some of that enforcement.
Dr Kendall: Basically, on enforcement I'm supportive of the position of the Ontario coalition, which is that they will support the provisions of this bill pending an evaluation, but their feeling is that in the long run it would be wise to move to a licensing system with licences for the sale of tobacco.
In the city of Toronto we have a double way of assessing the bylaws. One is by swift response to complaints by environmental health officers and the other is that our environmental health officers have, as part of their job, enforcement of the bylaws during their regular inspection visits to restaurants or health care facilities. A couple of years ago we added a provision that they would also look at the adherence to the bylaws around vending machines, which were supposed to be within eyesight and control of an operator of a facility.
We're lucky perhaps in that we have more resources than others and have been able to do that in the past. I think to move it routinely onward, most health units, including ours now with the economic downturn and the staff restrictions that we face, would require assistance in adding environmental health officers to adequately enforce and monitor compliance with our bylaws.
We have found that compliance is acceptably high. A minority of workplaces and a minority of restaurants aren't in compliance. Once we find they're not in compliance they rapidly come into compliance. We've been very pleased with the way this has worked, but if we hadn't followed it up I don't think we'd have had that degree of compliance. People would have realized that they could get away with it.
Mrs Karen Haslam (Perth): I wanted to talk compliance also, but that does beg the question then, since you're talking about the money available for health officers or for bylaw enforcement officers in that in some cases that isn't working as effectively, do you feel a licensing setup would be better positioned for enforcement than the statute model that we're putting forward at this particular time in this particular piece of legislation?
Dr Kendall: Rather than hold up this present bill I would suggest that you monitor compliance and enforcement and be prepared to put in place a self-financing licensing system if it were shown that compliance and monitoring were inadequate.
Mrs Haslam: When you say "monitor," there was a suggestion that there be a report on the effectiveness and whether it was working. Is that what you're recommending, similar to what we've heard before as a year-end report to the Ministry of Health, something along that line?
Dr Kendall: Yes, and I think you would include in it that we did surveys. We monitored by doing a survey, visiting a randomly selected number of institutions where the bylaw was in effect and observing directly and asking questions. That was how we did some monitoring, and I would suggest that that be built in after the passage of this bylaw.
Mrs Haslam: Did you find that the compliance helped curb young people from access to tobacco products?
Dr Kendall: I think that there are so many countervailing forces going on at the same time that statistically what we see in young people is a kind of flattening, if you like, and some indication that younger women are taking up smoking preferentially. I don't have a really up-to-date survey of young people in Toronto, so I'm just looking at Ontario statistics and assuming that Ontario would be the same.
The Chair: Thank you very much, Dr Kendall, for coming before the committee this morning.
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MEDICAL OFFICERS OF HEALTH OF THE GREATER TORONTO AREA
The Chair: If I could then call on the medical officers of health for the greater Toronto area.
Dr Jim Mitchell: I'm Jim Mitchell. I'm the medical officer of health for the city of York but I'm representing all six medical officers of health of the Metro Toronto area. Even though some of us are going to make separate presentations -- for example, you've had a presentation from Dr Kendall already -- we have also agreed to make a joint presentation.
The Chair: Would you mind just introducing your colleague who has also come to the table.
Dr Mitchell: This is Dr Egbert, who is the medical officer of health for the city of Etobicoke.
I'd certainly like to begin by congratulating you on taking steps to restrict the leading preventable cause of death and disability in Ontario. It kills 13,000 Ontario residents every year. The setup of my comments will follow the format of the bill.
With regard to section 3 about the provision of tobacco to persons under 19, I'd make the point which Dr Kendall has already made, that most of the people who smoke began smoking before they were 19. If they reach the age of 20 without smoking it's very unlikely that they will ever become smokers during their life. In enforcing this, using age-of-majority cards and photographic identification would be very helpful. I might even suggest that sales be further restricted by either licensing all the tobacco retailers, and this can be a self-financing sort of licensing through licensing fees, or you may even wish to consider restricting tobacco sales to a few stores such as the LCBO stores.
With regard to section 4 about prohibition of sales in designated places, the one that seems to be taking most of the press headlines is with regard to pharmacies. I would point out, as I presume the pharmacy association is going to point out, that the professional body of the pharmacists has requested this legislation. The opposition comes not from the pharmacists but rather from the owners of the pharmacies, the owners of the pharmacies who are themselves owned by a corporation that also owns the largest tobacco company in Canada, which I believe has a very distinct conflict of interest. The pharmacists themselves, who do not have a conflict of interest, are quite definite in not wanting to sell tobacco.
With regard to the argument that's been brought forward about loss of income, in 1992 the Canadian Pharmaceutical Association did a survey of 56 pharmacies and it found that the great majority of them had no income loss or a minimal income loss, 13 stores had marginal losses and 7 had moderate losses, but within two years these losses had been recouped.
With regard to sections 5 and 6, packaging, health warnings and signs, I'd like to make two points. One is kiddie packs, that is packs which have fewer than 20 cigarettes in them: We believe that these are put together for one purpose only and that is to make them cheaper so that children can afford to buy them. That is in clear violation of the law, which says that you should not sell to children.
With regard to plain packaging, a recent survey by the Canadian Cancer Society concluded that young people, who are the ones who are being recruited into this habit which is going to kill some of them, are much less likely to start smoking if cigarettes are not packaged in these nice, attractive packages which are designed by cigarette companies to sell cigarettes.
Section 7, about vending machines: We can simply say that we applaud your decision because this is a major loophole; that is, vending machines are a major loophole in letting cigarettes end up in the hands of children, because vending machines simply are not well supervised.
With regard to reports in section 8 -- I mention it here simply because it refers to reports; it's not reports from wholesalers and distributors -- we do think it would be very helpful to require a report annually from the chief medical officer of health of Ontario informing the Legislature of progress towards the province's tobacco use reduction targets and the effectiveness of this act which you're debating right now. We think this would be very useful, something like the Auditor General's report, in bringing to the public eye the state of tobacco in the province every year.
About sections 9 and 11, about controls related to smoking tobacco, I would again mention, as Dr Kendall did, that there's one big omission here, and that is the workplace. I am not an expert in the legislative process and it may be that it's better to put this into a separate act rather than amend this act, but I would point out that there is a very gaping omission in this with regard to restricting smoking, and that is the workplace where the majority of adults spend the majority of their waking hours, and this should be covered.
It's very short, and I think I'll let you catch up on your timetable. We felt it would be more appropriate to be to the point rather than to take a long time.
The Chair: Thank you, and that gives us more time for questions, too. We'll start with Mr McGuinty.
Mr McGuinty: Thank you both for your presentation. We have a couple of products in the province here which are legal and we treat them similarly to some extent. We've got cigarettes, tobacco products, and then we have alcohol. Cigarettes, it seems to me, are much more addictive than alcohol, although alcohol if abused can become addictive. They both can cause illness, but cigarettes even more so in terms of even a little use can hurt.
Cigarettes present us the number one preventable illness in the country, but what we've done is we've told kids that it's unlawful for them to use alcohol below a certain age; in fact, we've got a law on the books that says it's an offence for them to consume alcohol before they're 19 years of age. Why don't we do the same with cigarettes? Why are we short-selling kids in terms of their ability to assume responsibility?
Dr Mitchell: I'm not quite sure the point you're getting at, but one of the things that concerns me about what I think you're arguing about is the relationship between what really should be done and what the law says, and the law frequently does not reflect reality or what should be happening. Whether something is legal or illegal is as much due to a societal quirk as anything else. For example, if tobacco were to be introduced today as a new product, it would not be allowed because it's known to cause death and disability. It is present in our society because it came in at a time when society didn't know the harm that was going to result from that. With some other things, like heroin and cocaine, we do know that and as a result they're illegal.
Mr McGuinty: Why should an 18-year-old, for instance, not be assigned some responsibility for smoking when we recognize as a society that it causes all kinds of problems, health and economic? Why are we letting them off the hook, so to speak? Wouldn't a more comprehensive approach -- I'm just floating this -- to dealing with the problem require that it's kind of a two-way street? If you sell it, it's a problem; if you buy it, it's a problem.
Dr Mitchell: This legislation that we're suggesting is just one part of a lot of things that are being done with tobacco. The thing that you do not see here is the education which is going on in the schools and elsewhere directed at children, pointing out to them that tobacco is not something that they should have anything to do with.
The other thing is -- I don't know whether you're intending it this way -- but I detect a strong flavour of blame-the-victim in your question. The reason I react to that is that people have an ability to resist up to a certain point. If there is one person who is doing something and everybody else in the society is doing something different and getting on that one person for not doing it, then than person is very likely to go along with it. Call it peer pressure with regard to smoking; call it advertising which encourages people to smoke, which is still present in the United States and spills over into this country whether we like it or not.
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There is certainly an element of individual responsibility, but I would in no way put the entire onus on the individual, because one individual is just that, one person, and if you try to stand them up against the tide of the entire society, they're not going to be able to stand up against that.
Mr Jim Wilson: Thank you for your comments. Mr McGuinty is floating an idea, or in fact stealing an idea, that was put forward by my party yesterday. But none the less, I think we both share a concern and I think agree that we've seen enough evidence in the few short days that we've been sitting in this committee to at least have the idea in our heads that the current model doesn't seem to be working very well, that some new teeth have to be put into the system to really drive the message home.
I guess what I didn't hear in your response, although I did appreciate the fact that perhaps -- and I didn't think of it before, when you talk about we're sort of putting blame on the victim, and I'll think about that. But what I didn't hear in your response is why we treat alcohol so much different than cigarettes and why, in the current model, the people who are responsible and the people who are punished are the retailers. All we're doing in this bill is bumping it up one more year, to 19 years of age, than the current law.
I'd like to know from you whether you think it's feasible, why don't we make either the possession or the consumption of cigarettes for those below the age of 19 or below the age of 18 illegal, like we do for alcohol? We would probably need a phase-in period because a number of young people are addicted now, but have the medical officers of health, or anyone, explored this in any great degree?
Dr Mitchell: I think the prime reason is that it tends to go along, we feel, the blame-the-victim philosophy. We feel it's better to go after those who are selling and profiting from the sale of these products rather than the persons who are being victimized by them. There's profit in this, lots and lots of profit. I don't need to tell you that, but there is.
Mr Jim Wilson: There's profit in pornography which leads people to do awful things when they're addicted to pornography, yet in that case we punish both the offender and the people who propagate pornography. There are thousands of substances and things in this world that are bad for you that the law treats both sides of the equation punitively. And we don't do that, we don't put any responsibility on the young people who are clearly seeking out illegal cigarettes. I don't think you totally get bribed to buy a carton of cigarettes. I think it's a two-way street. You've got to have the money in your pocket to buy them, and you're making a decision that "I'm going to go buy cigarettes," in lieu of buying a football, or something else.
So, I think there should be some responsibility on young people. What do you think of that?
Mrs Haslam: Letters, we'll get letters.
Mr Jim Wilson: We're going to get a lot of letters and phone calls, but it's fun.
Dr Mitchell: I don't know the individual members here or their party affiliation and, quite frankly, I don't know whether this is an honest suggestion or a method of trying to derail this legislation.
Mr Jim Wilson: That's an unfair --
Dr Mitchell: Since I really don't know your motivation, I find it difficult to respond to you more than what I have done already. I think this act is an excellent start. It is not perfect, but just as the longest journey starts with one step, I think this is one more step in the journey and I think we ought to take it. If it's not complete, then fine, you can come back and improve it, as you suggest.
Mr Jim Wilson: Just to alleviate your concerns, questioning our motives --
Mr Anthony Perruzza (Downsview): You've got only one motive.
Mr Jim Wilson: -- is not really the best idea and I take offence to it. It is a sincere effort. I mean, we take heat when we float these ideas. People don't like them. I think, just for the record, so you'll understand, all three parties agree with about 98% of the contents of this legislation and the hearings have simply boiled down to a couple of contentious issues. Given the fact that the government's decided we're going to have four weeks of hearings on tobacco, we're floating around some other ideas which may lead to future legislation.
Dr Mitchell: May I also suggest that the other two medical officers of health may have some ideas about this. I believe Dr Egbert and Dr Kendall would also have some comments as well.
Dr A.M. Egbert: Let me add in response to the question that it would be ideal, a step in the right direction, to have the same regulation for the sale of cigarettes as it is for alcohol and raising the age in the same manner to the level of 19, as it is for alcohol. I would think it would be even better to have photo identification of persons purchasing cigarettes and regulate it in that way. It would be more effective. Similarly, the licensing of sellers, the availability of cigarettes from agents who are licensed to sell cigarettes, and perhaps even going a step further of having cigarettes only being sold in certain premises, such as LCBOs or Brewers Retail, would also be a step in making access more difficult.
The Chair: Did you wish to comment on that? Please, welcome back to the table.
Dr Kendall: Thank you. On the issue of whether one should have sanctions against underage persons who smoke or possess cigarettes, I think you'd really want to examine that looking at the numbers of children who currently possess and smoke cigarettes, which we're trying to discourage, because if you were to pass such a bill tomorrow or next month, you would at a stroke put 50% of our children at some time or another between the ages of 8 and 19 on the wrong side of the law. I think there will be social and economic and philosophical issues there which would need some more debate and discussion than we could probably give them this morning.
Mr Jim Wilson: Just a final comment. I appreciate that and thought of that to the extent that perhaps you would pass a law saying effective several years from now -- because this law speaks to a target of 1995, smoke-free places. So it's not impossible in law to grandfather, as it were, or set a target, or simply do it as part of the tobacco strategy and say that by the year 2010 or whatever, we will make it illegal along these lines.
Mr Noel Duignan (Halton North): I am one who has never smoked -- never have; never even wanted to -- and I believe the companies that actually manufacture cigarettes are in fact manufacturers of death and people who sell it are dealers in death as well. That's my own personal opinion, and if that's the case, like alcohol, we should tightly regulate and control the sale of tobacco products.
I was wondering about your opinion. At the federal level should we be placing cigarettes under the Hazardous Products Act? By doing that, then we can tightly control the importation, the advertising and the selling of the cigarettes. Would you encourage actually the federal government to look at moving the whole question of cigarettes under the Hazardous Products Act?
Dr Mitchell: Dr Kendall says that he's done a bit of research on that and I'll let him comment.
Dr Kendall: I was going to cede the floor to Dr Egbert, who wanted to go first.
Dr Egbert: I certainly agree that the federal government should be moving in that direction. I understand in the States cigarettes have been classified as one of the hazardous products, and perhaps our federal government should be moving in that direction. I would certainly support that.
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Mr Duignan: I believe some of the problems experienced in relation to the smuggling of tobacco across the border could be more effectively dealt with under this act than under the present situation they're experiencing right now.
Also, maybe you could tell me a little bit about how in the municipal workplace you regulate smoking or what you're intending to do or how you're going about doing it right now.
Dr Egbert: Etobicoke has been known for many, many years to be a leader in regulating the sale of cigarettes and cigarette smoking in our community. We have very stringent local bylaws to regulate smoking. Our bylaws regulate smoking in bus shelters, bingo halls, bars and even private workplaces. I think the legislation, Bill 119, should move in that direction, to regulating smoking in private workplaces. I would certainly like to see some amendments to make the regulation even more stringent, as it is in some local municipalities.
Mrs Haslam: I'd like to build on that, because that was an area I wanted to ask you about too. Bill 119 allows for more restrictive legislation at the local level through municipal bylaws, and some municipalities have or have requested private legislation to enable workplace smoking control restrictions in public places. What would municipalities like to see included in Bill 119 to help address some of these concerns? Would they like to see more restrictions in this legislation, or would they like to see more availability for local municipalities to put in place the legislation that is necessary?
Dr Egbert: I think it would be much more appropriate to have a provincial act to regulate smoking throughout the province of Ontario rather than each municipality seeking private legislation, as we have done in Etobicoke, to come forward with more stringent local bylaws. I think it should be uniformly applied throughout the province of Ontario.
Mrs Haslam: One more quick question. This is a great report, let me tell you. I keep all the reports. This is the most comprehensive, short, not-more-than-50-pages report I've ever seen. I really like this, because you were succinct, to the point and I've got little checkmarks saying: "Gee, this is great. It really lays it out for me." So four pages; I'm impressed with this, rather than the 54 that go on and on. Not to say that other reports aren't good; it's just that this really draws together exactly where you want to be and exactly what you want to say.
I want to go into the time lines question. You talked about tobacco control. You looked at vending machines, and I've got "time lines" written there because they're in a situation. We've had them come to us and say, "We really need some time to get the vending machines under control and out of the areas," and the time lines around a tobacco control board.
Do you feel the timing is right? Should this legislation put in place a tobacco control operation, or do you feel this is a good step and perhaps we should see this as a step going forward and the long-term goal would be similar to an LCBO? I just don't know if socially in our culture and in our society the timing is right for a tobacco control board.
Dr Mitchell: You're probably correct. I put in that concept about selling it only through the LCBO simply because I think ultimately that's a very good way to go. I would not at all disagree that it might be a little bit early for the province of Ontario. We're probably not ready for it.
Mrs Haslam: That's all the questions.
The Chair: Did anyone else want to comment on that, just before we close?
Thank you, gentlemen, for coming before the committee and for the presentation you've made this morning.
ROYAL CANADIAN LEGION
The Chair: I call the next witness, from the Royal Canadian Legion. As he is coming forward, I'd just note for members of the committee that we've circulated a copy of the Smoking in the Workplace Act and also the news clippings from the last day or so.
Mr Jack Currie: I'm Jack Currie, veterans' service officer for the Legion for Metropolitan Toronto and I'm also a representative for the Legion on the board at Sunnybrook hospital. I come this morning to ask you to consider the need of continuing to allow the veteran residents of facilities such as Sunnybrook Health Science Centre and other veterans' homes to purchase tobacco products onsite, such as in their tuck shops and in the Kilgour wing of the veterans' and in the Legion Toronto homes.
Many veterans in the Sunnybrook hospital have stopped smoking because of our health rules and our stop-smoking program, but we have 350 residents there in K wing, and 70 still smoke. Some of these veterans started smoking when they joined the army, like me, in 1939, at 18 years of age. We were given all kinds of free cigarettes, so we started smoking. But most of them have now quit and those over 70 have continued to smoke for 55 years. To expect them to stop is almost impossible, whatever programs we try to do.
Many of them are not physically able to go out and purchase cigarettes, and for them not to have a place like the tuck shop to buy them, the only thing that's going to happen will be to encourage contraband cigarettes to be sold throughout the hospital. We've had this problem with dial-a-bottle and we've been able to stop this, but cigarettes seem to be an impossibility to stop when there is not a place for them to purchase them. It's almost impossible to ask these people to go outside and buy cigarettes. Many of them have not got the ability to leave, and if we remove their opportunity to buy cigarettes from their tuck shops, this just means that contraband cigarettes will be in there. It's unfortunate they're already there and the veterans are paying a premium for these cigarettes on the weekends when there is no other available place to buy them.
So I've come this morning to urge you to reconsider Bill 119 and allow the veterans' hospitals, the veterans' wings of the hospitals and the veterans' homes to continue to be able to sell cigarettes in their tuck shops. That is my submission, and I hope you will reconsider it.
The Chair: The parliamentary assistant will start.
Mr O'Connor: I want to thank you first for coming and representing the Legion and its members.
The act currently doesn't allow for the exemption of sales in this type of situation because it's a health facility. Any exemptions that will be dealt with -- and we're going to hear presentations from people like yourself -- will be made as we get into the regulation process of the legislation. No decision has been made right now, so it's appropriate that you come to the committee and make a presentation. Thank you.
Mr Jim Wilson: Thank you, sir, for your presentation, because I think you raise a very good point. I'm astounded to hear what you said near the end of your presentation, that on weekends, when the tuck shop is closed, people are coming in and selling the veterans contraband cigarettes at a premium price. How often does that occur?
Mr Currie: I don't know how often it has occurred, but it has occurred in the last short while. I know that a nurse in an area where they were not supposed to smoke found cigarettes, and they must have been contraband because they had no stamp on them to say they had been paid for. So somebody brought in contraband cigarettes. I understand the veterans' service council chairman said they went up to $7 a pack on the weekend.
Mr Jim Wilson: It's criminal in a number of ways.
Mr Currie: I haven't found any of these situations myself, but we're scared that this would be the norm if we can't buy cigarettes in the tuck shop. There's only 70 who smoke and we do have a smoking bylaw from North York and we have built smoking rooms. They're ventilated to the outside. There's no reason why the veteran can't go in there and smoke. We still have a little problem with the veteran who will not be told what to do, who wants to smoke in the areas that are restricted. But if we get veterans smoking in restricted areas like the rooms and the halls, then we have the danger of once again a fire. We've had this happen before when we didn't have restricted areas.
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Mr Jim Wilson: Good point. One of the reasons the government would like to ban the sale of cigarettes in health facilities and pharmacies is that they feel, in particularly the case of pharmacies, that it sends out a conflicting message to young people. The argument is made, of course, that it's a health facility and therefore it shouldn't be selling, even though it's a legal product, something that's detrimental to your health. Because the parliamentary assistant said that perhaps they would think of making an exemption for the veterans, I should ask: Do a lot of young people go by the tuck shop when they're visiting their grandpas?
Mr Currie: Not really, because the tuck shop is kind of a closed area. They do go by, but there are closed doors and they have to go through the doors.
The hours of the tuck shop are generally regulated and it's for veterans only, and the ruling that we have with our new smoking bylaw is that visitors are not allowed to smoke. If a visitor comes in, he must smoke outside or not smoke at all. The only ones allowed in the smoking lounges that we have are the residents that live there. So this cuts down on the public smoking in the hospital quite a bit. I imagine it's cut down a tremendous lot, if you hear the complaints.
Mrs Yvonne O'Neill (Ottawa-Rideau): I thank you so much for coming, Mr Currie, and may I thank you; you obviously have served your country well.
You said Sunnybrook and other veterans' facilities. Could you tell us how many you're thinking of?
Mr Currie: There is our Parkwood Hospital in London, and I have not talked to these people in London yet. They do have a tuck shop where veterans can buy cigarettes, or they do have their pub where they can buy cigarettes. Also, the Rideau Veterans Home has one, and our Legion home out in Island Creek does have a tuck shop and this is controlled. It's in the smoking or the residential area.
Mrs O'Neill: Is the tuck shop the only source in the facility, or would the coffee shop, for instance, also dispense cigarettes? It's limited to the tuck shops, is it?
Mr Currie: No, at the present time the coffee shop doesn't sell cigarettes, the cafeteria for the employees doesn't sell cigarettes, nor does the tuck shop over in the regular hospital sell cigarettes. So the only place that we're actually selling cigarettes is in the veterans' wing.
Mrs O'Neill: The area is limited, as you said? The employees can't smoke in that area?
Mr Currie: No.
Mrs O'Neill: Visitors? It's just the veterans?
Mr Currie: Employees or visitors cannot smoke.
Mrs O'Neill: And you're meeting all the bylaws of the local municipality.
Mr Currie: Right.
Mrs O'Neill: Thank you so much.
Mr Currie: I can leave with you the North York because --
Mrs O'Neill: Please do that.
The Chair: We'll get that at the conclusion of your submission. Mr McGuinty.
Mr McGuinty: Thank you very much for coming before us today, Mr Currie. I don't really have a question; just to tell you about one of the best jobs I ever had. After grade 13, I was an orderly for one year at the National Defence Medical Centre, and people were moved from the Rideau Veterans Home into the medical centre when they became more chronic care. I bathed veterans, shaved them, brushed their hair, helped dress them, everything, and of course the intention of all the care that was delivered there was to help maintain as much pride and sense of dignity for the patients on that ward.
There were very few things that you could do in a real sense that would give these men a great deal of enjoyment, but one of the things that almost all of them looked forward to was a cigarette, and I can recall that there was a man there by the name of Dr McIntosh. He was a physician, a patient, a veteran of the First World War. I said, "Dr McIntosh, you really shouldn't be smoking, should you?" I can recall what he said to me. He said, "How would you like me to turn you upside down and bounce you on your head?" This was particularly funny because he was confined to a wheelchair and weighed less than 100 pounds.
In any event, it was very obvious to me that this was one of the few pleasures these men had in life and I think it's important we make some provision for that.
Mr Currie: I was a young fellow. I went overseas and I didn't smoke. At the time, my dad was a member of the Royal Canadian Legion from the First World War, and the church and everyone sent me cigarettes. They were sending them for $2 a carton at that time and they were very good because they came in nice square packets and I used to put them in my large pack and it made it nice and square on the side of my bed.
Mr Perruzza: I'd like to thank you for taking the time to appear before this committee. I think it's refreshing, and we need to hear from people like yourself representing a group of people who -- I don't think there's anybody around this table who would take issue with people who have served their country with diligence and with a lot of heart.
However, having said that, I'd like to go back to something you said about the expectation to stop and the kinds of things that cigarettes do and the fact that people can't leave to go buy cigarettes from outside and so on. It would seem to me that health care and substances that are the antithesis to good health, that run contrary to good health, somehow shouldn't have a place in the same place, because you can't on the one hand say, "You know we'd like you to do well and live a healthy existence," and at the same time and in the same place, say, "but it's okay for you to run your lungs ragged and drive yourself to an early grave." That to me poses a bit of a difficulty,
I appreciated your comments about people who have smoked for many years and that it would be difficult for them to go out and be able to purchase cigarettes. Certainly, we're not talking about kids and we're not talking about introducing new smokers into our society in your particular situation. I don't know how many 12-, 13- and 14-year-olds would visit your locations and at that point buy cigarettes.
That's something I think needs to be looked at and I'm pleased to hear the parliamentary assistant say there may be exemptions, particularly for those people who find it very difficult to leave the premises and be able to purchase cigarettes and so on.
I'd certainly like to sit down and look at that and try to develop options where we could say: "Fine, we understand. You've smoked for 50 or 55 years and you're not going to make an effort to stop now." If society were to bring pressure to bear on you, it wouldn't help. In fact, it might even harm your situation even more by denying you that thing you've had for so many years and have come to expect and desire and want.
I would sit down and look at that and try to develop ways that we could say, "Let's preserve the integrity of what health care's intended to do and let's not introduce into that system a substance that runs contrary to what health care and good health is supposed to mean."
However, I wanted to ask you a question. Can your veterans purchase all the daily staple items that people require on an ongoing basis in the facilities? I find one of the things that I have to buy a lot of are socks and toothpaste and razor blades and shaving cream and those kinds of things. Can you buy all those sort of daily items in your shop or do you have to go outside or do they have to be delivered somehow by other people?
Mr Currie: The hospital itself supplies practically all those needs, like razor blades, shaving cream, soap and all that. The hospital supplies that to the veteran when he's in the hospital. Any other shortage that he needs, all he has to do is phone me and one of the legionnaires will be up there in an hour with more than he can handle.
If you recall, someone wrote in the paper back a few years ago that the veterans didn't have any soap. Well, we were swamped with soap, shaving cream and razor blades to the point that we didn't have a place to store them. All those things are there available for them. All those things that you're talking about are supplied and there's no shortage of them.
Daily or monthly I have a meeting there with the veterans' council and if they require anything, the Legion supplies it right away. There's no problem.
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Mr Perruzza: What you're saying is that on a daily basis, if people needed cigarettes, cigars, tobacco or those kinds of things, they would just ask you for them and they would be delivered by you and sold in the --
Mr Currie: Not cigarettes and tobacco. We don't deliver that any more. We stopped doing that because the problem is that if a group of people come in with cigarettes, they don't know who smokes or who can't smoke and the nurses have brought in a program there of non-smoking. A lot of these people are on oxygen and have lung problems and the nurses will not let them smoke. For those who can smoke, the nurses generally control it, because if a person is unable maybe to look after himself, the nurse sees that he goes to the lounge and she supplies him with the cigarettes or what is necessary. He buys the cigarettes because we no longer buy them.
Mr Perruzza: Getting back to something my colleague and good friend Mr Wilson was talking about, this contraband thing, people coming in and selling these contraband cigarettes, how do you regulate that? You're saying, "If we deliver them, we can't tell you who can smoke and who can't smoke and the nurses are the ones who regulate it," and so on and so forth.
Some guy shows up there and wants to sell cigarettes illegally, and cheaper I may add. Obviously, that raises a question in my own mind: Do you go into the shop and buy them at a regular price, whatever the regular price is nowadays -- I imagine it's well over $7 -- or do you buy them contraband for $4 or $5 a pack, and how would that change in any way if you were to eliminate the shop?
Mr Currie: We have security and the security officers are watching who goes up to these floors. If a guy comes in there and says he's visiting and he's trying to sell cigarettes, we had this problem with alcohol with the Dial-A-Bottle, and we had to stop these people from even coming into the building. This would be the same thing with the contraband cigarettes. We would have to stop it because if a person's, say, up on the third floor and he has a problem with not being able to control himself so he can light a cigarette, and he gets contraband cigarettes and they supply him with matches and a lighter, the first thing you know we have somebody with a fire. This has happened many times in the past before we started this program of non-smoking and controlling the smoking.
Mr Perruzza: Thank you very much. You were very helpful.
The Chair: The parliamentary assistant just had one final comment.
Mr O'Connor: I just wanted to clarify for you that the act, as it's currently written, doesn't allow for the exemption of the sale of tobacco, but for smoking to take place. Your comments coming to this committee are certainly going to be useful to us. I think all the discussion we've had in some of the other areas that my colleagues have brought up will help us as we take a look at this issue. As to the nurses having control of the tobacco substance itself with the legionnaires who are still smokers and those who perhaps shouldn't be smoking because of health risk, all of that will be useful for us as we try to decide where we go from here.
The Chair: You mentioned that you had with you, I believe, a copy of the North York bylaw. I think that would be of interest to members. I'll have the clerk get that from you. Thank you again for coming before the committee today.
PHARMA PLUS DRUGMARTS LTD
The Chair: I call upon the representatives from Pharma Plus Drugmarts Ltd, please.
Mr Jim Wilson: Mr Chair, while we're waiting for our next witnesses, I wonder if I could have unanimous consent to correct someone else's Hansard record.
The Chair: Probably not. I don't think I'll even put that to a vote.
Welcome to the committee. If you would be good enough to introduce yourselves, then please go ahead with your presentation.
Ms Rochelle Stenzler: Thank you for meeting with us this morning. We will take only a few minutes to explain Pharma Plus Drugmarts' position on Bill 119, the proposed Ontario tobacco act, and our reasons for that position. To start, however, you should know a bit about who we are, just on our own and as our company.
My name is Rochelle Stenzler. I'm the president and general manager of Pharma Plus Drugmarts. I am also an Ontario registered pharmacist with nearly 20 years of experience in community pharmacy. With me today is Tim Carter, who looks after public affairs for our company.
Our purpose is to outline the Pharma Plus position in areas affected by the proposed Ontario tobacco act. We also welcome this chance to answer any questions you may have.
Pharma Plus Drugmarts is Ontario's second-largest drugstore chain, with 133 stores in this province and another 10 in Manitoba. We are a wholly Canadian-owned company and an autonomous subsidiary of the Oshawa Group. Each of our stores is corporately owned, not franchised, which means nearly 3,000 Ontario residents are Pharma Plus employees, working in our stores and our Mississauga head office.
Although Pharma Plus is a relatively new name in communities across the province, we have a long history in Ontario. Past drugstore chains, such as Tamblyn Drugmarts, Boots Drug Stores, Safeguard drugs and Drug City are now represented under the Pharma Plus banner. Our stores are moderate in size, averaging about 5,000 square feet, with a product mix which covers over-the-counter medications, health and beauty aids, household supplies, confection, stationery and other sundries.
Of our total selling area, less than 10%, or under 500 square feet in each store, is devoted to the prescription department, with the balance distributed among the other product lines I mentioned earlier. In other words, only a small section of a Pharma Plus Drugmart is perceived by our customers to represent a health care facility. They see the majority of our store as a convenient place to buy a wide range of merchandise.
To begin, it is important to acknowledge that we support several of the stated tobacco strategy objectives advanced by the Ministry of Health. Specifically, we wholeheartedly endorse Bill 119's intent to discourage children and adolescents from starting smoking, to reduce the overall use of tobacco and to decrease public exposure to secondhand smoke.
However, we strongly oppose paragraph 4(2)8, the proposed ban on tobacco sales from drugstores. It is excessively punitive and inflicts unfair hardship on our segment of the retail industry. Moreover, we are convinced it will prove to be totally counterproductive to the very objectives you are trying to achieve. I will explain why we oppose banning tobacco from all drugstores and at the same time discuss how we believe such a ban would affect tobacco use and total market consumption.
Let us concede at the outset that tobacco does generate a small profit in many of our stores. However, our gross margin on cigarettes is only approximately 10%, not counting any losses to theft. This 10% is less than half the typical store average gross margin rate, from which we must pay all our total operating expenses before any profit can be realized. More important than the slim margin is tobacco's contribution to our product mix and its ability to attract other sales. Furthermore, it is important to consider the general economic environment in which drugstores operate and then examine the specific role of tobacco in that business.
The recession, despite expert proclamations to the contrary, continues to grip this province. Official unemployment is pegged at roughly 11%, while the federal government in January suggested that this figure in fact understates reality. It fails to take into account those who have given up looking for work or who have settled for part-time employment when they really need full-time. Whatever the actual number may be, clearly we have a lot of people out of work. It follows then that if they don't have jobs, they don't spend as much money in any store, including the drugstore.
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At the same time, even people who are working are spending less. Consumer confidence remains feeble and the effect can be seen clearly in sales results at most retailers. As an industry, we continue to be hit hard and are struggling today for our very survival.
A natural result of decreased consumer spending is the recent dramatic increase in competition. Each player in the market is trying to find a way to attract those scarce customer dollars into their stores. We see traditional drugstore products being promoted in non-traditional outlets such as department and hardware stores as they work to protect and expand their market share.
At the same time, most retailers have been forced to reduce prices to try to win business. Although you may sell almost as many items using this strategy, your margin is severely impacted. The overall result of this competitive activity has been to encourage consumers to be extremely value-conscious and frequently completely won over by price consideration alone.
Furthermore, the drugstore segment has toiled with additional challenges not faced by other retailers. We have been hit by both the social contract and ongoing government efforts to contain the costs of the Ontario drug benefit program. For example, our professional fee for prescriptions billed to ODB had been frozen since June 1990 at $6.47, while many of our costs of doing business have increased substantially. In September 1993, the social contract rolled that figure back to $5.86, further reducing our profitability.
In the past two years alone, the Ministry of Health has de-listed more than 100 drugs from the drug benefit program and instituted other significant changes to the extent of coverage offered. While these actions have saved the government more than $100 million, they have cost drugstores dearly in lost sales. Many patients simply cannot or will not buy the products if ODB doesn't cover them. Others may buy them more sparingly or less often, depending on their personal finances.
Compounding the problem is ODB's consistently slow payment of outstanding accounts, which impedes cash flow and viability even more. At this instant, the Ontario government owes Pharma Plus Drugmarts $8 million and is taking an average of 45 days to pay for prescriptions we fill on its behalf.
Taking their cue from ODB, insurance companies and other drug plan administrators are also putting pressure on pharmacy to reduce our professional fee. When added to other factors, such as large-quantity prescriptions and new, more expensive drugs, the overall financial performance of the prescription department of most drugstores is deteriorating rapidly.
In fact, our gross margin on prescriptions has dropped nearly 20 percentage points in the last decade, and for 1993 alone is a full percentage point lower than it was in 1992. If we had to depend on our prescription sales alone, in many locations we would not make enough money to keep our doors open to the public.
To remain economically viable, therefore, many drugstores rely more and more on their front-store, non-prescription sales, but as we've already discussed, market factors are reducing the profitability of this segment of the store as well. Without a profit, there is no reason to keep a store open. It cannot run as a public service.
However, the public does benefit from having a dependable drugstore in the community. Where else can a person get medical advice on the spot, without an appointment, at any hour of the day or evening? Where else can they get that advice at no cost to either themselves or their medical plans? Many times, a patient will require no medication whatsoever for the condition they describe and pharmacists therefore receive no compensation for their time and counsel.
The Ministry of Health has recognized and exploited this free service of community pharmacy in its new pilot program in and around London, Ontario. By discouraging patients with cold symptoms from consulting their physician, the government hopes to save $3 million in OHIP billings. As the ministry knows, many of those patients will consult their pharmacist and receive advice such as, "Rest in bed and drink plenty of fluids." In case after case, no products will be sold, no profit will be made. Free, on-demand medical advice is part of the contribution only a profitable pharmacy can offer the community.
In my opening remarks, I mentioned that Pharma Plus operates 133 drugstores in Ontario. Eleven months ago, appearing before a government committee dealing with this same topic, I was able to say we ran 136 stores in this province. Since then, we have closed six and opened only three. If you have any doubt that the economy and the other factors I have talked about are taking their toll, I suggest you speak with any of the almost 50 ex-employees from stores we were forced to close in 1993 whom we could find no place for in other stores.
Further, you would find it interesting to speak with some of their former customers and patients who have had to find another, often less convenient drugstore to meet their needs. They can tell you in detail of the hardship caused by these difficult times.
What does all this have to do with Pharma Plus selling tobacco products? Let me explain.
Traditionally, tobacco products have been low-margin items for drugstores, priced, as I mentioned earlier, at levels only about 10% above cost. In addition to any value they have on their own, their major advantage from our perspective has been their ability to draw customers into our stores.
A recent Coopers and Lybrand study commissioned by the Committee of Independent Pharmacists and presented to you yesterday shows that for every dollar smokers spend on tobacco in a drugstore they spend a further 37 cents on other items.
Coopers's very conservative estimate suggests we will lose only 25% of those companion sales or roughly 10 cents for every lost tobacco dollar. For example, assuming a carton of cigarettes sells for about $40 before PST and GST, we will lose at the very least a further $4 sale to each lost tobacco customer. Forgoing the small profit on the tobacco sale therefore is only part of the penalty we will pay for this new law. We will also lose the profit on the companion sales.
Of course, if they cannot buy it from us the customers will buy their tobacco from other sources, including retailers who have not been singled out by this law. In many cases, these will be competitors who offer many other products which we sell, such as toiletries and beauty aids. What chance do we have that our smoking customers will come back to us for these or other front-store items once they are already inside such a competitor's store? Worse, the next time they need one of these products, there is a distinct risk they will return to our competitor even if they do not need to buy tobacco at that time. Clearly, we can expect ongoing erosion of our sales beyond merely tobacco products.
Our store lease agreements are another factor that complicates the tobacco picture. In our stores, we pay a percentage of our gross sales as part of our rent. However, to accommodate the low margin on tobacco, most of our leases provide for a reduced or even zero percentage to be paid on those tobacco sales. If we no longer can sell tobacco and somehow are able to find products to sell in its place we will be hard pressed to replace the lost sales dollar for dollar. Moreover, for any extra sales we can generate, we will find ourselves owing our landlords a higher rent as a percentage of sales.
It's not difficult to predict what effect losing more business and paying more rent will have on our stores. In the extreme, we will have to close a number of them. In fact, following a thorough store-by-store analysis, we can give a cautious estimate suggesting at least 10 of our stores will become potential closures if we lose tobacco from our product mix. That represents a loss of about 90 full-time and 80 part-time jobs. In other words, in our company alone, banning tobacco sales will cost 170 jobs in Ontario. Moreover, even in the stores which remain open, we will have to decrease staff hours to varying degrees.
The majority of Pharma Plus store employees are represented by one of two unions: the United Food and Commercial Workers International Union or the Retail, Wholesale and Department Store Union. That means we have a negotiated procedure to follow when hours are decreased. In the situation I've described in stores that we keep open, some full-time employees would drop to part-time and see their benefits reduced proportionately. At the same time, they would displace other part-timers, thereby causing further job loss. Clearly, not only would Pharma Plus experience yet another blow to our business, but significant numbers of our employees would lose their jobs if the government enacts this legislation. At the same time, closing any drugstore reduces the public's access to no-cost, front-line health care advice.
Some sceptics will point to other drugstores which discontinued selling tobacco products and yet remain in business today. A close examination of these situations often reveals that these stores were typically quite small in terms of retailing selling space, had low tobacco sales to start with, did not achieve a high level of companion sales or were able to find a way to replace the attraction and margin that tobacco provided in their stores. One of the keys in these situations was that the retailers made the decision to discontinue tobacco sale of their own free will. Furthermore, they were able to select and control the timing of this change to their business.
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Looking back over the last two to three years, we have seen the sales of cigarettes plummet from our stores. In fact, our tobacco sales for 1993 were less than half of what they were in 1991. Ignoring the financial impact, this would be wonderful news from a health promotion point of view if it represented a corresponding drop in the volume of tobacco being smoked. It does not.
What it represents is the volume of tobacco now being purchased from other sources, especially the black market. A study conducted by the forensic research firm of Lindquist Avey Macdonald Baskerville and recently presented to this committee showed that more than one quarter of all tobacco consumed in the province is now purchased on the black market. Alarmingly, the contraband tonnage has increased more than 50 times in seven years.
We can see this element of the marketplace is completely out of control. Any new rules which the government may impose to attempt to achieve its objectives will mean little in the face of advancing market chaos. For example, while drugstores and other responsible retailers carefully enforce age restrictions on the purchase of tobacco, black market vendors sell to anyone, regardless of age. As the Lindquist Avey study showed, underage smokers already rarely buy their tobacco from drugstores because we are among the best enforcers of the province's age restrictions.
When you consider that the average carton price of cigarettes on the illicit market is roughly 50% of the legal retail price, including GST and PST, it is not hard to understand the drop in the legal share of the market. No wonder the black market pricing has contributed to an increase in consumption, the first reported by the federal Ministry of Health in years. Any further action which serves to enlarge the illegal part of the market will only serve to accelerate this trend and damage the government's ability to realize its objectives of reducing consumption.
As mentioned, the Lindquist study showed drugstores to be among the best retailers at obeying the law by stocking only legal, tax-paid inventory. It also reported finding evidence of an increase in neighbourhood non-pharmacy competitors carrying dual cigarette inventory. In this situation, legal product is generally sold to unknown, non-regular patrons while familiar, trustworthy customers receive contraband inventory. The contraband customer gets a lower price and the retailer receives a higher margin; in other words, contraband product is now being sold by existing retail outlets, some of which are neighbourhood competitors to our stores.
Should our declining group of regular cigarette customers find themselves unable to buy tobacco at the drugstore, they will in many cases turn to another local store. If this retailer is one who stocks dual inventory, he probably will sell this new customer legal stock initially. As the customer becomes a regular, the retailer will then likely move the customer to contraband inventory at a lower price and a higher profit.
Instead of retail supporting government's objectives, some segments may actively move to the contraband market for their own profits. In this way, the proposed tightening of rules for the legitimate portion of the market will serve to expand the illegal side, decrease government control, diminish greatly needed tax revenues and ultimately prevent realization of the government's objectives.
We can see that rather than contribute to the ministry's goals, a drugstore ban will actually work against its achievement. In essence, the proposed ban will remove the most supportive section of the retail market in the fight for control over the sale of this product. More tobacco will be smoked, young smokers will have greater access to cigarettes through the expanded contraband market, and there will be no reduction in secondhand smoke.
In closing, I would like to restate our position. Pharmacists are dedicated professionals committed to helping their patients maintain their health. Selling tobacco in the same retail outlet does not compromise that professional role, and its sales help preserve the financial viability of many drugstores while sustaining related employment.
Removal of tobacco at this time would cause needless economic hardship. Government intervention in the manner proposed is contrary to the principles which foster a free-enterprise, market-based system. Previously presented research has identified drugstores as being particularly helpful in enforcing age restrictions and avoiding dual inventory or contraband merchandising. As a result, Pharma Plus believes a legislated removal of tobacco from drugstores would be inconsistent with promoting the government's stated tobacco strategy.
Thank you for the opportunity to present our views.
Mr McGuinty: Thank you very much for your presentation and for a comprehensive overview of the impact Bill 119 would have, and I guess a good review of what government has done over the years to pharmacies.
I've got to ask you this question, though: One of the impressions we are left with is that any of the large chains that are against 119, that particular provision, are really lackeys of the smoking manufacturers. Are you owned in any way by a tobacco company?
Ms Stenzler: Not in any way.
Mr McGuinty: No connection?
Ms Stenzler: No connection. We're Pharma Plus and we're owned by the Oshawa Group Ltd.
Mr McGuinty: Where do you rank in terms of the size of chains in the province?
Ms Stenzler: Second in number of stores.
Mr McGuinty: How many employees, again?
Ms Stenzler: Three thousand.
Mr McGuinty: So you're not connected to a tobacco company?
Ms Stenzler: Not at all.
Mr McGuinty: The second thing I want to ask you is, we've heard that some pharmacies, chains even, have chosen voluntarily to no longer sell tobacco products in their stores and they have been able to cope financially quite well. Why couldn't you do the same?
Ms Stenzler: I think the situation you're speaking of is different for every single retailer. There is no taking all stores and putting them in one pile. Within retail pharmacy today, there are stores that range in size from 500 square feet to 10,000 square feet, and even larger if you get into the discount drug market. In looking at that, there are drugstores very clearly that had a very low reliance on tobacco at any time in their existence, because the sheer size of their store in many cases doesn't allow it. They are truly pharmacies with very minimal amounts of retail other product in the store. Therefore, the majority of the stores that have taken that decision have done so based on their economics for their situation.
Within our chain, we also have some stores that do not sell tobacco and those decisions have been made based on each store on its own circumstance.
Mr McGuinty: Do I understand it that if someone in the store chose not to sell tobacco, they could do so?
Ms Stenzler: No, the impetus for the decision came from a business reason combined with looking at the environment in which we operated and whether or not it was required or not required to that store's mix. We have one location in London where when we pulled tobacco out -- we are beneath where there are medical locations -- the doctors were the ones who complained when we removed tobacco.
Mr McGuinty: I'm wondering about the job losses here. I gather a lot of that is due to the fact that this comes in, this comes down like a hammer, right away. Could that impact be moderated somehow if this deadline was delayed?
Ms Stenzler: I'm sorry. I missed the beginning of your question.
Mr McGuinty: How many job losses did you project?
Ms Stenzler: It is 90 full-time and 80 part-time.
Mr McGuinty: And those would be experienced in the event this provision came into effect, as scheduled, under this bill?
Ms Stenzler: It would come into effect as the store probably normalized in its new existence and could not survive based on the dollars it would generate, both in volume and profit.
Mr McGuinty: What if that deadline was moved further down the road, with more time to adjust?
Ms Stenzler: That would certainly help retailers get conditioned to what they have to deal with in order to accommodate that. I said in my presentation we've already dropped about 50% of our volume. We've had to manage that decline in volume quite carefully over the last couple of years, even to survive to this point. It has been very difficult. The key thing that people tend not to understand or realize is that tobacco is stored behind the checkout in a pharmacy. If you remove tobacco, you're going to get very little benefit of that merchandising space in terms of replacing those sales.
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Mr Jim Wilson: I want to explore three areas. One is along the lines of what you were just commenting on. Actually, that argument has been turned around by some presenters, and that is that your tobacco sales have been going down -- you mention a 50% decrease since 1991 -- and that therefore if the government goes ahead and bans you from selling tobacco altogether, you should be able to handle it; you've been handling it so far. Frankly, coming from a retail family myself, I know the answer, but I'd like you to further explain it to members of the committee.
Ms Stenzler: As I've said, obviously what's gone on in the last couple of years has not been driven by anybody's desire. It has been the shift in the marketplace from the traditional retailer. As I said, from research it appears it's going into the black market. Therefore, retailers have literally been living day by day and doing their best to sustain that decline in volume, and although it has been, I'll say, fairly dramatic, it has still been two years in which it's gone down 50%. That is quite a difference from taking 100% out in the balance of a year.
Mr Jim Wilson: Just on that latter point, because it was unfortunately missed by the media during the Coopers and Lybrand presentation the other day, what I think failed to be pointed out was that it's going down everywhere because of the contraband. It's not like your decrease in volume since 1991 in cigarette sales was because consumers decided to stop buying cigarettes from drugstores. You could say the same for the other shops along the mall that sell cigarettes.
Ms Stenzler: Exactly. In fact, all retailers will report drops in the same magnitude as I've just reported for our chain.
Mr Jim Wilson: The other thing I wanted to explore, and I'm very pleased that you had it in your brief, is in terms of customer perception of the drugstore. I said on the first day of the hearings that as a young person, my perception of the drugstore was a place where you could get prohibited products, or wanting to revise that language, restricted products. I had no other reason to go to a drugstore unless my mother sent me or I was doing a science project. That's about the only time I remember going to a drugstore. It might have been because we owned a grocery store and I didn't have to go to the drugstore for anything else, but it also might have been that drugstores in those days, not too many years ago, in a small town like Alliston were really just the pharmaceutical counter. It was profitable and that's all you really needed.
Can you give us a feel for your customers' perception now? You mention that less than 10% of your actual retail space now is the drug counter. Do you have any other proof to offer with regard to your customers' perception of your store as a retailer?
Ms Stenzler: The proof we have is that we have done research in the past. In the last five or six years, since there's been the focus on tobacco, we certainly have undertaken significant research to make our own decisions in terms of, could we benefit in other ways if we made certain business moves?
The research tells us that if you prod customers and talk with them, as opposed to just asking the question, "Do you think a drugstore should or shouldn't carry the product?" you will clearly find out that they look to a drugstore for far beyond the prescriptions and OTCs. That is something very much of years gone by. That was the traditional core, the corner drugstore, and there are still probably close to 1,000 of the 2,300 stores in Ontario that are very much like that. Those are the people claiming to be the Good Samaritans, but they had very little reliability or mix of tobacco to begin with.
Mr Jim Wilson: I guess from the very beginning -- I heard it again on the radio yesterday, somebody once again saying that if the government really wanted to restrict the sale of tobacco or limit its consumption by young people, why in the world wouldn't they put it in a store that already plays that role with respect to prescription drugs and other harmful substances? Could you just comment on that, because it seems to me, trying to use a little bit of logic looking at this section of the act, that the section defies logic.
Ms Stenzler: In many ways you are leading to something that probably from a sense standpoint should be thought of, and that's very much that pharmacists today are the keepers and dispensers of all other addictive products. If you look at this, that tobacco is an addictive product, one could turn around and say it should only be sold from behind the prescription counter by pharmacists and maybe even by prescription. That could be looked at as a flip side. We have all the narcotics back there. They're more addicting and in many cases could create more trouble. Many regular drugs could create the same kinds of difficulties with health hazards and certainly we are the keepers of those products.
Mr Jim Wilson: Finally, it is suggested by a number of groups that perhaps the next step in the next decade is to restrict the sale of tobacco products to LCBO stores or beer stores, and to set up a tobacco control board or to give new responsibilities to the liquor control board, which to me seems like a great big hassle when you've already got pharmacies which, as you say, are already controlling addictive products.
I suspect the government doesn't want to take the heat from the thousands and hundreds of thousands of corner store owners if it were suggested that actually pharmacies should be the only ones selling tobacco.
Ms Stenzler: I think I'll ask Mr Carter, actually, to respond to that one.
Mr Tim Carter: I think that what you find with the pharmacies having trouble financially with the removal of tobacco, you might extend that argument for other stores that rely on it.
One of the things that would come forward, I think, in your hearings on that would be what's happening with the market. The market right now is moving to a Quebec situation which is contraband, to a majority of it. With the United States next door, you would advance that by controlling it, and you would have to address the smuggling issue to execute that plan.
The Chair: We'll move on to our next questioner. I'll just comment and this will show my age, but I always remember that the reason you picked this or that pharmacy was the soda fountain.
Mrs Haslam: What's a soda fountain? Could you explain that to me? I'm not sure what a soda fountain is.
The Chair: They were great places.
Ms Stenzler: Actually, Tamblyn Drugmarts were the ones that had the soda foundations.
Mrs Haslam: What's a Tamblyn?
Ms Stenzler: It's two precursors and a Pharma Plus.
The Chair: Sorry, I digressed and got the committee off on another tangent.
Mr Tony Martin (Sault Ste Marie): I also appreciate the fact that you've come forward today. Certainly you are a major player in the area of how we dispense drugs in the province and somebody who's going to be impacted very clearly by this legislation, and it's good to hear from you. It's also good to hear you state clearly that you are in fact a retailer, because the discussion that's going back and forth here in many instances is, are you a health practitioner or are you a retailer? That seems to be a somewhat grey area and we're trying to come to terms with some of that.
I also appreciate the comment you made about the fact that pharmacies are, for the most part, all of them I guess, not getting into the contraband sale of cigarettes. I think that's something that should be lauded and we thank you for your contribution in that very difficult challenge that we're all facing at the moment around the question of cigarettes.
However, I want to focus, since you did come as a retailer, on that particular issue in my questioning here because I want some clarification from you.
Just to go back a bit, the basic premise of this legislation is that a pharmacy is a health service, and most of that service or a good chunk of that service is paid for by government. We may have to agree to disagree, I guess, on the issue of whether selling tobacco products beside the health products is inconsistent in terms of a message and what that's about.
However, I wanted to focus, as I said, on the retail section. I remember sitting at a table here not so long ago around the question of Sunday shopping and talking about fairness and level playing fields and all that kind of thing, and sitting at home in my office in Sault Ste Marie and listening to all the corner stores coming in and telling me how unfair it was, and how it was going to take away from them a market share by allowing the Pharma Plus and the Shoppers Drug Mart and all that to get into the business of being open on Sunday.
We went ahead with that legislation and they had to deal with that. I guess they would say that wasn't fair, but that's the way it was in those days, and you were certainly in favour of that at that time.
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The other thing I suggest to you is that you have in this instance a monopoly on a host of products here. Would you see it, given your argument, as being fair for us maybe to extend the opportunity for corner stores to get into the business of dispensing drugs in order to make it an equal or a fair or a level playing field in terms of the competition here that we're talking about? Those are my questions.
Ms Stenzler: If I could, I'd like to clarify some of your comments. Firstly, drugstores have always been allowed to be open Sundays.
Mr Martin: Drugstores, yes.
Ms Stenzler: Pharma Plus Drugmart is an average 5,000-square-foot store. It was a 7,500-square-foot rule. I don't think it was an issue at all. In fact, almost all retailers, traditional drugstore retailers, have always been able to be open. There were very few that fell into the exempt, over 7,500 square feet. That's just a matter of clarification.
Beyond that, with respect to your question, I want to be quite clear. There's a very distinct difference about people coming forward and saying, "You already corner the market or are the only ones who can have prescriptions or OTCs of certain kinds." That is not true. Anybody who meets certain regulations and requirements can become a registered pharmacy. In fact, that's part of the difficulty in this province, that there are not very stringent rules on what it takes to be a pharmacy.
If you go through the trouble, you hire a pharmacist, you have running water, you have a dispensary laid out as they say and you have a library, somebody from the college of pharmacists will come in and say, "You're a pharmacy." People are not precluded from getting into that business should they so want to.
This is taking a legal product and restricting it from one segment of the market. That's significantly different in my mind from saying that today pharmacies are the only ones who have dispensaries. Anybody can do that. It's in fact why department stores and other stores are starting to put in dispensaries.
Mrs Haslam: With all due respect, when you answer my colleague's question, you call yourself a drugstore: "Drugstores are open on Sunday." "I'm a drugstore." When you answer Mr Wilson's questions, you are a retailer. You talk about the jobs and the products and you're a retailer. That's the question here for me, looking at the health issues around this.
I'd like to deal with you as a pharmacist. As a pharmacist, does smoking has a negative effect on health?
Ms Stenzler: Yes.
Mrs Haslam: Oh, I'm glad you're brief. I get long answers from these other people. Do you, as a pharmacist, believe the ultimate goal of Ontarians is to move towards a tobacco-free society?
Ms Stenzler: Yes.
Mrs Haslam: Now, you're a pharmacist. Okay, I want to go into a little bit about this retailer versus pharmacist. As a retailer, you can hire a pharmacist. Does that make a pharmacy? You talked about what makes a pharmacy: running water, a library. You hire a pharmacist. Is that correct?
Ms Stenzler: Correct.
Mrs Haslam: As a retailer, in order to put the word "drug" in your sign, you have to hire a pharmacist.
Ms Stenzler: Correct.
Mrs Haslam: Okay. So there I think is the major problem. The retailers are saying, "We want to sell for profits." The pharmacists are saying: "It's a conflict for me. I'm in a health facility." When the pharmacists came before other committees, they said: "We are health practitioners. We want to be governed as a health practitioner. Me, health practitioner." Now we find that retailers are saying: "No, I'm a retailer. I'm a businessperson. I have a profit line." I think there's a definite conflict there.
In your position, since 10% of your store space is a drug counter, would it be easier for you to say, "Goodbye, drug counter," for 10% of your store space, or would it be easier for you, profitabilitywise, to say goodbye to the tobacco products? Ultimately, you have to make that decision. You're in a strange situation where you're a pharmacist-retailer, I understand. You're going to have to make a choice. If you were given that choice, which one of those two would you choose? Are you a retailer or a pharmacist?
Ms Stenzler: I'll start by saying I'm both and I don't see any reason why you can't be both. We have pharmacists who work in that 10% of the store and some of the front-store areas as well, and then we have clerks and the regular retail environment that surrounds any other normal retail environment in the balance of the footage. That's my first answer: I'll say, if you're saying am I a retailer or a pharmacist, I'm both.
Mrs Haslam: I think the time has come for a decision, and what we're looking at here for a lot of people. As a pharmacist, you must follow certain rules and regulations. You take an oath. You are in the business of promoting health. As a conflict of interest, it must be difficult to promote healthy living when you know, as a retailer -- or the retailer that hired you as a pharmacist is making profit in one way or another off a poisonous product that is detrimental to health.
I think the question is the presumption that financial profitability supersedes the health policies that we as a government are trying to put in place with this particular piece of legislation.
Ms Stenzler: I'm not sure I can say I totally agree with your comments --
Mrs Haslam: That's easy. I don't agree with everything you say.
Ms Stenzler: -- and that's fine. I think the key here is this: It's interesting you raised this, because I've been through many rounds of negotiations with the Ontario Ministry of Health. It's interesting that the ministry, at that time, continued to point out to pharmacists that they don't need X amount of money for a professional fee because they have the whole rest of their store to help them make money. So it's very curious that we sit here today and we're being told that we can't be both, yet when the ministry doesn't want to pay us a professional fee that's adequate to reimburse us, at that time it's a valid reason.
Mrs Haslam: That's a valid point and I've heard that point before. I understand your concern in dealing with that. If this legislation puts you in a position where you are either a pharmacist or a retailer, I would perhaps put forward the view that as a pharmacist you may have a better chance at negotiations when the time comes.
Ms Stenzler: I don't think we're here to debate that today.
Mr Jim Wilson: They don't negotiate.
Ms Stenzler: Yes, everything is unilaterally imposed, so we don't negotiate with the ministry.
Interjection: The pharmacists walked away from the table.
Ms Stenzler: That was social contract; separate negotiations.
The Chair: One brief question, and Mr McGuinty has a supplementary which I'll allow as well.
Mrs Haslam: Mr Chair, you're such a wonderful Chair, and you're so fair and I do --
The Chair: Flattery will get you everywhere.
Mrs Haslam: Oh, I hope so. It doesn't get me much anywhere else.
Interjection: Much better than the one we had yesterday.
Mrs Haslam: Much better than the one we had yesterday.
I was interested in your comments about over-the-counter because, to tell you the truth, I know that when you talk about the things that were removed from the drug formulary, we are talking laxatives, we are talking things that are available over the counter, antihistamines and some cough remedies and certain of those things. Are you saying that you were not able to pick those up in over-the-counter sales? That to me is a surprise, because in one way it shows me then, how necessary were they when the taxpayers were paying the shot versus how necessary are they now? When you talk about $100 million that the government is saving, let me remind you that is a saving to taxpayers. I was interested to hear you say you're not picking up the profit?
Ms Stenzler: I think it's what I said in my paper. When you remove something from being covered by a drug plan, it is then up to the consumer that they have to be out of pocket. Some people just can't afford it. Some of the seniors cannot pay for it, and those that have to get it are certainly getting it, but they tend to --
Mrs Haslam: It's my understanding that they can go back to the doctor and there are other things on the formulary that are available to them.
Ms Stenzler: That may be the case. My point is really that some of the sales, yes, have been transferred into the OTC segment, but certainly, again, it has not been a matched situation, where if someone was getting it that way, they aren't getting it the other way.
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Mr McGuinty: I just wanted to take advantage of your presence here. As you can see, a lot of the debate centres around the symbolic value and the perceived paradox, for some people, as to your selling tobacco products at the same time you are supposed to be a health care deliverer. We've had the opinions of various members of the committee here, and that's fair enough, and then we've heard from pharmacists and from the anti-smoking groups. With respect to all of those people, I think the important group is the ordinary person on the street. What do they think of when they think of a pharmacy? Not what I think and not -- we're into this bureaucracy here and understanding it.
Do you have any breakdown? Of the people who go into a drugstore, how many go there for prescriptions and how many go there for other items? Maybe another breakdown is, how many go there for non-health-related reasons?
Ms Stenzler: Without having my company's statistics in front of me, first of all, the figures will vary by store, by location. If it is a mall location or a high-traffic location, the majority of customers come for the front of the store. If you're a corner neighbourhood location in a strip plaza, or freestanding on a street, you may have more people come to the back of your store.
There is also some cross-pollenization between the two areas, so their primary destination may be one part or the other and some of them do tend to make auxiliary purchases when they're there. So the numbers vary. It's just like, can you close your store or eliminate tobacco? Every store is different.
Mr Carter: Can I answer the rest of that question? We don't feel, as part of the health industry, that making a decision on behalf of our customers whether they engage in a product or not makes us any purer. We haven't looked towards corporate censorship on that point, nor do we think that government censorship on that is appropriate in this case, particularly in light of the fact that drugstores will actually help achieve the government's objectives, and without drugstores, those objectives will be harder to realize.
The Chair: Thank you both very much for coming before the committee with your presentation and answering our questions.
The committee will then stand adjourned until 2 o'clock. If I could just ask members, we have a very full afternoon, so perhaps we could start at 2 o'clock sharp.
Mrs O'Neill: When will we have the decision about the 23rd or the 24th?
The Chair: I will repeat the decision that was made at the beginning of our session at 10 o'clock sharp this morning. At that hour of 10 o'clock sharp, the committee decided that it would meet on February 24. It further decided that for clause-by-clause, it would be on Monday, Tuesday and Wednesday, March 7, 8 and 9, beginning at 1 o'clock on Monday, March 7.
The committee stands adjourned until 2 o'clock.
The committee recessed from 1202 to 1402.
ADDICTION RESEARCH FOUNDATION
The Chair: Our first witness this afternoon will be from the Addiction Research Foundation, if you'd be good enough to come forward please and introduce yourself for the purposes of Hansard and the viewing audience out there. We have a copy of your paper.
Mr Mark Taylor: Thank you, Mr Beer. I'm Mark Taylor. I'm the president of the Addiction Research Foundation which, I imagine you all know, is an agency of the government of Ontario. My colleague conferring there, if I can get her attention, is Dr Roberta Ferrence, who is a senior scientist of the Addiction Research Foundation and also -- correct me if I give the wrong precise title, Roberta -- the director of Ontario's tobacco research unit that was recently established.
I will be setting out the position of the Addiction Research Foundation on Bill 119, a position based on many years of research by our scientists, including Dr Ferrence. At the conclusion of my remarks Dr Ferrence would like to add a few brief remarks of her own.
Being a public health organization the foundation is, of course, applauding the measures contained in this bill. We think it is coming not a moment too soon because we have seen some disturbing trends recently among our young people.
You may recall some of the reports in the news media last November when we released the latest Ontario student drug use survey. The decline in drug use that we had been witnessing through the 1980s suddenly stopped; in fact the use of some drugs increased.
One of the most disturbing results in the survey came from the grade 7 students. Between 1991 and 1993, smoking among grade 7 students increased from 6% to more than 9%, a 50% increase. I would like to emphasize here that these students are smoking a product that is not only harmful to their health but highly addictive. The addictive agent in tobacco is nicotine, which has been described by the US Surgeon General as just as addicting as heroin and cocaine. While the Addiction Research Foundation does not like to compare different drugs in quite that manner, we have studied the difficulty in quitting smoking.
The ARF surveyed clients who had sought treatment at our facility for problems with alcohol, cocaine and heroin, among other drugs, and who had also tried to quit smoking: 57% of them said that cigarettes were harder to give up. That's harder than, for example, heroin or cocaine.
There is also a strong psychological component to the addiction. The head of our smoking clinic, Dr Rick Frecker, says that smokers have the same attachment to cigarettes as they would have to a friend. You might find that amusing, but when smokers quit, Dr Frecker says, they actually go through a period of mourning. If they have always had a cigarette with their coffee, they will now drink that coffee and feel the painful loss of a friend.
Young people can quickly become addicted to tobacco, but stopping is not so quick. Half of the smokers we asked in the Ontario student survey had tried unsuccessfully to quit smoking in the previous 12 months. Almost a third of those tried to quit three or more times. Almost half of those who tried to quit could not abstain from smoking for longer than one week and another 25% could abstain only from a week to a month.
We cannot, of course, expect totally to prevent young people from experimenting with cigarettes. After all, testing parental and societal limits is a simple and clear part of growing up. But we do think that Ontario should do all it can to prevent them from becoming addicted. There are two approaches which we can take to accomplishing this: Ontario should reduce young people's access to tobacco and we should reduce the appeal of tobacco.
Access is currently a big problem. The grade 7 students who are starting to smoke are minors, yet they have little difficulty in getting cigarettes. Bill 119 quite rightly proposes to restrict the sale of tobacco to persons 19 or older. Adolescents in fact consistently underestimate the addictiveness of tobacco. They are also being given a mixed message if they can start one legal addictive substance at 18, tobacco, and another substance at age 19, alcohol. Their youthfulness leads to other health concerns. The US Surgeon General reports that the earlier in life you start to smoke the more likely you are to become a heavy smoker, have more difficulty in quitting and have greater risk of developing a smoking-related disease.
Adolescents will experiment with cigarettes before they reach the legal age, but the higher the legal age the longer we can prevent them from smoking regularly. We have seen this with alcohol. If you can delay a young person's regular use of alcohol, you may permanently reduce their drinking. Raising the age to 19 means that most high school students will not legally be able to get cigarettes. The new legal age will also mean that store owners will be able to demand to see a person's age of majority card as proof of identification when selling cigarettes.
Bill 119 also places restrictions on retail establishments, which the foundation supports. Research about alcohol indicates that if you broaden the distribution of alcohol, consumption will rise. In other words, if you make it easier to get, more people will drink, and if more people drink, more people will experience problems. The same holds true for tobacco. The flip side is that if you make the product harder to get, fewer people will consume it which, if you think about it, is just common sense. By restricting the outlets that can sell tobacco, Bill 119 will again make it more difficult for adolescents to smoke regularly.
There has been a lot of controversy over the proposed ban on the sale of tobacco in pharmacies. Cigarette manufacturers are blaming the government for this move, but let's remember that the proposal came originally from the pharmacists themselves.
In addition to reducing the ability of young people to buy cigarettes, taking tobacco out of pharmacies would have a great deal of symbolic value. It would remove another powerfully mixed message.
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It would break the link between tobacco and a health care setting. Pharmacists would step squarely in line with other health care professionals in promoting good health, not selling a product that leads to disease and premature death.
It has been suggested that pharmacists who sell tobacco would be able to counsel customers to quit smoking. They should certainly do that, but I cannot accept the mixed messages in urging a customer to quit while with the other hand selling to them.
The Addiction Research Foundation applauds the Ontario College of Pharmacists for spearheading the move to end this conflict of interest.
Bill 119 also proposes the banning of vending machines that sell tobacco. Vending machines are very difficult to monitor, and teens who are not able to buy tobacco at retail stores would naturally turn to vending machines as their source. The foundation wholeheartedly supports a total ban on them.
Enforcement of these restrictions is, of course, key to the success of this legislation. It is no secret that current regulations are not enforced, enabling minors to get cigarettes with ease. The foundation is greatly encouraged by provisions allowing the Minister of Health to appoint inspectors and by the fines stipulated by the bill. These should encourage greater compliance with the law.
As I mentioned a few moments ago, the other approach to preventing young people from taking up cigarettes is reducing their appeal. This is an area that may not be in the province's exclusive area of jurisdiction, but I would like the committee to recognize it and to consider it.
Tobacco advertising has been banned in Canada, although that is being challenged in court, but promotional efforts on the part of the tobacco manufacturers have not disappeared.
When you walk into a corner store you can still see forms of tobacco promotion at the point of purchase. Cigarette packages are prominently displayed at many store counters, for example. We should eliminate point-of-purchase promotions.
Even more disturbing, tobacco manufacturers are allowed to sponsor sporting and cultural events, and even to establish foundations that take on the names and graphic styles of various cigarette brands.
The February issue of Flare, a magazine aimed at young women, has a two-page advertising spread sponsored by Matinée Ltd Fashion Foundation. Matinée is, of course, a brand that is popular among young women. Believe me, this advertisement which I will show you is recognizably extremely similar to a Matinée cigarette pack. It surely is advertising.
That is the advertisement. That is a Matinée cigarette pack. I think recognizably, we are dealing with the same thing. It is, in my mind, absolutely tantamount to advertising in the same way as each morning I drive to work along the Gardiner Expressway and pass the most enormous pack of du Maurier cigarettes that you have ever seen, which is of course the du Maurier theatre.
By allowing this, we are letting cigarette manufacturers circumvent the advertising ban while maintaining the illusion that smoking is synonymous with glamour.
Although Bill 119 does not address this, I would like to add that the foundation strongly supports continued high taxes on tobacco. Indeed, one cannot talk meaningfully about tobacco laws and policies at the moment without considering the smuggling furore.
Much is being said about cigarette taxes and the burgeoning market in smuggling. Some critics liken it to the Prohibition era. They say that high taxes and smuggling are breeding a disrespect for the law that is eating away at the social fabric.
Thankfully, Ontario has stood firm on this issue, but other governments are wavering. We are very concerned with the reports that the federal cabinet is still seriously considering lowering cigarette taxes.
We support current tax levels on tobacco for a very simple reason. They reduce consumption. Research conducted in both Canada and the United States shows that adolescents are particularly sensitive to price. If cigarette prices are high, young people are less likely to start smoking or to increase their smoking. Conversely, if prices drop, young people, in disproportionate numbers, will start to smoke. Nevertheless, high prices and high taxes do contribute to the smuggling problem, and we agree that it must be dealt with. But to do so by lowering taxes is absolutely the worst way. At best it would put a crimp on smuggling, but at the expense of declining tax revenues and of more people starting to smoke. If more people start smoking, then in the long run more will die prematurely; to reverse the old saying, a classic case of short-term gain for long-term pain.
But in reality, is it in fact even a short-term gain to reduce cigarette taxes? Let us ask ourselves for a moment who would benefit from a tax, and therefore a price, reduction? Would smokers gain? Well, we know that 75% of all smokers want to quit and that high prices are the best way of reducing smoking. Indeed, the foundation's surveys tell us that even before smuggling became a major issue, 40% of smokers themselves, and that's a minority of the population at large, wanted to maintain or increase taxes.
Would it be retailers who benefit? Maybe, but provided we deal with smuggling, the proportion of about a quarter of the cigarette market that has been lost to smuggling should come back to them anyway. I can see no reason why we should put them in a better position than they were before all this furore started.
What about manufacturers? Well, what about them? They have already made enormous windfall gains from this situation. They have been able to pump up their profits under the cover of high taxes. Beyond that, they have shamelessly manipulated the situation to their great advantage. Why on earth would we cave in to their equivocations and their obfuscations? Why would we let these profiteering puppeteers continue to pull our strings on this issue?
The fact is that it took us several years to get into this mess and there isn't a quick fix. Lowering taxes makes no sense at all. Through taxes, we have made big gains in the past decade in reducing smoking and thereby saving lives. In fact Canadian taxes are not high by the standards of developed countries, whereas US taxes are absurdly low. We must deal with smuggling not by lowering taxes but by encouraging US federal and state governments to increase their taxes, as they intend, to finance the Clinton health care plan.
We also must reimpose the highly effective Canadian federal export tax, which drove the cigarette manufacturers to such a frenzy of lobbying that it was mysteriously withdrawn shortly after it was introduced, and we must increase enforcement efforts. The problem of smuggling will not be solved overnight or by a single measure, but it can be solved.
These comments have already extended well beyond the purpose and intent of Bill 119 itself and indeed to matters partly beyond provincial jurisdiction. But Bill 119 will be of little significance if it is not seen in a broader context and if other appropriate steps are not taken by intergovernmental relationship or by other means available.
In summary, reduced access, as proposed in Bill 119, and continued taxation at current levels is undeniably the most potent combination of measures we as a society can undertake to reduce smoking among our young people. If these measures are implemented, the new generation will thank us in years to come.
I'd like to thank you for your attention. I'd be happy to answer any questions you may have, but first I'll ask my colleague Dr Roberta Ferrence to give you a few brief comments of her own.
Dr Roberta Ferrence: Thank you, Mark. Good afternoon. I am a senior scientist with the Addiction Research Foundation and also the director of the Ontario tobacco research unit. I've been involved in tobacco research for more than 10 years and in addiction research for more than 20 years.
I could give you some horrifying information about the health damage caused by smoking in Ontario. I could offer you depressing statistics about mortality from smoking-related illnesses that will happen in the future. As important as these are, and I think you've heard some of them from other speakers, I'm not going to do that today.
On a more personal level, I could tell you about my grandmother, one of the first of the new women who began smoking in the 1920s. She died of pneumonia at age 35, leaving six children. I could tell you about her husband, my grandfather, who helped her to become a smoker. He died at age 52 of coronary heart disease. I never knew these grandparents.
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I could tell you about their children: My uncle, a heavy smoker, who died at age 52 of an aortic aneurysm, which is a cause of death that is four times higher in smokers; or his sister, my aunt, who recently died at age 70 of oral cancer brought on by tobacco and alcohol use; or about my own parents. My mother, the child of two smoking parents, started lighting up at age 13. She finally quit in her late 60s when a heart condition was diagnosed and, fortunately, she's still with us. My father smoked a pipe for 50 years and finally quit after he had a heart attack.
I could tell you about my own experience, about starting to smoke at age 17 because I wanted to find out how my mother felt when she had to have a cigarette. I was doing early research on addiction, I guess. I started as a half-pack-a-day smoker.
I don't think that my family is unusual, but this is all in the past and what I really want to tell you about is the future. What I want to tell you about is my son.
I'm a parent, like many of you. My oldest son is 18 and he has been smoking for seven years. He was able to begin his addiction buying cigarettes at the corner store at the age of 11. I have not smoked for 25 years. My children know about the hazards of smoking. My home is smoke-free. My children were exposed to health education in the classroom, and for this child it didn't help.
My son is my litmus test for what works. He has no problem with educational programs or media campaigns; he just ignores them. What he can't ignore and what upsets him most and what he confronts me with are tax increases and effective restrictions on sales to minors. Unfortunately, it's too late for the proposed legislation to greatly affect my son; he turns 19 this year. At age 35, if he hasn't quit, he will have smoked for 25 years and will be at risk of serious health problems at that early an age.
For all the children who are now aged 10, 12, 16 or even 18 who are starting to smoke, this legislation is critical. Delaying the onset of regular smoking by six or seven years will make a huge difference. They may in fact never become addicted smokers.
The legislation is important, but we have had legislation on the books for almost 100 years. It must be enforced. Enforcement is critical and it can be done. Some US communities have reduced sales to minors, in compliance with the Synar amendment, to 20%. We can do the same; we can do better.
The Chair: Thank you very much, and we'll move right to questions. Mr Arnott.
Mr Ted Arnott (Wellington): Thank you very much for your presentation. It was excellent. I agree with almost everything in here. There's one thing I would like to ask you about, though, and that is your suggestion that the tobacco taxes in the United States be increased.
Every Democratic president, to my recollection, since Harry Truman has promised the people of the United States universal health care. I'm not holding my breath for Bill Clinton. I hope he's successful, but I wouldn't be surprised if he's unsuccessful. There's also the matter of state governments to consider and there's also the matter of Congress to consider. He doesn't have as much direct control over his own legislative agenda as our Prime Minister and Premier.
Do you really think it's realistic in the short to medium term that taxes in the United States will rise such that our problem with respect to smuggling will diminish?
Dr Ferrence: I think it's a likely but not a sure outcome. We do have the option also of lobbying neighbouring states, and if we do both kinds of efforts we're more likely to be successful in at least one area.
Getting the United States to raise their prices is only part of the package. The other options that we've talked about, and others have talked about, such as the export tax or restricting exports and package changes and a number of other things, are all part of a package and it could be done without cooperation from the US. But I'm optimistic that there will be significant changes there.
Mr Arnott: Another question that we discussed yesterday and we've been sort of tossing it around: If you're under 19 right now, it's an offence and you can be charged and fined for consuming alcohol. The actual person who's consuming it can be charged. Do you think it would be a disincentive to young people if it were illegal for the actual consumption, for actually lighting up a cigarette, smoking a cigarette and being in possession of a cigarette? Do you think that would help at all?
Dr Ferrence: The federal legislation applies to possession as well as purchase, and it has been in effect since 1908 and hasn't been enforced.
Mr Arnott: Very nominal --
Dr Ferrence: My personal feeling is that you don't attack the victim. Kids are not to blame for lighting up at the age of 12. We have to go after the suppliers. We have to structure society so that it's not possible for kids to smoke.
Mr Arnott: I just think that a kid at age 18 carries some degree of responsibility for his own actions. In a situation where we're saying that the vendor who sells tobacco to -- assuming this bill passes -- an 18-year-old adult really, and the vendor has to carry 100% of the responsibility and all the repercussions and the 18-year-old walks out of the store, puffing and smiling, it just doesn't seem right to me.
Dr Ferrence: But we have similar attitudes towards the sale of alcohol. Increasingly people are charging the server rather than the individual who gets drunk. I think people who sell products in a society have more responsibility than the individual, because they have more privileges, they have a licence to make money from this product, and I think with those privileges come responsibilities. The problems of enforcement on an individual level are enormous. It is much easier to enforce when you have outlets rather than individuals. I think it's also a lot more palatable to most people.
Mrs Haslam: I'd like to take a look at a couple of your concepts. You talk about alcohol. Obviously the Addiction Research Foundation has done a lot of work in this area, and in tobacco. You talk about broadening the distribution, therefore consumption will rise, and you talk about if you make the product harder to get, fewer people will consume it. By restricting the outlets that sell tobacco, Bill 119 will again make it more difficult for adolescents to smoke regularly. I would like to think you mean adolescents and adults to smoke regularly.
But it's been brought up to us that by taking it out of one place -- and I'm not saying aye or nay; I'm just saying it's been brought to our attention that if you take it out of the one place that doesn't want to see it go out of their stores, the consumption won't go down, because they aren't the ones selling to the adolescents under age. They're the ones who are actually controlling it better. I'm wondering if you could elaborate a little on this around the distribution and the accessibility, whether it's to adolescents or adults, whether your research does really talk to that issue.
Dr Ferrence: There is a fairly large literature on outlets in the alcohol area. It is true when you have saturation, when you have an outlet for tobacco on every corner, that removing a quarter of the outlets isn't going to make an enormous difference. It will probably make some difference, but you're not going to cut consumption in half just from that one measure.
I think its main importance is -- I hate to use the word "symbolic"; it's more than that. It's getting it out of the health care system. It's only Canada and the US in the world that sell tobacco in pharmacies. Most people would find this absolutely bizarre.
Certainly in a small community, what they found is when there are only a few outlets, removing some outlets can make a substantial difference. I think we have to see this as part of removing it, and this is the way the bill was intended from the health care area rather than from the retail area. I think there's an important difference there. As Mr Taylor mentioned, there's an additional matter that pharmacists charge a rather hefty fee for dispensing drugs. When they do this, some of them, especially in small pharmacies, do counsel patients. When a pharmacist is prescribing a nicotine replacement product or prescribing, say, something to someone who has bronchitis or some other smoking-related illness, this is an opportunity for the pharmacist to engage in some counselling and some prevention or secondary intervention work.
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If they are selling tobacco, I think they're less likely to do this. They have a serious conflict of interest, and that I think is another key reason. It's just like if you eliminate advertising from publications, all of a sudden you find it's much easier to get in an article on the health effects of smoking. It's the same sort of thought, and I think that's a critical point as well.
The main purpose of the measure is not to reduce consumption, but if we go on to eliminate other sources in the future, we will have an even more sizeable effect on consumption.
Mrs Haslam: That was an interesting point. Lightbulbs went off in my head when you talked about putting an article in when some of your advertising dollars are being given by a tobacco manufacturer. That's a very good point. I totally missed that in my thinking about this.
You talked about enforcement -- you don't attack the victims -- and that in some places, through effective enforcement, the results of adolescents smoking have been reduced to 20%, and you say that we can do better. Your bottom line was that we can do better. I wondered if you had suggestions on how you could do better on the enforcement.
My concern is that we're talking about taking them out of an area where pharmacists are when it isn't the pharmacists selling it, it's the clerks at the front of the store, and then better enforcement in any of those stores, in convenience stores or all, is necessary. But how would you get it to 20%?
Dr Ferrence: It has been reduced to 20% in some US states by sting operations with regular enforcement, not particularly high fines, but it's the frequency of checking out, are kids being sold to? Throughout the United States I think licensing is the rule. It is easier when you do have licensing to keep track of what's going on and there is more of a penalty there, but it can be done by other means.
Mr McGuinty: Thank you very much, both of you, for your presentation. I want to take the opportunity as well to compliment you for the work that you do. It proved to be of invaluable assistance to me in putting together my private member's bill. I think I may even have spoken with you in that regard, Dr Ferrence. I'm sure the government found your statistics very helpful as well.
I wanted to ask you about this recent increase in tobacco usage we're seeing with young people. Do you know the contributing factors behind that?
Dr Ferrence: We have seen a small increase among grade 7 students in our latest student survey. It's difficult to tell. It would be more helpful to have another year of data to see if this is a trend. But it's concerning.
I think quite seriously that the major part of the problem is that we haven't made major gains in enforcement at the local level. In the US, with their much lower prices but higher levels of enforcement in many states, they are actually starting to see increases now among adolescents. But their prices are so much lower that it's not difficult to understand.
Mr Taylor: If I may, I'd just like to add to that answer. As a non-scientist, I'm always entitled to be a little more speculative than my scientific colleagues.
I think, with the wisdom of hindsight, it is not unreasonable to speculate that the increase in smoking among grade 7s, which is something we observed last year, in the middle of last year, roughly speaking, may at least be associated with the pretty ready availability of cheap smuggled cigarettes. I can't prove that, but it doesn't seem unreasonable to speculate in that direction.
Also, though, and more disconcertingly in my mind, it is associated with an increased attitude, or a decreased attitude, if you like, of the willingness to cooperate and to depend on colleagues, siblings, school mates and so on. There is a process taking place in school children's attitudes, or students' attitudes, that seems to be withdrawing from that sense of connectedness. Again, I am extrapolating way beyond anything the data justify. I'm just applying my own judgement to it.
I don't see that being inconsistent with the attitudes that surround smuggling and the sense that: "Oh, well, everybody's doing their own thing, they're doing it for their own advantage. Why shouldn't I?" I think there is a syndrome of me firstism which the smuggling issue is simply a beautiful visible example of.
The Chair: Thank you very much. I'm sure we could profitably spend more time and I regret that just with the number of witnesses we have to conclude at that point. Again, thank you for coming before the committee.
MEDIS HEALTH AND PHARMACEUTICAL SERVICES
The Chair: If I could then call on the representatives from the Medis Health and Pharmaceutical Services organization. Could I just remind members that we're in a new phase here. I will be rotating and beginning with Mr Arnott, and then if we have time for more, but we may only have time for one question per witness. I'd appreciate your help and assistance because it will be difficult.
Welcome to the committee, and if you would be good enough to introduce yourself, we have a copy of your brief and please go ahead.
Mr Frank Goodman: My name is Frank Goodman and I am regional vice-president of Medis Health and Pharmaceutical Services. Mr Chairman, ladies and gentlemen, thank you for the opportunity to present my views and to represent my organization to your committee during your deliberations on Bill 119.
I represent Medis Health and Pharmaceutical Services Inc, which is a wholly owned subsidiary of McKesson, a public company. I'm responsible primarily for the operations of Medis in the province of Ontario. Medis is primarily a pharmaceutical distributor. Our mission statement is, "Medis is Canada's leading distributor to pharmacies, fulfilling customer needs by offering superior service at a competitive price and the most efficient distribution system in the health care industry."
Medis employs over 1,200 people in Canada and has 12 distribution centres located from Vancouver, British Columbia, to St John's, Newfoundland. In Ontario, Medis employs over 300 people with distribution centres in both Toronto and Ottawa. We stock over 3,500 different pharmaceutical products alone. Every day we fill about 30,000 order lines which are shipped to over 1,100 pharmacies in Ontario, mostly via our own fleet of 36 trucks. Our investment in product inventory exceeds $40 million.
Virtually all our customers are pharmacies and include independent drugstores, hospital pharmacies and chain drugstores in every geographical area of the province. We supply a full range of pharmaceutical products, as well as non-prescription drugs, health and beauty care items, confectionery and tobacco. We even stock pharmacists' supplies, such as vials, bags and labels. We are virtually a one-stop shop for our client pharmacies.
At the outset of my discussion, I want to make it very clear that we support the fundamental intent and the principles of Bill 119. There is considerable evidence to support the fact that tobacco is a harmful product, and it is in the best interests of society to reduce tobacco consumption, particularly by young people. However, we are seriously concerned with the implications of selectively forcing the removal of tobacco from any given retail format, in this case drugstores.
Tobacco is a legal commodity. As such, it is reprehensible to discriminate against or for any particular class of trade to the advantage of others. We do not see how the removal of tobacco from drugstores will further the objectives of Bill 119, of the government or of society. It is unlikely that people will stop smoking because they can't purchase their cigarettes in drugstores. There are just too many other sources of supply.
I'm sure this committee has heard and will hear more from representatives of the drugstore industry how drugstores are more responsible than most tobacco outlets relating to sale to minors, and you've also heard of the direct financial impact on drugstores of the removal. I'm sure you've also heard how the removal of tobacco from drugstores will fuel the underground economy, which is not at all particular about selling to minors and which is destroying the tax base in our society and encouraging organized crime. All of these will directly force drugstores to close, to reduce staff or to reduce opening hours and ultimately to reduce health care service.
I'd like to demonstrate to you yet another impact of the removal of tobacco from drugstores that relates directly to my industry, and that will translate to a health care cost and a health care quality issue for our province.
Medis's core business is the distribution of pharmaceuticals. We provide an essential service within the health care industry by ensuring that every drug is economically available in every hospital and every community pharmacy in every community without delay.
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The Ontario drug industry consists of several hundred manufacturers, large and small, over 2,200 retail pharmacies, many of them small dispensaries in rural communities, and over 200 hospital pharmacies, many of them also in remote communities across this vast province.
It's impossible for every pharmacy to stock every drug at all times. Distributors such as Medis make it possible for any pharmacy to purchase any drug in quantities as small as a single bottle and to get delivery of that drug either the same day or the very next day in virtually any part of Ontario, however remote.
Other product categories are serviced by Medis as a convenience to our customers to enable them to manage their businesses as efficiently as possible. Tobacco is such a category. It is handled by distributors at minimal incremental cost.
I'd like to illustrate this. When a retailer places an order from Medis, we must take the order electronically, verify the credit rating of the retailer. Our warehouse order fillers pick the order and pack the order, and our trucks deliver the order. Then we collect our bill, and the cycle is complete. We have a large investment in physical facilities, inventory, computers and materials handling technology.
Every one of the activities that I mentioned must take place for every order, regardless of whether that order is for a single bottle of pills or a large number of drugs or whether the order also contains shampoo, candy bars or cigarettes. Therefore, the additional cost to handle the cigarette business is quite small. So the profit we make on this transaction helps us to offset the cost of delivering drugs in small quantities every day to the most remote community. In fact, the drug distribution industry is a major contributor to the efficient operation of the health care system, since our net service charge is in the low single-digit range. By the way, Ontario drug distributors have by far the lowest service charges in Canada, competitive with the largest markets in the USA.
One of the principles espoused by the Ministry of Health is universal access to health care throughout the province. In support of this principle, Medis charges the same prices for its drug distribution service regardless of the location or the size of the retail store or of the size of the order.
If tobacco products are removed from drugstores by Bill 119, then Medis will have reduced profit opportunities. This will force us to raise our prices for pharmaceuticals, which will increase the cost of health care to all Ontarians and to the Ministry of Health through the Ontario drug benefit plan, which pays for about 40% of prescription drugs in the province.
Alternatively, Medis will have to reduce staff and inventory to reduce expenses. This will substantially reduce our ability to provide the service to our customers that they need in order to provide rapid access to all drugs to all patients. We may have to cut deliveries to twice a week or have more out-of-stock situations.
Can you imagine a scenario -- and I'll address this personally to the members of the committee -- where your vacationing eight-year-old son has a severe, acute infection and the local, rural drugstore doesn't have the prescribed product in stock? Even worse, the pharmacist then tells you that his distributor has reduced service and the next truck won't arrive for three days. None of us would consider that's acceptable, but that is the kind of option facing our industry if tobacco is removed from pharmacies. Our investors will force management to cut costs and curtail service in order to maintain profits. That's the real world.
We sincerely hope that you'll take a hard look at the pharmacy provisions of Bill 119 and that you'll agree with us that they serve no purpose and they could damage an essential element of health care, which is fast and efficient availability of any drug, anywhere in the province, at any time.
Thanks for your attention, and I'll be happy to answer any questions that you may have.
Mr Arnott: Thank you very much for your presentation. Yesterday, the Non-Smokers' Rights Association made a presentation here and the name of your company came up. There was a handout that was released --
Mr Goodman: I'm impressed.
Mr Arnott: Are you aware of this?
Mr Goodman: Yes, I am.
Mr Arnott: Okay. It appears to be a promotion that has been sent by your company to pharmaceutical buyers, and it says:
"We've lowered our upcharge on hundreds of high-velocity pharmaceutical products. Compare our prices and save. Further, all purchases, including drop shipments, contribute to your volume rebate plateau. Just a few extra cases of tobacco per week can double your volume rebate on all pharmaceuticals. Contact your Medis sales representative for details."
It appears to be encouraging the pharmacists to sell as much tobacco as possible, such that they'll have a reduction in the cost of their pharmaceuticals. Now, is that presently the policy of your company, to encourage that sort of thing?
Mr Goodman: I'd like to make several points related to that. Firstly, I was aware that the issue was raised here. The particular flyer was distributed in January 1990. It was publicized to the Queen's Park media by Mr Mahood's group in May 1993, so I would assume that it just came to his attention at that point in time.
The particular program that it discussed is not currently the program, but it is fair to say that a customer who concentrates his business with our organization, buys everything that he can through our organization, will be a more profitable customer for us and we share that profitability back to him by way of discounts.
At the moment, through Bills 54 and 55, we're not able to give rebates on pharmaceuticals to bring it below BAP, but we do have a rebate program on pharmaceuticals which are sold above BAP, and a pharmacist who buys a high quantity of product in total from us can get a higher discount than others. That discount is applied to his pharmaceutical products, and I would make the point that this simply supports the main premise of my discussion, which is that tobacco business adds to our profitability and allows us to distribute pharmaceuticals at lower cost.
The Chair: Mr Goodman, could you just tell us: BAP?
Mr Goodman: I'm sorry. Best available price.
Mr Arnott: That's a problem, because it indicates that the pharmacist may have a direct incentive to try to maximize his or her sales of cigarettes.
Mr Goodman: Well, I would suggest to you that there's nothing that we sell to the pharmacist that he can't buy from 100 other sources. We're simply encouraging him to purchase his tobacco from us and not from competitors who may or may not sell pharmaceutical products.
Mr Arnott: Pharmacists' groups are opposed to this provision in the bill, in that they're the only ones who can sell tobacco responsibly, yet it appears the potential is there for a direct interest in trying to push tobacco as fast as you can.
Mr Goodman: I would suggest to you that the additional profit generated by a pharmacist from buying his tobacco from us as opposed to any one of a number of other wholesalers, who may not be pharmaceutical wholesalers, that additional profit would be trivial in comparison to the total sales of his tobacco volume. It's a very small number and would certainly not give him incentive to behave any differently than he otherwise would.
The Chair: Mr Wessenger, you have one minute.
Mr Paul Wessenger (Simcoe Centre): Okay. That's going to be very quick then. First of all, I'd just like to ask you, do you personally feel that cigarette smoking is adverse to health, and do you think we ought to encourage it in our society?
Mr Goodman: I did point out in my brief that we do support the fundamental intent of Bill 119.
Mr Wessenger: This is the whole point about health professionals: Health professionals are supposed to promote health. Don't you see a problem with health professionals being seen to promote something that is not healthy? Doctors smoking would be against promoting good health, pharmacists handing out a poison is against good health. Medis Health and Pharmaceutical Services Inc selling tobacco is a conflict of interest in the impression you're creating. It would be interesting to know, for instance, how much is tobacco out of your total sales.
The Chair: Question, please.
Mr Wessenger: That's what I've got. How many?
Mr Goodman: I think there were three questions in there.
Mrs Haslam: We try to do that.
Mr Goodman: I don't think that it's my part to comment on the ethical issues associated with selling tobacco in drugstores. I'm here as a businessman and I'm here to tell you the impact the proposed legislation will have on my business directly and then indirectly on the health of Ontarians. I don't think it's my position to comment on the ethics of the matter.
The Chair: Thank you very much for coming before the committee and for your presentation.
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METROPOLITAN TORONTO PHARMACISTS ASSOCIATION
Mr Samuel Hirsch: My name is Samuel Hirsch and I am the past president of the Metropolitan Toronto Pharmacists Association. I'm joined here by Ruth Mallon, current president of the MTPA. We are here to speak on behalf of the Metropolitan Toronto Pharmacists Association's written submission to the ministry in respect of Bill 119.
What you've received is our actual submission. What we're going to talk on today is just to summarize some key points of it. In that case, we'll try to be brief and not inconvenience the time we have here, and hopefully have some questions afterwards.
The Chair: Thank you for the fuller brief as well.
Mr Hirsch: That's quite all right.
When I say we represent the Metro Toronto Pharmacists Association, I'm referring to the more than 200 pharmacist members who have shown their support for our submission. The members who operate in or are employed by community pharmacies are particularly concerned because they believe they are being regarded as part of the problem when indeed they see themselves as part of the solution.
Community pharmacies in Metro Toronto and a large percentage of the 1,500 pharmacies in Ontario are often the first-line professionals in the consumer health chain, coming face to face with patients who have a medical or health concern. These patients, who in some cases have limited access to their physicians, look to the pharmacist for information, for education and medication counselling.
For example, the patient may ask the pharmacist: "What's good for this cough? I can't seem to shake it." The pharmacist may ask the patient if he or she is a smoker, and this information can be used to counsel a patient regarding smoking and health and cessation. By contrast, the same person who purchases cigarettes at convenience stores, mass merchandisers or gasoline bars will never be exposed to anti-smoking counselling.
Pharmacies are not part of the problem; we are part of the solution. We believe that sections of Bill 119 are entirely valid and we are prepared to support them; for example, the minimum legal age, vending machines and of course penalties for selling to minors.
While on the topic of minors, I find the supposition that selling tobacco in the front shop of a pharmacy gives minors the impression that pharmacists approve of smoking to be a little strained. What of the thousands of other legal products we sell? What aura of approval do pharmacists give to disposable diapers, condoms, hair preparations? In fact pharmacists who are responsible for handling narcotics and other controlled substances give out a much stronger message about tobacco use when they refuse to sell to minors; and, yes, we do refuse to sell tobacco to minors. We are very, very strong in that respect.
As you are well aware, removing tobacco from about 1,500 pharmacies in Ontario, leaving almost 30,000 other vendors to pick up the slack, is merely reshuffling the market so that 30,000 retailers experience increased sales and 1,500 are left struggling to recover from the blow. What makes it worse is that many of these 30,000 other vendors are our neighbours, in the same shopping centre, strip mall, next door or perhaps down the street. This is a trade barrier and this is within the borders of our own province.
I'll give you an example: Down the street from my pharmacy is a small bakery selling nice breads and pastries. When the owner of this particular shop first heard of the pharmacy provision in Bill 119, not knowing how the system worked, that you needed three readings and hearings, his immediate reaction was to start selling tobacco in anticipation of my being taken out of the market. The same is true for my small greengrocer right beside me. Without being enacted, Bill 119 has already succeeded in increasing the availability of tobacco, and this with no new jobs being created.
We are distressed, as you might also be, by the magnitude of illegal smuggling of cigarettes, which is increasing daily. It robs the province of much-needed tax revenue. We submit that if the inevitable happens and 1,500 legal retail outlets are removed from the geography of Ontario, thereby making access less convenient for smokers, more and more of them will turn to the underground market system. The result? Less and less tax revenue for the province and no decrease in smoking.
The MTPA is not alone in protesting the proposed removal of pharmacies from the retail tobacco trade. I'm sure you've heard many points made over and over again, namely, you won't influence people's decisions about smoking, you won't reduce consumption by one single cigarette, you won't stop new retailers from filling the need in the market created by the forced exit of pharmacies, you won't keep supermarkets, convenience stores and gas stations from expanding their tobacco business. In short, you will not achieve the government's health strategies in this point.
What will happen? What will we achieve? You will inflict financial damage on community pharmacies. You will force the closure of some pharmacies that are already reeling from intense competition and overall decreased consumer spending. You will create additional hardship in the community at large because of closed pharmacies. For example, our seniors will lose access to the long-standing relationship, in some cases, with their local community pharmacist. In certain cases, the elderly will have to travel further afield to have their health needs met. Pharmacies that manage to survive will do so by downsizing. This means some permanent loss of jobs. Pharmacies will not have the sales and customer base to warrant such customer services as we now give: extended hours, delivery of emergency prescriptions.
History shows that even those who have favoured the removal of tobacco products for sale in pharmacies have not won their points. The example in Quebec, a recommendation by l'Ordre des pharmaciens du Québec, was considered by the Quebec health ministry and subsequently by a cabinet committee and its legal counsel. The bill in question was never implemented because the government recognized both the economic viability of pharmacies and legal ramifications from possible court challenges.
Pharmacists are united on their democratic right to choose what products they put on their shelves to ensure the profitability and viability of their businesses. We really don't want to be told what legal products can or cannot be sold. Many pharmacy organizations throughout the country, including MTPA and the OPA, Ontario Pharmacists' Association, advocate that governments should allow pharmacists to decide for themselves whether or not they sell tobacco.
As you know, we are already a very highly regulated profession. We accept rules and regulations when the purpose makes sense. We cannot accept anything as senseless as the pharmacy restrictions proposed by Bill 119, whose purpose seems to be nothing more than the government's attempt to position its resolve as politically correct, symbolic and idealistic.
In our written submission, which I mentioned previously, we proposed an additional strategy that can contribute to reduced tobacco consumption, a strategy that can uniquely be implemented by the community pharmacist. Of all retail tobacco outlets, the drugstore is the only one that provides education about smoking cessation programs and nicotine replacement therapies. As demonstrated in my earlier example, the staffs of all other tobacco outlets are not equipped to counsel a patient about the hazards of tobacco use.
With respect, we suggest that government should be using our services to help alleviate the situation. Please don't exclude us. Don't restrict our business. Don't put some of us out of business altogether. We are not part of the problem; we are part of the solution.
Now I'd like to introduce Ruth Mallon, who will carry on with her presentation.
Ms Ruth Mallon: Picking up from my colleague's last point, we don't believe that your strategy, as proposed in Bill 119, will have any positive impact on at least two elements of your strategy, namely, protection from exposure to environmental tobacco smoke and encouragement of smoking cessation, nor do we believe that a strategy based on social acceptance will have any appreciable effect.
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Our contention is reinforced by the chief medical officer of health, "Voluntary long-term avoidance of smoking can be extremely difficult for those who have become addicted to nicotine, even when they are strongly motivated to stop." We think tobacco use is too important an issue to be left strictly in the realm of social engineering and symbolic gestures, especially given the recent data revealing increased rates of smoking.
As it is now, especially in Metro Toronto, the ban on smoking in commercial and public buildings has forced addicted smokers outdoors, even in subzero weather. They are made to feel substandard and second-class citizens. They are becoming alienated from our society, yet they continue to smoke, not because they haven't heard the health warnings, but because they just can't. They need our help, not our derision.
We agree with the medical officer of health that we must take thorough and relentless action to help smokers to quit. Your strategy of duplicate warnings on packaging and a campaign is probably not what the medical officer of health had in mind when he said "relentless action." Thirty years of messages have not worked. That's why we're here today. More messages alone may be an escalating commitment to a losing course of action.
A ban on tobacco sales in pharmacies would send a message to smokers, but not the one you anticipate. Consumers will interpret this message as, "Buy your tobacco products elsewhere," and they will. I do not see anything in this bill that prevents anyone in this room from opening up new businesses selling tobacco. Your strategy lacks one important component, one in which pharmacists can play a critical role, a professional face-to-face voice of authority to children and adults about tobacco use and about the availability of smoking cessation programs and nicotine replacement therapies.
Throughout Ontario, teachers are bringing groups of youngsters to the pharmacy to learn about good drugs and bad drugs. Throughout Ontario, pharmacists are conducting community seminars on drug use and abuse. We are a prime communication vehicle to reinforce the government's message.
Our proposed alternative to the ban relies on this economic truth. While the demand for tobacco is inelastic in the short run, the demand for a cessation drug, a therapy, is elastic. In effect, you can increase the demand for all forms of cessation therapy by lowering its cost to the consumer. Because the nicotine in tobacco and nicotine drug therapies can be considered interchangeable products with no other substitutes, any increase in the demand for one results in a decrease in the demand for the other. An elegant balance exists. We propose too that the government tackle secondhand smoke issues on an environmental front, much as it did with the tire tax program that was set up for the purpose of finding means to reduce the environmental impact of that particular waste.
We submit that more creative research is needed before the decision is made to put the axe to the retail drug industry in Ontario, research that finds ways to truly help addicted smokers who are role models, truly influence the developing habits of children and truly addresses reduces the environmental impact of tobacco use.
In conclusion, we hope you will consider our suggested alternatives in which we have a role to play. We are not part of the problem. We want to be part of the solution. We hope you recognize that our suggested alternatives are based on an understanding of drug addition and the realization that our patients need our services. We are not part of the problem. We are part of the solution. Please don't throw the baby out with the bathwater.
The Chair: Thanks very much, and again thank you for the longer presentation which you've given to us and which we can read. I'm going to try to get in two questioners here, Miss Haslam and Mr McGuinty.
Mrs Haslam: On the front of your thing here, it says that your membership works in chain drugstores. I wondered if one of those chain drugstores was Shoppers Drug Mart?
Ms Mallon: Some of our members are indeed Shoppers Drug Mart pharmacists.
Mrs Haslam: Mr Hirsch, are you a pharmacist and what is the name of your drugstore?
Mr Hirsch: I franchise a Shoppers Drug Mart in Toronto.
Mrs Haslam: Well, you're in luck, because I heard this morning that Imasco, your parent company, has just posted fourth-quarter net earnings that rose 13% to $125 million. That is a tobacco company that has made, in one quarter, $125 million in profit. So if you're a Shoppers Drug Mart --
Mr Jim Wilson: Make them illegal then.
Mrs Haslam: I said he was lucky, Mr Wilson. I said he was lucky.
Interjections.
Mr Hirsch: If I may, Ms Haslam --
The Chair: Order, please.
Interjections.
Mrs Haslam: I wanted to understand --
The Chair: Order, please. Miss Haslam. Look, there are times when we have questions or where there will be differences of opinion, but if we could have the question as direct as possible and then permit the witness to respond, I would appreciate the cooperation of committee members.
Mrs Haslam: I understand. I don't yell at Mr Wilson when he goes on his trips.
I understand that Shoppers Drug Mart in some medical clinics do not sell tobacco. I understand also that there are few Shoppers Drug Marts that are dispensers only. I wondered, though, do all Shoppers Drug Marts have the total freedom of choice to decide if they sell tobacco?
Mr Hirsch: First of all, I'd like to comment on what you mention about Imasco posting results. Imasco consists actually of five units.
Mrs Haslam: Yes, I'm well aware of that.
Mr Hirsch: So the tobacco unit is just one piece of the entirety of the company.
Mrs Haslam: So is Shoppers Drug Mart.
Mr Hirsch: That's correct and there are other pieces as well so we have profitability in one section and not so much in the other.
Mrs Haslam: I spoke with one of the gentlemen in your company and he said that even though there's a 20% decrease in tobacco sales, it's still a profitable item, so I'm well aware that you are one of five groups in Imasco.
Mr Hirsch: That's correct. On your second question, whether or not our freedom to sell tobacco -- as we said before, the product itself is a legal product. Also, its economic viability sustains our business and there is no reason, while it is a legal product, for us not to sell it.
Mrs Haslam: Do you have a choice?
Mr Hirsch: We have a choice of what we sell, in most cases, but we prefer at this point to sell tobacco. That's been the thesis --
Mrs Haslam: But as an independent owner of a Shoppers Drug Mart, do you have the choice and is it your decision if you will sell tobacco?
Mr Hirsch: I would be foolhardy not to sell a legal product.
Mrs Haslam: Do you have the choice?
Mr Hirsch: It's not a question of choice; I'd want to. Just like I have the choice to sell toothpaste, like I have the choice to sell diapers, like I have the choice of anything else, it would be foolhardy for me not to sell a viable product.
Mrs Haslam: So you could actually say no to tobacco, is what I'm trying to find out.
Mr Hirsch: It's not a question of saying no; it's a question of being in business.
Interjections.
The Chair: Order, please. The question's been asked and the gentleman has responded.
Mr McGuinty: Thank you for your presentation. This is a controversial issue, as you will have gathered, no doubt.
To me, there's really only one issue here at the end of the day. I'll be very frank with you, I find it difficult to accept that pharmacists can both sell tobacco products and counsel against the use of tobacco products at the same time. I don't feel we should really give a lot of weight to the argument that pharmacists are more responsible in terms of how they sell tobacco products.
The important issue here for me is we have to weigh the gain purportedly to be achieved by banning the sale of tobacco in a pharmacy against the economic loss that will be sustained. I've got some numbers on the losses. I've got a Coopers and Lybrand report. We had Pharma Plus people in here talking about some numbers. The presenter before you gave us an idea of some of the downsides.
My concern is, I need some numbers to attach to this symbolic side. Maybe you can help me in this regard. Have any surveys ever been done on your customers as to why they go in? How many are going in for prescriptions and how many are going in for other items?
Mr Hirsch: We know the majority of them come in for regular drug items. We know there is a small percentage who do come in for the tobacco products. It's a simple process to find out exactly where they're headed for when they come into a pharmacy. In many cases, they're just coming in there on impulse.
As far as getting hard numbers, I find it difficult, especially people who have been coming to this committee and making all sorts of predictions on what's going to happen, when our governments, our federal government, our provincial government, can't even predict the deficit.
There's no way of knowing hard numbers when you're losing jobs, when we're going to take out a product. One thing we do know, and we have proof of it, is that some of the stores will close. Some have already closed and this is going to be the inevitable outcome. We can't look into our crystal ball right now and say exactly what's going to happen, but we are dealing with an economic truism.
On the other hand, we still feel that education is the big thing. We have heard over the days that once people are 20 years old, they're committed smokers. We propose that we'd like to get them when they're younger, when they're children. We want to go into the public schools. We feel we should be going after them at age 7, 8 and 9. When we walked in here Ruth and I saw nine children sitting on the stairs, five of whom were smoking. This was about one hour ago. So we have a problem out there. Pharmacists want to be part of it but we need our economic viability.
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Ms Mallon: Don't misunderstand us. We think tobacco is a horrible thing and I don't think there's anyone in their right mind who -- what we're saying is that we're selling these cigarettes to addicted people. We didn't make them addicted. They were already addicted before they go to us. Youngsters are buying their tobacco from the guy who sells the drugs in the high school. I have never seen any statistics to say, "Well, if you do this symbolic gesture, a health professional doesn't smoke" -- it used to be very common that pharmacists smoked right in the dispensary. It was very common that doctors smoked as well. We've stopped all that. There's no smoking in pharmacies. We've done what we can.
However, it comes to a point where we can't go any farther and I'm not sure whether just taking it right out of there is going to stop one smoker. If taking it out of pharmacies puts 10 people out of work, people whom I work with and I like very much and I can't see them getting another job, then I think we've done more harm than we have actually helped anyone.
The Chair: I regret that we're out of time but I want to thank you for coming before the committee and for your written presentation as well.
KAREN GRAHAM
The Chair: Next is Miss Karen Graham. Welcome. We have a copy of your presentation, so please proceed.
Ms Karen Graham: Thank you very much, Mr Chairman, committee members, ladies and gentlemen, for the opportunity to express my opinion on an issue which I've followed with interest for the past few years.
I've been a pharmacist in Ontario since 1980 and I've been very fortunate to have practised in a number of different pharmacy settings, including community pharmacy practice, hospital pharmacy practice, the Ontario Hospital Association and the pharmaceutical industry. I now view my profession from the vantage point of a health consultant as Panacea Consulting. I'll be very brief in my remarks this afternoon.
I'm here to speak in support of Bill 119 as it relates to the sale of tobacco products by pharmacies. I commend you on this initiative. I believe that this progressive legislation will lead the way to improved regulation of tobacco across the country, particularly as it relates to the sale of products in pharmacies.
My personal involvement in the tobacco issue began with the Canadian Society of Hospital Pharmacists through which, as a board member, I personally initiated resolutions on this issue. Both the Ontario and national organizations have passed resolutions at their respective annual meetings which clearly articulate a position against the sale of tobacco products by pharmacies. These associations represent some 2,000 pharmacists across Canada, 1,000 of whom practise hospital pharmacy in the province of Ontario.
As a registered pharmacist I've also written to my professional licensing body, the Ontario College of Pharmacists, to encourage action against the sale of tobacco products by pharmacies. As well, I've attached to the brief that I supplied for you a copy of the letter published in the Globe and Mail recently in which I expressed my personal support for your legislation.
I believe that this is a very simple issue and I'm disappointed that attempts to encourage voluntary withdrawal of tobacco products from community pharmacies have largely failed. It now appears that legislation is the only way to end a conflict of interest which in my opinion has been an embarrassment to my profession for far too long.
Tobacco products are lethal. Pharmacists have a duty to the public to promote health and prevent disease. Pharmacists who practise in settings which sell tobacco products not only profit from the products themselves but they also profit from the sale of medications used to treat nicotine addiction, as well as medications used to treat the inevitable consequences of tobacco use, including asthma, lung cancer and other malignancies of the respiratory system, emphysema, bronchitis, coronary artery disease, cerebrovascular disease etc. The list is very long.
Many pharmacies across Canada have either never sold or have voluntarily withdrawn tobacco products and to my knowledge none has gone out of business. In fact, the Canadian Pharmaceutical Association published a study in 1992 of 56 pharmacies which had eliminated tobacco product sales: 59% had no income loss or actually saw an increase in overall sales, 13% had marginal losses and 7% had moderate losses. Of those 20, all had recouped their losses by the end of two years.
Pharmacy associations have supported the voluntary withdrawal of tobacco products. Sadly, in view of the relatively low number of pharmacies which have complied voluntarily, it appears that legislation is now necessary. The profit motive must never be served ahead of the professional motive, to promote health and prevent disease. Pharmacists exist to meet the drug-related needs of our patients. I believe that arguments based on the freedom to compete in a retail environment should be relegated to retailers, not supported by professionals. As a pharmacist I really believe that we must observe our moral imperative to first do no harm.
The Chair: Thanks for the attachments to your brief. We'll begin the questioning with Mr Arnott.
Mr Arnott: Thank you for coming here. It's good to hear from Erin township. I want to tell you that you're not the only one in Wellington county who's taken this view. I did a major survey of everyone in Wellington county back in the summertime and I raised the issue of the discussion paper that the government had released. I gave the whole story and suggested there's a possibility that the pharmacies are going to lose their ability to sell tobacco if this bill goes through. The response in Wellington county to the question, "Do you support the government's plan to impose stricter regulations governing cigarette smoking and sales?" was this: 58.5% yes, about 31% no, so a significant majority for what we're saying.
Also in Wellington county we know that we have some small towns with pharmacies, and in those small towns the pharmacy is an important component of the local health care system. We don't want to lose any of our pharmacies. If some are sort of on the borderline and they need that sale of tobacco and they tell us this, what do we say to them?
Ms Graham: I believe that the loss of business due to the decreasing sale of tobacco products is really a red herring. Based on the information available from the Canadian Pharmaceutical Association and my understanding that no one has gone out of business who has either never sold tobacco products or who has recently stopped voluntarily selling them, I think that's a spurious argument.
Mr Wessenger: Thank you very much for your presentation. I really appreciated your comments and I think you outline the dilemma that everyone faces, especially with self-regulating professionals, the dilemma between ethics and economic self-interest. I think all professions face that and I gather you feel that the ethical considerations should prevail over the economic considerations.
Would you also extend that to the whole question of tobacco? Do you think the ultimate goal should be the elimination of the tobacco industry and elimination -- Utopian, of course -- of tobacco consumption? Is that a worthwhile goal pursuing?
Ms Graham: I think it's entirely worthwhile and highly Utopian. It's a complex issue. I'd like to add, in terms of the retail versus profession issue, I think that pharmacists have been forced to become retailers in order to survive as businesses, in some cases small businesses, and I think a related issue to this whole argument is how pharmacists are reimbursed for their services. That whole issue really has to be looked at, obviously not in this forum, but I don't want to leave the impression that I'm naïve enough to think that if pharmacists did no retailing they could survive. In today's environment they couldn't, in the community pharmacy setting. That's a side issue, I suppose.
The Chair: Thank you very much, Ms Graham, for coming to the committee today.
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A&P DRUG MART LTD
The Chair: If I could call on our next witness, the representative from A&P Drug Mart Ltd. Welcome to the committee. We have a copy of your brief. If you'd be good enough to introduce yourself and then have some fresh Toronto water.
Mr Phil Rosenberg: Chlorinated?
The Chair: Yes. Who knows what's in it. Welcome to the committee and please go ahead.
Mr Rosenberg: Mr Chairman and honourable members of the committee, good afternoon and many thanks for the opportunity to address the tobacco issue and Bill 119. I'm Phil Rosenberg, general manager and director of A&P Drug Mart Ltd. I represent not only A&P Drug Mart, with 25 pharmacies located within 25 of the 245 supermarkets owned by A&P Canada, but unofficially I speak as well for the non-traditional pharmacy segment, that is, Woolco, K mart, Zellers, Loblaws etc, all of whom have pharmacy departments within the confines of much larger stores, be they supermarkets or department stores. By the way, A&P Drug Mart is a contributing member of the Ontario Chain Drug Association.
As a professional pharmacist conscious of the health factor and the related costs, it would be extremely difficult to argue against a smoke-free society. As well, if pharmacy in Ontario is limited to an apothecary approach, that is, the dispensing of prescriptions and the sale of OTC -- over-the-counter -- products only, it would be much easier to resolve this tobacco issue.
The ultimate solution, as far as I'm concerned, would be the total ban of tobacco products from sale in Ontario and even Canada. Next best would be the limiting of tobacco sales to exclusively government-operated tobacco shops, similar to the handling of liquor in Ontario, thereby creating a truly level playing field for all retailers.
Unfortunately, it's extremely doubtful that such a Utopian solution could be achieved. The elimination of tobacco from pharmacies will in fact do little to curb the use of tobacco in society, since these products will be available in numerous other types of outlets, and indeed some general merchandise type of outlets have already introduced tobacco products for sale in their locations as a customer draw. This is evidenced by the increased sale of cigarettes in gas stations, not to mention the proliferation of contraband product available that we keep hearing so much about. I won't go into any more detail in this matter, as it's been covered by numerous presenters at these hearings.
I feel it's essential that the standing committee look at the economic aspects of the practice of pharmacy in Ontario and indeed take into consideration the ramifications that might take place on the total prescription and medication delivery system which exists in Ontario today. Tobacco sales in pharmacies provide good cash flow and provide a reasonable amount of profitability, which helps offset the overall costs of running a pharmacy. The reduction in revenue could impact dramatically on hours of service and numbers of days of service provided by pharmacies as well. Similarly, hours available and wages payable to staff pharmacists could be affected, especially in the more remote communities.
I'm sure you are aware that the number of tablets per prescription is increasing dramatically, as is the cost of all the newer medication being developed. These factors are contributing to lower profit margins and increased costs of inventory maintenance. While these are economic issues, they are also totally professional in nature. So is the prescription dispensing fee both professional and economic in nature. Yet the government of Ontario sets the dispensing fee for Ontario drug benefit prescriptions, and in spite of mediator reports recommending increases, escalating costs of manning the pharmacy dispensary have been totally ignored, with no fee increase allowed in almost four years. In fact, as a result of the social contract in 1993, fees were actually rolled back by 61 cents, or 9.43%.
The Ministry of Health looks at pharmacies as professional health providers in relation to this tobacco legislation, yet when government reimbursement for over-the-counter medication was changed in June 1992 under the ODB program, from payment of a dispensing fee to a markup on cost of product only, we were then considered merchants or retailers. But today, the government looks to pharmacies to provide pharmacy care, patient counselling, proper private counselling areas, drug usage intervention, tighter control on drug abuse etc, yet dispensing fees are being reduced. As well, more and more over-the-counter medications, once the domain of pharmacy, are now being granted GP, or general product, status and consequently can be sold anywhere. That's being done by the Canadian government.
Yes, pharmacy is both a profession and a retailer. I suggest that the government should leave retailing to retailers and that this tobacco legislation is an unwarranted interference in the marketplace for as long as tobacco remains a legal product -- I repeat, a legal product.
Please be advised that there are over 160 pharmacies in Ontario operating as non-traditional pharmacies. The major players are Zellers, with 70 pharmacies in Ontario; K mart with 10; A&P with 25; Woolco with 29; and Loblaws currently with 17, plus others in various department stores.
Within the over 150 pharmacies outlined above, there's currently a total of 183 full-time pharmacists, 199 part-time pharmacists, 69 full-time pharmacy assistants or technicians and 192 part-time pharmacy assistants or technicians. In addition, there are a large number of head office positions in place for these non-traditional pharmacies; ie, administrative, supervisory, merchandising, secretarial, bookkeeping, payroll, accounting, finance, buying, benefit clerks etc. I must say that some of the part-time pharmacists and pharmacy assistants do overlap and in fact work in more than one store, and might perhaps be working part time for me as well as for Woolco. That we don't know direct numbers on.
Many of the non-traditional pharmacies mentioned are either franchised or subleased, or they may be wholly-owned by parent company, but in all cases the pharmacies are a small department within a much larger retail operation. In none of these operations does the pharmacy get involved in the sale of merchandise which doesn't relate directly to prescriptions or over-the-counter medication, nor does the pharmacy have any say or control over what is carried elsewhere in the store. As well, the consumer realizes that the pharmacy has nothing to do with the sale of tobacco, tires, furniture or even lettuce that may be offered for sale in these non-traditional stores where these non-traditional pharmacies are located.
It is not in my jurisdiction to guess which way the decision by upper management of these various retailers would go as to the removal of pharmacy service or the cessation of the sale of tobacco products in these non-traditional pharmacy stores if Bill 119 is passed as is. I do know that a great many prescription patients will be deprived of convenient and satisfactory prescription service if the parent retailers opt for tobacco sales over maintaining prescription departments.
Worse yet would be the tremendous unemployment created in Ontario if these non-traditional pharmacies were closed. Allowing for the smaller non-traditional pharmacy players in addition to the previously listed stores, over 200 full-time pharmacists, 150 part-time pharmacists, 90 full-time assistants, 200 part-time assistants and office staff would all be pushed out into the job market at the same time.
What would have been accomplished? Inconvenience for many prescription patients, including a great number of seniors who enjoy visiting these larger establishments as an outing; a shifting of tobacco purchases from pharmacies to other retailers such as convenience stores and gas bars where controls may be much less stringent; a greater squeeze on traditional pharmacy cash flow and profitability; the tremendous potential impact of unemployed pharmacists and related personnel which could result.
A truly level retail playing field, as far as the retail sale of tobacco is concerned, could prove to be essential to many of our current pharmacy owners, as other forms of retail would benefit by the legislation as proposed.
While it is my belief that the legislation is well intended and might enhance the image of pharmacy, I'm extremely concerned that the legislated implementation of such a ban would result in major resentment towards our provincial government by many of the group members and perhaps even result in some lawsuits as well. Voluntary cessation of the sale of tobacco products by individual pharmacy owners, based on their own personal ethics and economics, makes much more sense.
To increase the age requirement for the purchase of tobacco products, to launch an extensive educational program aimed at our youth and expectant mothers, to increase fines for sales to minors and impose penalties in this regard, and all the other provisions in Bill 119 are well founded and should be proceeded with immediately.
I know you have had many similar submissions already over the last few days -- the Coopers and Lybrand study, the Lindquist study, the Committee of Independent Pharmacists, the Ontario Chain Drug Association, as well as many others -- which all indicate the tremendous negative impact Bill 119, as it exists, will have on pharmacy economics -- reduced customer counts, loss of companion sales, potential job loss, potential pharmacy closings, loss of pharmacy revenue and so on -- only to drive tobacco sales to other retail vendors or to more underground sources.
The true intent of Bill 119, to reduce smoking and strive for a smoke-free society, will not be achieved by removing the sale of tobacco products from pharmacy. Please pay heed to the economic arguments put forth by the previous pharmacy presenters as well as to this brief.
In addition -- and this is not in your notes -- to having a pharmacist on board at A&P, there are other positive implications at A&P which the Ontario College of Pharmacists could back up. As you know, they're involved with compliance etc. Any questions they have about food stores carrying products that perhaps they shouldn't or are questionable, if there are pharmacies involved in those food stores the situation is resolved immediately.
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Very recently, we had a complaint called in to A&P stores to our customer complaint department, basically, and it was as follows: Recently, two minors, age 15, were interviewed on a popular Toronto radio show and stated that one of our stores is where they can purchase their tobacco products. An irate customer called and asked how this could be. Immediately on January 24, a letter went out from the vice-president of operations of each of various banners to the store manager.
"Subject: Sale of tobacco products to persons under the age of 18.
"As you are aware, it is illegal to sell cigarettes or tobacco products to any person under 18 years of age. Recently two minors age 15 were interviewed on a popular Toronto radio show and stated that one of our stores is where they can purchase their tobacco products.
"It is essential that every one of our cashiers, both full-time and part-time, are totally aware of the legislation and adhere to the law regarding the sale of tobacco. New signs will be sent out once again concerning the sales restriction and should be posted in the counting room, lunchroom, near the time clock, as well as in the tobacco sales area.
"In addition, each manager should read this letter and acknowledge understanding of the legislation by signing the letter below and returning same to your district manager. Your immediate attention to this matter is appreciated."
We didn't just go with the little government signage, which as you know is probably a red square, four by six. No, we go much higher and we try to get the message across. I feel it's the influence of professional pharmacists involved in department stores and in the supermarkets that create things like this to happen. I think Bill 119 jeopardizes that fact.
In my humble opinion, the pharmacy restriction should be totally removed from the legislation with a move towards a total ban or a government-controlled tobacco sales environment. Such action would be deemed as much more realistic by both the profession and the public sector. At the bottom of my presentation, there's a chart with the larger players, Woolco, Zellers, K mart, Loblaws etc with how many pharmacies they currently have in Ontario. There are others planned. I know our company has several on the books. Loblaws intended to have 25 by the end of 1994. Zellers has three on the books currently and there you have the full-time and part-time pharmacists and assistants that are currently working for us.
I didn't bother checking with some of the smaller players that have one or two pharmacies only in Ontario such as Eaton's, The Bay, Safeway, Knob Hill etc.
Thank you for the opportunity of speaking to you.
The Chair: Thank you very much. We'll try to work in two questioners.
Mr McGuinty: Thank you very much for coming forward. You've shed some new light on this issue of your non-traditional pharmacies.
While the government is trying to argue that the symbolism is very important in terms of people thinking of traditional drugstores as health care providers and there's something paradoxical about selling tobacco at the same time, I'm not sure how it could argued that people think of Zellers or K mart or A&P or Woolco or Loblaws as a drugstore. I have a great deal of difficulty with that.
The other thing that you told us here today, and it makes sense, is that if your head office decides that it's going to shut down pharmacies -- I'm not sure, I understand tobacco's a pretty profitable product -- you cannot re-employ trained pharmacists, I gather, elsewhere in any of those stores. Is that correct?
Mr Rosenberg: That's very true. What are we going to do, ask a pharmacist to manage the corner Becker's store? "Take the night shift. You're used to working to 10 o'clock at night anyway so you might as well take the night shift and you can sell cigarettes at Becker's."
Pharmacists, as you all know, have four years' university education, plus internships, continuing education programs on the go that they adhere to. What are we going to do with all these people? They cannot go anywhere else. What else are they going to do? This is what they're trained for.
A retraining program for pharmacists who are scientifically trained would be an expensive tax burden, whether it's unemployment or whatever, the burden to retrain professional people like pharmacists or even pharmacy assistants who have gone to a community college, taken courses, have several years of experience working in a dispensary.
At A&P for instance, our pharmacy assistants belong to the store union, and for them to even apply for a pharmacy assistant position with us they must have graduated from a community college that is recognized with a pharmacy assistant diploma or they must have a minimum of two years' dispensary experience in a pharmacy. Where are these people going to go?
As you mentioned, the larger department stores, tobacco may be a large percentage of their volume. If you understand business, the cash flow in the tobacco business is tremendous. You have a very fast rate of turnover, and while you may only be making a 5% to 10% margin, and I think you heard those figures earlier, the fact that they're turning over so frequently, your direct profit on that item -- and if you've had any accountants' studies, direct profit on any particular item has a major impact on cash flow and the amount of financing you require to carry a product.
I mentioned the inventory in dispensaries is going up, with the new cost of drugs. The turnover in dispensary inventory is very low, in fact. So it is a matter of economics, and I'm here just to talk economics. From an ethical and moral point of view, that's something else. But from an economic point of view and especially with non-traditional pharmacy, I really don't know which way the decision will be made by these major players.
You've got Wal-Mart coming in. They have pharmacy and tobacco in all their stores south of the border. What's going to happen here? I don't know. The Zellers situation, they're ready to open three more stores. Loblaws has eight more on the books by the end of this year. We have two that I know of for sure and we're looking at two or three others. Are we going to put a stop to this type of pharmacy? Our types of pharmacies, in many rural communities, are very, very important and very popular.
Mr Jim Wilson: Thank you for your presentation. As Mr McGuinty has pointed out, you do shed some new and interesting light on it.
I had no idea there were some many non-traditional pharmacies. I didn't know Zellers had 70, for example, Woolco at 29, K mart at 10, Loblaws at 17, of these types of pharmacies.
I think yours is the clearest example of the fact that people who walk in don't associate the jeans in the Zellers store with the drug product back at the drug counter. Clearly, your customers must know the difference between the drug counter and the retail store that they're in. You even mentioned lettuce, and I'm glad you mentioned lettuce.
Mr Rosenberg: The consumer mindset is such that the pharmacy is a professional department regardless of where it's found. My pharmacists do counsel, they do go out and speak to senior citizens' groups, they go out and speak to schools.
You can walk into any pharmacy in most of these department stores, I'm sure, and in most of these supermarkets, and there is counselling material on tobacco available, including videos that you can take home with you, pamphlets, whether they're our own or whether they're supplied by a patch manufacturer or what have you. They are there and the pharmacists are available to counsel.
Mr Jim Wilson: We've heard the average markups in pharmacy, and particularly as Health critic, I know where that trend is going: less and less profitable. In fact, if I were a retailer, and my family's been in retail for a number of years, I'd pick the cigarette counter over the pharmacy counter when you see the profits in cigarettes.
I know pharmacies, for example, have been using dispensing fees as loss-leaders. They're losing money on their pharmacy as far as I can tell, and I've had pharmacies come in and say they are. If I were you and your fellow colleagues, I would be extremely worried about this decision.
It's pretty hard to squeeze profitability out of a pharmacy counter when your prices are controlled by government to the best available price plus 10%, so I don't know where you're going to go on that.
If I was in retail looking for a loss-leader and knowing that other pharmacies are being knocked out in the same mall, if I were Zellers, I'd double the cigarette display and try and get some profitability out of that and use cigarettes as loss-leaders. What do you think of all that?
Mr Rosenberg: I have to agree with you. I did a quick study this morning at the office. I pulled off some tobacco sales for the last few weeks and I transformed that into a year's tobacco sales compared to what my pharmacies do in a year. I looked at the margin kickout on tobacco and it's less than 10%.
By the way, I may get shot, but our tobacco sales at A&P are 40% of what they were before the advertising legislation came into place, and that's good. They're 40% as of this morning, and I'm looking at the last few weeks' sales.
I looked at the profitability based on approximately 5% margin on tobacco -- and that's low, because many people make 10%, but I took 5%; I wanted to be on the safe side -- and in our 243 stores, because there are 243 of them compared to 25 pharmacies, the annual profitability on the tobacco far exceeded my contribution last year.
The Chair: I'm sorry that we're out of time, but I want to thank you for coming before the committee this afternoon.
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HAMILTON-WENTWORTH HEALTH AND SOCIAL SERVICES COMMITTEE
The Chair: If I could then call on our next witness, Mr Dominic Agostino. Welcome to the committee. If you'd be good enough to identify yourself and then please go ahead with your presentation.
Mr Dominic Agostino: My name is Dominic Agostino, chairman of the health and social services committee of the region of Hamilton-Wentworth. I am pleased to be here today along with Jim Ford, our chief public health inspector in our department of public health services, who has played a hand in preparing. I think it's better if he comes up to the front. If there are questions, he can probably answer much better than I could.
Thank you for the opportunity to be here. The Hamilton-Wentworth health and social services committee and council fully endorse the short- and long-term goals and objectives of the Ontario tobacco strategy. The proposed act, Bill 119, is a very good piece of legislation in principle and clearly demonstrates the Ontario government's commitment to protect the public, and especially our youth, from tobacco, which is a hazardous and addictive substance. The Hamilton-Wentworth health and social services committee's recommendations concerning the proposed act support the attainment of the Ontario tobacco strategy goals.
One of the biggest difficulties in the fight against tobacco I believe to be the multibillion-dollar direct and indirect recruitment of young people by the tobacco companies, which clearly shows the need for legislation from all levels of government to deal with this. Provincial, federal and municipal governments must attack this issue head-on as it is unquestionably an immoral, unethical and deliberate inducement of young people to begin smoking. It is obvious that the tobacco industry needs recruits, and unfortunately they are succeeding.
We are seeing an increase in the number of young people who are smoking. It is obvious that if this trend is allowed to continue, the current number of deaths related to smoking in Ontario, which appears to be about 13,000 per year, will continue to increase. All levels of government must attack this issue head-on. I believe the time for pussy-footing has to end. We must call a spade a spade on this issue. Tobacco companies cannot and should not be allowed to continue, through back-door advertising such as lifestyle, car racing, theatres and fashion foundations and other methods, to give messages to young people that tobacco smoking is acceptable. I believe this legislation is a part of that strategy, and I believe also we must do more.
We strongly support the increase in the legal age of purchase to 19. Increasing the age to 19 is a positive step towards putting tobacco accessibility on the same restrictive level as alcohol. All tobacco products are hazardous and addictive and should be treated with the same restrictions as liquor. Tobacco sales should be controlled, in our view, by a tobacco control board through government-run outlets or existing LCBO outlets.
If the sale of tobacco is to continue through existing retail outlets, then retailers must be made more accountable. A provincial licensing system with revokable licences is needed to motivate retailers to comply, fearing loss of revenue through licence suspensions, as is the case with alcohol. This would be self-financing from licensing fees.
The recruitment begins early. Most children start smoking between 12 and 14 years of age. Health and Welfare Canada surveys show that 90% of young smokers start before the age of 17. 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. It is difficult to deal with the problem once children become addicted, and tobacco is a powerfully addictive product.
We believe the use of the age-of-majority card currently used in Ontario provides easy identification for the purchaser of tobacco. It allows for an enforcement mechanism that prevents the retailer from selling to minors and inadvertently breaking the law.
I'll give you an example. In Hamilton we have legislation, licences and the same things as everyone else. On the weekend I took my 7-year-old nephew, who looks about 8, maybe 9 at the most, to two outlets, two different parts of the city, and asked him to go in and purchase cigarettes. In both cases he walked out of there with cigarettes. He's 7 but he's a big kid; he could pass for 9. In both cases he succeeded in walking out of the store without any questions asked. I was waiting in the car, and then I went in and dealt with the retailer at that point. But this is a 7-year-old child. This is supposedly the type of awareness that is out there, and that to me is a perfect example of the need for stronger legislation that has to be effective and has to be enforced properly.
We're concerned about the enforcement, a mechanism that includes fines and bans on the sale of tobacco. The provincial government has not published yet at this point how it plans to enforce the Tobacco Control Act. We believe the government and opposition parties will ensure that there's effective and consistent enforcement. Without adequate enforcement the legislation will be ineffective. Enforcement of the legislation is essential for ensuring compliance and preventing access by minors. In Hamilton, when licensing was introduced, we were able to appreciate the enormity of the task of policing tobacco outlets. Licensing provided accurate information for policy planning.
Enforcement needs to occur at every level of government. The enforcement body needs to be strengthened to include public health inspectors, bylaw enforcement officers and provincial offence officers.
The third point I want to talk about briefly is the banning of tobacco in pharmacies and other health care facilities. It appears to have been a popular subject in the half hour or 45 minutes I've been here today.
As we are aware, approximately 25% of tobacco sales made in Ontario occur through pharmacies. We strongly support the banning of tobacco sales from pharmacies. The current level of tobacco outlets must be reduced. We support the banning of these sales. We believe the message that health care facilities and pharmacies should not sell tobacco should be consistent.
The major benefit of the termination of tobacco sales in pharmacies is the elimination of a conflicting message about the risk of tobacco products being sent to all people of all ages, but especially to the young. On one hand, health professionals are saying that tobacco industry products are the cause of 30% of cancer deaths, 30% of heart disease and 90% of lung disease deaths. On the other hand, government undermines the risk message by allowing these products to be sold and promoted in health care facilities, including pharmacies. The Ontario Medical Association has condemned this practice. Basically, the message that kids get is, "If it's okay to be sold in a place that we're supposed to go to to get better, where we get our medication, then it obviously can't be too bad a product." Pharmacists should not sell an addictive product that kills people.
I'll go past some of this. You can read it on your own and go along with the presentation. However, the absence of cigarettes from drugstores would encourage pharmacists to become full members of the health care team and, without their conspicuous conflict of interest, would enable them to engage in real counselling about the risks of tobacco use. I find it interesting where on one hand they're standing there selling products that are supposed to promote and help health and are counselling against tobacco, and you walk to the other end of the store and they're selling the same products that they're counselling you as to the risks of. Clearly there's a mixed message there that comes out loud and clear. To me, it is really unethical for pharmacies to be involved in selling products that are clearly harmful if used as intended. This piece of legislation should ban that and make it quite clear and send a very consistent message.
We support the banning of vending machines from the sale of tobacco. We believe it will control access and will also control the sales as far as the age. We support the health warnings and age limits on premises. We think that is an extremely important part of the legislation that continues to send out the very positive message.
The aspect of prohibiting smoking in designated places and all health facilities except residential facilities: The provincial goal to make all schools, workplaces and public buildings smoke-free by 1995 will in our view not be accomplished by the proposed Tobacco Control Act. The hazardous effects of environmental tobacco are well established. On page 5 of the original discussion paper of the Ontario Tobacco Act in January 1993, it was stated, "Places where people routinely go for their day-to-day activities should be free from this environmental health hazard."
Eliminating smoking from all workplaces, all public places and all health facilities is the only way to protect the public from needless exposure to environmental tobacco smoke. Non-smokers in Ontario comprise 73% of the population. Legislation should protect the public by making smoke-free space the norm in Ontario. This is the most effective short-term means of reducing consumption, and then smuggling and the other problems that come with that.
The aspect of requiring health warnings and other information on tobacco packaging: We endorse the province's intention under this act to require additional health warnings. Federal health warnings on tobacco packages should be reinforced by provincial legislation. Children and adolescents, like the population in general, have a generalized awareness that smoking is bad for you. Beyond the superficial level of awareness, most young people have no idea of the nature of the risk or the magnitude of the danger associated with tobacco products. Kids aren't aware of the increased risk of diseases caused by smoking, the prognosis for such illnesses, and the impact of quitting smoking on these risks.
Because tobacco products kill when used as intended and because the industry has been totally negligent in informing its customers as to the serious risks to which smokers are exposed, Canadian governments at all levels should assume responsibility for informing tobacco users and potential users of the consequences of tobacco use.
In partial fulfilment of this responsibility, the federal government, via the Tobacco Products Control Act, requires manufacturers to carry the warnings which are currently printed on tobacco products. What is not widely known is that these warnings establish minimal standards for tobacco warnings in Canada. In fact, subsection 9(3) of the TPCA allows the provinces to require more stringent and better-targeted provincial warnings.
What is surprising is that even though the federal government almost invites the provinces to give children, adolescents and existing smokers better warnings; to date not a single province has gone far enough to do so.
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My recommendation on this issue would be very simple: that tobacco products be sold in plain brown packages with black lettering identifying the brand and other pertinent information on one side of the package, and on the other side in very clear, bold letters, the following line, "This product, used as intended, will severely harm your health and can kill you."
One other brief point, and that is, I urge the government and this committee to do everything possible to discourage the federal government from what I believe to be a very wrongheaded, short-term quick fix to a bigger problem by trying to reduce taxes. I think it is absolutely ludicrous to compromise and risk the health of young people, particularly through making cigarettes more affordable. Although it's not related to this committee, any message that can go out that way I think would help everyone across the province. Thank you, and sorry for being a little longer.
The Chair: Thank you. I want to try and work in two questions: Mr Wilson and Ms Haslam.
Mr Jim Wilson: Thank you, sir, for your presentation. Most of what you said I could and do agree with. As you know, having been in the room for a while, we're somewhat bogged down with the issue of banning the sale of tobacco products from pharmacies, and you said, as many other presenters have said to us, that pharmacies should not be selling products that kill people.
I'd ask you, what do you think pharmacies do and why do you think we have them? One of the primary reasons, of course, is we entrust them with products that kill people. That's why we have restricted products and people go to school for four or five years to learn how to handle those products. We put them behind counters so they're not readily accessible. One of the decisions Health and Welfare Canada makes in making the decision whether it's going to be an over-the-counter drug or a behind-the-counter drug is, how will this kill you and to what effect can it kill you and can we trust the public to do it without counselling and without prescription?
Following on that logic, then perhaps we should be moving cigarettes into pharmacies and putting them back where prescription drugs and all the other stuff that can kill you are dispensed.
Mr Agostino: Very clearly there's a distinct difference between the two. The products that are sold behind the counter, if taken as prescribed and if taken appropriately, will not or should not harm your health. A problem with medication is that if it's overdosed or taken improperly, then it will harm your health. Clearly, that same standard does not apply to tobacco. There's no safe level of tobacco smoking. There's no proper level or proper way of tobacco. Any type of tobacco smoke is going to harm you. I see a clear distinction between the two: One, if used properly, is going to help you; the other one, if used properly, is going to ultimately kill you.
Mr Jim Wilson: Okay, but today's context is that tobacco is a legal product. It is a poison. Shouldn't it go where all the other legal poisons are kept in our society?
Mr Agostino: To me, I do distinguish clearly the difference with the other poisonous products that you're talking about, if used improperly. If somebody's got a virus and they go in and get an antibiotic, that is not a poisonous product in the sense that if used properly, it's going to help you and it's going to make you better. I don't know how you can apply that same principle to cigarettes in any way, shape or form.
Very clearly, it's the message they're sending out. I understand that people will get cigarettes elsewhere. You're not going to stop somebody from smoking because they're not available in the drugstore, "I'll go to the Becker store at the corner," but it's that consistent message that we're trying to send out that it's a health issue, and to do it in a facility where they're there to promote better health I think is hypocritical and ludicrous.
Mrs Haslam: I understand what you're saying about taxes. I certainly will be writing my letter to Mr Chrétien, not that he's going to listen to me.
Mr Agostino: I've written mine as well.
Mrs Haslam: Oh, good. I want to talk just very quickly, and I know time lines are very hard, about the idea of enforcement. On page 5 you said that licensing was introduced. Do you find that more effective? Why do you think a licensing system would be more effective -- or do you? -- than what is presently presented in this legislation?
Mr Agostino: A licensing system I think would give a very clear mechanism and a very clear sort of, "If you don't do it, here's what's going to happen." I mean, what we have done in Hamilton is an example. We've just started a mechanism where you have to be licensed to sell tobacco products. Very clearly, the threat at the end of the process is if you're selling tobacco products to minors, then we can pull that licence and that ability for you to sell tobacco.
Mrs Haslam: More effective than the statutory model that is now present?
Mr Agostino: I think this could work as well. I'm not suggesting it's more effective. Also, we want a deal. Our ultimate goal would be to have it through some controlled mechanism, like the LCBO, under the control board. That ultimately would be the goal we would want to look at, to add to that. But clearly what is here is a step in that same direction.
The Chair: Thank you very much for coming before the committee today.
BARRY PHILLIPS
The Chair: If I could call on Mr Barry Phillips, welcome to the committee. For committee members, Mr Phillips does not have a written presentation.
Mr Barry Phillips: I apologize for not having it with me.
The Chair: That's quite all right.
Mr O'Connor: That's all right. Save a tree.
Mr Barry Phillips: I saved a couple of trees.
I want to thank you for the opportunity to present to you today. My name is Barry Phillips and I'm a licensed pharmacist. I am the owner of the Shoppers Drug Mart at Royal York Road and Bloor Street here in Toronto.
I am also the immediate past president of the Ontario College of Pharmacists. I finished my most recent term as president last October. I was also president of the college in 1985, so I guess I am both the past president and a past president. I know you've had a lot of them around. I am also a past president of the Pharmacy Examining Board of Canada. I have served as a college council member since 1977 and I am currently on the executive of the college. I am presently the chairman of the bylaws and legislation committee and the quality assurance committee.
I must make it clear, however, that I am not here representing a college today. I am here as a pharmacist and retailer on behalf of my staff and myself.
Like many of the other presenters before the committee, I also congratulate the government on Bill 119 and the measures it includes to prevent young people from starting to smoke. However, I am strongly opposed to the pharmacy ban in Bill 119.
I believe that there is no public good achieved by removing tobacco from pharmacies and that it would lead to a serious decrease in the public's access to pharmacy services. In the end, the interests of the public will not be served, nor will there be any resultant decrease in the amount of smoking.
As a member of the council of the Ontario College of Pharmacists, I am elected by pharmacists in my district. However, my role at the college is to protect and serve the interests of the public and not to address the interests of my fellow pharmacists.
There are often issues that raise conflict between the interests of pharmacists and the interests of the public. The college has dealt with many such conflicts in the past and I'm sure that we will have many more in the future. Although it has seen much more media attention than many issues we deal with, the tobacco issue is not unique in that regard.
As a member of the council of the college I've been involved in many issues of public policy in the past. For example, in the next few months the council will be involved in the development and codification of standards of practice for all pharmacists in this province to ensure that every Ontarian receives the best possible pharmaceutical care from their pharmacist. The role will be expanded in that all pharmacists will be required to fulfil consultation requirements on all new prescriptions and, when necessary, on refill prescriptions.
It is widely accepted that the pharmacist is an underutilized health care resource. This resource should be tapped to improve the level and promotion of health care in this province. In the same fashion, the pharmacist has a significant role to play in the solution to attain a smoke-free society, rather than be excluded. Pharmacists every day counsel patients on the proper use of medications. This resource should and is being harnessed on the sale of nicotine chewing gum and patches by providing education and counselling to the smoker about the perils of smoking and the options for quitting.
In any other locations that sell tobacco, such as gas bars and convenience stores, there is no literature on cessation options available for the smoker who wants to quit. Most pharmacies make this type of information available. Certainly, I do in mine.
I have been embroiled in this debate for over three years at the college and I have yet to see any evidence that banning tobacco in pharmacies will have any health care benefits. There is no proof that even one person will stop smoking as a result of a ban in pharmacies. In fact, the health care groups that have appeared before you agree that it will not reduce consumption. To them, it is a symbolic gesture. What, I ask, will it actually accomplish?
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There is, however, compelling evidence that the economic repercussions on local community pharmacies will be devastating. I have heard story after story from my colleagues and the pharmacists in my district about the tremendous pressures they are experiencing in their businesses from the recession, Ontario drug benefit deletions and the social contract.
The independent pharmacists presented the Coopers and Lybrand study that shows there will be 119 pharmacies, many in small communities, that will be forced to close. This means the public will be underserved and there will likely be whole communities that will not have a pharmacy. I cannot with conscience support a decision that will restrict the public's access to pharmacy services. This is not at all consistent with the mandate of our profession.
From a public policy point of view, I have to ask where the pharmacy ban fits. It will not lead to a reduction in smoking or even a better level of control over the sales to minors. It appears to be an appeasement to the non-smoker advocacy groups, with nothing to do with the broader goal of reducing consumption of tobacco.
Many of the non-smokers' advocacy groups that have appeared before you have tried to link the tragedy of tobacco-related deaths to the sale of tobacco in pharmacies. Certainly, the tobacco epidemic is a tragedy. However, these interest groups are trying to use an outrageous argument to appeal to people's emotions and to get your attention. I think that is grossly unfair to pharmacy operators. I personally find this to be a completely illogical argument, simply because the smoker has many retail outlets to purchase tobacco and one retailer cannot be singled out as responsible.
Speaking of singling out one type of retailer, in the past Shoppers Drug Mart has been the victim of sting operations by the non-smokers' rights organization in an attempt to entrap our employees, by disguising a young person and having them try to purchase tobacco in our stores. In fact, we are concerned that they are about to undertake another sting operation in the next few days while these hearings are under way.
I attempt to be very diligent in instilling in my employees the necessity to make absolutely sure they are not selling tobacco to minors and to refuse the sale if there is any doubt whatsoever. At my last staff meeting on Sunday, we once again discussed the issue and I alerted them to the possibility of a further sting attempt. We have a training video for my staff and a declaration they are asked to read and sign when they are hired. They are well aware that if they knowingly sell tobacco to minors, they will be disciplined or even dismissed.
We keep hearing from health care groups about the inconsistency or paradox associated with pharmacies selling tobacco. These inconsistencies would easily be resolved if tobacco was sold as a controlled substance in pharmacies or in a similar controlled environment. Pharmacists are faced with paradoxical situations based on the products we sell on a regular basis. For example, the college has endorsed the sale of needles and syringes by pharmacists to drug addicts. In fact, the Ontario government sponsors needle exchanges in a non-judgemental atmosphere. As we all know, street drugs are a very lethal product, and the provision of needles to addicts certainly raises the same ethical issues.
Pharmacists sell contentious and dangerous products every day. That is why we have so many regulations and requirements of pharmacists. That is why we have standards that must be met before a pharmacy can be licensed or a pharmacist can practise in this province. We already have a well-established environment for the sale of controlled items, so it follows, if the government is truly concerned about the control of tobacco, pharmacies would be an ideal place for its controlled sale.
The idea of a tobacco control board, similar to the LCBO, has been raised as another option to control its sale, especially to young people. As we are very much aware, if a person does not start smoking before 18, the chances are very low that they will ever smoke. I believe these are two viable options available to the government if it is really serious about having a smoke-free society in Ontario.
Paragraph 4(2)8 in Bill 119 exists to a large extent because of the resolution that was passed at the college almost three years ago. The Minister of Health has openly stated that the government is acting on the wishes of the Ontario College of Pharmacists. The implication is that she is also acting on the wishes of the pharmacists in this province. I can tell you that is not the case.
However, you should be aware that it has been some time since the college asked the government to start a phase-in of tobacco withdrawal, and I feel very strongly that it should be aware of these events.
In October 1990, the Non-Smokers' Rights Association held a press conference to announce their attack on the profession of pharmacy and the sale of tobacco. I was quite startled by their use of the public forum to initiate this issue.
Messrs Mahood and Ronson were subsequently invited to a college council meeting. It was decided very quickly that a task force should be struck and during the next few months the committee consulted with many health care groups. I must add that many pharmacists appeared before the committee in council to voice their opposition to a ban.
Nevertheless, in June 1991, the Ontario College of Pharmacists passed a resolution to ask the Minister of Health to phase out the sale of tobacco in pharmacies. I was a member of council at that time and I voted against the resolution, for the same reasons I have enunciated now.
In August 1991, the Ontario college held elections to council. Eight council members who supported the resolution lost their bids for re-election and the incoming councillors were elected primarily because of their belief that the removal of tobacco should be a voluntary decision made by the pharmacist, depending on his or her personal circumstances.
The council is very clearly divided on this issue, and both sides have become fully entrenched in their positions. There are many members of council who would really prefer if the whole issue would go away. There is a great deal of reluctance on the part of many of my council colleagues to wade back into this controversial issue. I can understand their reluctance and sympathize with their dilemma. Many feel that what is done is done, that now it is in the government's hands and that it is not our job to further debate the issue.
However, I believe there is too much at stake, and that is why I am appealing to this committee. It is the job of this committee of the Legislature to consider the impact this ban will have on the public's access to pharmacy services, as well as the economic health of pharmacies and any potential health care benefits. It is up to you to determine whether the cost in terms of jobs lost and economic hardship to community pharmacies will be offset by any public good. I know you will find that this ban will produce no benefits to the public and will, as shown by the independent pharmacists' report by Coopers and Lybrand, hurt the public access to health care. I thank you all very much for your attention and the opportunity.
Mr Drummond White (Durham Centre): Mr Phillips, thank you very much for your presentation. As a pharmacist and as a member of the college and in fact a past president of that college, the essential thrust of your profession as a health care profession is really to regulate and dispense substances which have a therapeutic range of some health benefit but which also have some danger involved, as Mr Wilson was pointing out with the last presentation. Many of the medications have tremendous health benefits but they also have some dangers. That's why they're prescribed medications. That's why they're not over-the-counter or available in a corner store.
What's the therapeutic range of cigarettes? Is there a therapeutic value to cigarettes?
Mr Barry Phillips: If you spoke to my 77-year-old mother-in-law, who has been addicted to cigarettes for quite a substantial period of time, and you asked her to stop smoking, as I have many times, and provided her with counselling and material on her smoking habit, as well as the fact that she has emphysema -- as I said, I've really done the best I can. As a matter of fact, she doesn't like coming to my house because we don't allow her to smoke inside the house --
Interjection.
Mr Barry Phillips: -- which is good in one way, yes.
Mr White: But she's not a pharmacist. You are.
Mr Barry Phillips: No, she's not, but --
Mr White: You are the one who determines the therapeutic ranges.
The Chair: Mr White, why don't you let the witness please answer the question.
Mr Barry Phillips: What I'm saying to you is that this is a product that is legal. Unfortunately, there are a number of individuals who are addicted to it and cannot stop smoking, and will not, and at 77 years of age, her feeling is that she doesn't want to stop smoking. That individual will be entitled to purchase that product.
I think the thrust is that the under-18-year-olds -- we want a smoke-free Ontario in the near future. Unfortunately, my 77-year-old mother-in-law, if she keeps smoking, is not going to be around very much longer, so we won't have to worry about her polluting the air.
It's the 18- and 17- and 16- and 15-year-olds who really are the problem. We can't get those people started. I think it must be in a controlled atmosphere. It must be either in a tobacco control outlet or in a pharmacy behind the counter where there can be counselling, where it does provide that opportunity, where it does provide that control on the sale of drugs and the sale of tobacco.
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Mr White: Wouldn't it be contradictory for you to be selling a product which has no therapeutic value, behind the counter?
Mr Barry Phillips: Look at it in the same way as a needle and syringe that is provided to a drug addict. Certainly, the drug addict is not getting any therapeutic value out of the street drugs. He's getting a high and he'll probably kill himself a lot faster with the street drugs than he would with tobacco, and yet we --
Mr White: But you're not selling cocaine.
Mr Barry Phillips: No, but we sell the means for them to inject heroin and those types of drugs into their bodies.
Mr Jim Wilson: Thank you, sir, very much for coming forward, because the government has put a lot of faith in the fact that the council in 1991 passed the resolution asking for this ban. Many of us in private meetings have heard the controversy surrounding that and you've been very courageous and forthright in bringing that to this forum.
First of all, I would say there's no therapeutic value in cigarettes and that's not what's on trial here when it comes to this particular section. It is, to my party, a freedom of business issue, a survivability issue for some businesses and a discriminatory issue in terms of you can't or you shouldn't pick on one section of the retail sector over another when it comes to a legal product.
Having said all that, I'll go back to the pharmacy council. If that vote were to be held today -- remember this whole thing hinges on the council asked for it and somehow this could decrease consumption if they ban this, particularly among young people -- how would the vote go on the council, in your opinion?
Mr Barry Phillips: It's very difficult to say because we have a new council that was just elected and started in October 1993 and it hasn't come to a vote with this particular council, so I wouldn't even guess. It depends. A lot of people feel: "Let's ignore this. Let's not bring this up and let's just hope it goes away. you've got it, it's your problem now and we don't have to worry about it."
The Chair: I'm sorry. We're going to have to move on. Thank you very much for coming before the committee and for your presentation.
ONTARIO NATUROPATHIC ASSOCIATION
Ms Patricia Wales: Good afternoon, ladies and gentlemen. The Ontario Naturopathic Association is here to present a brief presentation in support of Bill 119 and some background information as to why we're even interested in that.
Naturopathic medicine emphasizes health promotion and disease prevention. The therapeutic approach is based on enhancing the healing response by supporting and stimulating normal body processes. A healthy diet, optimum levels of nutrients, adequate rest and exercise and a positive attitude are elements that all promote health. By contrast, low levels of essential nutrients, skimping on rest and exercise and using stimulants like tobacco cause health to deteriorate.
Naturopathic doctors focus on lifestyle choices that increase health reserves and that decrease the accumulation of toxic substances, so supporting all measures that remove exposure to smoke is consistent with our practice and the needs of our patients.
The connection between smoking and the killer diseases is well known and well documented. Cancer, lung disease, cardiovascular disease and stroke are the visible end results of repeated insults to the body, and smoking is one of the most common insults connected with that. However, there are many other effects of smoking that are also well researched and documented, but that may not be as well known.
The whole body is affected when people are exposed to smoke and the effects are cumulative. The smoker chooses to be exposed. The non-smoker is also at risk because of passive or involuntary smoking of environmental tobacco smoke.
The negative effects of smoking seem to be based on three physiological responses: the stimulant effect of nicotine, the constriction of blood vessels and therefore a decrease of blood flow that results, and the toxic effects of all the chemicals that are in tobacco smoke.
Parental smoking affects fetal development. Smoking mothers produce smaller weight babies, which have a higher risk of perinatal death. Expectant mothers who do not smoke but whose mothers smoked are also at greater risk of miscarriage than those whose mothers did not smoke. It's a significant finding.
Secondhand smoke has been linked to lung cancer in non-smokers and also to respiratory ailments in young children, infants and pets who live in the houses of smokers.
Fractures take longer to heal in smokers. Smoking reduces bone mass and contributes to the risk of osteoporotic fractures. Smoking decreases the level of the very antioxidant nutrients that help protect against carcinogens, nutrients such as vitamin C, beta-carotene, vitamin A, vitamin E and vitamin B6.
Smoking depresses the immune system. It's also a major risk for oesophageal and bladder cancer, as well as the mouth and throat cancer we'd suspect. Smoking contributes to skin aging and wrinkling and to low back pain, probably through malnutrition of the disc making it vulnerable to mechanical stress.
Smoking is correlated to a long list of physical complaints, things which all of us can be aware of in ourselves: coughing, sore throat, increase in phlegm and sputum, loss of appetite, stomach pain and ulcers, diarrhoea, heartburn, gum problems, bad breath, shortness of breath, itchy skin, pale face, palpitations, feeling flushed or feverish, back pain as we mentioned, weakness, fatigue, irritation, sensitivity or nervousness.
Health education should and must focus on the many complaints that people can monitor and prevent themselves, not just on the end result killer diseases.
Tobacco is a highly addictive substance. That's been well researched and documented, but it's also evidenced by the speed with which new smokers habituate to smoking and the great difficulty they experience when they attempt to quit.
As we've heard here today, 90% of smokers become addicted before the age of 20, so one of the most effective ways to reduce the damaging effects of smoking on health is to prevent teenagers from starting. Bill 119 addresses this by taking affirmative action to reduce the supply of tobacco products to minors.
Another important step to reduce the effects of smoking is to reduce the number of people who are affected by smoke, and Bill 119 addresses this by removing smoking from public places and health facilities, protecting the health of people who choose to be smoke-free.
The biggest hurdle is probably the addictive nature of smoking. By limiting outlets for sale, Bill 119 makes purchase of tobacco products less convenient and accessible. Licensing of outlets would go even further to control that access.
Warnings on packages presently keep the message of health hazard before the eyes of the users, which obviously they all choose to ignore. With teenagers influenced by the presence of tobacco companies at many major events, plain paper packaging would reduce the carryover effect of such advertising.
Naturopathic medicine provides effective programs to help people stop smoking. Antioxidant nutrients, specific botanical medicines, acupuncture treatment and focused relaxation techniques are of significant effect in breaking the smoking addictive pattern.
The success of any stop-smoking program depends on the personal motivation to quit. Even more important than that, probably the single most important factor is preventing people from starting in the first place.
Besides all the things we have talked about today, another really important factor in prevention is looking at the reasons, physiologically and psychologically, that cause people to start in the first place. We need the combined efforts of public, government and business to reduce this identifiable and removable health hazard. The colossal cost of tobacco-related diseases in human lives, quality of life and health care dollars has been well enunciated by the chief medical officer of health.
The Ontario Naturopathic Association wishes to voice its support for Bill 119 and state that further provisions to license tobacco outlets and to require plain paper packaging would also receive our support.
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Mr Ron Eddy (Brant-Haldimand): Thank you for your presentation and for listing the findings. It would be my hope that every citizen would have the opportunity to read and consider those findings; very important.
Because you've stated that you fully support Bill 119, I would expect that you feel it should go further and that there would be additional items that could and should be included in the bill, perhaps even a total ban. Would you care to comment on that?
Ms Wales: I'm not quite sure what you mean by a total ban. Sales anywhere?
Mr Eddy: Banning tobacco products, making it an illegal product, rather than continuing to have it as a legal product. What other features do you think should be included in the bill?
Ms Wales: I've listed the ones that I feel we can really stand there and support, and those are finding ways to decrease access for young people and also making it so that non-smokers are not exposed to smoke they do not choose to be.
One of the issues for people we see, who are extremely environmentally sensitive -- they may very well be like the canaries in the mine, telling the rest of us things are happening -- is that even being around someone who has smoke on their clothing, going into an establishment where there may not be smoking but which smokers frequent, is an exposure to environmental smoke. Some of the research studies recently have shown that the smoke that lingers as a smell in clothing and in furniture is actually the most toxic part of the side-stream smoke, because it has remained there and is gassing off slowly.
Those would be our biggest concerns. I think we have to work with all of society to find solutions that are not just going to drive things underground, but are going to find a way to really tackle this problem and increase our ability to have healthy people in our society.
Mr Eddy: Thank you for your information.
The Chair: Thank you very much for coming before the committee today and for your presentation.
RICHARD STEIN
Mr Richard Stein: Thank you very much for inviting me. I don't have a presentation. What I'd like to do is share my experience of the last 30 years since I've graduated.
Richard Stein is the owner of what we call the Medicine Shoppe. The Medicine Shoppe is an independent -- and I stress independent -- pharmacy, a very small pharmacy located in the west part of Toronto. We're in a medical building. I bought my store in 1974.
The store never sold cigarettes, so that wasn't really an issue. I thought about it for maybe five or 10 seconds and I knew I wasn't going to sell cigarettes, although all my competitors did. But I knew I had to find other areas to make the pharmacy viable and profitable. That's what I'd like to share with the committee this morning -- this afternoon, tonight, whatever. Am I not nervous? I'm nervous.
I must say I stress independence, because I'm an independent pharmacy. I've always gone my own way. Just recently, the Medicine Shoppe is now a national franchise and you'll see many Medicine Shoppes, I hope, across the country. It would be my biggest pleasure to go head to head with Shoppers Drug Mart. Although very small, I believe we're very professional. I must say, now that the Shoppers Drug Mart pharmacists have left, I can really talk quite freely.
I was fortunate that my location in the west of Toronto was right on Bloor Street and in a medical building. We're in the corner of a medical building. At that time, 20 years ago, most of the doctors did smoke and they asked me frequently, "Would you please get me," or, "Could I buy?" I constantly refused to sell them.
I needed to find other profit centres, other niche markets that I could sell as a pharmacist. For the next several years, I concentrated on expanding the area of home health care items, creating departments such as durable medical equipment with wheelchairs, canes, commodes. We went into ostomy supplies; orthopaedic supplies, which includes sports, medicine braces, back braces, shoulder braces and so on; surgical stockings and compression therapy for those people who are suffering from lymphedema and varicose veins.
We went into mastectomy forms and breast prostheses for women suffering from breast cancer. This required a major commitment on my part and my wife's part, who was involved in the surgical fittings and the breast prostheses, a major commitment in resources and financial commitment, and in time and energy spent at various conferences, seminars and schools, and this continues on today.
We have two consultation rooms. As Mr Phillips mentioned, he counsels his patients on the medications. We counsel our patients not only on the medications, but on their medical fittings and their surgical supplies.
What of the future? I'm very positive. Everybody's crying the blues. I haven't yet had the need to do that. I've just returned from a seminar in the States on specialty compounding. This is not my brochure, but I will have one like it in a short time. Prior to 1950, compounding was very prevalent in pharmacies. The doctors would not write for brand X, they would give you several chemicals and ask us to compound them in. It's come full circle. Pharmacists who are doing very well in the United States profitably are compounding chemicals. They're meeting patients' needs and this is what I propose to do.
Also, our pharmacy will set up one of the first, if not the first, pain clinics. We're going to have a pain treatment clinic with the use of magnetic devices and electromagnetic modalities to treat pain. This will be under the supervision of a trained physiotherapist or a kinesiologist. We're also developing a lymphedema treatment clinic. Under my direction, the same person will use pneumatic compression devices to treat those patients with lymphedema.
Compounding customized medication, as I mentioned: These are some of the devices that we can compound. These are all blanks, but we will ask the physician what he would like us to put into them.
We're also developing a book- and video-lending library, because we're moving away from the product and towards information. Providing information will be the pharmacist's key role in the future.
I've practised pharmacy since 1963 and I've enjoyed every minute of it. I am proud to be a pharmacist. I'm proud to meet my patients' needs not only pharmaceutically but in other areas. I support Bill 119 and I commend the committee for hearing me.
I have a little placard that I put up in my store. Because we don't sell cigarettes, I thought, why not say so to my patients? I'll read this to you, "Although cigarettes provide some pharmacies with healthy profits, we decided years ago we'd rather have healthy customers."
Just to show you, the medical fitting department is more than 50% of my total sales volume; pharmacists can reach out into different areas and develop many profit centres for their patients' needs.
Thank you for your time and I'd be happy to answer any questions. If I don't know the answers, I'll take your phone number.
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Mr Jim Wilson: Thank you for your presentation. On the issue of the ban of tobacco sales in pharmacies, obviously you're expanding and have expanded your pharmacy into some very interesting areas and I think you're going to hit a good niche mark.
The compounding market: I know what you mean. In the United States it's a growing market and people probably long for the day when the pharmacist is actually a chemist again. I wish you all the best.
Mr Stein: Thank you very much.
Mr Jim Wilson: In the prosthesis department, I just had a first cousin Patrick O'Leary go bankrupt on that one, because in a small town like Tottenham, two in town is one too many. Not everyone can get in it, or certainly there's a limited market there.
Mr Stein: There's a limited market there, and that's why I could not make it in any one market. You need a broad base and that's why I developed all those niches. We're fortunate that my wife's breast prosthesis business is very good, but we're in a large centre. In a small town, it wouldn't work. They'd have to take on ancillary services to provide.
Mr Jim Wilson: I think that's the worry, though, of some of these pharmacists. In many of the smaller towns in Ontario and the towns I represent, there might be two or three pharmacists, or four now I think now in the case of Alliston, which has a population of only 6,800 people but has a large rural area around it.
Those who are selling tobacco feel it's one of the reasons they're still in business, because it's enabling them to compete on the retail side with other retailers down the street who are selling tobacco. They simply feel that if the government were to remove their ability to sell that product, it may be the last straw.
Mr Stein: I feel very strongly that they can turn that around full circle by being a total health care provider and offering information on health care. Our phone rings off the hook, because people don't know where to turn. They call us. We don't sell tobacco, but we don't have to sell tobacco. I don't even want to sell tobacco. I want to sell health care items and I stress that very strongly. They come to us for health care items and I make it. That's why I have my little sign. People go across the street to buy their tobacco and they come to us for their health care items, because we're perceived as being a health care store.
No doubt that's what they'll likely have to do. So far, my sense of these hearings is that the government is not budging very much on this particular provision. You may want to start consulting, telling them how to get into various niche markets, but the fact of the matter is that I think some of them are going to go out of business through no fault of their own.
Mr Stein: But they don't have to. There are so many areas out there, if they'd just open their eyes. There are so many areas out there, even with four stores in town, that don't sell tobacco. People are going to go to other food stores to buy their tobacco. There are other areas in the health care industry that people are literally dying to find information on, to find the products and to find the services. I think that's what we as pharmacists have to capitalize on.
Mr Martin: I also want to thank you for coming forward. I find your presentation rather refreshing and enlightening, because as I listen to the presentations that come forward, particularly on this piece of the legislation, I sometimes find it quite confusing. You've clarified a few things for me this afternoon, and that's the question of whether pharmacies are in the health business or in the retail business in a different way.
We certainly today had a number of the retailers come forward to talk to us about the impact of this legislation on their operations. It seems to me that maybe some of the problem they're presenting here and suggesting that we are somehow compounding for them is actually something they brought on themselves by moving over the years away from the very professional, sophisticated business of pharmacy you're explaining and describing here today to actually simply being distributors of a product and then a million other things.
There's a complaint right now that the way pharmacists are being paid by the government, for example, is by the number of pills they dispense. They become dispensers as opposed to the kinds of other things that they could get into actually, in fact in partnership with us. There's some suggestion to the government by folks like yourself that the very valuable counselling you do as a pharmacist should be worth some value to the government and should be paid for so that pharmacies could return a bit more even than what they've traditionally done over the years.
I suggested this morning that maybe where the pharmacies are in this instance saying that we're creating an unlevel playing field by taking away from them the ability to sell cigarettes, they have a non-level playing field in that they have a monopoly re the dispensing of pharmacy products and all the other things that they can do.
The answer that came back was, "Anybody could become a pharmacy." I suggested that maybe we should allow corner stores to get into the pharmacy business. The suggestion that came back was: "Okay, that's fine. That could happen." I felt that was a rather facile, simple response to a question that maybe was a bit more difficult than that. Could you respond to that?
Mr Stein: Pharmacists will be going down for the third time and they're just going to be grasping at straws, but they don't really have to, if they take a look at their patients' health care needs, tobacco not being one of them, and just begin to satisfy one or two of those needs, and then one or two of those needs later on, and another one, and then keep adding. That's all I did: one step at a time.
Mr Martin: What you're telling me is pharmacy is a very specialized area, and if it is developed further --
Mr Stein: Pharmacy is a wonderful venue for expanding as a total health care provider in the way of product services, in the way of medical fittings, surgical stockings, product information, special compounding. Pharmacy is, I feel, the very best of all the medical professions to provide the kind of services we have at our disposal.
I think those few pharmacists who are really keen and lose their tobacco, are forced out of it, should look to other areas in the health care fields and start providing some of those services. They don't have to be run by the government. They don't have to be ADP, the assistive devices programs. They can be for cash, Visa or cheque, across-the-counter sales of health-related items. That will more than make up. I'm just speaking from my own experience.
The Chair: Thank you very much for coming before the committee today and for your presentation. We appreciate it.
COUNCIL FOR A TOBACCO-FREE YORK REGION
The Chair: I call on the representatives for the Council for a Tobacco-Free York Region. We want to welcome you to the committee. The parliamentary assistant and I both have to declare a conflict of interest, as we're delighted to see people from York region. It's great to have you here. Perhaps you could introduce yourselves and then just organize your presentation however you think best.
Ms Joanne Kaashoek: Good afternoon. My name's Joanne Kaashoek. I'm the chair of the Council for a Tobacco-Free York Region.
Ms Tania Gabrielle: I'm Tania Gabrielle.
Ms Linda Pugilese: I'm Linda Pugilese. We attend Father Bressani Catholic High School in Woodbridge.
Mr Fady Samaha: I'm Fady Samaha.
Mr Frank Casicaro: I'm Frank Casicaro. We attend Sacred Heart Catholic High School in Newmarket.
Ms Kaashoek: The Council for a Tobacco-Free York Region is a coalition of community members and health agencies that work together to reduce and eliminate tobacco use in York region. Our mandate is to support non-smokers in securing smoke-free environments, but at the same time we engage in educational campaigns which raise community awareness about tobacco use issues.
First, we would like to offer our support to the Ontario Tobacco Control Act and commend the NDP government for introducing this legislation which protects the health and wellbeing of young people in our communities. We also commend those opposition members who support Bill 119.
At the same time, we're very concerned about the fact that some opposition members are criticizing aspects of the bill such as the pharmacy ban and the vending machine ban. Protecting the health of youth today and tomorrow should be a non-partisan matter. It is unfortunate that the opposition parties are attacking this excellent piece of legislation.
If Bill 119 is implemented, it will have a vast impact on the health of future generations of youth in York region, based on our population analysis, which is included within this report.
We are aware that tobacco is the worst health epidemic in history. In York region alone, 400 men and women aged 35 and over have died prematurely in 1990 from smoking-related causes. This number is conservative, as it does not include neonatal deaths, miscarriages, deaths from passive smoking or data from past smokers.
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In 1990, approximately 50,000 people aged 20 and over in York region were smokers.
York region youth have a great deal to say about how many youths smoke in their schools and how easy it is for them to gain access to tobacco products.
I will now turn the presentation over to Linda Pugliese and Tania Gabrielle.
Ms Gabrielle: Linda and I are part of our school's student wellness council. We took a survey within our school to find out how many students smoke. After surveying 1,122 students, we found that 20% of the students smoke. However, we believe the percentage to be much higher because it seems that almost everyone smokes in our school. Of those 20% who admitted to smoking, 50% started between the ages of 14 and 16, and 48% of those people said they would like to quit.
Ms Pugilese: Our school's wellness council also went to local stores and gas stations within the community, and we were able to purchase cigarettes from nine out of the 10 stores, even though we are under age. This made us realize how accessible cigarettes are to teenagers.
I personally believe that many teenagers begin smoking because they're pressured into it by their friends, to raise their self-esteem, or simply because they have nothing better to do. It doesn't help that cigarettes are so accessible to teenagers. Teenagers do not stop to think about the long-term effect smoking will have on their lives. I believe that Bill 119 will help to reduce teenagers' accessibility to cigarettes and hopefully make them think twice about smoking.
I'll now turn the presentation over to Frank and Fady.
Mr Casicaro: We both attend Sacred Heart, as you know, and we felt that there was a major smoking problem in our school, because in our school we have a designated smoking section behind the school and we noticed there were a lot of teenagers who smoked.
Grades 9 and 10 usually were the most populated, so we felt there was a need to start up a support group at our school for students who are interested in quitting smoking. We both feel that the smoking section in our school is a bad idea, considering that we're trying to help students quit smoking. We felt that if we started up a non-smoking program, then we could help students, at least at our school, quit.
Fady and I did a survey at our school to see exactly how many people smoke and how many cigarettes they smoke a day.
Mr Samaha: The people we surveyed were between grades 9 and 11. We surveyed some grade 12s and 13s, but it was basically 9 to 11.
Out of 313 students surveyed, we found that 23% are smokers and 77% aren't. Out of the 23% who smoke, 75% of them smoke one to 10 cigarettes per day and 25% smoke more. Out of the people interested in quitting, there were 56% interested and 44% not, and for the people interested in the program, there were 39% interested and 61% not.
This might not seem like a lot of kids that are smoking, but it is. If you go out there and you see these kids, they're wasting their life on the cigarette, and it's so easy to get cigarettes now. You don't have to buy a pack anymore. You can just go into stores and buy a cigarette for 25 cents, and that's what's happening. They don't get ID from you or anything; you just walk into any store.
We were in Toronto, before we came here, near the Eaton Centre, and we walked into a couple of stores. We'd just go in there, "Can we get a pack of cigarettes?" and nobody would say to you, "Listen, let me see some ID." They just say, "Okay," and that shouldn't be happening. That's why a ban should be done.
We believe that if the stores that sell cigarettes got licences, it would be better. Then they'd think twice before selling to teenagers, because if these stores get caught selling to people under 18, their licence may be revoked. That will make them think twice. That's why we believe, if Bill 119 was passed, then there would be less youths using this deadly drug and hopefully no youth at all.
Ms Kaashoek: Thanks, Frank and Fady. I want to just outline some of the provisions that we're very much in support of, and then add some recommendations in terms of how we believe Bill 119 can be strengthened.
We are very much in support of those provisions which increase controls on tobacco sales to minors and those provisions that reduce tobacco outlets through the ban of cigarette sales in vending machines and in pharmacies. We're very much in favour of banning cigarette sales by health care professionals, and especially in pharmacies, to remove the contradiction of providing health and also providing illness. We're very much in favour of improving packaging controls and provincial health warnings and prohibiting smoking in designated public places. We're also very interested in strengthening the non-compliance penalties.
I want to draw your attention to page 7, which describes in more detail how Bill 119 can help the Council for a Tobacco-Free York Region deal with some of the issues and concerns that we have ongoing in our region right now. I won't dwell on that. I want to move ahead to the recommendations section because it's very important.
Even though the provisions in Bill 119 are very good, we have concerns with certain aspects of the bill. If we as health professionals and politicians are really serious about protecting our youth from tobacco addiction, we need to provide consistent individual and societal messages about the addictive properties and ill-health effects of tobacco products. Educational messages about tobacco will never be effective without strong social legislation that supports the rights of non-smokers and restricts tobacco sales to youth.
Young people are especially aware of inconsistencies in messages that tell them not to smoke. Smoking is still allowed in most public spaces and workplaces in York region. Cigarettes, prominently displayed through exciting sponsorships and attractive packaging, are readily available to youth under the age of 18 either in kiddie packs or even in single cigarettes. The message to youth is that smoking must not be that bad for you because it is so visible in our society and it is part of the lives of so many adults.
Our first recommendation is that, if we want to really enforce and make sure that tobacco is not sold to minors, we need to develop a licensing system for tobacco retailers. Tobacco retailers need some type of incentive that is going to deter them from selling to minors. Two recent studies in the USA confirm this by showing that education alone was not effective in reducing retailer sales to minors. Only after an effective licensing and enforcement strategy was introduced did sales decline from 70% to less than 5%. That is significant and should not be overlooked.
The need for a strong Bill 119 is greater than ever in the face of the federal government's proposed tax rollbacks. The Council for a Tobacco-Free York Region believes that a tax rollback would do very little to deal with the smuggling issue and it would only add to the tobacco industry's sizeable profits, to the detriment of the health of thousands of children and adults. A licensing system of tobacco retailers would help all governments, municipal, provincial and federal, deal with the smuggling crisis.
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Our second recommendation is that we need to provide a more consistent message to young people and adults about smoking and secondhand smoke and their harmful effects, and we can do that by banning smoking in all workplaces.
We get a lot of calls from people in York region who work in workplaces that have no controls at all in terms of banning smoking. They call us and tell us about how difficult it is for them to work in these environments. They ask what recourse they have. Their recourse is a long, laborious procedure because there are nine different municipalities in York region, each with a different non-smoking bylaw. It's important to provide a strong minimum standard against -- is my time up?
The Chair: It's okay. I just know there are some questions.
Ms Kaashoek: As cigarette smoke and secondhand smoke are classified as a class A carcinogen containing more than 4,000 toxic chemicals, there should be no further hesitation in banning the substance from work sites.
Briefly, I want to just say that our council is very interested in supporting the provisions in Bill 119. In the fall we're hoping to do an education campaign around some of the provisions in terms of targeting retailers and informing them of the law and their duty not to sell to minors, and we believe that a strengthened Bill 119 could help us make this educational campaign more effective.
In conclusion, I just want to say that the speedy passage of this legislation would very much help the Council for a Tobacco-Free York Region in securing a smoke-free York region.
The Chair: Thank you, and we also had the full brief to read, but I know there are some questions and I just want to make sure we have some time for that. We'll begin with the parliamentary assistant.
Mr O'Connor: Both members from York region sitting here would like to ask you some questions. The Chair isn't allowed to and has graciously allowed me, but usually I'm on the receiving end of questions.
I want to talk to the young people here because I really appreciate your coming to the committee. Of course the legislation is geared for young people, trying to keep young people from starting the habit of smoking.
In the legislation, again, is the vending machine ban. Licensed premises, which are restaurants and taverns and what not that sell alcoholic beverages, which you can't consume of course until you're of the age of majority, have vending machines in them. We heard that the federal legislation doesn't include a total ban like ours does but excludes it to that.
As a young person, do you feel that you could go into a licensed premise, go to a vending machine and purchase cigarettes without somebody saying, "Hey, what are you doing?" That's one of the areas that we're trying to focus on as part of the legislation as well as a number of other areas. I just wonder if you want to comment on the vending machine element.
Mr Samaha: We can. If you want to buy cigarettes from a vending machine, nobody's going to stop you. When me and my friends go out -- there are some who smoke -- there are vending machines in doughnut shops too and you just go up to them and you ask the lady for change, she gives you the change and you go buy it. Nobody's saying anything. They just want to make a profit. They're not going to ask you for identification or anything.
Ms Gabrielle: Also, my father used to smoke and if there was ever a time he needed cigarettes, if we were in a restaurant he'd give me money, I'd go to the vending machine and get him cigarettes. Nobody would stop me. This was even before; I was 13 or 14, I would just go up, get some change and go get them. Nobody would say anything.
Mr O'Connor: That would be a licensed premise.
Mr Jim Wilson: Thank you for your presentation. I think you did an excellent job. My party, the Progressive Conservative Party, agrees with most of what you've said and we're interested in looking at some sort of licensing provisions.
Two things were pointed out, though. One is that the opposition parties have a little problem with the vending machine thing. I think we should just explain we don't have any problem with banning vending machines; we just think if the government takes away something, takes away part of your business, it should compensate you. We don't think that's a big thing. That's the official stance of my party on it.
The second one is with respect to pharmacies. When the government had its press conference to announce this legislation, the minister herself announced to all of the press gallery, all the people and the reporters, when they said, "Do you have any proof at all that banning the sale of tobacco products in pharmacies will in any way stop young people from smoking or reduce the chance that they'll start smoking?" she said, "No, we don't have any proof. We just think it might." There have been a lot of people coming towards us saying, "We don't see how that will because they'll just go down the other end of the mall and buy them at the smoke shop or whatever."
We've been saying things like maybe we should make it illegal, like we do for alcohol, for young people under the age of 19 to smoke. You can't drink so why in the world do we let you smoke? The current model -- and this law just makes the current model one year older; it's 18 now and then it goes to 19 -- puts all the blame on the grocery store clerk or the owner of the pharmacy, whoever sells you the cigarettes, and we think that young people should take some responsibility. After all, we're going to charge little kids with not wearing their bicycle helmets and we charge people all the time with drinking under age or having open alcohol in their possession under age. So that's one thing we're thinking of.
I don't want you to get the impression that the opposition people are bad people. Part of our job is to --
Interjection.
Mr Jim Wilson: No, I saw that, because a lot of you wouldn't make eye contact, and I thought they must think we're really bad, but we're not. Part of our job in a parliamentary democracy is to point out flaws, and when we aren't totally convinced on something, there's a whole pile of other people out there who want to have their views brought forward, so we try to help them do that.
I will ask you a specific question about pharmacies. Fady, you mentioned that you can get cigarettes at pretty well any store and nobody ever asks for ID. It seems to me that if the government really wants to control the sale of this product, who would you trust more, the Becker store clerk or the pharmacist, to check for ID? Which leads to, maybe we should move all the cigarettes into the pharmacy and take them out of all the other stores. After all, that's where all the other poisons are kept.
That's what we've been saying, so if it's confusing I'm sorry.
Mr Casicaro: Pharmacies may tend to ask the person for ID more than maybe a corner Becker store or whatever but there are some pharmacies that will not ask for ID when students walk in and buy cigarettes.
One thing to do is probably ban the sale of cigarettes from pharmacies, but that may also have the students go to smoke shops on the corner or whatever. Like he mentioned earlier, maybe if there was a licence put in; if you walk into a liquor store and a minor purchases a bottle of liquor, the liquor store could get their licence revoked so they wouldn't be able to sell liquor any more. If a store had a licence to sell cigarettes, then that could give them the incentive not to sell to people under 18 or 19, the age limit, and they might be afraid that their licence would be revoked. That could be a key thing there.
The Chair: Thank you. I'm sorry our time has run out. I'm going to sneak in a quick question.
Mrs Haslam: Go for it.
The Chair: I think one of the really interesting things in your coming here is that you've done a survey with students and young people who are the people who are the object of the bill. I just wondered, would it be possible for the committee to get a copy of that? Is it in a format that we could make copies and circulate it?
Mr Samaha: We've got our study here so you can take copies of it. It's in a book here right now.
The Chair: I promise to bring it back and perhaps could drop it back to you through your office in Newmarket. The clerk will take it. Thanks very much.
On behalf of the committee I thank you all for coming in again and for the work that you've done and for sharing your views with us. We thank you.
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FREDERICK BASS
The Chair: If I could then call Dr Frederick Bass, if he would come forward. Dr Bass, welcome to the committee. It's probably fair to say you may have come farther than anyone else to present to the committee.
Dr Frederick Bass: When I saw in the Globe and Mail about three, four weeks ago your advertisement, and knowing that I was coming here at this very hour -- in fact I arrived an hour ago -- I couldn't resist calling and seeing if I could contribute, not really as a representative of the BC Medical Association but as a very interested individual.
The Chair: You are welcome. We're glad the flight landed. Please go ahead.
Dr Bass: Thank you. I appreciate the opportunity to speak. I'd like to say three sets of things. First, I'd like make general comments about where I have seen politicians and this issue. Second, I'd like to make some specific recommendations which you may have in front of you in the form of a letter that I've written. Third, I'd like to make some brief comments about Bill 119.
As you know, BC recently finally issued the regulations for the Tobacco Sales Act after sitting on the formation of them for a year and a half.
What I'd like to say, first of all, is I think politicians really don't get it in terms of smoking. It really takes some perspective and it really takes some standing back and looking at what smoking is. For the most part, there are very few politicians I have seen who really understand what's going on.
The tobacco trade is institutionalized legal drug addiction. Tobacco is the most prevalent cause of cancer, of heart disease, of unnecessary death and of medical cost. It's the most prevalent one in Canada and it's rapidly becoming the most prevalent one in the world. Certainly, it's the most prevalent cause of mortality in the world now, including the Third World countries. Tobacco is an addiction which starts in childhood, and right now in Canada it's falling disproportionately on people who are uneducated and who are vulnerable.
I really haven't had to function from your perspective, but from my perspective the way politicians usually work is to compromise. They hear a range of views and they find some ground that hopefully makes the fewest people angry and sometimes the most people happy.
When you compromise with the tobacco industry or with people who are selling tobacco, you are compromising the brains of children. You are comprising the brains of children with respect to starting them on the road to addiction.
A 13-year-old kid is so remote from heart disease, lung cancer etc that it's meaningless, but every day that this 13-year-old smokes, she or he is digging himself or herself a little deeper into nicotine addition. There is a nice -- I don't know if it's nice, but there is a prospective study in California that shows that between the ages of 11 and 14, the cohort of girls that they were following were addicting themselves. Of course, you're not only compromising the brains; you're compromising the lungs. School children get more lung disease when they're exposed to cigarette smoke, and ultimately their hearts.
The third introductory thing I want to say is that for 90% of smokers, their addiction is really a form of slavery. That sounds exaggerated, but I'll tell you that only 10% of smokers smoke fewer than five cigarettes a day, and if they really could take it or leave it, many more would be smoking five cigarettes a day. It is not that way with alcohol.
Canada produced an extraordinary study after the 1988 Surgeon General's report called Tobacco, Nicotine and Addiction. When the Royal Society of Canada was asked to choose between the terms "addiction," "dependence" and "habituation," they came down very clearly on the side of addiction even though --
The Chair: Sorry. Just on that study, is that from the federal Department of Health and Welfare?
Dr Bass: No. Perrin Beatty, Minister of National Health and Welfare, and the Department of Health and Welfare commissioned the Royal Society.
The Chair: The Royal Society?
Dr Bass: Right. The Royal Society of Canada. I certainly would recommend you look at it, because they make this comparison between the proportion of smokers who have to use the substance on a daily basis versus the proportion of alcohol users who have to use it on a daily basis.
The other thing is that only one third of smokers do not smoke 365 days a year when you go out in the population and ask them, find out how long they've been off. This is a highly addictive substance.
What this committee does is going to determine whether the corner store still stays in the business of addicting kids. It's that simple. If you seek to compromise and get some middle ground among all the people who are going to sit at this table and talk to you, I doubt that you'll pick the best long-term solution. It'll take a lot of courage to pick the best long-term solution.
I'd like to just go through the letter that I wrote. I am chair of the tobacco and illness committee of the British Columbia Medical Association. I direct a project which helps all the interested physicians that we can recruit in BC to help their patients stop smoking, and it now represents 400 physicians, 13% of the GPs in the province.
I just want to quickly touch on the recommendations. The bottom line here, I think every one of you will agree, is whether kids, children, continue smoking and continue easy access to tobacco.
Therefore, my first recommendation is that you track what happens so that you have an annual report that looks at what is the prevalence of underage smoking, where do kids get their cigarettes and what proportion of corner stores are selling to kids.
Second, the previous party mentioned the data from Woodridge, Illinois. It's in the Journal of the American Medical Association and it has been circulated to you. There is a gentleman there who should be in this room. He came to Victoria. His name is Sergeant Bruce Talbot and he can tell you, very clearly in no uncertain terms, why education and a voluntary approach did not work. He has no axe to grind. He just has his experience. The coincidence there was that there was a sociologist who was actually studying the subject of buying at stores as he was getting interested in it, and were it not for that coincidence, we wouldn't have the kind of information that Sergeant Talbot is able to provide.
The third point is, it's fine to pass a law but, for goodness' sake, whatever you decide to do, put some money into making it happen. It's so easy to pass a law and not put the dollars. This is a tremendous investment. The dollar costs of medical care that come from smoking are underestimated. I know about this. I did a doctoral thesis at Johns Hopkins after I got my MD on this very subject.
The fourth, and this I think is going to seem unpalatable to a lot of you, is that you have to provide for sting operations. How in the world is an inspector going to walk into a store and know if it sells to children? What they do in Woodridge, Illinois, is the police deputize 13-year-olds and that's the way they find out, and they do it on a regular basis.
They know that the baseline study was at 83% of vendors were selling to underage kids. They know that after the first volunteer vendor education program went in, it went up to 93%. They know that after the first warning that vendors got, it actually dropped only to 33%, and they know that after they closed down the stores just for one day and pulled the licences, after all these other things were tried, the next time they looked at the frequency of stores selling to kids, it was 0%, and three months later it was 0%. So you need to do sting operations. If you're concerned about underage kids buying cigarettes, there's no other way to find out. I wish there was a nicer word than "sting."
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Fifth, one of the things they also did in Woodridge, and I think Mr Wilson has just referred to it in a more exaggerated way, is that they are able to ticket any youngster who is in possession of tobacco, and the ticket goes to the parents. I recommended here that anyone who's duly trained and has the authority have the authority and obligation to confiscate tobacco a youngster has. Again, a ticket for possession.
With respect to your bill, section 6, I think the warning should be about what the warning to kids should be about, and that is not just health but addiction.
Section 12, aboriginals: You know, the cigarette is a white man's invention. It was introduced to the world in 1876 at the World's Fair. Natives did not use cigarettes. How many people in this room have ever seen a native ceremony involving tobacco? Several of you have. Four of you have.
I think I would speak for native use of tobacco in the traditional native way, and I wonder if you might invite some native elders to at least appear before the committee so as to arrive at a better definition, to arrive at a clear definition, of what native traditional use of tobacco is, because I'll tell you, cigarettes are not traditional native use of tobacco.
By the way, you should note that a cigarette functions, because of the physiology, as one of the most addicting forms of intake of tobacco -- not one of, the most addicting form -- because basically what happens when you inhale cigarette smoke is that you dump it into the arterial tree. It's even worse than injecting it into a vein in the arm. It gets to the brain right away.
So cigarettes are a very powerful, very negative form of tobacco use. Native traditional use is a much more elegant form, and I would urge you to get consultation about that, and also to seek definition. To me, this is a licence for native hustlers to hustle. I would fully support the wording of this to recognize truly native traditional use. I thought it was excellent seeing these youngsters here. I would urge you to speak to non-smoking youngsters who are adventurous enough to go into a store and try to purchase tobacco. Have you had any, or do you plan to have any, of that kind of testimony?
The Chair: We've had the students who are here, but it's they who have requested to come before the committee.
Mr O'Connor: We actually had a presentation yesterday from Halton region, I believe, where they had undertaken sting operations. The minister's position on sting operations, though, is that the minister doesn't want to conduct sting operations with people who are under the age of 19, but maybe people who are over the age of 19 who appear to be under the age of 19. But it has been documented and we've actually had presentations to the committee by people.
Dr Bass: This girl, aged 13, who made the front page of the Province -- the headline is: "Dead Easy: It's Like Helping Kids Commit Suicide, Says Young Cigarette Buyer" -- appeared before the Legislative Assembly committee, the select committee, and I think the testimony of a youngster who isn't a smoker would be really very informative for you.
I would like to congratulate you on including pharmacies in the designated places. We don't have any randomized control trials. Some things you do, you just have limited evidence on, but I think -- and this is my feeling; there is no hard evidence on this -- that children, when they see cigarettes and candies sold in a pharmacy, are getting the wrong message. I think that if the pharmacy is going to be part of the health care system, it shouldn't be selling the number one preventable cause of death.
Mr Eddy: Dr Bass, thank you for taking the time to appear before us and making the presentation, especially for suggestions to improve Bill 119. I notice in talking about the best long-term solution to tobacco control, however, you did not mention anything about a ban of tobacco products or making tobacco indeed illegal. Realizing, and you may be aware, that there is a very large underground economy in contraband cigarettes, especially in this province, completely out of control -- you may be aware of that -- what do you think of a ban now or in the future some time?
Dr Bass: I would not be for a ban. I think it's impractical. But I would be for something that Ontario shied away from. I was very excited about your considering sale only in provincial stores. The number of people buried via tobacco is four times that buried via alcohol, and we have provincial stores in BC for alcohol but not for tobacco. We don't even know how many vendors there are in BC for the most addictive and lethal product around. So that would be the direction, I would think, to go. Put it in a provincial store.
The Chair: Dr Bass, I regret that we're at the end of the day and I'm afraid we still have several presenters, but I do want to thank you very much for coming, as I said at the beginning, from so far away. For the documentation, I wonder if before you leave the clerk might just be able to make a copy of that one article you showed, the one you had of the student.
Dr Bass: Oh, the student. Okay, sure.
Mrs Haslam: Mr Chair, I would like clarification here. Remember when I talked about 3,000 adolescents become new smokers daily and everyone said no, it was a month. This article says it's 3,000 adolescents become new smokers daily. Is that in the States compared to 3,000 a month in Canada? Are you aware of the discrepancies in this information?
Dr Bass: Well, the States is always 10 times what Canada is. That's my formula, and it works usually.
Mrs Haslam: This documents says what I said, 3,000 adolescents daily start smoking.
The Chair: That's something perhaps we could ask Bob to check out.
Mrs Haslam: Thank you. That's fine. I just noticed that, and I was called up on it.
Dr Bass: May I just say one thing to Mr Eddy? Please, if you're interested in smuggling, look at the cancer society -- an excellent report. The recommendations in this report are not discussed in the media.
Mr Jim Wilson: That's the most recent one?
Dr Bass: Yes. This is January 1994.
The Chair: I was just going to say with that we have had a number of the cancer divisions in Ontario and we will be having a submission from the Canadian Cancer Society. I suspect they will bring that forward.
Dr Bass: One of their recommendations is to encourage provincial licensing in order to do something about smuggling. Certainly, if you went to a provincial store, that would be the ultimate in terms of controlling the flow of tobacco -- cigarettes.
The Chair: Again, thank you very much for coming before the committee. We'll return that clipping momentarily.
CARMEN PAQUIN
The Chair: If I could then call on Ms Carmen Paquin, I'm sorry we're running a little bit late, but we welcome you and look forward to your presentation.
Ms Carmen Paquin: Thank you. Good afternoon to Mr Chairperson and Mr Arnott and the committee people as well. My presentation is very short.
We do not debate whether cigarette smoking is harmful to the smoker or whether secondhand smoke affects non-smokers. The problems arise when the smokers smoke in areas where others are affected, primarily anywhere in an indoor area. Since we spend 92% of our time indoors, the air that we breathe becomes very important.
Since voluntary policies do not work, it becomes necessary for government to make legislation that will work. It is difficult for me to accept that provinces have not come up with satisfactory solutions when the federal government has done so, and I speak primarily of the no-smoking policies in the federal bill called the Non-smokers' Health Act, which prohibits smoking in any federal building or on federal property, a policy which has been in effect since January 1988 and is 100% successful. Smoking should not be permitted at any time or in any place, whether it is a workplace or a public area. There should be no designated smoking area.
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Because children and teenagers are not sufficiently informed about the dangers of smoking, they cannot make an intelligent decision whether to smoke or not. Restricting tobacco product purchases by raising the age to 19 is a step in the right direction and will help in the ongoing process to educate children, teenagers and adults to the harmful effects of tobacco products.
Removing the sale of tobacco products from such places as hospitals and medical buildings, psychiatric facilities, nursing homes and pharmacies, especially pharmacies located inside hospitals and medical buildings, is absolutely necessary. The above establishments which continue to sell tobacco products should consider no longer referring to themselves as health care professionals, because that is a contradiction.
I know of two pharmacies that have chosen to not sell cigarettes and have suffered no financial disadvantages. One has never sold cigarettes in 20 years and the other has replaced that area formerly occupied by cigarettes with natural health care products.
I am making a presentation today because I know that tobacco products kill. I will work to help the government make changes through public education, community programs and legislation, all of which are necessary to prevent people from starting to smoke, for helping smokers to quit and to protect people and animals from harmful effects of secondhand smoke. I would like to thank and support the Honourable Ruth Grier, the Ontario Minister of Health, for presenting a strong piece of legislation.
Mr Wessenger: Thank you for your presentation. You indicate you'd like to see the restrictions in smoking in public places strengthened. By "public places," do you mean interior space? You basically mean interior, not outdoor, space.
Ms Paquin: Yes, shopping malls and those kinds of places where I feel I don't have a choice when I go in there, so I choose to not go to such places.
Mr Wessenger: Fine, thank you.
Ms Paquin: I have a couple of comments, if I may. Is this being recorded?
The Chair: Yes, it is.
Mr Jim Wilson: It will be repeated tonight too, so you can go home and watch it.
Ms Paquin: Really? No, I'm not going to do that.
Mr Jim Wilson: I just have a question because I really haven't had a chance to ask it before, I don't think. There's the prohibition banning the selling of cigarettes and smoking, I guess, in psychiatric facilities. We did get a petition from Penetanguishene Mental Health Centre, from the residents' council. Actually, I think it's a council that is an advocacy council for residents; it's non-residents who are advocating for the residents inside. There were quite a few names on it, saying that it just really added stress to their lives.
We do know that there's a higher percentage of psychiatric patients who smoke than the rest of the population. Have you given any thought to that? I'll have to dig it out, but they claim that it would add more stress to their already stressful lives if they couldn't smoke, and I think it has put the government in a bit of a predicament. I don't think we're quite sure what to do with it.
The Chair: Before she answers, did you say that you understood that they cannot smoke in psychiatric institutions today? Because I thought in fact they could.
Mr Jim Wilson: No, they can in designated areas. Under this new act, they won't be able to buy any, and they can't go out to buy them. I'm not sure, in terms of being prohibited to smoke, whether or not -- because we don't know what the regulations are -- they'll even be able to smoke there.
Ms Paquin: The first point is that nicotine is not a stress reducer, so for them to not be able to smoke would not be an increase in stress; it would be a reduction. Every 30 minutes, when they believe they would like to have a cigarette to lower their stress levels, they're fooling themselves; they're increasing their stress level.
The other thing is it's just plain and simply blackmail. That's what that is. What about the health care workers who have to be inside that room, along with alcohol counselling or whatever? They themselves are being exposed to a group of 20 or 30 or 40 people who say they cannot go an hour for their counselling without smoking, and those people who are the health care workers have no choice. They should have a choice.
The Chair: Thank you. You said you wished to add something?
Ms Paquin: Yes, I was listening to Dr Bass, I think his name is. I know this subject very well. One of the things they have discovered is that it takes as little as three cigarettes for a child to become addicted. They say that if a child is around the age of 10, he or she can smoke three cigarettes, or over a period of three months several packages of cigarettes, and they are addicted for life. So I think it was important to raise that point.
I was involved federally with no smoking on airplanes and I was a principal player in that. If people can go 12 hours without smoking on an airplane, there is no reason on this earth why they cannot work eight hours in an office without smoking. I very seriously present that to you. I know it; I'm there. I'm a flight attendant with Air Canada, and we have a huge success. I say to you, if we can do it, anybody else can do it.
The Chair: Thank you very much for coming before the committee today.
UNIVERSITY OF TORONTO, FACULTY OF PHARMACY, CLASS OF 1994
The Chair: I call on our last presenter, or presenters -- I'm not sure -- from the University of Toronto, faculty of pharmacy, class of 1994. You are all welcome to the committee. Please just introduce yourselves and go ahead with your presentation.
Ms Mona Sabharwal: As you said, we are the graduating class of 1994 at the faculty of pharmacy. My name is Mona Sabharwal. I'm currently the class of 1994 vice-president.
Mr Tony Antoniou: My name is Tony Antoniou. I'm the graduating class president.
Ms Arima Ventin: My name is Arima Ventin. I'm the secretary-treasurer from the 1994 council.
Ms Sabharwal: Again, before we begin, I'd like to thank you for your time and the opportunity to express our views regarding Bill 119. You may be wondering why, as students, we are interested in speaking to you today on Bill 119. I'll just explain that to you.
I'm sure you've had many pharmacy groups come and speak to you regarding this issue. We all feel that as future practitioners we offer a different perspective. As students we do support Bill 119 in its efforts to remove tobacco from pharmacies as well as recognizing pharmacy as a health care facility.
We'd like to present three main ideas that we feel are central to the issues around Bill 119. Those are mainly ethical, professional and economic issues. I'd like to point out that the debate so far has really centred on economic issues, and we all feel very strongly that the debate should centre more around the professional and ethical issues.
In school what we are taught is to be health care providers. We are taught to put the health of our patients at the focus of our practice. We do this by identifying, resolving and preventing drug-related problems. Also, given the accessibility of pharmacy as a profession, we feel that pharmacists can play a key role in promoting general overall good health: diet, exercise and leading a healthy lifestyle basically. Thus, we find that selling cigarettes and tobacco products in a pharmacy setting is contradictory to the role of a health care professional.
We all know that smoking is a killer. There have been many studies that show that smoking increases the risk of serious lung diseases such as chronic obstructive pulmonary disease. It is the leading cause of preventable death in Canada. This is undebatable. We feel that pharmacies should be points of smoking cessation and not smoking initiation. We feel counselling on smoking cessation is worthwhile for pharmacists because studies have shown that a small, three- to five-minute conversation with many smokers can result in approximately 6% of smokers quitting smoking, and 6% of a large population can have a great impact.
As well, looking at this issue from an ethical viewpoint, the Ontario College of Pharmacists has created a code of ethics. In that code it strongly suggests that pharmacists focus the patient, again, at the centre of their practice. It also stresses that pharmacists should not knowingly provide a patient with a product that they know will harm them. This is an ethical principle that is known as non-malfeasance. Again, selling tobacco products contradicts that ethical principle. It is unquestionable that nicotine and the other various chemicals found in cigarette smoke are indeed harmful to patients.
We recognize the fact that decreasing the availability of cigarettes may not stop people from smoking, but what we do realize is that it may prevent people from starting. We also realize that pharmacists can play a great role in providing support and assisting patients in quitting smoking. Again, I'd like to stress that point of smoking cessation.
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Finally, we recognize there is an economic impact of Bill 119. It affects consumers, it affects retailers, it affects government. So it affects most Ontarians. Many groups have claimed impacts such as over 300 pharmacies closing if tobacco products are removed from pharmacies. They've also claimed up to 10,000 jobs being lost. For other remaining pharmacies that are open, they predict quite a bit of downsizing.
We find some of these claims a bit questionable, simply because of the fact that cigarette sales only account for about 1.5% of average total sales. If you compare that to, say, cosmetics in a pharmacy setting, that's about 3.6%. We know many pharmacies that have successfully not sold cosmetics and are still in business, so we feel that removing tobacco sales really is not going to have that much of an economic impact on pharmacy business.
What we think we should focus on are the indirect costs of smoking and tobacco sales. We know that smoking increases the number of sick days that people need, it increases doctors' visits and it increases the number of medications people use. So it becomes a public concern when the government and employers and the public have to pay for all these services and medications that people must use. Again, it becomes a concern for pharmacy, because as a health care profession, we'd like to have a common goal with the government in reducing overall health care costs, as well as seeing a decrease in patient mortality and morbidity.
Some closing remarks: I'd like to stress that the debate by many pharmacy groups has been on the economic impact of Bill 119 and removing tobacco from pharmacies, but we'd like to move that debate to a more professional and ethical debate and not an economic one.
Again, I'd like to thank you. We'd be very open to any questions you may have.
The Chair: Fine. Thanks very much. There are some questions, and we'll start with Mr Wessenger.
Mr Wessenger: Thank you very much for your presentation. We had an earlier presentation today by a pharmacist who indicated that he had found many opportunities for pharmacy with respect to expanding its role in the health area by going into other health products. Even from a business point of view, he felt that there were enough economic opportunities for the pharmacist, so it wouldn't be an undue restriction to take away tobacco. Do you feel there are many economic opportunities for pharmacists in the health area?
Ms Ventin: We feel that removal of tobacco products from pharmacies shouldn't be substituted with another product. A lot of pharmacists come up with the idea that once you remove one product from the shelf, you should replace it with another one. What we feel we could do in this area is, instead of replacing it with another product, use our services. So we think we can make up for the removal of tobacco with using our services to provide smoking cessation and improving patient counselling, increasing the areas that are used for patient counselling and speaking with patients about other matters as well.
Mr Jim Wilson: Thank you for your presentation. I think if the 1994 class and all of your successors come out of university with the same attitude, then we won't have any need for this particular provision that has created so much controversy in this legislation. It's always nice to see people from my own alma mater, the University of Toronto.
I think, though, when you make your presentation, you talk about the training you've had, which is modern-day pharmacy training, which is far more focused on the provision of health care, less on retail.
When someone like Larry Rosen graduated in the 1950s, and we all know Larry, he learned more about retail when he first started into pharmacy. He learned his pharmacy in school, and then apprenticing under a pharmacist, he learned a lot about retail. He and so many other pharmacists who appeared before us make no bones about the fact that it is just an economic issue for them.
In fact I thought he was extremely honest in the press conference the other day, saying, "Yes, it's an ethical dilemma." I don't think he has come to solving it in his own mind. But it's the only way that he learned pharmacy, and his pharmacies have become dependent on the retail side. In his case, he tells us there's the need to sell cigarettes to keep up with the competitors.
What do you say? I think there's hope in the future, and I assume most of your classmates have similar feelings to yourself. Is there any way we should be grandfathering people like Larry Rosen who have been in the business for 40 years and who sell cigarettes? Do we say, "Whenever you sell your business, the next pharmacist-owner who comes along can't sell cigarettes"? Anybody ever give any thought to that?
Mr Antoniou: I think it's important that pharmacists take a step back for a minute sometimes and rethink what they are there for. A pharmacy is not given the right to dispense drugs and to provide patients with information so that it can go and then determine what it can merchandise. A pharmacy is there first for its patients.
Regardless of when you graduated, even back in the 1950s, you were still taught to provide the best product. You may have been taught that on the job, but we are not taught how to be merchandisers. We have always been taught how to be the best possible health care providers.
I think pharmacists have to rethink what their purpose is. Their purpose is not to supply products conveniently; their purpose is to be the most knowledgeable expert on drug therapy. I think all pharmacists have to rethink that, rethink what they are there for.
Mr Jim Wilson: This is a point that was raised today with the so-called non-traditional pharmacies, and that is the pharmacy counter at the back of a Zellers store. I thought it was a fairly compelling presentation. The pharmacist said it would be very difficult for him to think that the customers coming in the front of the Zellers store in any way connect those products with the pharmacy department in that store. Yet under this legislation they won't be allowed to sell cigarettes in the front of the pharmacy store. Keep in mind this is a legal product. We're not banning the sale of cigarettes, we're just banning it in one retail sector or health sector, depending on -- they say they're both.
Ms Sabharwal: I think that's the problem that pharmacy has always had, distinguishing whether it is a retail profession or a health profession. I know today it can't really be considered as a retail profession. This is what we are taught anyway, because we're not given the skills to know how to become a good merchandiser or a good retailer.
It really is hard for many pharmacists to come to grips with that themselves. It may be easier for us because we've only had that health background. But I agree, it is very hard for someone to differentiate -- for many consumers, for other professionals maybe. But I'd definitely like to stress that we think of pharmacy as a health profession and, as such, economics shouldn't really come into play for us.
Mr Antoniou: I think the message we want to give basically is that a pharmacist can no longer wear two hats. He or she cannot say, "At the back of my store or in whatever part of the store I am, I will provide the patient with knowledge about this and I will talk to them about their medics and I will talk to them about their condition and help them improve their lifestyle, while then at the front of the store there's promotion for a product that contradicts everything I'm attempting to do at the back of the store." I think the emphasis has to be put back on the health.
Ms Ventin: With regard to the issue of Zellers or a store like Loblaws that has a large front shop or a grocery store type store with a pharmacy added on, I think the belief is that if you're going to own a pharmacy, it's a pharmacy, stop, period, end of story.
What a pharmacy is there for is to give information to the patients and to provide appropriate drug therapy to those patients. It's not there for convenience reasons, to sell Kleenex boxes, to sell vegetables, to sell the deli products to get your sandwiches, or tobacco products. I think part of the focus has to be that pharmacy is a health profession, and pharmacies should be looked at in that way.
Mr Jim Wilson: The reality is the act does look at it the other way too in terms of the Zellers store. They will be prohibited from selling a product.
Ms Ventin: Then they would have to comply with those regulations. I think if they want to take on the idea of having a pharmacy in their stores, then they should have to look at the ideas that go behind owning a pharmacy and what the principles are there for and what pharmacists do. If they have problems with that, for example, the removal of tobacco from those stores, they'll have to rethink their decision of bringing a pharmacy into their store.
The Chair: Last question, Mr White.
Mr White: We've had a lot of discussion about pharmacy. That's been one of the major issues before our committee. We haven't talked too much about school yard smoking and other kinds of phenomena, but there have been a lot of pharmacists who've come in front of us on both sides of this issue. Many pharmacists say they're retailers; others say they're health care professionals.
I'm wondering, seeing as you're in the process of graduating and becoming licensed pharmacists in the province of Ontario, how many courses did you take in your degree, or will you be taking by the time you complete, whose focus is on retailing?
Ms Sabharwal: None.
Mr White: None. Are you aware that some 17% of the tobacco product in this province is sold in pharmacies, which would equate to the death of about 2,000 people a year? That creates a moral dilemma, I would think.
Ms Sabharwal: Exactly. That's what we see the debate as, a moral and professional dilemma. Obviously it is a professional dilemma, since many professionals can't seem to figure out whether it is retail, just even trying to figure out what pharmacy is. It's a professional dilemma for some professionals. This is the problem, and that's why we feel the debate should centre on the fact that it is an ethical dilemma and not an economic one.
Mr White: Clearly your course of study has not entailed one single course in retailing.
Ms Sabharwal: No.
Ms Ventin: I think that was a really good point, that there are so many deaths with smoking, and that's why we do take a very strong stand in that we feel that our role is in smoking cessation. That's what we really want to accomplish.
Ms Sabharwal: I think any health professional right now should realize that the goal is now towards health promotion, and it's impossible to do that when, at the same time, you're selling a product that you know will cause your patients harm. Pharmacists should realize that role, that they should be a resource for patients to have a healthier lifestyle, not an unhealthy lifestyle.
The Chair: Thank you again, all three, for coming. It's been a long day, but we really appreciate it and found your presentation most interesting.
Ms Sabharwal: I'd just like to thank you again and as well mention that we will have a written submission handed in tomorrow, but unfortunately we've had quite a bit of homework to do.
The Chair: That's good to know, because we're interested in standards too.
Members, just before you leave, again to remind everyone that we reconvene on Monday in London at 11 am. It's London, Ontario, Mr Eddy, in case anyone is thinking of heading to England. On Wednesday we are in Sudbury.
With that, the committee stands adjourned until 11 o'clock Monday morning in London.
The committee adjourned at 1744.