Examination of Witnesses (Questions 540
- 559)
THURSDAY 13 JANUARY 2000
MR MARTIN
BROUGHTON, MR
PETER WILSON,
MR GARETH
DAVIS, MR
DAVID DAVIES
AND DR
AXEL GIETZ
540. You think it is simply an individual choice
which a person is free to make and it is really a question of
how they see their lifestyle?
(Mr Wilson) To give up smoking?
541. Yes?
(Mr Wilson) Yes. I think people can choose to stop
smoking. It can be hard for some people, I acknowledge that, it
can be very hard for some people, but it can be done and the evidence
is that it is being done. Many people who have given up have not
had recourse to any assistance whatsoever but if it can be done,
yes.
542. What would you say the difference is between
a habit and an addiction?
(Mr Wilson) In the way those words are used today
probably very similar but in the past the word addiction has had
other connotations associated with it such as tolerance levels,
degrees of intoxication which are just not appropriate to cigarettes
but the definition of the word addiction has changed. I accept
that the way that word is used today, basically almost interchangeable
with the word habit, describing that as something that is hard
to give up, yes, smoking could well be described as addictive.
543. Does addiction not suggest some greater
barrier?
(Mr Wilson) I do not believe it does in the way that
the word is used today. I would like to make a point that it may
be seen that way by some people. The more that smokers are—there
can be emotion involved here—led to believe that what they
are doing is addictive I believe that could be a barrier and a
disincentive to them trying to stop.
544. We are advised that a scientific study
has shown that heroin addicts are considerably more likely to
give up heroin than cigarette smokers. Heroin and cocaine addicts
rate giving up smoking as more difficult than quitting their problem
drug.
(Mr Wilson) I am really not qualified to talk about
heroin and cocaine. I would have thought that—this is a
lay observation—a user of heroin or cocaine may well have
no alternative but to give up whereas a cigarette smoker derives
a considerable amount of enjoyment without any physical impairment,
without any impairment of his judgment, without any impairment
to the way that a smoker's life is conducted. I still come back
to the fact can people give up. Do they give up? The answer is
yes.
545. A cigarette is really a nicotine delivery
system, is it not? When people get the nicotine then it stimulates
them in a certain way and therefore they find it very, very hard
to do without it. Some of the tobacco industry's research is geared
to seeing how rapidly the nicotine can be delivered simply because
that is the means by which a person becomes addicted and after
which they find it much more difficult to quit.
(Mr Wilson) I am not aware of any research that we
have undertaken on that. I do not believe we have. Certainly we
do not take any steps to increase the impact of nicotine in our
products. I think the cigarette is a number of things, certainly
it contains nicotine but I think smokers smoke for a number of
reasons, it is a very complex subject. Yes, nicotine will figure
amongst those reasons and I am sure there are others. Perhaps
something like a nicotine patch would suffice if all people were
looking for was nicotine but I think they are looking for a lot
more in a cigarette than nicotine. We do not do anything to enhance
the performance of the nicotine in the product.
546. You are not aware of anything you do to
increase or speed up the rate at which nicotine is delivered to
the brain?
(Mr Wilson) No.
547. That would go for all the companies, would
it?
(Mr Gareth Davis) Yes.
(Dr Gietz) Yes.
(Mr Broughton) I think I would just like to comment
on the parallel you are trying to run between cigarettes and cocaine
and heroin, I think you will find that there have been scientific
studies done on the euphoria effect, the sedation effect and the
stimulation effect of heroin, cocaine, smoking, alcohol, caffeine
and sex and between those tobacco consistently comes out at the
bottom of the list. A very completely different product to heroin
and cocaine. It comes out either at or below the level of caffeine.
I think you will probably be pleased to know that sex comes out
highest on a couple of those but on of all of them tobacco is
the one that comes out right at the bottom.
Dr Brand: That is why it is such a very bad
value addiction, you do not actually get much out of it.
Mr Gunnell
548. The information we have is that cocaine
and heroin addicts are much more likely to give up the heroin
and cocaine than they are to give up smoking.
(Mr Broughton) I think that is a completely different
issue, if I may suggest. I think the point about giving things
up is having the motivation and the belief that you can. I think
where you will find those kinds of statistics are quoted, heroin
addicts and cocaine addicts give up with a lot of outside help
and with a much structured tailored programme. The cigarette numbers
you are talking about are people who try to give up and then come
back, without any outside help. I think the point Mr Wilson is
making about a huge number of former smokers. I think you will
see the evidence is 95 per cent of those give up without any outside
help whatsoever. I think you are trying to mix two completely
different situations and come up with some very misleading numbers.
549. I would agree that a great degree of publicity
is given to heroin and cocaine and perhaps a greater degree of
effort is given to dealing with people when they come off heroin
and cocaine, I would accept that. I think the effect of it is
quite similar and we had evidence in the United States of companies
not unrelated to your companies which did see it as important
to deliver the nicotine to the brain as rapidly as possible. None
of you know anything about that?
(Mr Broughton) I think that is a whole area which
I am happy to get into. I think I would need you to expand somewhat
on the point you are making to be able to respond.
550. I think my view is that nicotine is addictive
and that once a person is under its influence they find that it
is very hard not to continue to receive the same stimulation and,
therefore, we heard in the United States certainly that companies
did regard the cigarette as a nicotine delivery system and the
more efficiently it did that in getting the nicotine to reach
the brain then in a sense the more satisfaction they gave and
also people found it very much harder to quit. People's internal
mechanisms made sure they continued to get the same stimulus and
therefore they remained smokers.
(Mr Broughton) This is a very complex subject and
I am very happy to get into it if you will give me a few moments,
Chairman. I think it is very misleading to take a simplistic view
of the subject. What is undeniable is that nicotine is one, and
quite probably the most likely reason why smokers continue to
smoke. However, and in a sense I can refer back to a question
that Dr Brand asked earlier of Mr Wilson, we have done quite a
lot of research and test marketing on trying to change the tar
nicotine ratios. We have done it in conjunction with Government
initially, and subsequently when Government dropped it we continued.
The theory being here that if it is tar they get but nicotine
they want then hold the nicotine at the same level and reduce
the tar and by supplying the consumer with what he wants you are
reducing the damaging effect. That was the theory of it. The hypothesis
proved unfounded. What it proved was that if you changed that
ratio substantially then the tests indicated that the consumer
was not interested, he did not like the product, he did not want
to smoke the product. The nicotine level was exactly the same
as it had been before but the ratio between the two had changed.
I think that is one example, it is a very simplistic way to look
at it. Another thing is that what we have seen in this whole product
modification strategy is that lowering tar lowers nicotine because
they do come down, there is a relationship between the two. One
of the concerns the industry had at the outset, and the health
authorities had at the outset, was would that lead to people smoking
many more cigarettes because if they had a certain nicotine content
or intake that they required. If you reduce the amount of nicotine
they might smoke a lot more cigarettes, a very logical concern
if that was the theory, not proven. We did demonstrate that people
do not smoke more low tar cigarettes.
Chairman
551. With respect, we can supply you with evidence
which suggests exactly the contrary to what you are telling us.
From both the States and this country we have received evidence
that says exactly the opposite, that people do in fact compensate
by smoking more.
(Mr Broughton) There is a certain element of compensation.
552. Can you specify what you mean because I
am confused. I know that is not unusual but—
(Mr Broughton) There were two sorts of compensation.
One element was the one I have talked about that people would
smoke many more cigarettes in order to get the same amount of
nicotine. The other element was that people would draw harder
on the cigarettes in order to try and take more of the nicotine
in from the cigarette. Now, the former clearly has not occurred.
I would be very surprised if you have evidence that indicates
that low tar smokers, therefore low nicotine smokers, smoke substantially
more a day than they used to before. I have never seen that evidence
at all and I would be interested in receiving that if you have.
On compensation, yes, there is some element of compensation. I
think it is fair to say companies brought the theory of compensation
to the authorities' notice at the outset and were concerned about
what would happen. Nevertheless, despite the fact that there has
been some compensation occurring what is clear is on the whole
people who smoke lower tar cigarettes do not compensate anywhere
near sufficiently to get the same amount as they used to get on
higher tar cigarettes, dramatically different. There is some compensation
but it is only a fairly small amount of compensation relative
to what may have been expected and was the theory at the time.
553. Can I ask whether Mr Davies agrees with
this point that has just been made? Clearly we are interested
in what your company has done and what you showed us in the States.
Would you accept the point that Mr Broughton has just made?
(Mr David Davies) In relation to the compensatory
behaviour of smokers, I think substantially we agree. There is
clearly compensation. Whether there is compensation which results
in a low tar smoker inhaling the levels of a high tar smoker we
doubt.
(Mr Wilson) Chairman, can I add, this is a very complex
subject, the point Mr Davies has just made. It depends where the
smoker has come from. If the smoker is moving from a 12 milligram
product to a ten milligram product there will probably be a very
small compensation. If a smoker is moving from a high tar product
to a low tar product then, yes, there is likely to be more compensation.
What happens over time? These are very hard things to understand:
is the compensation immediate and does it change over time? There
are so many elements in it. Certainly I accept, yes, there is
some compensation but it is by no means total.
554. I am going to come back to John Gunnell
in a minute but I wanted to raise the compensation issue, we have
got on to it now so if I could just pursue one further question
with Mr Gareth Davis. I was interested that your evidence does
not mention compensatory smoking whatsoever. Do you not accept
it or was it something you omitted to mention for some other reason?
(Mr Gareth Davis) Maybe, Chairman, it was an omission.
I am aware that even at the time of the initiation of the product
modification programme compensation was certainly pointed out
by the companies. I think it was acknowledged by the ISCSH.[163]
Mr Gunnell
555. I would like to give you a paragraph from
the submission that we received from ASH on this area of addiction.
They say "However, it could be argued that one of the strongest
indicators of the addictive nature of nicotine is the huge discrepancy
between the stated desire to quit and quitting success rates.
Independent surveys have consistently shown that almost three-quarters
of all smokers want to end their habit at any one time -yet less
than 20 per cent of those who begin a course of cessation treatments
manage to abstain for a whole year. Without treatment the numbers
are even lower—evidence suggests that only around three
per cent of those who attempt to quit without help become permanent
ex-smokers. The powerful nature of nicotine addiction is also
evident in the reluctance of some smokers to quit even after undergoing
surgery for smoking induced illness—according to independent
research around 40 per cent of laryngectomy patients try smoking
soon after surgery, and over half of all lung cancer patients
also resume their habit." I think that paragraph points powerfully
to the fact that those who actually wish to stop smoking and those
who make, if you like, new year resolutions that they will stop
smoking, unless they have help very, very few of them ever succeed
and very few succeed with help. That is because nicotine is powerfully
addictive. I do not think that you would dispute that evidence.
(Mr Wilson) All I can do is point out to you that
there are some 11 to 12 million ex regular smokers in this country
today who have chosen to stop smoking and who have succeeded stopping
smoking which is a very similar number to the number of people
who are continuing regular smokers.
(Mr Broughton) On the first part of that comment about
80 per cent of smokers saying they would like to give up, I have
said before and I repeat that it is down to a degree to the motivation
and the belief that you can. I am not at all surprised that you
get a statement where 80 per cent say they would like to give
up but then do not. You talked about new year resolutions, Mr
Gunnell, I make a new year resolution every year, like a lot of
people make a New Year resolution every year, to take a lot more
exercise, the fact that I do not do it does not make me addicted
to a sedentary lifestyle, it is just the manner of motivation
and personal lifestyle. Often you think you would like to do something
but you do not do it. I do not think that is the definition of
addiction.
Mr Gunnell: I would suggest to you that nicotine
has a powerful effect which makes it additionally difficult for
a person to fulfil that intention to quit and I do not think that
is very clear from the evidence given.
Dr Brand
556. In relation to the nicotine thing, is there
such a thing as controlled smoking as there is controlled drinking?
You were implying that if people smoked less they might not be
classified as smokers almost in statistical terms. Is one of the
problems between you and the public health lobby that you have
a different definition of a smoker?
(Mr Broughton) I do not think I have a particularly
different definition of a smoker. I think sometimes people in
simplistic terms do take the life time heavy smokers as the definition
of a smoker which I think misrepresents the position. Is there
such a thing as a controlled smoker? Let me just add, I was certainly
not trying to say that people who smoke fewer should be eliminated
from the definition, they are still smokers.
557. So you would accept that regular users
of cigarettes, irrespective of the numbers used, are smokers?
(Mr Broughton) Yes.
558. Or carry the same risk or are in the risk
categories?
(Mr Broughton) Yes, I absolutely accept that. Are
there such things as controlled smokers? I think if you speak
to smokers, if you know any, Chairman, I think you will find that
people have very different habits. You will find a lot of people
smoke at the office but not at home, smoke at home but not at
the office, do not smoke at all except when they go out for a
drink or something like that, or smoke when they have a cup of
coffee. So I think in controlled smokers`, yes, people do control
when they smoke.
559. From your research what is the variation
between the number of cigarettes smoked by regular smoker? Is
it a fairly narrow field or is it the whole spectrum between two
and 40?
(Mr Broughton) It is hugely different. It is different
in different countries. One of the interesting things is even
if you take the average incidence it is dramatically different
in different countries. It is a wide range within any one country.
I think using averages can be misleading. A lot of people smoke
heavily, a lot of people smoke what you might call moderately,
not very many smoke very lightly.
163 Note by witness: The topic of compensatory smoking
was considered in Imperial Tobacco`s letter to the Clerk of the
Committee dated 11 January, 2000. Back
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