PUBLIC
AWARENESS CONTINUED
DURING THE
1950S AND
1960S
8.11 On 30 September 1950, Doll and Hill
published their first epidemiological study[89]
reporting an association between smoking and lung cancer. The
study had been commissioned in 1947 by the MRC, which had received
a request from the Ministry of Health the previous year to conduct
an investigation into the question of lung cancer. The report
generated considerable press interest.[90]
More publicity followed with the publication on 20 November 1951
of the MRC's own report for 1948-50 which concluded that there
was some association between cancer of the lung and smoking.[91]
8.12 In December 1952, Doll and Hill published
their second report concerning smoking and lung cancer. This report
again received considerable publicity from the press and the then
new medium of television.[92]
In the view of most social commentators, the publication of the
reports of Doll and Hill became the catalyst for a much higher
level of debate about smoking and health in the UK and worldwide.
8.13 During the period 1951 to 1953 the
statistical panel of the Government's Standing Advisory Committee
on Cancer and Radiotherapy examined the evidence contained in
the Doll and Hill reports. The view of that panel of experts was
that the conclusions reached by Doll and Hill were sound. The
panel acknowledged that a causal relationship between smoking
and lung cancer had not been proven, but the report went on to
say that there was "a strong presumption until some positive
evidence to the contrary is found, that the connection between
smoking and lung cancer is causal.
8.14 On 12 February 1954, Mr Iain Macleod,
the Minister of Health made a statement in the House of Commons
in which he expressed his view that there was a relationship between
smoking and lung cancer, although noting that the causation question
was complex and that other factors such as air pollution, geographic
location and occupation may be involved. The statement received
wide publicity in the popular press.[93]
A front page article in the Daily Mirror contained the following
lead-in line:[94]
"The great smoking controversy has been
flung into the arena of public discussion again by yesterday's
announcement in Parliament that an apparent link between smoking
and cancer of the lung has been established."
8.15 In the statement the Minister also
announced that the UK tobacco manufacturers, including Gallaher,
had pledged a fund to the MRC for research into the causes of
cancer. The fund provided for a research programme lasting eight
years.
8.16 In June 1954 the press reported on
another study conducted by Doll and Hill published in the British
Medical Journal in which Doll and Hill reported on the preliminary
results of a prospective epidemiological study of 40,000 British
doctors. They claimed to have found that doctors who continued
to smoke had a higher death rate from lung cancer than non-smokers.
Headlines included:
"Smoking and Cancer: 40,000 doctors
in new tests" Daily Herald—25 June 1954
"Cancer Deaths Accelerated By Smoking"
Daily Telegraph—25 June 1954
"Smoking and Lung Cancer — Inquiry
Among the Doctors Brings Corroboratory Evidence" The
Manchester Guardian—25 June 1954
8.17 In 1956, the UK tobacco manufacturers,
including Gallaher, formed the TMSC. The TMSC and its successor,
the TRC, funded and carried out research in response to the smoking
and health issue from the late 1950s until the mid-1970s (see
section 4 for further details).
8.18 In November 1956, Doll and Hill published
another report on the statistical association between smoking
and lung cancer based upon the epidemiological study of 40,000
British doctors they had begun in 1951. They reported a statistical
association between mortality from lung cancer and smoking, a
stronger statistical association between lung cancer mortality
and "heavy" smoking than "light" smoking,
and a stronger statistical association between mortality from
lung cancer in those who continued to smoke than in those who
stopped smoking. This study also was widely reported upon by the
popular press.[95]
8.19 Dr Horace Joules of Central Middlesex
Hospital was also an outspoken critic of smoking whose statements
often were reported in the popular press. On 28 February 1954,
at a conference on respiratory diseases, Dr Joules stated that
every man over 45 who smoked more than 20 cigarettes a day should
be X-Rayed each year.[96]
In a 9 February 1956 letter to the editor of The Times,[97]
Dr Joules included a graph depicting a sharp rise in mortality
from lung cancer in comparison to that from other cancers, claiming
that the rise in mortality from lung cancer followed the increase
in cigarette consumption in the UK. The following month, in another
letter to the editor of The Times, Dr Joules advocated stopping
smoking even at middle-age and later, claiming that evidence suggested
that the risk of lung cancer could be reduced for each year of
abstention.[98]
This advice to smokers was echoed by Doll and Hill in a May 1956
British Medical Journal, reported by the press, in which they
stated that giving up smoking in middle-age would decrease the
smokers' chances of developing lung cancer.[99]
8.20 Other physicians, such as Dr Lennox
Johnston of Wallasey, and Dr Alton Ochsner, an American surgeon
and past president of the American Cancer Society received press
coverage as well. Writing in a 1952 edition of the British Medical
Journal, Dr Johnston stated that tobacco should be treated as
a drug.[100]
Later in the year, Dr Johnston advised smokers on how to give
up the "habit" in The Lancet, and these recommendations
were reported in the popular press.[101]
An article in the 10 July 1955 Reynolds News discussed Dr Ochsner's
book, "Smoking and Cancer", which examined the statistical
association between smoking and lung cancer.[102]
8.21 Additionally, in 1956, the Ministry
of Education issued a revised edition of its handbook on health
education which contained a section directing schools to instruct
children on the relationship between cigarette smoking and lung
cancer. Furthermore, teachers were asked to set a personal example
by not smoking in front of their students.[103]
The handbook, entitled "Health Education in Schools",
contained the full text of a statement made by RH Turton, the
Minister of Health, on the statistical association between smoking
and lung cancer. A copy of the handbook was to be given to all
school-leavers. A comic book style pamphlet aimed at teenagers
was also prepared by the Central Council for Health Education
in 1956. The pamphlet, entitled "The Adventures of the Wisdom
Family, What—No Smoking", was distributed through local
Medical Officers of Health.
8.22 In May 1956, the Government issued
a second statement in which it said that there was an incontrovertible
statistical association between cigarette smoking and lung cancer.
8.23 The MRC issued a special report on
smoking and lung cancer in June 1957 which also reported on the
statistical association between cigarette smoking and the increased
incidence of lung cancer and which indicated that those who gave
up smoking had a reduced risk of mortality of up to one-half of
those who continued smoking. This report received extremely wide
press coverage, including front page headlines such as the following:
"Smoking and Cancer and You"
Daily Mirror—28 June 1957
"Heavy Smokers Warned: Cigarettes Will
Kill 1 in 8" Daily Mail—28 June 1957
"Smokers—it's up to you"
News Chronicle—28 June 1957
In addition to the front page story, the Daily
Mirror devoted two full pages of coverage to the story under the
heading: "Grim facts—Deaths are going up".
8.24 In conjunction with the release of
the June 1957 MRC report, the Minister of Health issued a statement
in which he emphasised that smoking was ultimately a personal
choice to be made by each individual: everyone will have to "make
up his mind, and must be relied upon as a responsible person to
act as seems best".[104]
8.25 The publicity prompted by the 1957
MRC report added to the existing public awareness that had already
been generated through the media on the claimed risks of smoking.
In addition, local health and educational authorities, which had
the statutory responsibility for health education[105],
conducted local health education campaigns about the claimed dangers
of smoking. Local health and educational authorities targeted
both adults and children by means of advertising campaigns, pamphlets,
films, television features, meetings and anti-smoking clinics.
Evidence can be found of these campaigns throughout the country.
For example, Dr Joules spoke to more than 250 children at a Croydon
school and screened an American made film which showed a surgeon
conducting a lung cancer operation in which a lung was removed.[106]
Posters relating the claimed dangers of smoking were sent to every
school in Devon by the county council.[107]
London school children leaving school were given "don't smoke"
advice in the form of a guide to health published by the London
County Council.[108]
Similarly, the Lincolnshire County Education Committee prepared
a circular to guide teachers in instructing children on the claimed
risks of smoking.[109]
8.26 In June 1957 the BBC screened a feature
on smoking and health in its "Facts and Figures" television
series and copies were placed in the Central Film Library where
they were borrowed by local authorities, schools and voluntary
bodies. In January 1958, the British Medical Association published
a pamphlet entitled "Smoking—The Facts".
8.27 In addition to the popular media and
various government and local authority campaigns, smokers were
exposed to the views of the people around them. For example, the
medical profession received information about smoking and health
from scientific and medical journals which regularly published
articles and studies on this subject.[110]
For example, the entire April 1954 issue of the journal Medical
World Monthly, the official publication of the Medical Practitioners'
Union, was devoted to smoking and health. A number of articles
recommended that doctors encourage patients to give up or reduce
their smoking. The 25 April 1954 edition of the Sunday Dispatch,
reported that the Medical World monthly publication advised doctors
to caution young people and their parents against smoking.[111]
8.28 Independent survey results demonstrated
that there was virtually universal awareness of the reported association
between smoking and lung cancer and of the possible risks of smoking.
For example, a 1959 survey conducted in Edinburgh revealed that
98 per cent of those questioned had already heard of the publicised
association between smoking and lung cancer.[112]
Another 1959 survey of 3,224 pupils in Edinburgh schools revealed
that an overwhelming majority of children believed that smoking
could be bad for one's health (90 per cent of boys' 93 per cent
of girls).[113]
When asked in what way smoking could be bad for health, the most
frequent reply was that it could cause cancer (55 per cent of
boys; 60 per cent of girls) and a further 13 per cent of boys
and 12 per cent of girls said that smoking was bad for the lungs
without mentioning cancer. There is no reason to believe that
awareness diminished as time progressed and the debate continued
in the media. Indeed, the results of the 1967 Government Social
Survey of Adults' and Adolescents' Smoking Habits and Attitudes
showed that 94 per cent of smokers had heard of the claimed connection
between smoking and lung cancer.[114]
8.29 Publicity throughout the 1950s and
1960s also focused on claims that cigarette smoking was addictive
or that for some people smoking may be a difficult habit to give
up. For example, a newspaper article in the Daily Mirror in 1962,
entitled "If you want to stop smoking", claimed that
"irritability, acute anxiety, tremor of hands, loss of concentration,
[and] even nausea" are among the "withdrawal symptoms"
that smokers may experience when they attempt to give up smoking.[115]
8.30 Claims that smoking may be addictive
were also conveyed through newspaper advertisements and articles
which concerned stop-smoking courses and programmes. For example,
the 24 October 1957 edition of the News Chronicle ran an advertisement
entitled "Stop smoking for your health's sake" which
offered a new treatment for the tobacco habit.[116]
A non-smoking course entitled the "New Cure" was advertised
in the 12 January 1956 edition of The Times.[117]
Other newspaper articles covered stop-smoking programmes involving
hypnosis.[118]
8.31 Numerous "how to stop smoking"
guides, pamphlets and books were published and began appearing
in bookstores. For example, a personal advertisement found in
the 6 January 1954 edition of the Daily Telegraph & Morning
Post promoted a booklet claiming to provide a "permanent
release" from smoking.[119]
Similar advertisements appeared in the Daily Telegraph regularly
throughout the mid to late 1950s.
8.32 Local newspapers carried numerous advertisements
for various stop-smoking products, such as pill substitutes and
imitation cigarettes, which portrayed smoking as addictive. For
instance, manufacturers of the cigarette imitation APAL frequently
advertised in the newspapers. One advertisement entitled "You
can stop smoking", which appeared in the 17 March 1954 edition
of the Daily Telegraph & Morning Post claimed that APAL "stops
the craving".[120]
Another APAL advertisement from the 30 June 1957 edition of the
Sunday Graphic proclaimed that APAL could help those who "doubt
[their] ability to break a deep-rooted habit".[121]
A large advertisement for Bantron "Smoking Deterrent Tablets"
which appeared in the 19 June 1962 edition of the Daily Sketch
claimed that giving up smoking may be "easier said than done".
This advertisement further claimed that Bantron tablets could
help the smoker give up or cut down by "removing the craving
for nicotine".[122]
Another advertisement found in the 16 January 1964 edition of
the Daily Sketch entitled "Chained to a cigarette?"
depicted a man chained to a lit cigarette and claimed that "Lobron
will set you free".[123]
8.33 In addition, daily newspapers printed
articles and letters from readers which described smoking as addictive
or habit forming. For example, a 25 February 1964 article appearing
in The Times discussed the claimed effects of nicotine on the
smoker and quoted Swedish Nobel Prizewinner, Professor Hugo Theorell,
who stated "it was to get nicotine that people—including
himself—were smoking".[124]
Other articles and letters from readers offered ideas on how to
"beat the habit". These suggestions ranged from everything
from deciding not to buy any more cigarettes and going "cold
turkey" to giving up smoking for Lent.[125]
8.34 In February 1960, the Minister of Health
in England and Wales and in 1961 the Secretary of State for Scotland
issued public statements to the effect that they were satisfied
that the public was aware of a possible association between smoking
and lung cancer. The Secretary of State for Scotland stated:[126]
"I do not think that there is any doubt
that people do know [of the possible association between smoking
and lung cancer]. The recent survey carried out in Edinburgh showed
that 98 per cent of people knew of the possible connection. Therefore
I think it is a matter for individual choice and responsibility."
8.35 In response to a question in Parliament
in February 1960 as to what further action he would take to publicise
the connection between cigarette smoking and lung cancer, Derek
Walker-Smith, the Minister of Health stated that:[127]
"Publicity on this matter is a continuing
responsibility for local health authorities as part of their arrangements
for health education."
He added:
"The object of this publicity is to make
people aware that smokers of cigarettes are more likely to get
lung cancer than non-smokers. I am satisfied that most people
in this country—indeed, nearly all the people in this country—understand
that point".
8.36 Massive publicity also accompanied
the 1962 Report by the RCP on Smoking and Health. Apart from lung
cancer, this report discussed smoking and bronchitis, coronary
heart disease and arterial disease of the heart or limbs. Publicity
surrounding the report included:[128]
"Cigarettes and cancer—Doctors
warn "Smoking can cut life" Daily Mail—8 March
1962
"Royal College of Physicians Report
Overwhelming case against smoking—Doctors find relation
to lung cancer proved" The Guardian—8 March 1962
"Shock Treatment Shakes the Smokers
and the Trade" The Sunday Times—18 March 1962
8.37 In the same year as the RCP Report
was published, the UK tobacco manufacturers, including Gallaher,
opened a purpose-built laboratory in Harrogate which was planned
the previous year, to continue the smoking and health-related
research begun by the TMSC in the mid-1950s.
8.38 The 1962 RCP Report was immediately
circulated to local education authorities and the Minister of
Education asked for the co-operation of the authorities, teachers
and all who worked with children to warn the young in "every
way possible of the dangers to their future health of smoking
. . . and [to] discourage [them] from forming the smoking habit".[129]
Lessons about the dangers of smoking were introduced in schools
as part of the regular curriculum. The effect of smoking on the
lungs was studied in biology classes and students were told about
the effect of smoking on physical fitness in physical education
training.[130]
The Ministry of Health issued two posters in May 1962 warning
of the dangers of smoking and two more posters featuring teenagers
were prepared by the Ministry of Education for use in schools
and youth clubs.[131]
8.39 Mobile information units were launched
by the Ministry of Health with full newspaper, TV and radio coverage.[132]
The units travelled up and down the country giving film shows
and lectures concerning the reported dangers of smoking.[133]
The main emphasis of the campaign was directed to young audiences
in schools and youth clubs.
8.40 The Government's anti-smoking campaign,
with its particular focus on persuading children not to smoke,
continued in 1963 with the enactment of a ten-fold increase in
the statutory penalties for selling cigarettes to children under
16.[134]
Anti-smoking advertisements placed by the Ministry of Health appeared
throughout the 1960s in magazines for children and in The Children's
Newspaper.[135]
8.41 In 1964, wide publicity was given to
the release of the first US Surgeon General's Report on smoking
and health in which the Surgeon General reported that smoking
was a health hazard which was causally related to lung cancer
in men.[136]
8.42 In 1968, the Health Education Council
in England and Wales and the Scottish Health Education Unit were
created and a nationally co-ordinated anti-smoking poster campaign
was launched the following year. Moreover, media interest in the
smoking and health debate was further fuelled by the second report
of the RCP in 1971.[137]
This called for, among other things, greater health education
in schools, health warnings on cigarette packets, increases in
tobacco tax and restrictions on smoking in public. The report
argued that "once adult smoking has begun to decline the
social environment will change to one in which smokers will wish
to stop and will find it easier to do so, and one in which fewer
children will wish to become smokers".
8.43 The second RCP report entitled "Smoking
and Health Now" received very wide press coverage:
"Dying for a smoke" Daily Mirror—6
January 1971
"Warning on packets of cigarettes first
likely outcome of smoking report" The Times—6 January
1971
"Dying for a smoke: Now Warnings on
Packets" The Sun—6 January 1971
"Cigarettes holocaust of death"
The Daily Telegraph—6 January 1971
"Warnings to go on cigarette packets?"
Daily Mail—6 January 1971
8.44 In September 1971, the Consumers' Association
published in "Which?" magazine its first report on cigarettes.
In addition to discussing a wide range of claimed risks and providing
tips on stopping smoking, it published a table of the tar and
nicotine yields of 26 different brands of cigarettes, one cigar
and one cigarillo. The article stated:
"There is some evidence that smoking a cigarette
with a low yield of `tar' and nicotine may help a little to reduce
the risk of death or disease. However, the risks associated with
smoking even a low-yield cigarette are considerable, when compared
to the risk of non-smokers, or ex-smokers. So switching to a low-yield
brand comes a poor second to giving up all together.
But, provided you don't smoke more if you switch
to a low-yield brand, it is clear that smoking a high yield brand
is a folly."
The article also noted that 58 per cent of those
who had stopped smoking had managed it without any difficulty.
8.45 The "Which?" article was
an impetus for increased demand by some smokers for cigarettes
with lower tar and nicotine yields. The tobacco manufacturers
responded accordingly with more products with lower tar and nicotine
yields.
8.46 Tar and nicotine yields for individual
brands from the surveys undertaken by the LGC were published from
April 1973 by the Department of Health and Social Security, mainly
on a bi-annual basis, and are generally referred to as the "league
tables". From the outset of the introduction of tar league
tables, brands of cigarettes manufactured by Gallaher were identified
as having the lowest tar yields (see section 4). All press and
poster advertising from September 1974 and all cigarette packets
from March 1976 stated the particular brand's tar group. The tar
groups were:
— "Low tar"—10mg tar
or less.
— "Low to middle tar"—11mg-16mg.
— "Middle tar"—17mg-22mg.
— "Middle to high tar"—23mg-28mg.
— "High tar"—29mg and
over.
8.47 The league tables were readily available
to consumers. They were made available in poster and leaflet form
and were given wide publicity by the Health Education Council
and others. A press release, "Tar and nicotine yields of
cigarettes: first table of main brands published" was also
issued on 11 April 1973 by the Department of Health and Social
Security.[138]
A leaflet was available to the public for free from libraries,
health centres and clinics, hospitals, chemists' shops and local
Social Security offices, or it could be obtained by writing to
the Health Education Council.[139]
Copies of the leaflets were reproduced as posters to be displayed
in public places. In addition to providing tar and nicotine yields,
the leaflets (and posters) contained health advice for smokers.
Retailers also received copies of the league tables from the tobacco
manufacturers in the form of a poster prepared by the Government.
In a letter to retailers, the Government requested that retailers
display the posters. The league tables also were widely publicised
by newspapers.[140]
8.48 To this day, smoking and health issues
continue to occupy a high level of focus in the media and this
helps to maintain a high degree of public awareness.
83 
