EVIDENCE

[Recorded by Electronic Apparatus]

Thursday, April 25, 1996

.1523

[English]

The Chair: We have a quorum. Pursuant to Standing Order 108(1), we are studying Bill C-222, a bill pertaining to warnings on alcoholic beverage containers.

Good afternoon, everyone. Our first witness today is Professor Robert Solomon, from the University of Western Ontario.

Professor Solomon, please come to the table. I would like to say welcome to you. We will allow you five minutes to say what you have to say, which then gives us lots of opportunity to question you. So please go ahead.

Professor Robert Solomon (Individual Presentation): Thank you. I'd like to thank you for the opportunity to appear before you. I have worked in the alcohol and drug policy field for the last 25 years, and I welcome Parliament's interest in this important issue.

Like all other manufacturers and suppliers, the alcohol industry has a legal obligation to warn consumers of the risks inherent in both the use and the foreseeable misuse of its products. However, it is well established that there is no duty to warn of obvious or known risks. If an alcohol manufacturer fails to adequately warn consumers and that failure causes or contributes to an individual's loss, that individual may sue the manufacturer and recover damages and negligence. Thus, without question, the industry has an obligation to adequately inform consumers of the risks in alcohol consumption.

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I have been an outspoken critic of the industry and of government regulators for advertisements and promotions that, in my view, portray alcohol in a fundamentally misleading light. Moreover, I believe that both the federal and provincial governments have the constitutional authority and the public policy justifications for rigorously regulating alcohol advertising, sponsorships, packaging and labelling. Alcohol is not a beverage like all others. Alcohol is the only intoxicating substance that we allow to be mass-marketed and mass-advertised in Canada. Along with that privileged position, the alcohol industry must accept certain responsibilities and regulations.

Legislation regulating alcohol content, health and safety information can be justified on two independent public policy grounds. First, the consumer has a right to know this information. Consumers have a right to be put in a position to make informed choices. Second, the government has an obligation and the right to regulate in an effort to reduce alcohol-related risks and harms. However, we must be careful to insure that what is done on this basis in terms of public health and safety actually works in reducing those risks and those harms. For example, while there is considerable support for public education initiatives and severe penalties in drinking and driving, there is abundant evidence to suggest that these initiatives often do little to reduce alcohol-related risks and harms.

To summarize to this point, I strongly believe Parliament has the legal authority and public policy justification to enact legislation governing alcohol packaging, labelling and advertising. Nevertheless, I cannot support the proposed warning label legislation, because I do not believe that it will advance the public interest in either improving the consumer's knowledge, or in reducing alcohol-related risks and harms.

First, these warnings are very general and address issues that the overwhelming majority of the public already understands. There is abundant research in the United States, which has virtually identical alcohol warnings, to suggest that such warnings have at best a modest, limited impact on consumer understanding. On a practical level, given that these warnings represent a minute initiative relative to the alcohol industry's $150-million-plus advertising programs each year, it would be very surprising if this legislation or these types of warnings were to have a significant impact.

Second, it is very difficult to craft meaningful messages about alcohol that can be communicated on a label. Unlike tobacco, alcohol is a product that many moderate users consume with no or any significant risk. Every time you smoke a cigarette you cause harm. It's easy to craft warnings for tobacco. But the message with alcohol, to be accurate, must be more subtle and complex.

Third, I fear the enactment of this legislation will preclude the enactment of other far more likely effective initiatives. The Australians have just introduced standard unit labelling of all alcohol beverage containers, coupled with a national campaign to educate Australians on safe and unsafe levels of consumption. Everything that I have read would suggest that these initiatives, coupled with targeted programs for high-risk populations, would do far more good both in informing the public and in reducing risks and harms than general warning labels. Indeed, I've been working with a coalition of health advocates and researchers and representatives from the industry to find areas of common interest that would advance the public cause.

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In conclusion, I applaud your interest and concern, but I would advise you to reconsider this proposal. We all want to ensure that our public health initiatives are not only soul-satisfying but will actually accomplish their stated goals. We would be well-advised, I think, to explore the Australian and American experiences and then come forward with an initiative that will reduce the unacceptable toll of alcohol-related death and injury in our society.

Thank you all very much.

The Chair: Thank you very much, Professor Solomon. Can you leave a copy of your comments with the clerk?

Prof. Solomon: I'll take them home, have them typed and fax them as soon as possible.

The Chair: Thank you very much.

Madame Picard.

[Translation]

Ms Picard (Drummond): We all know that warning labels alone on alcoholic beverage containers may not have the desired impact. However, if package labelling was combined with the education programs that exist today, don't you think this would serve to better warn consumers about the health risks of alcohol abuse?

[English]

Prof. Solomon: The specific warnings in the legislation warn people that driving and drinking don't mix, that alcohol and the use of machinery don't mix - sorry, I'm getting my warnings mixed up - that alcohol may be detrimental to health and that alcohol consumption when you're pregnant poses problems. The difficulty is that those aren't the areas in which I think the public needs information. So I have some concerns with the specific warnings being proposed.

I don't think we should introduce legislation if there's fairly good evidence that it's unlikely to have a positive impact. I view the warnings by themselves as falling into that category. I'd like to see other initiatives that would provide a greater impact.

[Translation]

Ms Picard: You haven't quite answered my question. Do you think that by combining labelling and existing education programs, we might come up with a more effective way of educating the public?

[English]

Prof. Solomon: The current programs we have in terms of consciousness-raising and alcohol, to my understanding of the empirical evidence, is that they have not had a significant effect. Although there's a lot of support for public education in the alcohol field, my understanding is that it has not had a significant effect. We need much more specific and detailed information.

The kind of information we need must be, I think, much more factual, information that if you have a blood alcohol level, for example, above 0.08 and get behind the wheel of a car, your chances of being killed in a car accident are 10 times greater than if you enter the car while sober. The difficulty is that the general education programs have not been particularly effective.

The other problem you have is that those programs aren't specifically targeted to meet the high-risk populations we have to get to. I think other types of initiatives are needed to address some of those types of problems.

If we're concerned about drinking and driving, there are lots of ways of dealing with that problem. The Australian experience is that a 0.05 law, as opposed to general education initiatives, dramatically reduced the number of fatally injured drivers in Australia who were legally impaired. So I'm not convinced that this legislation, coupled with existing educational programs, is likely to do much good.

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The Chair: Because of the shortness of time for each witness I'll move on to Mr. Murphy, please.

Mr. Murphy (Annapolis Valley - Hants): Thank you, Madam Chair.

Professor Solomon, you mentioned you're a lawyer.

Prof. Solomon: I'm a lawyer and law professor, yes.

Mr. Murphy: Right. I've been thinking about this subject. Do you think labelling would add to the liability of the industry if they were sued because they admitted this was a dangerous substance, or would you think it would cut their liability risk if they put the labelling on?

Prof. Solomon: I'm glad you asked me that. In my view, labelling would not affect their civil liability in Canada. In the United States, the federal warning legislation, both in tobacco and alcohol, contains language that prohibits any other message. That has been viewed as a federal pre-emption of civil liability.

Canadian law on pre-emption is different. Therefore, if the industry complied with these warnings, they could still be sued and held civilly liable. So this in my view neither increases nor decreases their potential civil liability. They have a duty in tort law to warn or adequately inform consumers of the risks. Compliance with federal legislation simply addresses and resolves the issue of federal liability. It does not preclude civil liability.

Mr. Murphy: The other part of my question is, if the federal government brought in legislation to force the industry to label, would we be tied up for the rest of our lives in lawsuits?

Prof. Solomon: In my view, you have the constitutional authority to enact alcohol warning label legislation. It would have to be carefully crafted so as to meet the constitutional requirements imposed. The message, after the RJR tobacco company, would probably have to be attributed to the government. So it would have to be ``Health Canada advises that....'' The Supreme Court of Canada, in a five to four judgment, had difficulty with the government attributing a message to the tobacco industry.

So I think if properly crafted, it wouldn't pose a constitutional problem.

Mr. Murphy: Thank you.

The Chair: Thank you, Mr. Murphy. Mr. Szabo.

Mr. Szabo (Mississauga South): Professor, during the first part of your presentation, where you said the alcohol industry has a responsibility and the consumer has a right to know, and you gave all of these wonderful reasons, I honestly thought you were going to support the labelling because of those reasons.

You stated in your understanding, or to your knowledge - maybe you can clarify which - an initiative such as labels does little. Could you give me the reference or authoritative support for that statement?

Prof. Solomon: I actually have a file of articles I brought with me on that issue.

Mr. Szabo: Would you be so kind as to provide copies of anything relevant to that statement to the clerk?

Prof. Solomon: Absolutely.

Mr. Szabo: Then all of us can take advantage of that. We can't deal with it all right now. Thank you for having that.

I assume you are familiar with research techniques. When you or others do studies, there are certain things you have to take into account. Would you agree that if you were going to measure the effectiveness of a label - for instance, a warning label on alcoholic beverages - it would be extremely difficult to measure its impact unless you could fully, or significantly, control or keep constant all other factors on what you're trying to measure?

Prof. Solomon: The ideal situation would be to have a change in one variable.

Mr. Szabo: Thank you very much.

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You said about the legal liability that the liability laws.... You're a lawyer. Are you familiar with the December 1995 judgment on the Hollis v. Dow Corning case?

Prof. Solomon: Yes, I am.

Mr. Szabo: Can you tell us what that judgment of the Supreme Court of Canada said?

Prof. Solomon: I have not reread it recently, but my recollection is that it recognized the manufacturer's duty to warn the consumer of the risks inherent in the use of their products and that merely having a learned intermediary does not preclude the liability of the manufacturer. This was particularly in the area of medical devices, but I would assume it would apply virtually identically to the pharmaceutical industry. That's my recollection of it. It's been a while since I read it, sir.

Mr. Szabo: I was on record when I appeared before this committee as saying that indeed in that particular case, the fact that there was a warning label mitigated the liability because the company attempted to warn the consumer of the impending danger. In fact, that was what the Supreme Court ruled.

Finally, I have one last question. Professor, do you presently or have you in the last ten years been a consultant to or worked for the alcohol beverage industry, being wine, liquor, or beer?

Prof. Solomon: I have done research that has been funded by the alcohol industry among others, yes.

Mr. Szabo: Thank you.

The Chair: Mr. Pillitteri.

Mr. Pillitteri (Niagara Falls): Thank you, Madam Chair.

I felt that Professor Solomon here was in a witness stand and was being asked for his opinion and asked questions. Certainly I don't feel he came in here to provide his input. For one, having worked for the alcohol industry does not preclude him from the knowledge of what is happening. Certainly he is not before a court. I think he's just barely expressed his opinion.

I would say to you, Professor Solomon, that if I were to quote some of the benefits of alcohol and what it does, certainly we'd have to put the benefits of alcohol on the label too. Wouldn't you say that? For instance, I remember my wife was in a hospital and at night-time she was given one ounce of brandy instead of a sleeping pill by her doctor. I wonder if we could also use that part of the benefit; of course there's been a lot of using it as a sleeping pill.

A lot of research has been done on the benefits of red wine. One has to take it in moderation. I just wonder whether the benefits that alcohol might have should be put on labels too.

Prof. Solomon: No. That's the short answer. I am more concerned that consumers be advised of the risks than that they be advised of the benefits. There may be other vehicles for that.

I do appreciate you mentioning that other point. I will work with anyone, any group in the alcohol field, who acts in the public interest. I have done some research for them, but I've also done research for the colleges of universities and for the liquor licence boards, including the board for the Yukon. I've done way more work with the Addiction Research Foundation, but I don't represent them any more than I represent anyone. I'm only here representing my own views.

Mr. Pillitteri: In other words, Professor Solomon, in your remarks you said that the industry has a responsibility to label other harmful parts.

Prof. Solomon: Absolutely.

Mr. Pillitteri: I know the industry has done a lot on education.

I would also point out that it is known that butter is fattening and has something to do with the arteries. Should we put labels on butter that it could be harmful?

.1545

Prof. Solomon: I would make a distinction. Alcohol is a unique product in our society. It poses unique risks, and therefore the obligation to warn is that much greater with alcohol than with a number of other products. The latest statistics I'm aware of indicate that alcohol is associated with 18,000 deaths a year in Canada. Those are preventable, so I think the obligation to inform is greater with alcohol than with other products. So I would see the obligation being different in the case of alcohol than with a number of other consumer products. I think the need is greater.

I just don't think this particular legislation is going to advance the cause much. My concern is that it will get in the way.

The Chair: I think you fooled us at the start. We all thought you were going to be in support of the bill, and then you phrased your comments very well. Thank you very much for coming into Ottawa to appear before us.

Prof. Solomon: It's my pleasure. Thank you.

The Chair: The next presenters are from the Addiction Research Foundation: Susan Bondy and Marianne Kobus-Matthews.

I welcome both of you to this committee. I look forward to hearing your presentation. Again, I apologize for being able to give you only a few minutes to present, but I think it's really important for committee members to have the time to ask questions, and we have only half an hour for each group of witnesses. Please go ahead.

Dr. Susan Bondy (Scientist, Addiction Research Foundation): Thank you very much for inviting the Addiction Research Foundation to comment on Bill C-222, a bill that proposes the requirement of warning labels on alcoholic beverages.

The Addiction Research Foundation is an agency of the Province of Ontario and is the primary alcohol and drug addiction research centre in Canada. The goal of the foundation's research and other program activities is to reduce the health and social consequences of drug use for the people of Ontario.

My name is Dr. Susan Bondy. I am a scientist with the foundation. With me is Ms Marianne Kobus-Matthews, a program consultant with the Metropolitan Toronto community programs office. I will speak first and Marianne will continue part-way through.

In our presentation today we will review very briefly the rationale for warning labels on alcoholic beverages and some of the evidence of their likely impact. We will then make several specific recommendations regarding the bill before us.

As the previous speaker said, alcohol is not like other products. There are risks associated with its use, and these risks are largely preventable. The Addiction Research Foundation supports this legislation because we believe that warning labels on alcoholic beverages provide the public with information needed to make informed choices about the use of alcohol.

Warning labels on consumer products exist to inform and remind the user of potential unintended hazards. Unlike other foodstuffs, alcoholic beverages contain the psychoactive drug ethanol. It is notable that cough remedies containing alcohol are required by law to warn against exceeding the recommended dose, driving and operating machinery, the medical contra-indications to using the active drug ingredient, but at the same time a beverage containing this very same drug carries none of these same warnings.

Alcohol has numerous effects. In terms of the short-term effects, it reduces the ability to process information and coordinate movement. As such, alcohol is an important cause of premature death due to trauma. Chronic use is also important as a cause of disability and death in Canada and is associated with substantial economic costs.

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The hazards associated with alcohol are recognized by Health Canada and many other international health agencies, as well as by the Canadian brewers, vintners and distillers, who have frequently themselves undertaken campaigns to inform the public about the potential hazards of drinking, particularly with respect to drunk driving, drinking during pregnancy and the excessive use of alcohol.

Given this information, it is reasonable for the government to require that warnings are carried on alcoholic beverages. The provision of this information by an appropriate government authority will serve to remind consumers of the possible hazards of this unique product.

There are several studies that have evaluated the effect of warning labels. The most notable ones are those that have evaluated the effect of the U.S. warning labels put in place in 1989. This work was undertaken mostly by the Alcohol Research Group at Berkeley, California, with the collaboration of the Addiction Research Foundation. Also, there is evidence from tobacco, on which much research has been done to develop effective warnings on packages.

There's an important distinction between warning labels on alcohol and tobacco products. The ultimate goal of public health efforts on tobacco is to convince consumers to stop using the product. However, for alcohol, the labels are not aimed at low-risk drinkers and the complete elimination of alcohol sales is not a viable public health goal. Many people can use alcohol moderately and not suffer any consequences. Similarly, a few people may benefit, in terms of their health, from drinking alcohol. So it should not be concluded that using tobacco literature here indicates that the goals are exactly the same.

To assess the effectiveness, you need to answer several questions. First, when the labels are in place, are they seen? Are they read? Are they understood and convincing? Do they change attitudes and beliefs? Do they change behaviour?

Research in the United States indicates that even though the U.S. warning labels have been criticized for being very small, very cluttered, often written sideways and in very small, convoluted words. Over the first 18 months after their appearance, they were seen by many consumers. Some 27% of Americans could remember seeing them.

More importantly, the labels have been proven to be a targeted education method. Heavier drinkers who were identified in follow-up surveys were more likely to see the labels than light drinkers. Among young men of 18 to 25 years old and who were heavy drinkers, 64% had seen the labels, compared to 27% overall. And 53% of heavy-drinking women of child-bearing age had seen the labels, which is, again, a higher number.

Is the message understood? There has been considerable research done, particularly for tobacco, to ensure that messages can be understood. It's impossible to evaluate the text in this particular bill as proposed because it has not undergone that kind of evaluation. I would recommend that it be evaluated very carefully. It uses vague terms such as ``may'' and ``can'', which undermine the effectiveness, complicated terms, such as ``detrimental'', and fairly vague warnings about general health.

Do the labels impart knowledge? Research on tobacco warnings showed that they will have a greater impact if the specific message is not well known already. It should be noted that in Canada's national alcohol and drug survey of 1994, more than 95% of Canadians over the age of 15 said yes when asked whether alcoholic beverages caused health problems, could cause somebody to have an accident, or could cause birth defects.

So these are not from unaided recall. They might be a little bit higher than with measures of unaided recall, but it's true that for these sort of general messages, the public already is quite aware. At least it has factual knowledge of these things.

Consider examples of messages that are more novel and that might be more effective: alcohol causes high blood pressure, alcohol should not be used by people with bleeding disorders, and it may be very dangerous to use alcohol with other medications. With respect to pregnancy, messages that are more specific, more positive and less well-known include: reducing alcohol use during pregnancy greatly increases the chances of a healthy baby, and women who drink during pregnancy should seek help if they have an alcohol problem.

Do warnings change attitudes and beliefs? In this case, the evidence is quite clear that there's more than just imparting factual knowledge. There's making that knowledge seem relevant to the user and making it clear that this can happen to them. Again, clear, direct wording is important. Yes, there is evidence that this kind of constant reminder does help to underscore the belief that this kind of consequence is real and can happen.

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Do the warnings change behaviour? Here the research evidence is very limited. The qualitative research on label design, which is done primarily for tobacco, can evaluate the knowledge, attitudes and perceptions of the impact, but not long-term behavioural changes. Studies of the effect of warning labels once they are in place are also limited. The expected impact is small and difficult to separate from other factors, as has already been implied.

Research offers only modest indications of behavioural effects. There is no evidence of a general reduction in alcohol problems in the U.S. since the labels were introduced. There are some examples of modest effects, however. For example, Dr. Lee Kaskutas of the Alcohol Research Group at Berkeley, California, has reported that people who recalled the warning labels on drinking and driving were more likely to take precautions against drinking and driving than people who couldn't recall seeing that warning.

It should be recognized, however, that research on the effects of warning labels are only capable of measuring these short-term effects, and from a public health point of view the possible long-term effects and the ability of warnings to remind, underscore and increase beliefs in the hazards may be important.

The warning labels signal and remind the purchaser that this is a commodity with the potential for harm, and the effect of that reminder may be gradual or delayed. It is important to see warning labels as only one part of a general public health effort to contain alcohol-related problems, which includes public education, healthy public policy, and effective and available treatment systems.

The Chair: We've gone eight minutes into your time. You have another presenter.

Dr. Bondy: I'm going directly to recommendations now.

Ms Marianne Kobus-Matthews (Program Officer, Addiction Research Foundation): I'll be brief. The information contained in the proposed label is correct. Alcoholic beverages are not like other consumer products: there are known, preventable risks associated with their use, and these are recognized both by the government health agencies and the manufacturers.

The text of the proposed warning does not include all known consequences of alcohol use, but the order of those specified does reflect the relative importance of these consequences for public health.

We are pleased that the proposed label did not attempt to incorporate messages about potential health benefits. This is a complex issue, and only certain individuals at high risk for heart disease are expected to achieve any net health benefit from moderate drinking relative to abstinence.

There is another type of consumer information that might be considered for inclusion on the label along with warnings. This is the indication of the alcohol content of the container in standard drinks. The public is often unaware of standard serving sizes and typically underestimates the amount of alcohol consumed.

We would support a requirement that a statement of alcohol content in standards drinks be placed on alcoholic beverages sold in Canada. Warning labels should not focus on fetal affects alone. The preamble to Bill C-222 deals mostly with fetal alcohol syndrome, but the proposed warning is more inclusive. Alcohol-related birth defects are a small part of the harm to the health and well-being of Canadians caused by alcohol. Far greater sources of hospitalizations, disability and early deaths arise from alcohol-related injuries, liver disease, neurological disorders and addiction.

Similarly, pregnant women make up only a very small percentage of those who are at increased risk of alcohol-related problems, or who should be made aware of the potential hazards of drinking. Warning about drinking during pregnancy should focus on what the public doesn't know. Pregnant women need to be told that they can reduce the risk by cutting down now.

Messages and implementation need to be evaluated. In order to guarantee that the labels are effective, we recommend that regulations specify how the labels are presented. We recommend that they be subjected to formal pre-testing.

One possibility is to refer this task to Health Canada, which should study the content and form. We also recommend that they consider rotated labels, the periodic review of the messages, and the use of Health Canada as the stated authority. As well, the effects of introducing labels should be evaluated.

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Warning labels must not be considered in isolation. Knowledge alone rarely results in changed behaviour. However, knowledge is an important first step. Warning labels should be enacted in order to reinforce, not replace, other forms of education. Warning labels are only one part of a comprehensive strategy to reduce alcohol-related harm, and they must be accompanied by a continued commitment to healthy public policy and an effective and available treatment system.

The greatest value in this approach is that exposure to alcohol and to the warnings are linked. Frequent users repeatedly see the warning and are reminded of the potential risk they may be taking each time they do.

Because the warning labels represent a minimal public expenditure, they can be a cost-effective prevention tool, even if their impact is small. Warning labels on alcoholic beverages should be part of a comprehensive prevention strategy, and the Addiction Research Foundation supports the efforts of Parliament to place this type of product information on alcoholic beverages.

Thank you.

The Chair: Members of the committee, we do have a copy of their presentation. Unfortunately it's in English only. We will get the French translation, and it will be distributed to all members.

Madame Picard.

[Translation]

Ms Picard: You have described the harmful effects of alcohol very well. You also talked about alcohol and drugs; I don't quite understand. When a person takes a drug or antibiotic purchased at the pharmacy or prescribed by a physician, there is always a warning on the label that combining the medication with alcohol could produce side effects such as blurred vision and that driving an automobile could be hazardous.

I haven't quite understood the connection that you are trying to establish between drugs which already warn about alcohol consumption and labelling on alcoholic beverage containers. We know the harmful effects of alcohol; you have described them very well to us.

You indicated that very little research had been done so far and that no evaluation had been conducted. You also said that labelling was but one important element. Do you really think that a label on a wine bottle will educate people in any significant way about alcohol abuse?

[English]

Dr. Bondy: You asked the question in terms of whether the labels would significantly change awareness. The way you asked that question is important.

[Translation]

Ms Picard: I'm not talking about a warning label, but a label stating that alcohol abuse can cause health problems and pose a risk to pregnant women. You seem to favour a warning label similar to what is currently found on drug bottles. Do you understand what I'm saying?

[English]

Dr. Bondy: I'm not sure I catch the nuance of your question, but I will hazard a guess at it.

The current form of warnings on medications exist.... First, alcohol is a medication in that it is a psychoactive drug, so in terms of categorizing the kinds of products that should bear consumer information about potential hazards, I would put alcohol in that category. You'd need additional information because of specific ingredients that have the potential to cause harm. So there I would link the two products.

However, research on warning labels on tobacco in particular would not indicate that the type of package inserts or warnings that contain very complicated text, are very lengthy, or use medical language, such as those you you see on medications, would be best in terms of first being seen and read by the majority of consumers and having instant impact during a very brief scanning.

The evidence for tobacco labels indicates that shorter sentences, fewer words, very clear messages, and messages that are personalized to the consumer and that direct them to do something specific would be more effective than very general messages.

You will find that the warnings that go on pharmaceutical products are very explicit. They talk about specific disorders. They don't make statements like ``may cause harm.'' I think that's important. That's a lesson we should learn.

[Translation]

Ms Picard: Thank you.

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[English]

The Chair: Next is Mr. Szabo.

Mr. Szabo: Thank you, Susan and Marianne. I have to tell you that you both sounded very much like you knew what you were talking about. I think that's very helpful to the committee in terms of its confidence level. You've raised some issues, and I want you to know that I have no pride of authorship of the label or any of these details. There are a lot of studies out there, and I think you're aware of many of them.

I want to pursue one aspect. I agree with you wholeheartedly that the purpose of labels is twofold: one is to inform; the second is to remind. As an example, the City of Toronto has just announced a new initiative where they pick the ten intersections in the city most prone to automobile accidents. They will be putting up signs on all four directions leading into that intersection. The signs, which have a picture of two cars and a collision taking place, simply say ``Collision Zone - Drive Smart''. It's going to work.

Dr. Bondy: Is it news to you?

Ms Kobus-Matthews: Yes.

Mr. Szabo: It was in the newspaper and on the news. I think it's excellent. The signs are about four feet by four feet. I think it's going to be an absolute windfall for the insurance industry, for Canadians, for everything. In any event, you might want to look into that -

Dr. Bondy: We certainly will.

Mr. Szabo: - and follow the progress there. I believe this is the same kind of thing.

Everybody knows what the problems associated with misuse of alcohol are. The critical thing in the Toronto example is that they've decided and in their wisdom said that the best time to do the remind part of the label is at the most critical time, when people are entering the intersection.

The most critical time I can think of in having a drink is reaching for the bottle. I think there's a parallel here. I want to explore it with them. I want to find out what kind of research they have to show that just telling people to drive smart, which everybody knows, is a good message to give.

You said, Dr. Bondy, that the evidence with regard to the U.S. experience didn't show a great deal of significant progress on the behavioural side. There was modest movement.

Dr. Bondy: There's some indirect evidence that people.... You will find with the tobacco research, as well as some of the alcohol stuff, when you bring people into laboratory settings and expose them to the labels they will report that they intend to change their behaviour. Those reports are not shocking, and there isn't any direct evidence that you will see a huge change in behaviour. That's agreed.

Mr. Szabo: The vintage of the data is 1993-94.

Dr. Bondy: Yes.

Mr. Szabo: So that's about four or five years' experience. Actually, it came in November of 1989, so really it would be about four years of information.

Dr. Bondy: That's right. Most of the convincing stuff was published about two years following -

Mr. Szabo: Now, here's the hit; here's the shoot. You also testified - this is like being a witness in court -

Dr. Bondy: It's okay.

Mr. Szabo: - you're on the public record.

You also said and commented - and I don't know whether it's from your own personal experience or from studies you read - that the U.S. labels are ineffective because they're too small, or.... You give a lot of recommendations.

If we have bad labelling in the United States, how could we possibly measure good things happening from bad labels?

Dr. Bondy: You're not the first to say that. That has been raised at a number of meetings of the American Public Health Association. Research articles have been published that say exactly that. When researchers travel to the States and occasionally say let's see what these U.S. labels look like, they sometimes don't see them. Sometimes they are very small, or they are written sideways up the bottle. We can look at older tobacco packaging and see the examples: gold lettering on a purple background.

I'm not saying the labels have to be disfiguring, but they should be legible.

Mr. Szabo: Thank you, Madame Chair.

The Chair: Mr. Pillitteri, you indicated you now wish to....

Mr. Pillitteri: Yes, thank you, Madame Chair.

Today, advertisement and consumption of alcohol has changed much, especially in Canada. I credit that more to education rather than anything else. But let me say one thing. When you talked about the labelling, I know some industries from time to time go on changing the labelling. Tomorrow, if they changed a label, they would also need the okay from the okay from the government or a part of government about what kind of a label they would have to adjust to, because if one implies that the kind of label has an effect, then definitely the government has to put in its input on how a label has to be designed, whether it's visible or it's not visible. But the fact is that since 1989 they've had labelling in the United States and consumption per capita was higher then and it's still higher today. Labels have not done anything.

.1610

I think the education factor is far greater, in terms of how close an individual is to being an alcoholic or how close he is to having too much consumption, when he goes to the doctor, rather than when he reads a label. I don't think that anyone of us is capable of knowing when we've reached the point, how much to consume, and which side we get on, when we start reading that label.

I would say that, moreover, when it comes to fetal alcohol syndrome, Dr. Gideon Koren from the Hospital of Sick Children and Dr. Ernest Abel from the Wayne Institute in Detroit, both specialists in FAS, stated that government warnings on alcohol beverages could create unnecessary anxiety, resulting in hysteria, termination of the pregnancy through abortion, etc. Do you believe these studies have taken place?

Dr. Bondy: I believe those studies have taken place, yes. I've heard those research findings reported by Drs. Koren and Abele on three occasions, and they feel that in their clinical populations they have seen women who are unreasonably concerned about moderate alcohol exposure during pregnancy and the potential to harm their child.

I believe them when they say that they've had these experiences. There are some limits to the degree to which we can extrapolate from their findings. First, they are dealing with a highly selected population. I personally have referred two unreasonably worried women to Gideon Koren so that he might calm them down.

People are often unreasonably afraid of rare events and not afraid enough of common events. People often appear in hospital convinced they have a cancer that they don't have. So the panic they see may not be representative. So I would deflate that evidence of harm, personally.

It is also true that if a woman is concerned about her drinking, and speaks to a doctor and is advised to cut down on her drinking, she can improve the chances at that point of having a healthy child. So the fact that people are presenting themselves for medical care out of a concern of an exposure for the child they're carrying is a good thing.

Mr. Pillitteri: Tell me something, have you ever done a study of how many people drink at home when they're actually able to reach this label? How many people go into hotels, restaurants, bars, and never get to see the glass, the bottle or the container. How many people are we addressing? How many are we not really misleading by having a label? Because we actually are doing it to the individuals who are more responsible, if they're buying a bottle of beer or a bottle of wine with their meal, rather than the one going out to drink. Are we addressing the whole issue?

Dr. Bondy: I don't have good figures for Ontario, but figures for the United States would say that the highest-risk drinkers tend to be beer drinkers and they tend to be youth who are not buying wine in restaurants. They tend to be drinking beer at home.

Also, the warning labels should be explicit. We're not talking about stop using alcohol altogether. We should be making very clear, very simple, explicit statements about high-risk behaviours and we shouldn't be targeting the wrong people.

The Chair: Thank you very much. I think that some of the points you made in your final recommendations are very good ones, and one in particular is the fact that you think that the educational process would have to go in tandem along with the labelling. I think the educational process is very important. Another interesting point was the fact that the fetal alcohol syndrome is a very small proportion of the alcohol-related problems and that maybe the bill should be expanded more broadly.

Thank you very much, and we'll look forward to studying your report more fully and coming forth with a recommendation. Thank you.

Dr. Bondy: Thank you.

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The Chair: The next group of witnesses are on Fetal Alcohol Support Network. One of the witnesses, on her way in a taxi, has not arrived. But would the other witnesses please come to the table. That is Joy Gilmore, I believe, Jackie Herbert and Margaret Sprenger.

Welcome. Some of you are from B.C. I welcome you to Ottawa. Another one is from Mississauga, and I welcome you to Ottawa too.

Whenever you're ready you can make your presentation. Again, we ask that you keep it reasonably short so that we can ask all those tough questions.

Who's going to go first?

Ms Joy Gilmore (Individual Presentation): I'm going to go.

The Chair: Okay, Ms Gilmore, please.

Ms Gilmore: Thank you for asking us here today. We're delighted to be here for us to tell our story.

I'm going to cut my presentation down because there are three of us. One lady's coming by cab. She had a late flight.

You may ask, why label alcohol? Why not, especially when the same alcohol products for export to the United States market are required by law to carry the U.S. Surgeon General's alcohol awareness warning label.

The Congress of the United States passed a bill October 21, 1988. We all know this. All alcoholic beverages going out of Canada are required to carry the Surgeon General's alcohol awareness warning label. This is a double standard.

The Yukon in 1991 and the Northwest Territories in 1993 passed their own legislation because they can no longer wait for the -

The Chairman: I'm sorry, Ms Gilmore, you're reading too fast. The translator's not keeping up.

Ms Gilmore: Okay. Should I back up?

The Chairman: Just a little bit slower. It's okay.

Ms Gilmore: I'm trying to let the other ladies have their turn too.

Labelling alcohol is an inexpensive educational tool. It raises awareness and educates men and women that drinking alcohol during a woman's pregnancy can cause physical, mental and emotional birth defects to the developing fetus. Alcohol with a warning label gives you education at your finger tips.

Labelling alcohol would benefit not only legal-age drinkers, but especially our under-age youth, who feel they must drink alcohol due to peer pressure to be accepted. By educating today's youth, it could only mean a decrease in alcohol birth defect children being born. As a nation, we would all benefit from this: the child, the family, the taxpayer and the health care system.

I would like to see a logo on the alcohol beverage container, as well as a printed message. This will alert those who are illiterate or may have a language barrier. The government warning label should be placed across the base of the can or the bottle, front or back of the container. Please, make it readable: black or red ink could be used when labelling, as white on a silver can of beer is not highly visible.

The U.S. brewery Anheuser-Busch proved the point when they increased the size of the printed alcohol awareness label on their products. Yes, it could be increased in size after much foot-dragging by the alcohol industry.

Prior to New York City posting the alcohol awareness warning sign, which reads ``Warning: Drinking Distilled Spirits, Beers, Coolers, Wine and Other Alcoholic Beverages During Pregnancy Can Cause Birth Defects'', Mr. George Gallup was hired to conduct a poll. A second poll was taken one year later and it showed the effectiveness of alcohol awareness warning signage. Alcohol awareness had increased by 14% for both men and women. That same sign can be found throughout the United States. In British Columbia, we now post the sign in 37 cities.

Through research it has been demonstrated that alcohol is very destructive to the developing fetus. Labelling alcohol is a very simple, inexpensive way to raise awareness. Why don't we do it?

Pregnancy and alcohol do not mix. A pregnant woman never drinks alone, for when she drinks her baby drinks with her.

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The Chair: Go ahead, Ms Wheway.

Ms Donna Wheway (B.C. FAS/E Support Network): Thank you for having us.

I'm here today to speak in favour of the labelling of alcoholic beverage containers specifically as it pertains to fetal alcohol syndrome and fetal alcohol effect and its impact on individuals and their families.

You have already heard that there is a cost of $1.5 million over the lifetime of a person with fetal alcohol syndrome or fetal alcohol effect. That obviously is a great deal of money. However, what is even more concerning is the incalculable cost to and damage done to thousands of families across Canada who are struggling with fetal alcohol syndrome every day.

I'm sure you and many others know of the growth retardation, characteristic facial features and central nervous system or brain damage caused by maternal alcohol consumption during pregnancy. But what does that mean in the long term to the individuals with FAS, their families and societies at large?

If a person is a little short or looks a little bit different, they'll generally get through life just fine. What brings them to the attention of various systems and gets them in trouble every time is the behaviours they have, which are caused by the invisible brain damage.

In 1994 a study was done on 426 people with fetal alcohol syndrome and fetal alcohol effect, with an age range of 12 to 49 years. The results of that study were staggering.

Of people with fetal alcohol syndrome, 21% went on to have problems with substance abuse; 32% of people with with fetal alcohol effect had problems with substance abuse. Of people with fetal alcohol syndrome, 32% had problems with mental illness, and 49% of people with fetal alcohol effect. Of people with fetal alcohol syndrome, 40% went on to have problems at school; 63% of people with fetal alcohol effect had school-related problems. Of people with fetal alcohol syndrome, 51% were in trouble with the law; 68% of people with fetal alcohol effect were in trouble with the law. Of people with fetal alcohol syndrome, 16% were homeless, and 30% of those with fetal alcohol effect. Of people with fetal alcohol syndrome, 35% had violent or threatening behaviours, and 50% of people with fetal alcohol effect did.

Overall, 74% of people with fetal alcohol syndrome had one or more of these secondary disabilities and 93% of people with fetal alcohol effect had one or more of them.

To be counted in that study, a person needed to have only one event in any of the categories. Multiple events per category were not included. We recently consulted on a case where one young man had 25 documented involvements with the criminal justice system in less than five years.

Not only does the study show the devastating long-term effects of fetal alcohol syndrome and effect; it also shows that contrary to the commonly held belief that FAS is worse than fetal alcohol effects, the outcome for people with fetal alcohol effect is often much worse. Why? Lack of early identification and intervention.

I am one of the coordinators of the Fetal Alcohol Syndrome and Effect Support Network of B.C. Every month we receive over 300 calls, mostly from British Columbia but also from across Canada, from families and professionals from various disciplines searching for support, help and understanding.

Living with FAS is not an easy or enviable task. I know this not only from the hundreds of calls from families we support but from first-hand knowledge. My husband and I have four children. Two have fetal alcohol syndrome. The impact on families living with and/or supporting people with FAS is enormous and often devastating.

We must label alcoholic beverage containers to educate people and hopefully prevent some FAS or FAE, especially in the lower-risk population. While I realize this is not the ultimate solution, it is a step forward, and a small step is better than no step at all.

We must also commit time, energy and funds to supporting individuals with FAS and their families who are already here and those yet to come.

Thank you.

The Chair: Thank you, Ms Wheway.

Ms Sprenger, do you have something to add too?

Ms Margaret Sprenger (Fetal Alcohol Support Network (Mississauga)): Yes.

The Chair: Please go ahead.

Ms Sprenger: I am the coordinator of the support group that is responsible for the Toronto area, and I have the hotline in my home. These are some observations I have made and some knowledge I have obtained from talking to people.

I am also in favour of labelling containers of alcoholic beverages. Alcohol is a teratogen. It is a mind-changing and mood-altering drug.

I have been following alcohol damage to the unborn child since 1983, but especially since 1989. Alcohol-related birth defects have affected me personally in my extended family and in foster children.

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It is said that many women at risk are being missed. They are not getting the message. Let us tell them at the point of purchase. It is not true that everyone knows about alcohol-related birth defects.

Everyone might have heard of the letters FAS, but, from my experience, they know very little about the actual effects of alcohol on the unborn child and on the people who are forced to relate to and care for these individuals in their lifetimes.

Here are some comments: ``If I had known, I would not have gone out drinking with my husband on weekends. I am not an alcoholic''. ``If I had known, I would not have adopted this child, knowing the history of his parents, but would have let him remain a foster child to ease my financial burden''. ``If I had known, I would not have insisted that he meet certain expectations in school that I now know were impossible for him to meet''.

We are in favour of labelling because it is a component of prevention. We also are in favour of treatment. But there really is no treatment. There is only assistance. The word ``treatment'' implies that the patient can get better. In the long run, prevention is less expensive than treatment. By what criteria does society measure cost? Is it in dollars?

I will list a few of the human costs of FAS and FAE. First there is grief over having a child who will never lead an independent adult life; betrayal by a system that says, ``Don't ask questions. You're lucky we found a baby for you to adopt''; abuse of care-givers from systems that tell them they are entirely at fault for their child's behaviour; abandonment by spouses and partners who burn out trying to cope; a sense of failure in that, despite all the best efforts, this child will end up in a specialized foster home, in the penal system, or on the streets; remorse because the other children in the family have been neglected because the afflicted child or adult requires all the parental attention.

Eighty percent of women drink. They and their drinking partners deserve to know all of the consequences of their actions.

The Chair: Thank you very much, Ms Sprenger.

Welcome, Ms Herbert. I understand that your plane from Winnipeg was delayed because of snow.

Ms Jackie Herbert (Individual Presentation): Yes. I have been up since 5:30 this morning sitting in the airport in Winnipeg.

I'll try to make my presentation very brief.

The Chair: Please do that. We're under tight time constraints.

Ms Herbert: I'm the mother of three children, of whom one is biological and two are adopted with FAE.

Basically we had no idea of what was wrong with our children when we adopted them. If you want to know what my life is like, read The Broken Cord. That's my life. I'd suggest that people get the book The Broken Cord. I'm in there somewhere.

After all the best efforts that we've put forward, my daughter became pregnant and has had the baby.

I'm here to say that labels give you information. I feel that the consumers are entitled to know what is happening, especially pregnant women.

Since their diagnoses, my daughters have become their own best advocates. Friends will come and say to them, ``If I drink, what will happen?'' I don't have them here with me, but I bought a couple of bottles. If it's there and you can see it, it makes you think.

I don't think the labels are a panacea, that they will stop them from the drinking. I'm not here to stop people from drinking, but I believe very strongly that if you're not informed about what alcohol can do to an unborn fetus....

Don't live under the illusion that it's just the native population. That's wrong. Every woman who drinks is putting her baby at risk. Alcohol doesn't know colour or race. If you're a woman and you drink, you're putting that baby at risk.

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I think that if you are to inform, labels would have to be done in a certain way, because a lot of our high-risk families can't read. They have to be done so that the people at most risk can understand them.

There is a lot more that I can say on this; however, I'll basically have to cut that short. But I do think they have to be applicable.

In summary, this is a problem that society has to come to grips with because we, as a society, have accepted alcohol as a drug, as our recreational drug. It is a drug - don't forget that - and a very dangerous one. Not only does it break up homes, it resulted in my having two children who will never attain their potential. I don't know what they could have been. They could have been scientists, like my oldest daughter, but we'll never know. That grieves me, it grieves them.

So I'm giving society notice that we have to morally and spiritually address this problem. It's time we sit up and say that the children are here and are our problem - they are everybody's problem.

The Chair: Thank you very much.

Ms Picard.

[Translation]

Ms Picard: Thank you for your very interesting testimony. When you talk about alcohol, are you talking about wine as well as spirits? Is alcohol abuse the only threat to the foetus?

A glass or two of wine at mealtime, even in the case of young children, is part of the customs and culture of certain countries such as France whereas here in Canada we drink milk or coffee. Has your research brought to light any differences? For instance, could gin be considered dangerous to the foetus?

[English]

Ms Herbert: I come from Europe originally. I'm from England, and my sister is a professor there. I'm very familiar with the habits of France because I've gone there many times on holidays. The research coming out of France indicates that they are only now realizing that with any alcohol - it doesn't matter whether it's beer or wine or spirits - there comes the mere fact that the alcohol has a teratogen. It's teratogenic, which means it kills and harms body cells.

There is a body of work in France - my sister has translated it for me - that has been done by the French government. The number of FAS children over there is astonishing. They are now beginning to come to grips with the fact that women cannot drink the way they they used to. So you are right.

Ms Wheway: Can I say something?

Interestingly enough, 1973 was when the term ``fetal alcohol syndrome'' was first coined in Seattle, Washington, but the first documented medical research came out of France in 1968. And it's any alcohol. It doesn't matter if it's wine, beer, coolers, or whatever.

[Translation]

Ms Picard: Are some women more at risk than others? France is not the only country where the consumption of wine is part of the culture. Not all children suffer from this syndrome. Are some women more at risk than others?

[English]

Ms Wheway: There are a lot of different variables. It depends on the age of the woman, her metabolism, whether or not she had a good diet when she was drinking, or a poor diet. There are all different kinds of mitigating circumstances that can impact on it, just like whether you drink or not. They say you should eat healthily when you're pregnant. If you don't eat healthily when you're pregnant and you consume alcohol, there's likely to be more damage than ever. But there are a lot of different mitigating circumstances that can impact on the development of the fetus.

Ms Sprenger: There is also a factor called timing. As a hand-out, I brought a chart today that shows at what stages the fetus can be harmed in various places, like the eyes, the ears, the hands and the brain. Some women are binge drinkers, and if they go on a binge - let's say they do it when the eyes are forming - they could have a child with very poor eyesight. So there are all these variables. That's why we say it is safer not to drink anything.

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As well, it depends upon the culture. I've talked to people who have immigrated here and then brought their relatives over. As soon as their relatives got here, they began to suspect these relatives were suffering from fetal alcohol syndrome, whereas at home nobody knew they had it because of the different culture. In our culture, we expect more of our children. We expect them to go through school and get good marks and go to college or go to university and have a career. In some cultures they don't expect that, so the slight effect of alcohol would not be noticed in some cultures.

The Chair: Thank you. Paul.

Mr. Szabo: Earlier you may have heard a suggestion that FAS was a small component of the damage, but I can tell you - and I want to tell all of you, because I know a little bit about each of you - that I'm aware of the ripple effect on family and friends and society at large, and that the costs are much larger than would be indicated by the number of birth defects. I am going to continue to pursue the warning label that includes the reference to abstention during pregnancy, on your behalf.

There has been also a suggestion that FAS or FAE may be caused by things other than alcohol, such as the environmental or chemicals in the air, etc. Have you heard that? What would be your response?

Ms Herbert: I think we as a society, because we have accepted alcohol as part and parcel of the fabric of our society, are not willing to look at it for what it is. It's a drug. We are very big on people being drug addicts, being addicted to heroin or speed, but we will not come to grips with the fact that alcohol is a drug. It hurts families.

Nothing causes FAS, which is 100% preventable, except alcohol. That's the bottom line. There are no ifs, buts, or in betweens. Unfortunately, for somebody like me, who has to sit and watch two beautiful girls never, ever attain their potential because of alcohol.... That hurts. That really hurts. It makes me extremely mad. Like you, I'll never give up, because my children are worth a lot. They're human beings. They have as much right to live on God's earth as my oldest daughters do. So I will not give up. That's the bottom line.

If this takes me the rest of my life, I will keep on fighting to get labels on bottles. No child should go through what we as family have had to go through. It's a ripple effect. That's the bottom line. I don't care how long it takes.

Ms Gilmore: I'd just like to make one comment. In the late fifties and early sixties, we fostered 29 children during a five-and-a-half-year period. Our first two little boys were native Indian children. We dearly loved these children.

Tom should have been in third grade at school. He was put in a special class with seven children. He could not read the primary reader. The teacher sent me home flashcards, which we could do a hundred times. As we all know here, the words ``book'' and ``look'' have the same components. The words ``soon'' and ``noon'' have the same components. Yet if Tom could get ``book'' and ``look'' right even once, that was lucky. The inability to read robs you of many things.

Ms Wheway: To go back to your question, there are studies that have duplicated the exact physical, exact neuro-behavioural problems in animals in a very controlled study. So if there were other things out in the environment causing this, I don't see how they could exactly duplicate the problems caused by alcohol.

The Chair: Mr. Pillitteri.

Mr. Pillitteri: I have more a comment than a question.

You made a remark - and I don't think I can leave it untouched - that immigrants who come into this country bring in their parents amd find out it's alcohol....

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This morning I was at a breakfast meeting, and I think it was more understanding. I just wonder how we, as Canadians, would feel going to a strange country and living in let's say China, the Orient, or any country where we do not speak the language and do not have an understanding of the culture. I just wonder what kind of position we would be in. I doubt it very much that I would put that to alcohol.

I assume that someone who doesn't consume alcohol or who does not care for alcohol could have a handle put on it that this was because of consumption of alcohol they had before.... I just want to make that remark.

Ms Sprenger: I'm referring to specific cases in which - and these were not parents, these were brothers and sisters - it is well known that there was alcoholism in the family. I'm saying that in their own culture they do not stand out, but when they come here they do stand out.

Mr. Pillitteri: That is exactly the remark I did not want to hear before. I heard it, and it's still stated the same way.

Ms Gilmore: May I make one other statement? In California, three years ago, when we were there, every time there was a commercial for advertising of alcohol of any sort, the Surgeon General alcohol awareness warning label came up at the right-hand side of the screen, which I thought was tremendous. So it didn't matter who was promoting their product, that little sign was on the screen.

I maintain that if you can label an alcohol container and a young child is underage and he doesn't really want to drink, but he's drinking because of peer pressure, regardless of whether he's at the beach, in a car, on the front lawn, on the back lawn, in somebody's rec room, or whether mom and dad are out, eventually, by turning that can around enough times, I hope the bells and whistles will go off. And when he is ready to have a family, he'll remember reading that label that told him he could have a child with a birth defect, because if fewer children are born healthy and intelligent, they are being robbed of so much, like the ability to read. Ladies and gentlemen, none of us would be here today if we could not read.

The Chair: Let me ask one question. Do you believe that the educational programs that most of the industry already puts forth on the dangers of drinking should continue? Another aspect is that when we pay for a prescription drug at the drugstore, and certainly my druggist does this, they list all of the dangers associated with this prescription drug - things we should be watching out for. Is there some way we can do that when someone picks up a case of beer, or could there be something on the table in the bar or whatever advising of the dangers of drinking?

Ms Gilmore: I feel that when a product is labelled, it doesn't matter where you take it. You can't escape from a label; it's there.

The Chair: But if you're drinking a draught beer, and many, many young people drink draught beer....

Ms Gilmore: But I was going to say that when signage is out there, and it's placed in all places that serve and sell an alcoholic drink, if we have signage, they are going to see it. Some time during the course of the evening while they're drinking beer, they're going to be visiting the rest room. So if they're out there....

As George Gallup provided for New York, the awareness had increased by 14%. This was only for people who were in establishments. Most drinking is done in a home or with friends, so if somebody comes over they can come to the kitchen and look at the beer can or bottle of wine that's being served for the evening.

Today with a lot of products in the United States, the labelling is no longer down the side; it is in the form across the back. I know, because I've been to the liquor store to check this out.

When I first started out, there were thirty products from California coming into Canada labelled; now there are about six or eight. I hope we will join and educate. It's the most inexpensive way to educate our youth who are underage - those who shouldn't be drinking who have snitched a beer or whatever from the fridge. Those are the people we want to get at, because I don't think we'll ever get to hard-core drinkers.

The Chair: We're almost out of time, unfortunately, but do you have a comment, Miss Wheway?

Ms Wheway: I was just going to say that I think there's been a lot of education out there around drinking and driving, and you see very graphic television commercials and everything else. While people may have heard of the term fetal alcohol syndrome, or fetal alcohol effects, very few people have a true picture of what that means. They call fetal alcohol syndrome a birth defect. Unfortunately, it's also an invisible birth defect.

If this person walked up to you on the street and you didn't have a good understanding of what FAS was and what it looked like, you would never know that the person was born with fetal alcohol syndrome, because it's not a visible handicap. That's what causes so many problems for our children and why so many of them do so poorly in the long run: because it goes unrecognized and unvalidated for so long. They're set up to fail over and over and over again throughout their lives.

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Ms Herbert: To capitalize on what was said, if you saw my daughters you'd never know there was anything wrong with them. For all intents and purposes, they look very normal. It is a hidden handicap. So a lot will be expected of them, but cognitively they cannot do it. So looks are very deceptive.

Ms Gilmore: That was the same with our Tom. He looked perfectly normal, except he was straight off the ceiling.

The Chair: Thank you very much. Half an hour is certainly not enough to listen to four very knowledgeable people in this area who have a lot of information that they wish to impart to us.

I appreciate your coming in. You've come all the way from three different centres: Mississauga, B.C., and Winnipeg.

Did you have any written presentation that you wished to leave with the clerk here?

Ms Gilmore: Yes, I did. This is the hangover that lasts for a lifetime. This is a normal brain and this is the brain of a fetal alcohol child. This was given to me by Dr. Robinson - he's retired from UBC, associated with Sunny Hill Hospital - from a slide on FAS. Each of you who have received a package from me today also received ``the brain'', as I call it. I lost my brain and Dr. Robinson went and took a picture off the slide and gave it to me.

The Chair: Our last two presenters are from the Canadian Centre on Substance Abuse:Mr. Jacques Lecavalier and Richard Garlick.

Mr. Jacques Lecavalier (Chief Executive Officer, Canadian Centre on Substance Abuse): We will not be longer than five or eight minutes. I will speak and then we can answer your questions.

I wish to thank you for inviting us to make this presentation on this important issue.

By way of introduction, the Canadian Centre on Substance Abuse was created in 1988 by an act of Parliament, which at the time received all-party support. It was created to provide a national focus to reduce the harm associated with alcohol and other drugs.

We are governed by a board of directors of fifteen people, six being nominated by the Governor in Council and the other nine by the board itself. We have an annual budget of about $2 million, nearly 40% of which is raised through projects and sales of services. The rest comes in by the way of a federal grant to our organization.

In supporting this bill I'd like to make three main points, which I will surface up front.

First, it is our contention that the review of research that we have conducted does not support the notion that warning labels will lead to changes in behaviour with respect to alcohol. However, it's common sense that labels serve to reinforce other measures and thus have an effect in the long term.

We take the strong position, as well, that consumers have a right to be informed about the products that can harm them.

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Finally, we look at warning labels as a passive measure that is not a substitute for other active intervention measures in a comprehensive approach to tackling the problems of alcohol.

Let me review that in perhaps a little more detail. Abusive alcohol exacts an enormous toll on our society in the form of social disruptions, illness, debt, and lost productivity.

In June of this year, the Canadian Centre on Substance Abuse, along with many other partner organizations, will release a study showing the costs of alcohol abuse to be in the vicinity of 1.5 % of gross domestic product. Yet provincial and federal governments collect several billion dollars every year in revenue from alcohol taxes. That goes to show you the love-hate relationship we have with this product.

In an environment where alcohol consumption is largely taken for granted, the odds are stacked against warning labels as a means of convincing people to drink responsibly. In other words, warning labels are most likely to be ignored by the very people who most need to heed them. Indeed, our review of research available cannot support the contention that warning labels lead to modified behaviours. Clearly, there is ample evidence to show an association between warning labels and an awareness of hazards, but no evidence of the next step, that it causes an effect in relationships and in influencing behaviours.

However, common sense would suggest that warning labels serve to reinforce other models of intervention over the long term. Indeed, it is clear that warnings on cigarette packages, for instance, along with more active interventions, have served to reduce the harm caused by tobacco.

We take the strong view that Bill C-222 should be passed mostly for reasons associated with consumer rights. Nearly 70 percent of Canadians believe there should be warning labels on alcohol products. Canadian producers put warning labels on exports going to the U.S. It seems appropriate to do no less for Canadians. Alcohol can produce toxic effects. Why should alcohol be treated any different from other consumer products that can cause harm.

We would welcome, therefore, the quick passage of Bill C-222. However, it is clear that the act has little chance of meeting its objectives as a stand-alone measure. We were very much impressed by the debates in the House pointing to the complementarity of warning labels as reinforcement to the investments of governments, voluntary organizations and the private sector in prevention, research, treatment and enforcement.

The challenge facing programmers and policy-makers in the substance abuse field is to create and nurture a context in which laws such as Bill C-222, and indeed Bill C-8, can work together in a host of other formal and informal measures to achieve meaningful results.

Since 1987, we have had such a framework of comprehensive measures under Canada's drug strategy. We are very concerned over a decision by the Department of Health to terminate its participation a year early. That decision, which came into effect four weeks ago, is currently being reviewed by the Minister of Health. If governments in Canada continue to dilute their commitment to tackling alcohol and drug issues, we will see an end to the gains we have made in this field in the past ten years.

By way of comparison, the net effect of terminating a vaccination program when prevalence of the disease has decreased or stabilized is highly predictable. Indeed, we are already witnessing increases in adolescent drug use and a softening of attitudes.

In summary, Madame Chair, CCSA applauds the positive concern demonstrated by Bill C-222, and we endorse its aims. We would urge members of this committee to support its adoption and champion a renewal of the government's long-term commitment to tackling in a comprehensive way the social health and economic harm associated with alcohol and other drugs. Thank you.

The Chair: Thank you very much.

Mr. Szabo.

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Mr. Szabo: Bill C-8 is controlled drugs and substances, which was reinstated from Bill C-7 from the prior Parliament. I just happened to be the chair of the committee that had that bill. I know, because we had it for 14 months. It deals with a whole host of things.

I gather that one of our recommendations was that, in addition to the bill, the committee, not the House, should undertake a review of Canada's drug strategy. I have a feeling that may very well happen in the fall if the committee is amenable to undertaking that awesome task.

I wanted to ask you, however, about the issue of measurement of success. You may have heard me earlier. I'm not sure if you were in the room, but there was an earlier discussion about changing a variable and wanting to determine its impact over a period of time. The ideal or desirable situation would be to freeze or hold constant all other factors so you could get a measurement. Otherwise, if you had an equal, negative, offsetting force, the measurement would show no movement. It might have had a very positive impact, but the net of the two shows nothing. So I think that's probably a common sense issue.

However, do you have any knowledge of the level of activity that took place with regard to all other efforts with regard to alcohol consumption and the responsible use of alcohol products that occurred at the same time, or from November 1989, through to whenever the most recent study was taken to measure the impact of labels?

My premise or hypothesis would be that since everybody in the industry is now saying labels have no major impact, during that same period, we invested something like $60 million from the industry's figures in educational and other related programs. They say this must have tremendous benefits that are much more than the impact of the labels.

The interesting thing is that this is going on during the same period in which the labels are in there, yet for the same measurement period we're saying labels don't work but the advertising and the educational programs do work. There's a contradiction here. The measurement must be the same and applied to both, but you couldn't hold one constant while the others were changing.

You're the experts in this thing. How does one rationalize this situation whereby you can suck and blow at the same time?

Mr. Lecavalier: I'm not sure if I can answer this question, but I'll try. It's clear that when we're looking at a measure like labels and at an effect on behaviour, that the behaviour is two steps removed.

I think the research, as you've probably seen, showed clearly that as a result of labels and counter-advertising, if I can put it that way, people are away of issues and dangers. But it's another step to link the behaviour in terms of the reduced harm of alcohol or the reduced abuse of alcohol directly to the one measure because there are so many confounding factors in our society.

Even the economy is a confounding factor. When there's a lot of stress, for instance, in the workplace and when young people can't find jobs in our country, those are factors that promote the use of substances. So it's very difficult to isolate any one measure from the harm we're trying to measure.

We are trying to make some progress in this respect. I mentioned in my presentation that the centre is attempting to estimate the cost of substance abuse across Canada. That will be broken down by alcohol, drugs and tobacco. I think we can refine our measurement. But at this stage, to isolate one measure from the other at the macro level is extremely difficult.

You can usually get a sense of the effect on an intervention activity at the local level through evaluation. But it's much more difficult to do it in terms of the broad policy measures.

So I agree that your question is extremely valid. We at the centre, along with other organizations in Canada, are looking to find ways to measure these kinds of impacts. Not only the impacts, but even measuring the total harm caused to our society by substance abuse is a difficult thing to do. I believe that once we can measure harm, then the second step that can reasonably be attained is to see what part of that harm is reasonably avoidable. The third question that comes normally from decision-makers is where do we invest to avoid this harm? The fourth question is the one you asked: what is our result?

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Mr. Szabo: One other quick question. In your experience, based on your knowledge, do you believe or do you know of any empirical evidence or authoritative study that would support the premise that label warnings related to the consumption of alcohol during pregnancy would cause extensive distress to someone to the point that it might cause spontaneous abortions?

Mr. Lecavalier: No. We don't know of any such evidence.

Mr. Szabo: Any cases?

Mr. Lecavalier: There may be some empirical evidence or some reported cases -

Mr. Szabo: Other serious health problems?

Mr. Lecavalier: I'm sorry?

Mr. Szabo: Not spontaneous abortions, but how about it causing other health problems as a result of seeing a warning or being told of a warning that it would cause problems?

Mr. Lecavalier: I can imagine.... I don't know that there is evidence -

Mr. Szabo: There's no major -

Mr. Lecavalier: - but common sense would suggest that if someone is pregnant and finds out later on -

Mr. Szabo: How about with regard to regulation? Have you got evidence that this warning label, or any kind of warning label, adding to the pile would be the straw that broke the camel's back and negate somehow the validity of all other warning labels we have in our society?

Mr. Lecavalier: Absolutely not.

The Chair: Mr. Pillitteri.

Mr. Pillitteri: Thank you, Madam Chair. I'm sorry, I'm not in this committee. I was never in this committee. I know very little about health, but I go by reading things.

As a matter of fact, talking about reading statistics and numbers, I read an article a while ago. It was from Denmark. Since the increases in the sale of wine - they bought 30% more wine - heart trouble and heart failures in Denmark decreased by 30%. Those are all merely statistics. I don't if it has a.... But they related it to what is in wine.

Something you did say, Mr. Lecavalier, was that research has found that the people who would most need the labelling were not being reached. You said that. You also stated.... The one that really struck me most was about labelling because of consumer rights. Does that mean that anything that affects consumer rights in the consumption of food, everything we eat normally...? Don't you honestly believe that if it's a consumer right in one element, then it should be a consumer right to have it stated - let's say anything, such as fat foods or anything that is harmful to health - and put on there? If it's right for one part of the consumer then shouldn't it be right for another part of the consumer? Labelling should be on there. You did state that the labelling on the substance of alcohol is consumer rights.

Mr. Lecavalier: What I was alluding to there is the fact that every other consumer product I'm aware of in our society that we use and is potentially toxic and causing harm to consumers is so labelled, so why should this one be any different?

Mr. Pillitteri: Not everything is labelled. No, sir.

Mr. Lecavalier: Everything that is harmful to people is labelled, that we're aware of.

Mr. Pillitteri: Also, how about the benefits of it? Do you think that possibly should...?

Mr. Lecavalier: It's clearly.... You raised the issue -

Mr. Pillitteri: It's consumer rights.

Mr. Lecavalier: Yes, indeed, it's a consumer right.

Mr. Pillitteri: Thank you.

Mr. Lecavalier: You raised the issue of benefits in the Scandinavian context. Indeed, there is overwhelming evidence today that alcohol has beneficial effects. There is no negation of this on our part. That's why the words that you put on the label are actually very difficult to -

Mr. Pillitteri: Put a doctor's prescription on the label.

Mr. Lecavalier: Well, let's face it, the more we look at this product, the more we come to the definition of a drug. It has risks and benefits. It affects the bodily function, exactly like a drug.

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The Chair: Mr. Murphy.

Mr. Murphy: I understand the arguments you put forward and so on, and the label as sort of a by-product of all of this, but you were talking about different strategies that need to go along with the holistic approach to educating people about the dangers of alcohol. Are there some strategies you're looking at or thinking about that we're not already doing, and could you tell us about them?

Mr. Lecavalier: I think my concern here is the decreased investment of many governments in the strategies that we, as a society, have deployed over the past decade. It's been clear over the past decade that drug use has been going down, that alcohol use has been going down. We're still trying to grapple with the issue of measuring harm, however. So we're very fearful that through decreased investments in these active measures we're going to see an increase in drug use in the contexts of a stressed workplace and of hopelessness with youth. In fact, we're seeing that already. This is not a time when.... We applaud the measure of putting forward laws, but this has to be done in a context in which governments continue to invest in this issue, not substitute one measure for the other. That's our concern.

Mr. Murphy: Thank you.

The Chair: Thank you very much. I don't have any questions, but I do want to say that this has been a very interesting two hours. We've heard many different sides on this issue. Most people were in support of the labelling today, and for very strong and compelling reasons.

I want to thank you all for coming in. We will obviously be reviewing your submission when reviewing the bill, and before we make our final report. So again, I extend my personal thanks to you.

Thank you, members of the committee. If there's no other further business, the meeting is adjourned.

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