Up In Smoke

Nova Scotia has taken some strong steps to curb use of tobacco and related products. There is the opportunity to do more.

The tobacco industry has waged a decades long campaign to prevent the truth about its products from becoming public knowledge. The fight is not yet over.

The first line of defense was that the connection between smoking and cancer was unproven. The US Surgeon General’s report of 1964, built on 7,000 articles that had been published by that date, concluded that there was a definite link. This led to the introduction of health warnings on packages, bans on certain kinds of advertising, and and the beginning of public education programs about the dangers of smoking.

The second battle was over nicotine. For years, the industry denied that nicotine was addictive. In fact, as one senior industry researcher observed to colleagues during the sixties, “The cigarette should not be conceived as a product but as a package. The product is nicotine.” Another industry executive likewise concluded that the industry was “in the business of selling nicotine, an addictive drug.” Needless to say, these observations did not immediately become public.

In 1996 Jeffrey Wigand, a research executive at tobacco company Brown & Williamson, became a whistle blower. As depicted in the movie The Insider, he revealed that the company had been intentionally boosting the nicotine delivered to smokers of its cigarettes, so as to increase their addictiveness.

The prolonged campaign to discourage smoking has been remarkably effective. Overall smoking rates reduced from 35% in 1985 to 16% in 2012. For young people aged 15-19 the reduction has been from 27% to 11%.

It is with this history in mind that we should view last week’s announced changes to tobacco legislation, which have two main thrusts.

First, the sale of flavoured tobacco (other than menthol) will be banned, including the flavoured juice often used in e-cigarettes. Flavoured tobacco products are an important part of that market, representing fully half of young people using tobacco products. The flavoured products are clearly targeted at younger customers.

Second, e-cigarettes will be subjected to the same regulations as tobacco products. E-cigarettes have become a new package for delivering nicotine, and as such have the same potential for being addictive. Though they are probably less harmful than tobacco products, studies are already finding the potential to deliver carcinogens. E-cigarettes will now be regulated in the same manner as tobacco, including forbidding sales to young people and restrictions on display or promotion.

The reactions are predictable. Imperial Tobacco, conveniently ignoring that nicotine is the real product, argued that e-cigarettes don’t contain any tobacco and regulating them the same way is a mistake.

The e-cigarette industry, recycling tobacco-defense arguments of the sixties, called Nova Scotia’s move “a ‘knee-jerk’ reaction based on incomplete science”. While agreeing with age restrictions, they argue that e-cigarettes are harm-reduction products if they help people give up tobacco. Perhaps so, but the product is still available to adults under the proposed legislation. Presumably, promotions and candy flavours in e-cigarettes are not important to helping adults wean themselves from tobacco.

Canada does not yet have good statistics on youth e-cigarette use. In the United States, the Centers for Disease Control found that more than a quarter-million youth who had never smoked used e-cigarettes in 2013, and that they were almost twice as likely to have intentions to smoke conventional cigarettes as those who had never used e-cigarettes. So e-cigarettes appear to be a gateway product to tobacco.

The campaign to reduce usage of tobacco and related products should continue until the numbers, particularly among young people, are trivially small. Nova Scotia’s government has established a leadership position with its new initiative, but more can be done:

  1. Slowly reduce the number of distribution points for tobacco and e-cigarettes. Allow no new retailers, and gradually phase out the licenses of existing private locations, perhaps with some compensation. In ten years’ time, have NSLC stores and previously existing tobacconists be the only distribution points in towns and cities.
  2. Eliminate branding. Require that all packaging not occupied by required health warnings be in a particularly unattractive brown. Assign a number to each product as the only distinguishing feature. Give the companies a month or two to tell customers what their product’s number will be. This is being done in Australia, and considered by other countries including New Zealand, Ireland, and France. Judging by the frenzied industry response, it must be having an impact.
  3. In addition to current age restrictions, make it illegal to sell to anyone born after 2000, so that it will never be legal to sell to today’s children.

Tobacco products and e-cigarettes are harmful to those who use them, and add to the cost of our health system. The industry that makes them has consistently hid the truth about their impact. The Liberals have taken some excellent steps to continue the successful battle against usage. They should not stop there. 

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