Wednesday, 23 October 2019

Job not done! Half a million Canadian workers are still exposed to second hand smoke on the job.

This week an updated report on the Burden of Occupational Cancer in Canada was circulated.

The research was prepared by the Occupational Cancer Research Centre with financial support from the Canadian Cancer Society and the Canadian Partnership Against Cancer.

The results on occupational exposure to second hand smoke might surprise those who think that workers are currently protected in Canada. By the CAREX's estimates, over half a million workers continue to be exposed.

Below (with permission) the sections of this report are reprinted.

------------------------------------------------------------

 SECOND-HAND SMOKE


Second-hand smoke is a mixture of solid particles and gases released from burning cigarettes and exhaled cigarette smoke (122). This mixture contains numerous carcinogenic substances such as benzene, formaldehyde, and benzo(a)pyrene (122, 123). Second-hand smoke is a wellestablished lung carcinogen, with limited evidence that it may also cause cancers of the larynx and pharynx (122). A large study that examined the effects of secondhand smoke exposure in workplaces found that the risk of lung cancer increased by 24% among non-smoking workers who were exposed to second-hand smoke. The study also found that among workers who were classified as highly exposed to second-hand smoke, the risk of lung cancer increased by 100% (124). Other health effects associated with exposure to second-hand smoke include heart disease, exacerbation of asthmatic and allergic reactions, and premature death (123, 125, 126). The 2006 United States Surgeon General’s report concluded that any exposure carries some risks to respiratory health (126).


EXPOSURE


All Canadian provinces have smoke-free regulations that restrict smoking in almost all enclosed workplaces, while some provinces allow a separated ventilated room to be built in the workplace (123). Some provinces have made exceptions for certain workplaces. For example, Ontario allows for controlled smoking areas for residents of residential care and psychiatric facilities, facilities for veterans, and hotels, motels or inns (127). In most provinces, the regulations set out permitted distances that smokers may smoke away from building entrances, windows and air intakes, although the distance varies by province, ranging from 5 metres in Alberta (128) to 6 metres in British Columbia (129), and 9 metres in both Ontario and Quebec (127, 130).

Despite a legislated smoking ban in indoor workplaces, CAREX Canada estimates that exposure still occurs and approximately 520,000 Canadian workers are exposed to second-hand smoke in their workplaces (131). The proportion of workers exposed to second-hand smoke varies by occupation (Figure 25). The sectors with the largest number of workers exposed to second-hand smoke include: trades, transport and equipment operations, where approximately 50% of exposure occurs, followed by sales and service industry (13% of all exposed workers). The largest number of exposed workers are employed in Ontario, Quebec and Alberta.


Figure 25
 Number of workers occupationally exposed to
secondhand smoke by level of exposure
and industry in Canada in 2006.



BURDEN


An estimated 130 lung, 35 pharynx and 20 larynx cancers are diagnosed each year in non-smokers in Canada. The attributable fraction of lung cancers due to occupational exposure to second-hand smoke is 0.6%. Most lung cancers due to exposure to second-hand smoke occur in the manufacturing sector and wholesale and retail trade (Figure 26). 


Figure 26
 Industry breakdown of total lung cancers attributed
to occupational exposure to secondhand smoke
in Canada in 2011.

Figure 27 presents the occupational burden of lung cancer attributable to secondhand smoke, by province. In Manitoba and Saskatchewan the attributable fraction is slightly higher, where approximately 0.7% of lung cancers diagnosed are due to occupational exposure to second-hand smoke. Differences in the breakdown of the labour force within provinces likely contributes to variations in attributable fractions across provinces (Figure 27). Burden estimates for second-hand smoke are presented here for non-smokers due to the difficulties in separating the impact of personal smoking and second-hand smoke exposure on cancer risk.



POLICY RECOMMENDATIONS FOR SECOND-HAND SMOKE


The general, overarching policy recommendations, presented later in this report, can be applied to second-hand smoke, in addition to the following specific recommendations: 

Build on successes by strengthening current smoke-free legislation and its enforcement. 

Exposure to second-hand smoke has decreased in recent decades as a result of new legislation, increased awareness of the health effects associated with secondhand smoke exposure, and populationwide changes in smoking behaviour (132). However, workers continue to be exposed, even in workplaces with smokefree policies, indicating that enforcement of existing policies may be an issue (131). Furthermore, the strength of smoke-free legislation varies by province. For example, only Ontario’s legislation specifically states that home health care workers have the right to request that a person refrain from smoking in the health care workers’ presence, and the degree to which this is enforced is unknown (127). Smoking bans have been evaluated as the most effective measure for reducing second-hand smoke exposure (133). Legislation must be expanded across provinces to protect workers who are not covered by current legislation (i.e., outdoor workers, workers providing services in client’s homes). Furthermore, efforts must be jointly taken by agencies responsible for public health and Ministries of Labour to enforce smoke-free legislation in workplaces across all provinces. These efforts could include aligning their regulatory and enforcement strategies to the extent that their individual mandates will allow. 

REFERENCES

122. International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans. Volume 100E. Part E. A review of human carcinogens. Personal Habits and Indoor Combustions. Lyon, FR: International Agency for Research on Cancer; 2012. 
123. Canadian Centre for Occupational Health and Safety (CCOHS). OSH Answers Fact Sheets. Environmental Tobacco Smoke (ETS) [Internet]. 2017 [cited August 15, 2019]. 
124. Stayner L, Bena J, Sasco AJ, Smith R, Steenland K, Kreuzer M, et al. Lung cancer risk and workplace exposure to environmental tobacco smoke. Am J Public Health. 2007;97(3):545-51. 
125. Leone A, Giannini D, Bellotto C, Balbarini A. Passive smoking and coronary heart disease. Current Vascular Pharmacology. 2004;2(2):175-82. 
126. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006.
127. Government of Ontario. Smoke-Free Ontario Act, 2017, S.O. 2017, c. 26, Sched 3 [Internet]. 2019 
128. Government of Alberta. Alberta Regulation 240/2007, Tobacco and Smoking Reduction Regulation. Edmonton, AB: Alberta Queen’s Printer [Internet]. 2018.
129. Government of British Columbia. B.C. Reg. 232/2007, Tobacco and Vapour Products Control Regulation. Victoria, BC: Queen’s Printer [Internet]. 2019 [cited June 24, 2019]. 
131. CAREX Canada. Second-hand Smoke - Occupational Estimates [Internet]. 2019 [cited June 15, 2019]. 
132. Ontario Tobacco Research Unit. Smoke-Free Ontario Strategy Monitoring Report [Internet]. 2016 [cited August 15, 2019]. 
133. McNabola A, Gill LW. The control of environmental tobacco smoke: a policy review. Int J Environ Res Public Health. 2009;6(2):741-58

Monday, 21 October 2019

Do e-cigarettes beat NRT as cessation aids? A key study provides two opposing results - yet only one was reported.

There are thousands of scientific studies on tobacco use published every month (37,000 so far this year!), but only a few find their way into the mainstream media. Among those, even fewer seem to have real influence on government policies.

In my circles, one of the most influential papers this year was a British study on the effectiveness of e-cigarettes at helping smokers quit. Psychologist Dr. Peter Hajek and his colleagues used the "gold standard" methods of a randomized clinical trial to compare E-cigarettes (consumer products) against NRT (licensed therapies) at as cessation products.

The results of this study were published in the New England Journal of Medicine in January and immediately reported by media outlets across the world. Time magazine said the study showed  "E-Cigs More Effective Than Nicotine Replacements in Helping Smokers Quit", a messages echoed in many Canadian media outlets.

The idea that e-cigs are *twice as good at helping smokers quit* as NRT has now taken root.

Indeed, in some important quarters in Ottawa it seems to have become part of the tobacco control belief system. More than once over the past few months have I have heard this study cited as a reason that governments should continue to allow e-cigarette promotions.

Differing points of view

Yet Dr. Hajek and his team are not the only highly qualified researchers looking into this issue, and theirs is not the only scientific conclusion on offer.

Among other respected public health scientists who have looked at the efficacy of e-cigarettes as cessation products are those at the World Health Organization. This summer, after considering Dr. Hajek's results and others, the WHO concluded:
Although some [Electronic nicotine delivery systems] have been shown to help smokers quit conventional smoking under certain conditions, when used as NRTs the scientific evidence is inconclusive. There have only been a limited number of randomized control trials and longitudinal studies investigating the role of ENDS as potential cessation aids offered to a population, and their conclusions are equivocal.
This is not the only time that Dr. Hajek and the World Health Organization have come to starkly different conclusions about interpreting research findings. In 2014, Dr. Hajek was among a research team which openly criticized the WHO, accusing it of "misleading" the public with the following statements:  "Youth are rapidly adopting e-cigarettes", "the hope that e-cigarettes will reduce harm by delivering 'clean' nicotine will not be realized in continuing dual users" and "E-cigarettes deliver lower levels of toxins that conventional cigarettes, but they still deliver some toxins."

Nor is it the first time that Dr. Hajek has nailed his colours to the mast of e-cigarettes being so safe that their use should be promoted. He was part of the scientific team  that advised Public Health England to promote the idea that the differences in harm between e-cigarettes and cigarettes could be quantified, and that the comparative measure was "95% safer". Canada's Heart and Stroke Foundation and The Lancet are among the many who have criticized the use of the "95% safer" claim.

A second look at the outcomes of Dr. Hajek's experiment.

The data presented in the table below shows a broader range of outcomes from Dr. Hajek's study, drawing data from the NEJM paper and also in a NIHR Health Technology Assessment report published in August, i.e.
  • "The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group".   
  • "Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants])"
  • "19 participants in the NRT arm using NRT at 12 months ..."
  • "173 participants in the e-cigarette arm using e-cigarettes at 12 months... "
  • "Among the e-cigarette arm abstainers, two were using non-allocated NRT at 12 months, whereas in the NRT arm, nine [abstainers] were using non-allocated e-cigarettes."
(No information was found on the number of people who used both NRT and e-cigarettes. Even if they were some, the results presented below would not differ greatly.)



NRT performed twice as well as E-cigs at achieving nicotine abstinance.

These results support the following statements:
  • Participants in the E-CIG group had almost double the success in stopping using cigarettes (18% vs 9.9%). This is as the media reported.
  • Participants in the NRT group had more than double the success in ending nicotine use (7% vs. 3.2%). This is something the media failed to report. 
  • Participants in the E-CIG group had a much higher risk of becoming dual users (25.1% vs. 15.2%). This is something that the media also failed to report.
Other important conclusions can also be drawn from these outcomes:
  • For people trying to beat nicotine addiction, failure continues to overwhelm success. This should heighten concerns about increase uptake of nicotine use.
  • Those who have the opportunity to use e-cigarettes, including those who are encouraged to use NRT instead, are much more likely to both smoke and vape than they are to only vape. This might dampen enthusiasm that those who try vaping will be able to switch completely.
Higher standards of evidence

Single clinical trials, no matter how well performed or reported, are not usually considered the strongest evidence base for decision making. That distinction is usually reserved for systematic reveiws of multiple studies.


In 2016 two systematic reviews of e-cigarettes as cessation aids were conducted. They did not come to the same conclusion.

One was by the Cochrane reviews (and Dr. Hajek participated in this review.) This panel focused on the results of 2 randomized clinical trials, and concluded that "There is evidence from two trials that ECs help smokers to stop smoking in the long term compared with placebo ECs." The quality of those studies was considered low, and Dr. Hajek's 2019 results will likely strengthen this conclusion in subsequent Cochrane reviews.

The other was a systematic review and meta analysis conducted by U.S. physician Dr. Sara Kalkhoran and Dr. Stanton Glantz.  They looked over the same literature field, and included the same 2 clinical trials as the Cochrane review had. In addition, they considered the results of 20 studies with control groups and other studies. The conclusions from this analysis were that rather than helping smokers quit,  e-cigarettes made it harder for them to do so. The "odds of quitting cigarettes were 28% lower in those who used e-cigarettes compared with those who did not use e-cigarettes."

A Canadian study involving more than 6,000 smokers was included in the Kalkhoran review, but not by the Cochrane team. It was conducted at CAMH, and eventually published both as a conference paper and as a journal article. Those would-be quitters who used e-cigarettes were less likely to succeed in quitting. "E-cig adoption seems to negatively affect cessation outcomes and provides no benefit as a harm reduction tool  ..." 

This year researchers at the Ontario Tobacco Research Unit published a review of "E-Cigarette Use for Smoking Cessation." They found "a wide range of results" and - while clearly open to the idea of using vaping as a cessation tool - nontheless reported that "In general, the scientific literature regarding the effectiveness of e-cigarettes as a smoking cessation aid remains inconclusive."

The Montreal Jewish General is leading a clinical trial on e-cigarettes as cessation devices, partnersing with several hospitals across Canada. Their results are not expected until next year.

Policy implications

Setting policy or clinical practice guidelines on the role of e-cigarettes is challenging in the messy real world of competing evidence, uncertainty, nuance and concious/unconcious bias. And that is before commercial influence and tobacco industry interference is added to the mix!

Currently, smokers who want to quit smoking have a variety of tools available to them, including a variety of licensed NRT therapies, non-licensed e-cigarettes, as well as proven and unproven behavioural supports that range from telephone counselling to hypnotherapy. None of the above has been the choice of most successful quitters.

Smokers (and those who pay for quitting programs) are entitled to know the benefits and the risks of the approaches on offer. In the case of e-cigarettes, Dr. Hajek's paper is presented as evidence that E-cigarettes are a better option than NRT. The same paper also provides evidence that NRT is a better option for those who want to overcome addiction and also for those who want to avoid the additional risks of dual use.

Thursday, 17 October 2019

There ain't no flies on us: BAT-Imperial Tobacco reassures vapers that their products aren't to blame

Are you old enough to remember the Frank statement?  Probably not.

It  was the iconic moment in the 1950s, when tobacco companies begain to speak directly to the public about the growing evidence that smoking caused lung cancer.

This In the subsequent decades it has been denounced by U.S. courts and historians as a PR exercise aimed at reassuring smokers instead of warning them. Canadian companies took a similar strategy of offering reassurance, although their tactics did not involve widely published commitments. These strategies were similarly denounced by courts.

Earlier this week we learned that Canadian Tobacco Companies have engaged PR firms to try to forestall regulations on their products.

In that context, it is interesting to consider more closely the message that BAT/Imperial Tobacco is sending to its customers .

There are echoes of the Frank statement in this communication -- an expression of concern and a pledge to research candy wrapped around a core message of denial (nothing proven!) and deflection of responsibility (THC!).

Move on, customers, nothing to see here!

ICYMI the text  from govype.ca is printed below. 

To Our Customers
Given the recent cases of acute respiratory illness from vaping reported in the US recently, we fully support any measures that will ensure the safety of those consumers who use vaping liquids and devices. As the distributor of Vype vaping products across Canada, Imperial Tobacco Canada takes consumer safety responsibilities very seriously.

Although investigators in the USA have not yet finally determined the cause of all of the recently reported cases, the US Food and Drug Administration is warning that there appears to be a particular danger for people who have bought vaping products on the street (i.e. not sourced from a reputable manufacturer), and for those who vape liquids with oils containing THC or containing an additive called “Vitamin E Acetate”.

Our parent company, British American Tobacco (BAT), has invested billions of dollars in the research and development of their potentially reduced risk products and the ingredients and components used in these products have been scrutinised by the BAT team of 50 toxicologists for their suitability for vaping.

To the best of our knowledge, no Vype products have been identified in any of the US reports to date. We can confirm that oils containing THC and Vitamin E Acetate are not, and have never been, added to our Vype products.

As for the one possible case in Canada, few details have been shared and authorities have not contacted us about it, which suggests it does not involve our product.

UPDATED OCTOBER 11th  
The US Food and Drug Administration (FDA) warns public to stop using Tetrahydrocannabinol (THC)-containing vaping products and any vaping products obtained off the street.

The FDA has issued a recent important consumer guidance on recent vaping illnesses dated 4th October 2019 entitled, “FDA warns public to stop using Tetrahydrocannabinol (THC)-containing vaping products and any vaping products obtained off the street."

Please see the full text of that consumer guidance by clicking the link here.

Tuesday, 15 October 2019

Public Health leaders strengthen their call for action on vaping

The power to speak 

Medical officers of health have special responsibilities and powers in the Canadian health system. Although they work for municipal, provincial and federal governments, many have the authority to speak out about health risks without having to get approval from elected officials.

Federal law, for example, gives Canada's Chief Public Health Officer, Dr. Theresa Tam, the specific authority to "communicate with the public ... for the purpose of providing information or seeking their views about public health issues." This authority continues even during an election period, when the rest of the public service is under 'caretaker' restrictions.

The advice of one Medical Officer of Health is worth noting. The combined advice of all 14 has even greater significance.

Senior MOHs from the provinces, territories and federal system work together through the Council of Chief Medical Officers of Health. This council has spoken out about vaping twice this year - first on April 11 and then again exactly six months later, on Friday October 11.

Comparing these two statements allows us to see how these physician leaders have deepened their understanding of the vaping problem and how they have changed their recommended approach to managing it.

A much-needed statement in April.

Vaping products were legalized in Canada in late spring of 2018, and it was not long before parents, teachers and communities were coming to grips with this new form of drug use. By late winter, the federal government was signalling that it was open to changing the law, but in a cautious way.

In April the Council of Chief MOH seemed willing to speak of the problem with more urgency than Ministers of Health were expressing. "We are seeing an alarming number of youth vaping in Canada," their statement read. "We cannot allow a new generation of Canadians to become dependent on nicotine and develop long-term risks to their health. We all have a role to play in protecting our youth.."

(How welcome this was for those who had been urging parliament to fix the problems with the federal law before the election, or even calling on the Minister of Finance to shoehorn an amendment into the Budget Bill.)

A strong stand in October. 

Only 10 days before the federal election, the Council issued its second statement on vaping. This time, its analysis of the problem had deepened and its call for action was more focused on regulators. In this statement, the Council goes much further than it did in April, and acknowledges for the first time that:
  • vaping is a gateway to tobacco use 
  • independent of tobacco use, vaping causes new public health challenges
  • vapers inhale cancer-causing chemicals
  • the compounds used in vaping products which are safe to eat (i.e. glycerol) may not be safe to inhale
  • Canadians should refrain from using e-cigarettes or vaping products 
  • vaping is not recommended for pregnant women or adults who do not currently use tobacco products. 
  • laws on vaping products should include plain packaging, health warnings and regulations on the marketing and sale of products and flavurings. 
Just as noteworthy were the ideas contained in the April statement which were dropped this month:
  • switching comipletely to vaping is a less harmful alternative to smoking.
  • putting the onus on youth, adults and health educators to manage the problem of youth vaping before putting the responsibility on government.
In its October statement, the Council of Chief Medical Officers of Health is now calling for the same policy changes as health groups have been promoting since the introduction of S-5, the parliamentary bill which became the new Tobacco and Vaping Products Act.  Its warnings against using vaping products are stronger and clearer than those currently communicated to the public by Health Canada.  It has moved away from encouraging smokers to switch to vaping to one of encouraging vapers to quit.

Let's just hope that health ministers and ministries are listening!

Monday, 14 October 2019

Everything old is new again: Tobacco companies set up a lobbying arm to fight vaping regulations.

The news on page 3 of this morning's edition of the Globe and Mail was a report from Carly Weeks that Canada's 3 big tobacco companies have set up a new lobby group to oppose vaping regulations. Surprise, Surprise.

In fairness, the news was already 3 weeks old. The launch of the Vaping Industry Trade Association (VITA) was announced through a press release issued on September 19th. This came on the same day that major health organizations demanded immediate tightening of regulations on vaping products. Coincidence? Perhaps. The organization had been planned for some while, as its website - vitaofcanada.com - was registered earlier this spring.

This is not the first or the only Canadian vaping industry lobbying group. The Canadian Vaping Association has made its views known to legislators and policy makers for a number of years. But there is an important distinction between these two groups, and the CVA is no friend of big tobacco. Its members are the specialty vaping shops whose grey-market business was disrupted when the federal government legalized the sale of e-cigarettes last year. Recently, this organization has called for the sale of vaping devices to be removed from corner stores. Convenience stores are arguably the ground zero of the youth vaping epidemic, but they are also the main route to market for the products sold by tobacco companies, and are the main competition to the CVA membership.

What is important to take away from today's story is that Canada's 3 big tobacco companies -- Imperial Tobacco, JTI-Macdonald and Rothmas, Benson and Hedges - are working together to influence government policy and that they are partnered with well-connected PR firms to oppose health regulations.

In short, these same companies are using the same strategies for the same purposes as they did with cigarettes a few decades ago -- strategies that have been denounced by Quebec courts as being an unlawful conspiracy.

The companies unlawfully conspired through the CTMC, say the courts.

It is not even 8 months since the Quebec Court of Appeal issued its judgment against these companies. After combing through decades of evidence and many thousands of exhibits detailing  their actions, the Appeal court upheld the 2015 verdict of Justice Riordan. In its unanimous 5-judge ruling, the Appeal Court also found that the tobacco companies had used their lobbying agency,  the Canadian Tobacco Manufacturers Council (CTMC), as a way to delay regulations and prevent  smokers from learning how harmful their products were. The courts described these actions using terms like "conspire" and "collude".

Their CTMC lobbying contributed to the courts' decision to hold them liable for the injuries suffered by some Quebec smokers:
"By engaging in this collusion for several decades in ...  the activities of the Ad Hoc Committee and thereafter the CTMC, the appellants jointly participated in a wrongful act which caused injury."
The courts found that the companies' bad faith efforts were not limited to government- and public-relations activities.  Their marketing practices were also found to be misleading, and part of an attempt to offer false reassurance to smokers or "lull" Canadians into a sense of non-urgency about the health risks.

(Quebec smokers have yet to receive a penny of the $13+ billion damages the court ordered -- but that is another story.)

Déja vu all over again

Like the CTMC in the 1960s, VITA was created this year in the wake of rapidly growing public, scientific and government concern about the harmfulness of nicotine products.

It was in 1962, after the UK Royal College of Physicians published a report condemning smoking as a cause of lung cancer that the Canadian tobacco companies laid down the basis of a public relations effort that would last for decades. They did so only when medical evidence of harm had reached a tipping point, and when major health bodies - like the Canadian Medical Association - were urging the government to do something to address this newly-understood problem.

Their PR campaign soon became formed as an "Ad Hoc Committee" to manage government relations, and then institutionalized into the CTMC. (You can read more about this sad history in paras 1000 to 1648 in a 2014 legal filing)

Sixty-plus years later, VITA was created in similar circumstances. The summer of 2019 was a blizzard of news stories about vaping - Congressional hearings, FDA enforcement actions, health bulletins! As the evidence accelerated, Canadian governments too were under increased pressure to force changes to the vaping market.

It was wrong then. Can it be less wrong now?

There is a direct parallel between the conspiracy that was so carefully documented and denounced in the Quebec class actions and the public relations efforts of the Canadian companies this fall. As before, instead of reaching out to provide customers with information about new research, the companies are today trying to deflect those concerns and convince the public that there is no urgent need for action.

Imperial Tobacco's press release from September 19 2019 is an example of how the company seeks to offer reassurance by dissociating its products from any documented health problems and to deflect concern to other possible causes of any adverse health effects.

There are echoes too in the packaging and marketing of the products, and the ways in which these fail to provide adequate warnings as they seek to diminish health concerns. From the Quebec court rulings, we now have very concrete and specific requirements for a manufacturers' duty to warn. (It is found in para 227 of Justice Riordan's ruling and is also pasted below). The warnings on the vaping products and advertisements today fall far short of this mark.

There are other ways in which today's vaping advertisements run against the court rulings because they would lead a "credulous and inexperienced consumer" to misjudge the health harms of the product being advertised. No regulator, so far as we know, has asked a court to consider whether campaigns like "looks small, hits big" mislead consumers in this way.

The Quebec courts have said this type of behaviour is wrongful. But that ruling is one made in hindsight - and does not appear to have had a preventative effect. Stronger health laws are needed to change the marketing of vaping products -- The core job of VITA is to prevent those laws from happening.


A different country. A different story.

In the United States, the companies are adopting a different public relations strategy.

At the end of September, JUUL announced that in the United States it would put down lobbying and marketing tools. It said it was "refraining from lobbying" the federal government and "committing to fully support and comply" with federal law. It pulled out of financing a referendum to overturn San Franciso's ban on e-cigarettes.

There are reasons why the companies take a different approach in the USA. The regulatory environment is different south of the border, where e-cigarettes have not yet been approved for sale by the FDA. Their sale is being allowed while the approval process is underway, but a decision is on the horizon.

In Canada in 2018, Parliament decided that it was in the public interest for these products to be marketed. No company is required to get approval, and there are negligible constraints on the product designs that can be introduced.

In the FDA system, the onus is on people wishing to introduce a new product to the market to demonstrate that doing so is appropriate for the protection of public health and provide evidence to this effect.

In Canada, at the federal level at least, the regulatory burden is on government, not industry. It is government which must demonstrate that a new regulation is appropriate for the protection of health and which must provide evidence of economic benefit to doing so.

What's a government to do? Just say no to VITA. 

Canadian governments which wish to avoid repeating the mistakes of the past should give wide berth to tobacco industry lobbying groups. Support for governments refusing to meet with the tobacco/vaping industry and its proxies can be found in a number of places.

For example, the global tobacco treaty - the Framework Convention on Tobacco Control -- requires that parties (like Canada) protect public health from tobacco industry interference. There are guidelines laid down on how to do so. Ten of 33 countries were recently assessed as doing better at this than Canada.

The Quebec Court of Appeal gives additional comfort for keeping lobbyists at bay. In its March 2019 ruling, it wagged its finger at the federal government for having given too much access to the CTMC.
[494] ... [The federal government] maintained a close relationship with their lobbyist, the CTMC, and so forth. Perhaps the government could even be accused of giving the impression, through this accredited collaboration, that tobacco was not really harmful or that it was not as harmful as some claimed, which was an impression that the appellants themselves were busy spreading, maintaining and building. Perhaps the government actually knew as much as the appellants about the dangers of cigarettes and should have banned the product or more severely restricted its distribution and above all should have done so sooner (the government didn't start until 1988, with the Tobacco Products Control Act, which came into force in 1989). Perhaps the government failed to inform the public and displayed reprehensible inaction...
According to this morning's report, VITA has set up meetings with legislators in Nova Scotia and has already met with Health Canada.

One sensible thing for Health Ministers to do would be to read the Quebec rulings and to counsel their staff against repeating the errors of the past.

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Justice Riordan's statement of a manufacturer's duty to warn
227. Our review of the case law and doctrine applicable in Quebec leads us to the following conclusions as to the scope of a manufacturer's duty to warn in the context of article 1468 and following:
a.  The duty to warn "serves to correct the knowledge imbalance between manufacturers and consumers by alerting consumers to any dangers and allowing them to make informed decisions concerning the safe use of the product";
b.  A manufacturer knows or is presumed to know the risks and dangers created by its product, as well as any manufacturing defects from which it may suffer;
c.   The manufacturer is presumed to know more about the risks of using its products than is the consumer;
d.  The consumer relies on the manufacturer for information about safety defects;
e.  It is not enough for a manufacturer to respect regulations governing information in the case of a dangerous product;
f.   The intensity of the duty to inform varies according to the circumstances, the nature of the product and the level of knowledge of the purchaser and the degree of danger in a product's use; the graver the danger the higher the duty to inform;
g.  Manufacturers of products to be ingested or consumed in the human body have a higher duty to inform;
h.  Where the ordinary use of a product brings a risk of danger, a general warning is not sufficient; the warning must be sufficiently detailed to give the consumer a full indication of each of the specific dangers arising from the use of the product;
i.   The manufacturer's knowledge that its product has caused bodily damage in other cases triggers the principle of precaution whereby it should warn of that possibility;
j.   The obligation to inform includes the duty not to give false information; in this area, both acts and omissions may amount to fault; and
k.  The obligation to inform includes the duty to provide instructions as to how to use the product so as to avoid or minimize risk.

Tuesday, 8 October 2019

Where 'leap frog' on vaping laws is needed, Yukon plays a slow game of 'catch up'.

This week Yukon introduced a bill to modernize its controls on vaping products. Bill No. 3, the "Tobacco and Vaping Products Control and Regulation Act" was introduced yesterday.

There are now only 3 provinces or territories - Saskatchewan, Alberta and Nunavut - that have failed to give regulatory acknowledgement to the public health challenges of vaping products.

A lot of has been learned in the four years since the first provincial laws were introduced. The 5 provinces east of Ontario legislated in 2015, as did Manitoba. These provinces deserve praise not only for being quick off the mark, but also for their foresight in imposing similar or the same rules on vaping as they did on tobacco producdts. (A fact sheet which compares provincial vaping regulations can be downloaded here).

For Yukon, however, it has taken some time to get there -- years since other provinces regulated and months since the views of Yukoners were canvassed this spring. (The brief "what we heard" brochure is dated in August, but was only released this week).

Yukon's new law, sadly, follows the most relaxed approach of to vaping reguations. It does not ban billboards or broadcast commercials for vaping products, as the laws in Quebec, Nova Scotia, PEI and Manitoba do. It does not ban the sale of these products on campuses or government buildings. It does not ban vaping in hotel rooms. There are no retail licensing requirements. The retail or manufacturing industry are not required to pay the costs of enforcement and inspection.

Given the recent evidence of new harms from vaping, and the concern about youth use, one might have expected Yukon to 'leap-frog' and propose more stringent measures than are currently in place in other provinces. They have not chosen this approach, but are instead proposing soft-touch regulations.

However, one measure in the Yukon bill stands out as a measure every jurisdiction should put in place. The law gives the government the power to require retailers to keep records and to make reports to government. With such a quickly moving problem as vaping, such information is much needed. (Similar authorities are in Ontario and Quebec laws, but have not yet been put to good use).

Let's hope Yukon's regulations strengthen this otherwise modest legislative proposal.





Tuesday, 17 September 2019

One week into the Canadian election, JUUL launches a political action campaign.

Tomorrow, the Canadian election campaign official enters its 2nd week. So far the focus has been on traditional voter issues -- jobs, the environment, taxes, etc.

But in the wake of the (now seven) recent deaths of young American vapers, the media has asked federal leaders whether they will follow the example of U.S. governments and put more restrictions on the marketing of vaping products. The response was a decided non-committal.

Is it a coincidence that in my e-mail today was an invitation from JUUL to "protect my vapour access" by becoming an "advocate for reasonable policies that protect adult access to vapour products to encourage them to make the switch from combustible cigarettes."? (As a keenly interested party, I had subscribed to their e-mail service.)

The invitation lead to a recruitment site  - The Switch Network  - which asked about my willingness to participate in a range of political actions -- from signing a petition, e-mailing elected officials, attending rallies or demonstrations or testifying at hearings.

A democracy depends on an active and engaged citizenry. But mobilizing addicts during an election?  I think that may be a new one, even for the nicotine industry.




Wednesday, 4 September 2019

Why so anodyne? Canadians need strong, effective and truthful warnings on vaping packages

The federal government summer season of no-big-decisions usually runs from third week of June (St. Jean Baptiste Day) to the first week of September (Labour Day). On the eve of the break this year, Health Canada handed public health groups with a challenging summer task: published in the Canada Gazette on Saturday June 22 were 27 pages of proposed regulations for vaping products. Responses were due 75 days later, on September 5.

The proposed regulations are no trivial matter. They are the first significant regulatory proposals from government to constrain the way that nicotine products are packaged and labelled, or to control the amount or type of nicotine that can be sold as a recreational drug. 

For decades, nicotine other than tobacco was controlled as a medication under the Food and Drugs Act. The tolerance that was given to vape shops was so extensive that many Canadians who bought nicotine liquids for vaping devices were likely unaware that they were participating in an illegal sale.

All this changed when the federal Tobacco and Vaping Products Act was approved by Parliament and proclaimed in May 2018. The legalization of nicotine changed the commercial market, bringing nicotine into the Fast Moving Consumer Goods (FMCG) market. Convenience stores became the route to market for multinational tobacco companies to compete for this new market. (Picture below courtesy of Toronto area South Bayview Bulletin Board).




Health Canada has yet to make public whether or how it will regulate the types of ads that appear in many convenience stores (several provinces have banned them). Their first priority was to develop labelling requirements and child-resistant container requirements. As Health Canada describes them, 

The proposed labelling requirements include a list of ingredients, and, depending on the presence of nicotine and its concentration, a health warning that nicotine is highly addictive, the concentration of nicotine, and warnings regarding the toxicity of nicotine when ingested. In addition, the proposed Regulations would set out expressions that may be used on the product or package to indicate when a vaping product is without nicotine. The proposed Regulations would also require refillable vaping products, including devices and their parts, to be child resistant.

Why so anodyne?

Health Canada's proposals for package warnings for vaping products are surprisingly unambitious for a country which invented graphic health warnings. The regulations require a only a text warning, only for one health effect and only on one side of the package. They are arguably less powerful than the warnings currently placed on a voluntary basis by the industry. 


Canada can do better 

This proposed warning seems even more  milquetoast now than it did when it was first Gazetted in June. South of the border, health authorities have spent the summer snarling at nicotine companies and expressing concerns about potential acute risks for young people who vape:
* top medical authorities issued unequivocal warnings that vaping products are "not safe" for non-smokers, 

Admittedly, only one other country currently requires graphic health warning messages on vaping product packages (South Korea). Admittedly, it is important to design them thoughtfully -- and that takes more than the 75 days given to respond to the proposed regulations. Admittedly, Health Canada should not leave the packages of these risky products unregulated for any longer than necessary.   

For that reason, we are proposing that in the short run, Health Canada require a strengthened and more prominent version of its warning be on all packages as soon as possible. Within the next year, however, it should be possible to refine and adapt a series of rotating messages which provide Canadians with the information about the range of health risks associated with vaping to which they are entitled. One of our suggestions on how to do this is shown below.



How much is too much? How fast is too fast? 

The proposed regulation also sets limits on how much nicotine is permitted in the liquids or cartridges used with vaping devices. The level -- at 66 mg / mL -- is much higher than any of the major products currently on the market. This is in stark contrast to the European Union, Israel, Korea, and Iceland where the maximum level allowed is 20 mg/mL. 

Nor does the regulation address the additional risks of nicotine salts -- which are shown even by the industry research to reach the brain more quickly than those which do not use this 'protonated' technology. It does little to respond to increasing concerns about the collateral damage of the nicotine arms race that is happening between JUUL and its imitators.

A time for sober second thought

More often than not, the final version of regulations varies little from the version that is initially published. Concerns about departmental regulation making once resulted in Parliament being given an opportunity to vet Tobacco regulations before they came into effect. This provision was removed when the law was updated  to include vaping products last year.

So the only recourse left is for a change of opinion by the department and the central agencies (Treasury Board, Privy Council Office, Cabinet) to which it reports. Cross your fingers!

Our submission

Physicians for a Smoke-Free Canada's full response to the proposed regulation can be downloaded here. Our key recommendations are:

1. Vaping packages should carry warnings of the following risks:
  • Vaping products may increase the risk of cardiovascular diseases.
  • Vaping products may increase the risk of lung diseases.
  • Vaping products are not effective smoking cessation devices for most people.
  • Dual use of vaping products and combustible cigarettes increases the risk of disease compared to exclusive use of either product.
  • Use of vaping products during pregnancy may harm the fetus
  • Young people who vape can harm the parts of their brain that control attention, learning, mood and impulse control.
  • Nicotine can harm adolescent brain development, which continues into the early to mid-20s
2. Manufacturers should be required to place warnings on at least 50% of the top of two principal display surfaces, with one side each for English and French.
3. Graphic health warnings for vaping product packages should be developed. 
4. Plain packaging of vaping products should be required.
5. The maximum allowable nicotine concentration should be set at 20 mg/mL.
6. The impact of the introduction of nicotine salts on youth vaping should be reviewed.

Sunday, 1 September 2019

ICYMI: Health Canada releases a trove of research reports on vaping and smoking

Finished with trashy beach novels? Looking for something more gritty to read? Canada's National Library has just the antidote to those light reading blues -- a stack of consumer research reports on Canadians' knowledge, attitudes and behaviours related to tobacco/nicotine.

It's only a little more than a year since the Canadian government opened the door for tobacco company marketing of vaping products (prior to that it was a tolerated grey market supplied by tolerated illegal manufacturers and distributors).

In that time, it has proven frustratingly difficult to assess the impact of this market liberalization on the use of these products. Most of the available survey data on vaping predates the marketing of Juul, Vype, Stlth and other mass marketed nicotine products.

Canada's traditional health surveillance system has a lot going for it -- but it has not yet caught up with the vaping phenomenon. The core federal health surveys (like the Canadian Community Health Survey) have largely ignored e-cigarettes and the specialized surveys (like the Canadian Tobacco Alcohol and Drug Survey) were inexplicably suspended for the year the nicotine market was liberalized.

To address this gap, Health Canada has put significant resources into consumer research. This may not yield the robust indicators on smoking and vaping patterns, but it does helps us understand a little more about what is motivating those who do.

Federal policy dictates that all public opinion research be made public through the library within 6 months of finalizing the field work. Because much of the field work wrapped up at the end of the last fiscal year, the reports were uploaded to the Library of Canada website in late August.

Five of these reports are linked below.

POR 067-18

Qualitative and quantitative research on perceptions of nicotine 

The report covered both smoking and vaping behaviours of Canadians aged 13 years and old, exploring several aspects of each. It involved both focus groups and on-line questionnaires (with more than 4000 respondents online)  and was conducted by the Earnscliffe Strategy Group.  Banner tables from the study are also available, and included with the usual demographic break-downs are information on Indigenous and non-Indigenous populations. (The results showing the much higher use of nicotine and cannabis and much lower expressions of concern by Indigenous participants is sobering indeed!).

Tidbit: 1 in 10 daily smokers also vape with nicotine every day. 4 in 10 vapers smoke every day.


POR 119-18 

Smoking Behaviour Journey Map


This innovative study sought insight into the role that tobacco use played in  adult smokers' lives. More than 500 smokers participated in an on-line survey and of those, 80 smokers submitted daily journals. The study confirmed that "Generally speaking, smoking appears to be a means to manage or cope with feelings and emotions. When it did come up, it was typically associated with the comfort of routine (and primarily the morning routine), or a moment for relaxation or quiet reflection. It can also have a calming effect when feeling overwhelmed or stressed."

Tidbit: 1 in 3 daily smokers use cannabis more than once per week.  1 in 10 use it every day.

POR 093-18 

Smokers and Recent Quitters’ Awareness and Perceptions of Options to Minimize Harms from Nicotine and Tobacco Products


This online survey was taken by 3,500 adult smokers and former smokers.  The researchers originally wanted to question people who had quit in the past year, but were unable to find enough of them. (!)  Given the publicity about e-cigarettes, a surprisingly low number of smokers (30%) acknowledged being familiar with them.

Tidbit: Almost 1 in 10 (8%) of former smokers use e-cigarettes daily. 1 in 6 recent quitters who has tried e-cigarettes continues to use them daily, compared with 1 in 15 recent quitters who has tried the patch and continues to use it.

POR 126-18 

Qualitative Testing of Revised Health Warnings for Cigarette Packages and on Cigarette 


This study reports on focus group testing of proposed health warning messages, and the views of young smokers and non smokers, and young adult and adult smokers. Participants were shown 44 potential health warning messages, and 52 on-cigarette warnings. (No country has yet implemented on-cigarette warnings).

Tidbit: "Reactions to having health warnings printed directly on cigarettes are viscerally negative among participants who smoke, as they are considered unnecessary to warn those who smoke, and a costly approach. However, the presence of on-cigarette health warnings made smoking less attractive to people who smoke and less frequent smokers expressed mixed opinion regarding its potential to impact awareness of health hazards."


POR 058-18

Public Opinion Research on Noticeability of Health Information Messages and effectiveness of Health Warnings for Tobacco Labelling


This online survey of 3000 Canadian smokers (aged 16 years or older) aimed to inform improvements to health information messages and health warning messages.

Tidbit:  1 in 3 smokers cannot recall seeing the Health Information Messages, even though they have been printed within each cigarette package for almost 20 years. 


Wednesday, 21 August 2019

Are we prepared for an e-cigarette price war?

CNBC reported today that the price war among vaping companies in the United States is driving the cost of experimenting with nicotine to below the cost of a candy bar. Some starter kits can be bought for as little as US$0.99. 

"Late last year, NJOY started selling its Ace e-cigarettes for 99 cents in stores, compared with the $7.99 it currently charges online." (Pictured below is one such offer from a US web-retailer).


The price war among vaping companies in Canada as not yet hit that level, although, as reported here earlier this summer, it has resulted in the price of  major vaping devices being cut in half in only 6 months. Thankfully they are not (at least yet!) at the levels observed in the USA.

It  could be only a matter of time before the companies launch a full-scale price war in Canada. If so, there is little sign that governments will be able to prevent young people from becoming collateral damage.

What could they be doing?  I'm glad you asked.

* Health ministries could prepare to amend tobacco and vaping laws in order to give themselves regulatory authority over promotional prices. Many of these laws already have some form of restraint on using price to induce young users -- measures like minimum package sizes and bans on certain discounts. But for the most part, price promotions for tobacco products (including vaping) are currently exempted. Filling this loop hole is more important than ever.

* the federal department of Innovation, Science and Economic Development (formerly Industry Canada) could prepare to undo the damage it imposed in 2009, when it  amended the Competition Act in the infamous omnibus budget bill of 2009. Before then, manufacturers could not set discriminatory wholesale prices between retailers. By re-inserting restrictions on wholesale price discounting for harmful products like tobacco and nicotine, this department could end the localized pricing practices that are undermining tobacco tax policies and stop them from expanding into nicotine.

* finance ministries can be exploring optimum tax policies for e-cigarettes. The World Bank has scoped out the use of taxes to discourage young people from vaping, and several U.S. states and other countries have already put e-cigarette taxes into effect. (Pictured below is the impact that US state-level taxes would have on a package of cartridge in Canada).



The importance of tax and price policies to reduce tobacco use has been recognized for several decades- and is a cornerstone of the Framework Convention on Tobacco Control

How many more children need to be addicted before this tool is taken out of the shed?


Tuesday, 13 August 2019

Monetizing peer pressure: JUUL joins in.

Some months ago, I received an e-mail from the Canadian marketers of Philip Morris' IQOS offering me the opportunity to earn $75 by putting them in touch with one of my friends who was willing to buy one of their products. "Each referred friend who meets an IQOS expert will receive $25", they promised and "For every friend who purchases IQOS, you will receive $75."


This, I believe, was a departure in tobacco marketing in Canada. I could not recall a previous time when tobacco companies recruited such a direct and sales-focused type of 'paid influencer'.

One might have thought that this practice was banned by Canadian tobacco law, which has for many years told manufacturers that they can't offer prizes, money or other inducements to purchase tobacco products. (IQOS and other heat-not-burn devices are considered tobacco products under federal law).

The ban was recently reaffirmed when the federal Tobacco and Vaping Products Act was overhauled in 2018:

29 No manufacturer or retailer shall
(a) provide or offer to provide any consideration, for the purchase of a tobacco product, including a gift to a purchaser or a third party, bonus, premium, cash rebate or right to participate in a game, draw, lottery or contest...


Six months have passed since Physicians for a Smoke-Free Canada filed a complaint to Health Canada about the IQOS referral offer yet the IQOS referral web-site is still active (referiqos.com).

Which brings us to JUUL.

Yesterday, JUUL presented me with a similar, if somewhat less lucrative, offer. As the e-mail presented the offer, every referred adult smoker who makes a purchase gets a discount of $20 on their account, with a similar credit given to the person who referred them.



The federal law sets different rules for vaping promotions than it does for tobacco. You are allowed to offer cash or other 'considerations' -- but only in a physical store ("retail establishment") to which young persons do not have access.

30.6 (1) No manufacturer or retailer shall, in a place to which young persons have access,
(a) offer to provide any consideration, for the purchase of a vaping product, including a gift to a purchaser or a third party, bonus, premium, cash rebate or right to participate in a game, draw, lottery or contest; or
(b) offer to furnish a vaping product in consideration of the purchase of a product or service or the performance of a service.


(2) No manufacturer or retailer shall, in a place other than a retail establishment where vaping products are ordinarily sold,
(a) provide any consideration, for the purchase of a vaping product, including a gift to a purchaser or a third party, bonus, premium, cash rebate or right to participate in a game, draw, lottery or contest; or
(b) furnish a vaping product in consideration of the purchase of a product or service or the performance of a service.


Influence peddling

Tobacco companies have long known that peer pressure is a driving force for uptake of nicotine. Imperial Tobacco Canada (BAT) infamously studied the role that peer pressure played in teenagers - its Project 16 report found "there is no doubt that peer group influence is the single most important factor in the decision by an adolescent to smoke."  

New communications technologies now allow the companies to harness the power of peer pressure -- and the law seems unable to prevent it from happening.

Everything new is old again

For a century, tobacco companies have pioneered marketing strategies and pushed the envelope of marketing codes and legal restrictions. For decades, governments have been caught flat footed, unable to keep up with, let alone control, the inventiveness and deep pockets of marketers. The difference now is that we know the consequences of regulatory inaction.

If paying people to encourage their friends to use use of addictive and harmful products is permitted under the federal TVPA, then a new law is needed.

Thursday, 8 August 2019

Imperial Tobacco is encouraging you to pimp your vape

On July, Imperial Tobacco posted an ad on its Instagram account, announcing that "ePod Skin Collections are coming soon. Stay tuned! Happy Canada Day!" 



Sure enough, later last month the company put on offer 19 different sleeves that can be used to dress up a vaping device. They are pretty spiff, and are sold under evocative descriptors like "maze", "tropico", "relief", and "express". The skins can be ordered from the company'  web-site for about $4 each.


When decorative covers were first sold by British American Tobacco for the ePen 3 in the United Kingdom, they were launched as "high fashion pieces" commissioned by clothing designer Henry Holland. His aim was to help consumers incorporate things in their lives that gave them "positivity", "empowerment" and helped them "feel really good about themselves."

Res ipsa loquitur

Linking addictive nicotine to a fashion lifestyle is likely not permitted under Canada's federal Tobacco and Vaping Products Act (s. 30.2), which may be why there was no similarly splashy launch to sale of these fashion accessories in Canada.

The Tobacco and Vaping Products Act says that "30.2 No person shall promote a vaping product, a vaping product-related brand element or a thing that displays a vaping product-related brand element by means of lifestyle advertising."

Health Canada recently finalized regulations to put cigarettes in plain packaging. One of the reasons for doing so was that branded packages functioned as 'mini-billboards', encouraging young people to try smoking.

By the same logic, these fancy-dress sleeves will serve as mini-billboards for vaping products -- a consumer-carried lifestyle advertisements.

Only in Canada, you say?  Pity.

The skins are not yet listed for sale in the few other countries where the epod is marketed, eg FranceGermany and the United Kingdom.

Visualizing the gains since 2000

I spent my coffee break this morning playing with the *awesome* visualization tools made available courtesy of ourworldindata.org based on data provided by the World Health Organization.

Enormous strides have been made over the past decade in standardizing health indicators and in making data available for analysis in ways previously unimaginable. Our thanks to those who have invested in this important work.

For reasons never made clear, Canadian health authorities have rarely age-standardized smoking rates. Most people start smoking when they are young and a proportion of them quit as they age - so it doesn't make sense to compare the smoking rates of a relatively young population (say Africa or Canada in the 1960s) with those of a relatively old population (say Japan or Canada in 2017!).

Because WHO age standardizes smoking rates in its Global Health Observatory repository, we can compare Canada's progress with other countries with a little more confidence.

The charts below suggest that:
  • wealthy countries with modest anti-smoking programs (France and Germany) have made little progress in reducing current smoking (daily and occasional) among men or women
  • wealthy countries with more active anti-smoking strategies and liberalized markets for harm-reduction/tobacco alternatives (United Kingdom, United States, Sweden), have made more progress against smoking
  • wealthy countries with more active smoking strategies and restricted markets for harm-reduction/tobacco alternatives (Canada  until 2016, Australia) have made similar progress. 
  • developing countries with more active smoking strategies and restricted markets for tobacco alternatives (Thailand, Brazil) have similarly made progress.

Data is more plentiful, more accurate and more usable -- but it still isn't enough to make a prima facie case that liberalized nicotine markets drive down current smoking. More analysis needed!




Wednesday, 31 July 2019

Big Data for Big Nicotine - Insights from the trademark registration for the JUUL C1

Yesterday, word went round that JUUL had opened a flagship store in Canada's flagship city. And to mark the opening of the store on Toronto's Queen Street West, the controversial vaping company launched a pilot program for its new "C1" device.  


The JUUL C1 differs from the current ubiquitous model in that it is equipped with bluetooth capacity, and is intended to be used in conjunction with a mobile app. Visitors to the store or JUUL's Canadian web-site (or the U.K. site where the C1 is also being sold) would have every reason to think that this has been done for their benefit:

How can the JUUL app benefit me?
The JUUL app, currently a pilot, is designed to help users manage their nicotine consumption and combat unauthorized use. The app provides connected features such as:

• Usage Monitor, gain greater control and visibility of your usage. Real-time monitoring with daily, weekly, and monthly tracking of your puff use.
• Device Lock, JUUL C1 features automatic device security. You can manually lock the device, or set it to Auto-Lock to prevent unauthorized use when your JUUL C1 is not being used by you.
• JUUL Locator, keep track of your JUUL C1. When in range, ring it to play a sound. When out of range, see where it was last paired to your phone to help you stay on your switching journey.


Missing from this sales-pitch, and from the Google Play store is information on how the mobile app connected to the vaping device can help JUUL monitor the consumer behaviour of nicotine users.

For this information, a more helpful source is the trade-mark database managed by Industry Canada.  Not quite 2 weeks ago (on July 22), JUUL filed its description of goods that would be sold under the JUUL C1 label. (Trademark registration 1976819). In addition to the location and blocking functions, the C1 also seems designed to monitor and report on the movements and communications of vapers. 

In their own words, JUUL C1 covers a host of other data-collection functions: 

"computer software for use in posting, transmitting, retrieving, receiving, reviewing, organizing, searching and managing text, audio, visual and multimedia data and content via computers, mobile phones, wired and wireless communication devices, and optical and electronic communications networks; computer software for calculating, mapping, transmitting and reporting information relating to the location, movement, proximity, departure and arrival of individuals and objects via computers, mobile phones, wired and wireless communication devices, and optical and electronic communications networks."


Juul is not the first company to include surveillance mechanisms in its device. Reuters commissioned a teardown of the bluetooth function of IQOS, and reported last year that the technology would allow the company to gather data from unwitting users.

In the era of digital marketing and Big Data, this type of consumer research can't be considered a surprising development. But shocking, nonetheless!.