Home > Joint Committee on Health debate - Quarterly meeting on health issues: discussion.

[Oireachtas] Joint Committee on Health debate - Quarterly meeting on health issues: discussion. (02 Oct 2019)

External website: https://www.oireachtas.ie/en/debates/debate/joint_...

Chairman Michael Harty: The purpose of this morning's meeting is to engage with the Minister for Health, the Department of Health and the HSE in our quarterly meetings on the current issues that face our health service. On behalf of the committee I welcome the Minister, Deputy Simon Harris. I am aware that he will be accompanied by a number of his Ministers of State who will attend as they become available.


Deputy Kate O'Connell: I am sure the Minister and the Department are aware of the increasing evidence on the harmful effects of vaping, which has emerged in recent years and is becoming very popular. All present are aware of the expansion of the industry onto high streets and, clearly, how profitable it must be if rates and so on can be paid on such a number of outlets for these products. If the products are to be marketed as a smoking cessation aid, they must be subjected to the normal regulatory approval processes and procedures. However, it appears that they are a technological drug delivery device. If they are not smoking cessation products, they are, essentially, glorified cigarettes. The formulations of nicotine used are addictive.


Michael Harty Chairman: I ask the Deputy to put her question.


Deputy Kate O'Connell: The product is highly addictive. It has been formulated to penetrate the lungs and blood system to a greater extent than cigarettes do. The raw material is nicotine, which tobacco companies have plenty of and want a market for. Somewhat like the Minister's thinking on vaccination, I am instinctively inclined to ban vaping altogether but I realise that is not possible. Will achievable regulations be brought in? Are we going to protect our children by banning these products? Will there be education on them in schools? It seems that much capital was spent on smoking cessation and we now have these new products, some of which are 20 times as addictive as cigarettes.


The behaviour of large tobacco companies in moving into this space is unethical and despicable. They are targeting our children. It is clear what they are doing. Large cigarette companies, which know the war on tobacco is under way and that we are heading towards a tobacco-free Ireland, are mooching into a new area. I was in a petrol station a few nights ago. Some time ago, the Oireachtas decided to bring in plain packaging and block the advertising of cigarettes. However, when I looked behind the counter in the station, I noticed that all of that advertising has been replaced by advertising for e-cigarettes. I am appalled at the number of Oireachtas Members who ask me to meet representatives of vaping companies.


I will never meet them, so Members - I am not referring to anyone in this room - can stop asking me to do so. This is a new arm of the tobacco industry, it is a threat to our children's health, and we need to call it out. What are we going to do about it? We will first ban the sale of e-cigarettes to children, people under the age of 18. We will bring draft legislation to Cabinet this month, I think, to do that. We in the Houses of the Oireachtas have a really good record of taking public health decisions on a cross-party basis, and I look forward to working with the committee in that regard.


Beyond the sale of e-cigarettes to children and the benefits or otherwise of vaping as a cessation tool, it is fair to say the evidence is evolving at a very rapid pace. HIQA did an assessment of this in 2017. I have now asked the Health Research Board, HRB, to look at the potential harmful impacts of e-cigarettes, vaping or whatever one wishes to call it. Its response is due next March. Step one, then, is to ban the sale of e-cigarettes to children. Step two is to look at the HRB evidence in March and see what further action we need to take. My instinct, not as a doctor but as someone who talks to doctors, is that there may be - may be - an understandable logic to a person already on tobacco moving to e-cigarettes. However, that is very different from targeting 14, 15 and 16 year old kids with nice, colourful things and children's flavoured e-cigarettes and advertising them to try to get around our rules on plain packaging. We will therefore have to take this very seriously and be very vigilant about it. The first step forward is banning the sale of e-cigarettes to under-18s.


Deputy Kate O'Connell: As the Minister knows, and I made it very clear that I feel strongly about the issue of vaping. Large tobacco and cigarette companies are mooching, so to speak, into vaping. To bring it back to another issue, the rise of the global cannabis market is predicted to be €123 billion by 2028. It seems very clear that big tobacco is involved in this market as well. It is similar in ways to the way that vaping has taken off. As somebody who only has facts and science to rely on, it is becoming increasingly difficult to win the argument and it is actually easier at times just to say nothing and pretend that one does not know anything about things because the level of angst if a person stands up to something like this is to some people not worth it. In my mind it is worth it. I feel particularly strongly about this issue, and while I am a major supporter of and am pro-decriminalisation of drugs, I feel very strongly about the statutory instrument signed at the end of June, which is contrary to the legal advice provided to this committee and contrary to the Health Products Regulatory Authority, HPRA, advice. In the HPRA report of 2016, Cannabis for Medical Use - A Scientific Review, the first paragraph of the executive summary states:


To date there is an absence of scientific data demonstrating the effectiveness (efficacy) of cannabis products.


It goes on to refer to conditions "such as those for which there is a public interest". I am concerned that, due to public interest and a ferocious campaign for the authorisation of medicinal cannabis, we have somehow diluted our drug regulations. The HPRA is only supposed to license and authorise medicinal products, and cannabis does not fit into that category. We do not yet have any trial data, which is important to take on board, as it is for any other drug.


When it comes to public health, we are depending on big tobacco, via vaping, to tell people how to tackle a nicotine addiction. How are we to deal with a market, which is potentially worth €128 billion, and is currently worth €60 billion to €80 billion, that purports to have a miracle product that will cure everything? We, as elected representatives, have to protect public health. This feeds into the phenomena of fake news, anti-vaxxers, and significant marketing and online influencers. We will face a public health nightmare in five or ten years because we will have diminished our regulation standards. Could a pharmaceutical company challenge the Department on this? Someone could rock up with cannabis, which does not have to go through the normal trials or regulatory process, while that company might have a drug that has gone through the trials and ticked all the boxes, and yet is not getting a marketing authorisation.


I also have an issue with the HPRA's remit, which at this point in time covers medical products. The product being allowed onto the market, albeit with limited access, is simply not a medicine. Populism has succeeded here to some extent. It is easier to use a statutory instrument than to legislate on this issue. I could be wrong but as a pharmacist, I feel strongly about drug regulation. Any dilution of regulations will lead to public health issues in the future. I realise I am standing alone on this issue because it seems like I do not want to give sick people and children this miracle medicine. However, claims have been made about treatments that simply cannot be true and that eat into the sound advances made in public health. Have the HSE or the Department predicted how we will deal with the challenges that will no doubt arrive on our doorstep in a number of years? They will have arisen under the Minister's watch because of a statutory instrument that allowed a product with no scientific basis onto the market.


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