Interventions in Committee
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Gregory Taylor
View Gregory Taylor Profile
Gregory Taylor
2014-11-19 17:43
Not at all; in fact I report directly to the Minister of Health, so I'm on equal footing with the president. The two of us report, so we now have two people working full time to run the agency and run outbreaks, for example.
If anything, it will enhance the role of the chief public health officer, because I can exclusively focus on ebola, on public health issues, on speaking to Canadians, on international connections, with the provinces and territories.
View Mike Allen Profile
Yes, I would, Chair.
I want to follow up with Mr. Taylor with a question specifically referencing your remarks where you said:
...we've been moving this way as an agency for some time now and have, in fact, adopted this type of management structure since 2012. At that time we began to separate out the roles and responsibilities of the CPHO on an interim basis.
Can you comment about the conflict during that two-year period? It sounds to me as if you've been doing some of the administration and everything else. What percentage of your time has been allocated to what we'll call the back-office things, as opposed to the things we really want you to do?
Gregory Taylor
View Gregory Taylor Profile
Gregory Taylor
2014-11-19 17:46
During that period of time, which was precipitated by David Butler-Jones' stroke and his stepping down, Krista Outhwaite continued as the acting deputy head and I was the deputy chief public health officer. So we separated the role and I focused on the content of the CPHO role and she focused on management. In essence we've been functioning like this for the last two and a half years, which I think has been very effective. I think I've been able to focus on a number of issues as the deputy chief public health officer, H5N1, etc., as we've been moving forward.
All this does in the current situation is stratify and formalize that role of the new CPHO.
View Andrew Saxton Profile
Thank you, Chair.
I just want to clarify that the chief public health officer is not losing any influence or advising powers when it comes to health issues with regard to division 20.
Sylvain Segard
View Sylvain Segard Profile
Sylvain Segard
2014-11-05 17:38
That is correct. The measure simply separates the authority for management and moves that over to the new president's function, whereas the CPHO will continue to have the same responsibilities and ability to advise directly the minister or Canadians on all matters related to public health.
View Matthew Kellway Profile
Dr. Britton, if I were to characterize your comments about the other risks that attend the e-cigarettes, including other substances that come out of these things in the vapour as somewhat more casual—I think your comment was that we can manage these risks—can you explain that? Is it the harm reduction approach that you take that suggests that we have a bigger issue to deal with the combustible cigarettes and, therefore, let's get on with figuring this out and set those longer term risks aside?
John Britton
View John Britton Profile
John Britton
2014-10-28 12:27
I wouldn't completely set them aside. I think one area that I would disagree with my colleague on here is that the risks of electronic cigarettes are unknown and will vary from product to product. Poor quality products burn or heat the nicotine less effectively and less thoroughly and produce more toxins than others, but with a good quality product the level of risk, although unknown, is in an order or two orders of magnitude lower than that of inhaling cigarette smoke. So whilst there is a risk there, that risk is trivial in comparison to the risk of continued smoking. The challenge is to try to minimize that risk as much as possible. As has been argued, it will be decades before we know what the impact of that is. But to minimize that risk by making the emissions as clean as is reasonable....
I think the risk is very low. So it's not that we can ignore it but I think we just have to keep it in perspective.
View David Wilks Profile
Thank you very much to both parties appearing today.
Firstly, Professor Britton, regarding a commissioned report to Public Health England, which you were involved with in May of this year, I wonder if I could just ask you a couple of questions. Part of that report said:
Electronic cigarettes, and other nicotine devices, therefore offer vast potential health benefits, but maximising those benefits while minimising harms and risks to society requires appropriate regulation, careful monitoring, and risk management. However the opportunity to harness this potential into public health policy, complementing existing comprehensive tobacco control policies, should not be missed.
What potential health benefits do you see in e-cigarettes as they currently exist? What changes to the current regulatory systems, if any, would be needed to maximize those benefits?
View David Wilks Profile
What potential health benefits do you see in e-cigarettes as they currently exist?
John Britton
View John Britton Profile
John Britton
2014-10-28 12:29
The current benefits are massive because lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease are the three biggest killers from cigarette smoking. Those conditions are, so far as any of us knows, caused almost entirely by constituents of tobacco smoke other than nicotine. It's not to say that nicotine is completely safe, but it's not the cause of the harm from tobacco smoking. So the benefits of electronic cigarettes are that if the entire population of smokers in Britain switched to electronic cigarettes from smoking tobacco, we would see the incidence of those conditions drop dramatically—heart disease in the very near future and COPD and lung cancer in the more distant future.
View David Wilks Profile
One of the questions I would have—and I'll relate to one of my family members who's a smoker, my lovely son, who has taken up e-cigarettes—is this. He will smoke e-cigarettes at home. He's part of our military family so when he goes on an exercise and he can't plug the e-cigarette in to recharge it, he goes and buys a pack of cigarettes because he can't still do without the nicotine. So my question to both you, Dr. Britton and Dr. Peruga, is this.
Aren't we just really substituting one for another? It seems to me from firsthand knowledge that I can see that we may be just substituting one for another. I understand the benefits. I can see potential benefits there. But how do we stop those people, for lack of a better word, from being dually addicted to two different substances? How do you stop that?
I'll start with you, Dr. Peruga, and then go to Dr. Britton.
Armando Peruga
View Armando Peruga Profile
Armando Peruga
2014-10-28 12:32
You pose a very interesting question, which is at the heart of the matter. It's that the potential benefit would be maximized when the great majority of smokers substitute entirely for electronic cigarettes. If that happens, the potential will become important.
There's a problem we see, at least in the research that has been published in terms of clinical trials, which are very limited in terms of how efficacious they are.... This doesn't amount to a body of evidence, but some of them show that they have a low efficacy, which leads basically to dual use in most of the smokers. It's difficult to know whether that's good or bad, because obviously you can make the argument that, well, if you smoke two cigarettes less a day, that's an advantage. The problem is a sore one and it's difficult to respond to, but there are two other questions you have to pose.
One, we know that the maximum benefit from quitting smoking is not necessarily in reducing the amount of tobacco. The risk reduces primarily from the duration of the use and not the amount used, so that's a concern. I'm not saying that this is the only factor to consider, but the fact that people will continue using tobacco will mean that the potential benefit of electronic cigarettes is greatly diminished.
The other thing is this: what does it mean to have dual use? I think we can agree that the ultimate goal is obviously to switch entirely from tobacco to ENDS and, if possible, to abandon the addiction to nicotine. Whether dual use is able to achieve that in the long term or offer possibilities to go back to the use of tobacco is something that is uncertain.
I'm sorry that at this point I have more questions than answers, but it is indeed a very important issue.
John Britton
View John Britton Profile
John Britton
2014-10-28 12:35
Well, I would say that your son is not addicted to two products. He's added to one thing, which is nicotine, and he's finding it from wherever he can get it, so the more alternative sources of nicotine there are out there for him, the better.
Being a smoker is like being trapped in a nightclub when a fire breaks out. You need as many exits as possible, and it doesn't matter which one you use.
However, dual use is common with these products, just as dual use is common with medicinal nicotine. But what we do know, and the British National Institute for Health and Care Excellence has accepted this in its guidance on harm reduction, is that dual users are much more likely to quit smoking completely than people who never experiment with an alternative nicotine product. So the outlook for your son is good: he's going to quit, but it may take him a year or two to get around to it. That's the reality.
The strength of electronic cigarettes is that it draws people like your son to try nicotine products, people who otherwise wouldn't. The history of NRT is that it's used by a small minority of smokers, and electronic cigarettes by a much greater proportion.
View Libby Davies Profile
Thank you very much, Chairperson.
First of all, it's been a very interesting discussion to hear your perspectives.
I'd just like to go back to Professor Britton and speak about the experience in the U.K. I do think there's a lot of mythology around addiction. The stuff that I've read argues that probably the most common and one of the most powerful addictions, which you alluded to, is caffeine. In fact withdrawal from caffeine is very, very severe, as anyone who has tried it will know. Yet it's so culturally accepted in our society that we barely talk about it. So there is relativity in this discussion.
I'm very curious to know about the British experience in terms of how the debate went politically. You speak about harm reduction, risk minimization, and how less is better than more; e-cigarettes are better than people smoking outright combustible cigarettes and so on. Yet in the debate we have here, there's a great fear about a harm reduction approach. It has almost become a bad terminology to use. We keep coming back to this notion that it's only zero tolerance and prohibition, which to my mind means chaos, and that it's somehow a better approach. I don't subscribe to that myself.
I just wonder about how the debate went politically. You talked about two different governments that adopted this approach. What was the debate like in the U.K. around e-cigarettes and from a harm reduction point of view?
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