What message does it send when a former federal health minister joins the board of an e-cigarette company, the way Rona Ambrose did?
The practise of public officeholders who make big salaries in government moving on to even bigger salaries as lobbyists, consultants or corporate board members, based largely on their insider knowledge is growing (see sidebar).
Still, members of the public health community were startled by Ambrose’s decision.
“I was shocked to learn that Rona Ambrose accepted a board position with Juul given her leadership position in politics in Canada,” said former Canadian Medical Association president Dr. Ruth Collins-Nakai, a cardiologist. “There is increasing evidence that both e-cigarettes and vaping, which deliver nicotine, flavourings and other additives to users via inhaled aerosols are more harmful than beneficial, especially to youth.
“Nicotine is addictive and exposure to it during adolescence can impact learning, memory and attention, in addition to an increased risk for future addiction to other drugs, and direct damage to the lungs. All e-cigarettes and especially Juul contain high levels of nicotine, which can initiate nicotine dependence.”
Ambrose became a Juul director in May. She “must have done due diligence on the company and must have known about these health effects. It is inexcusable for her as a previous health minister and therefore role model to have joined the Juul board,” said Collins-Nakai.
The Tyee directed some questions to Ambrose. Juul answered for the former minister.
Asked if she had or would be holding discussions with federal and provincial regulators dealing with Juul products, the company’s media relations spokesperson, Ted Kwong, replied, “No. Ms. Ambrose is an independent director and her role does not include lobbying.”
Asked to describe her role, the company said, “As an independent member of Juul’s board of directors, Rona Ambrose’s unique public health and regulatory experience will provide oversight and expertise as we continue to reset the vapor category and work to earn the trust of our stakeholders.”
Dr. Andrew Pipe is Canada’s leading expert on how to get people to stop smoking. His resume contains blue ribbon work — past chair of the Heart and Stroke Foundation, former chief of prevention and rehabilitation at the Ottawa Heart Institute, and now a professor in the faculty of medicine at the University of Ottawa involved in groundbreaking research.
Pipe has delivered lectures in 30 countries on the subject of smoking cessation and received the Order of Canada in 2002. He is adamantly opposed to the former minister teaming up with the vaping industry.
“I was astonished she accepted the position. I think the whole thing is absolutely deplorable. In some respects, it erases any legacy a former cabinet minister might have had. I saw her as an insightful, thoughtful politician. What an unfortunate capstone on a career.”
For her part, when she joined the board, Ambrose noted: “Smoking remains the leading cause of preventable death in the world, and supporting the potential of harm reduction for adult smokers is an important goal for individuals and health systems.” In other words, weaning them away from traditional cigarettes, which deliver to smokers’ lungs chemicals vaping does not.
Pipe isn’t buying that, noting that the entire e-cigarette industry is an adjunct of the tobacco industry. In fact, Altria, the parent company of tobacco giant Phillip Morris, owns a major 35-per-cent stake in Juul. And research has not found that vaping helps people quit smoking cigarettes. “The opposite is true,” concludes a report from the U.S. Surgeon General.
Pipe called ex-minister Ambrose’s comment about harm reduction a “meaningless bromide” that clouds the real issues.
By the time health authorities sounded alarms about vaping, Juul had risen to be the dominant player in a lightly regulated e-cigarette industry, providing fruit-flavour cartridges with twice the nicotine of some competitors, using marketing youth found appealing. E-cigarettes also were quickly becoming the method of choice for inhaling cannabis — and synthetic marijuana tied to severe health risks.
Quickly, Juul’s reputation shifted from that of a tech innovator offering a healthier alternative to smoking, to a recruiter for dangerous addictions. Its products, noted the Campaign for Tobacco-Free Kids, are “sleek, high-tech and easy to hide,” because they “look like USB flash drives and can be charged in the USB port of a computer.”
The U.S. Food and Drug Administration last year cracked down on e-cigarettes. And Juul’s CEO apologized for its role in getting so many teens hooked.
The CEO who apologized was replaced by a former executive at tobacco giant Altria. Juul’s chief regulatory officer is also from Altria. Its chief legal officer was assistant general counsel at Philip Morris for six years.
The U.S. Surgeon General has meanwhile declared vaping an “epidemic.” The Centre for Disease Control simply states: don’t use any e-cigarette.
“This is a company whose own reputation is in tatters — a deceptive, duplicitous part of a tobacco company,” said Pipe.
So what role might Ambrose play as a director, if she’s not doing any direct lobbying? In Pipe’s view, “They want to use her contacts to prevent meaningful regulation in this country. It’s all about money and addicting kids to candy tobacco.”
Canada’s health ministry is crafting regulations for makers of vaping products. Juul has lobbied the federal government 10 times since late 2018, including Health Canada, the House of Commons and the Treasury Board.
Juul says it follows strict guidelines to ensure its marketing is directed at adults, not young people. When she joined the board, Ambrose said: “These new technologies will not succeed in eradicating cigarettes unless businesses and regulators work together to successfully fight the problem of underage use.”
A big problem it is. According to the CDC, in 2019 about 30 per cent of U.S. high school students used tobacco products. For every one that smoked cigarettes, about five used e-cigarettes. This after cigarette smoking had declined steeply. In the early 1960s, 42 per cent of U.S. adults smoked cigarettes. Today, it’s 14 per cent. But vaping, concluded the American Medical Association, is creating “a new generation of nicotine addicts.”
It was enough to make U.S. President Donald Trump vow to ban flavoured e-cigarettes — until being warned of political fallout from his supporters, causing him to express this political calculus: “I never should have done this fucking vaping thing.”
In Canada, as in the U.S., teen vaping is on the rise. Twenty per cent of high school students reported using e-cigarettes in the previous month according to the 2018-2019 Canadian Student Tobacco, Alcohol and Drugs Survey. This was double the rate reported in the 2016-2017 report.
Last week, Health Canada announced a ban on vaping ads that can be seen by youth. The ban will come into effect at retail locations and online stores that sell e-cigarettes, except for adult only locations.
Juul said in an email that it “will fully comply and supports the goal of limiting access and appeal to underage use.” It said that it had “significantly curtailed its marketing activities” since January, “even in provinces where marketing activities are still allowed.”
The company said it also had imposed bulk purchase restrictions and strict online age verification controls. They have partnered with Amazon, eBay and Kijiji to remove listings from online marketplaces that were “non-age-gated.”
Colleen Flood, who is a law professor at University of Ottawa and inaugural director of the University of Ottawa Centre for Health Law, Policy and Ethics says the issue of how to regulate vaping is complex, and that if handled properly it could save “billions” of lives.
But she, too, worries about Juul’s connection to Altria, parent of Phillip Morris, which happens to make Marlboro cigarettes among other brands. “This ownership issue certainly raises the question of how truly Juul will adhere to the goal of stopping the transition from vaping to smoking and preventing children from being addicted,” Flood told The Tyee.
And that question makes her consider “the appointment of Rona Ambrose to a vaping company” to be “a problem.”
According to Rob Cunningham, chief policy analyst with the Canadian Cancer Society, there is reason to be concerned about what Jull sells. The company has a product in Canada and the U.S. with a nicotine concentration of 59 milligrams per millilitre, nearly triple the allowable level in the 28 countries of the European Union.
“It is certainly surprising and disappointing that a former health minister would join a tobacco company. Juul is Philip Morris — the two are inseparable,” Cunningham said.
Juul told The Tyee that “Juul Labs Inc. and its subsidiaries such as Juul Labs Canada are independent companies. Altria is a minority investor in Juul Labs Inc. Philip Morris International is not affiliated with Juul Labs Inc. or its subsidiaries in any way.”
But the website of Philip Morris International website, without mentioning Juul, declares the company has made a dramatic decision: “We will be far more than the leading cigarette company. We’re building PMI’s future on smoke free products that are a much better choice than cigarette smoking. Indeed, our vision — for all of us at PMI — is that these products will one day replace cigarettes.”
Pipe says that vision of tobacco-less future is oversold. He says it’s too simple to claim e-cigarettes reduce risk for their users compared to the traditional delivery of nicotine by smoking tobacco.
“That argument is often made in defence of e-cigarettes — there is no combustion, therefore no carcinogens are taken in. Not true. There are other lung and heart diseases besides lung cancer, and with e-cigarettes there is the inhalation of other harmful elements, including flavouring agents. The tobacco industry is absolutely reptilian in its conduct.”
And nicotine alone, so efficiently and addictively delivered through vaping, poses a serious health risk, Pipe emphasizes, particularly for young people.
“What we know now about the adolescent brain is astonishing. It has implications for all sorts of public policy, including the Criminal Code. Anyone who thinks that an 18-year-old is an adult is clearly ill-informed. Parts of the brain are not completely formed at that age, the parts that put brakes on some impulses.
“So they are much more susceptible to addiction. Nicotine is truly the gateway drug. Once you’ve learned to inhale, in just three to four days there is a transformation in brain structure and brain function. Neurological activity is laid down. Adolescents are absolutely more vulnerable to nicotine.”
Pipe is pessimistic about how the federal government might rein in the vaping “epidemic.”
“Regulations are forthcoming. But the approach that the House of Commons took initially was wholly inadequate. Health Canada is asleep at the switch. But the previous Harper government also has a lot to answer for — inertia and indifference, complete stagnation of anti-tobacco activity, and an ill-considered absence of controls on e-cigarettes.”
Six years ago, then-health minister Rona Ambrose urged Canadians against the use of e-cigarettes until a study of their risks and benefits could be done.
And then she got her chance to do something about it. On March 10, 2015, the House of Commons Standing Committee on Health issued a unanimous report calling for a new legal framework that would balance the risks of e-cigarettes with their benefits for smoking cessation. They wanted advertising restrictions, and limits on flavouring and nicotine content.
Ambrose was mandated to act within 120 days. The election was set for Oct. 19, 2015, but she took no action on the report before going to the polls.* When The Tyee asked Ambrose in an email why she did not act on the recommendations, the reply was: “Decline to comment.”
Today, Ambrose finds herself on the board of a company with a tsunami of legal problems in the United States. The company has been criminally investigated by federal prosecutors in California, although the focus of the investigation is unknown. Juul declined to comment to The Tyee about the investigation.
Juul has also been investigated by the Federal Trade Commission, and the Food and Drug Administration in relation to its advertising and marketing practices.
Juul says its products are not intended as cessation devices for existing smokers: “Juul is an alternative nicotine delivery product.” It realizes that “nicotine is addictive and can be harmful,” which is indicated on its packaging. “Juul Lab’s goal is to provide adult smokers with a nicotine experience that closely competes with cigarettes to transition them from combustible use.”
That statement, like others by the company and its investor tobacco giant Altria, make it sound as if nicotine addiction is just a fact of life. It follows that a company like Juul is on the right side of history — as might be a former health minister now being paid to guide it as a director.
Dr. Andrew Pipe takes a very different view. Of course, “we need to regulate the vaping product and its sale,” he says. But we also must “come up with innovative and imaginative strategies to retire this industry.”
By industry he means the business of nicotine delivery to human brains and bodies.
“And don’t talk about freedom of choice,” he adds. “Addiction is the antithesis of freedom of choice. This is how the body reacts: ‘Bathe me in nicotine or I’m going to make you profoundly sick and uncomfortable.’”
As for Ambrose, Pipe says Canada’s health organizations should be on guard. “They should be precluding any lobbying by Ambrose, any attempt to influence government about this industry and that company. She would have no credibility in meeting with health professionals.”
*Story updated on July 17 at 9:30 a.m. to correct that the election was set for Oct. 19, 2015, not 2020.