Examination of witnesses (Questions 60
- 79)
THURSDAY 18 NOVEMBER 1999
PROFESSOR LIAM
DONALDSON, DR
DAWN MILNER,
MR TIM
BAXTER AND
MR PAUL
LINCOLN
60. So in staffing terms, in effect, you have
three days from two individuals, one for two days, one for one
day, yourself, plus you have access to an advisory committee to
help you. What about the financial side? What is the money?
(Dr Milner) I am not sure I understand.
61. How much money does the Department of Health
give towards this area?
(Mr Baxter) Obviously there are the costs of the consultants,
the costs of the advisory committee's expenses, which are fairly
small. It should be said that we fund the Laboratory of the Government
Chemist to the tune of a bit over half a million a year to do
testing on cigarette brands. That is to do with the tar and nicotine
ratings.
62. Do you think that it would be fair to say
given the resources and back-up of the tobacco industry that with
the amount of staffing levels and access to specialist advisory
committees, plus the grant you make, that they can basically run
rings around you?
(Mr Baxter) I do not want to make a bid for resources
in this forum.
63. Why not? It might help you.
(Mr Baxter) Not with the Head of the Public Health
Group present. I think it is fair to say that in general we will
never have at a governmental level the resources in this area
that tobacco companies can afford to put in. If we had come to
you in your former incarnation asking for £x million for
scientific advice on this I am sure you would have said "Nice,
but I have got other priorities". Obviously this is very
very important but there are also other calls on resources. I
think I would go as far as to say it would be very nice to have
more resources and I would say that generally because my particular
team are highly stretched in all sorts of ways, not just scientific
resources, but you might wish to put this point to the Chief Medical
Officer.
64. I certainly take on board the point you
make about pressures on resources and the allocation. The thing
that just slightly surprises me is, taking into account the earlier
answers to questions and the public statements of Ministers that
they see combating the issues relating to smoking as such a top
priority to help in improving the health of the nation and also
in saving the drain on the National Health Service for the resources
needed to treat people suffering from smoking related illnesses,
the fact that there is not a greater determination within the
Department to give a greater priority to the staffing levels and
particularly the finance, notwithstanding the competing demands
on finance, to deal with this problem which seems to be in many
ways at the heart or one of the centres of the Government's health
policy.
(Mr Baxter) Perhaps it would be appropriate for the
Chief Medical Officer to comment on that simply because at my
level obviously I would say I want more resources.
(Professor Donaldson) I think your question started
by asking about resources devoted to the analysis of cigarettes.
The key to that in my view is greater disclosure of the content
of cigarettes. By putting research into the public domain researchers
all over the world, at no direct cost to us, will wish to study
the health effects of additives. I strongly commend to your attention
the policy of British Colombia which is the first jurisdiction
to require the disclosure of cigarette additives and I understand,
though I have not seen it, that the European Commission is currently
debating a Directive which might lead us along in a similar direction.
So to get that sort of information into the public domain would
lead to analysis being done by scientists all over the world and
there are a whole range of issues relating to additives that need
to be looked at scientifically. As far as the resources of the
Department of Health are concerned, there is always a balance
in running any programme between building up a large headquarters
which people delivering the services feel may not add value directly
to their work and having enough people to co-ordinate policy,
to devise policy, to advise Ministers and to assist with implementation.
The tobacco team is a small and over-stretched team. On the other
hand, money is being put into programmes at local level, in health
action zones and all sorts of things and I think that we would
have to be cautious about top-slicing money to appoint further
civil servants at the expense of money which can be used on the
ground to help people give up smoking, to fund more research and
to introduce other programmes of action that might be highly effective
in producing change.
65. I suppose there is the other argument that
if you had more resources for looking into a whole range of areas
of smoking and tobacco that could give greater scientific evidence
of the dangers of smoking it might have strengthened the case
to advise Ministers not to create—I know Mr Baxter does
not like the expression—loopholes in the advertising regulations.
(Professor Donaldson) Over the years successive governments
have put a lot of money into research into the health effects
of smoking, so that has gone on all along and the evidence that
has been accumulated is now very powerful and wide ranging. There
has been less research done into areas such as techniques for
achieving change through the media and through advertising campaigns
and so on, but research is being funded in those areas as well.
So I think there are some gaps in research, but as far as the
management of the programme is concerned, I think we probably
do need to build up our capacity a little bit centrally but not
to the extent that we would end up with very large teams of civil
servants draining the money that should properly be spent at local
level achieving change particularly in the deprived parts of the
country where smoking prevalence rates are very high and where
intractability to behaviour change is very great.
<vv18,70><mp1><it0><hi0><bh<mp2>Dr
Stoate<mp3>
<eh
66. It seems to me that the main thrust of government
policy on tobacco regulation in terms of product modification
has been towards reducing the levels of tar and nicotine in cigarettes.
Is that a fair comment to make?
(Professor Donaldson) I think it has certainly been
one strand of past policy, yes.
67. Do you think that is a good policy? Do you
think it has worked?
(Professor Donaldson) The evidence is not clear-cut
on that. Some scientists believe that it has helped, but some
of the trends in the United States on declines in mortality rates
have not suggested that that has had a major impact. My own view
is that I think that may have been a reasonable presumption to
have made in the past, but I think we need to re-examine that
particularly when we have seen a change in the nature of the lung
cancer tumour and where a new type of tumour has emerged over
the last 20 years or so and the strong scientific opinion is that
that occurs in the more peripheral parts of the lung and there
is strong scientific opinion that it has occurred because smokers
using low-tar cigarettes have been taking deeper puffs and therefore
getting smoke into the more distant parts of their lungs and a
type of tumour that would not have been seen at the beginning
of the smoking epidemic is now becoming much more common. For
a whole variety of reasons the idea of making a main thrust of
the policy reducing tar needs to be looked at.
68. You will be aware that recent findings have
shown that reducing the nicotine and tar yields is not a benefit
because smokers develop compensatory techniques, as you have alluded
to. Do you think, therefore, that cigarettes described as "light"
or "mild" are in fact any safer than any other brands?
(Professor Donaldson) I am not sure they are. I think,
more importantly, they may give the public the impression that
they are smoking something that is safe. There is no such thing
as a safe cigarette. It is a highly dangerous and lethal product.
I think it is an area that needs to be looked at very closely.
Indeed, the evidence on the risks shows that it is the duration
of smoking that has the greatest risk and the amount of cigarettes
smoked daily has a lesser risk. Perhaps I could quote the figures
which come from an excellent report by the World Bank and is referenced
in our submission to you. A three-fold increase in the duration
of smoking has a 100-fold increase in the risk of lung cancer,
whereas a three-fold increase in the daily number of cigarettes
smoked has only a three-fold increase in the risk of lung cancer.
So it is the duration of smoking and that is particularly important
when we consider teenagers, many of whom experiment with smoking,
making sure that that smoking does not persist through into adult
life.
69. I am very interested in those data, but
surely if the evidence seems to be that modification of type of
cigarette does not make that much difference, do you think companies
should be allowed to brand their cigarettes as mild or low-tar,
which seems to give the impression to the public that they are
somehow safer?
(Professor Donaldson) I think it is an area that needs
to be looked at because I think we are increasingly realising
that it does lead the public to have false reassurance about the
risks of smoking.
70. But you would like to see action taken to
prevent companies from branding cigarettes that appear to be safer
than others?
(Professor Donaldson) I would like to
see the subject reviewed very quickly, yes.
71. If I may move on to Mr Lincoln, the memorandum
which you sent in states that under the HEC—which was your
predecessor—the early publicity campaign encouraging smokers
to switch to light cigarettes was mistaken. What are you now doing
to inform the public of the dangers of smoking generally and particularly
the dangers of smoking so-called light cigarettes?
(Mr Lincoln) You are quite correct, in the early 1970s
and 1980s the HEC advised people to switch if they could not give
up and that was based on the best evidence at the time, but the
Health Education Authority has never done that. The advice is,
"If you don't smoke, don't, and if you do smoke, give up,"
and all our efforts are along those lines. Over the years we have
had a package of different projects of work within a programme
on tobacco control, smoking cessation and smoking prevention,
particularly pulling together the evidence from what are effective
interventions.
72. I agree with your overall stance on the
question, of course, but are you putting particular emphasis on
so-called light or mild cigarettes or are you making the public
particularly aware of those?
(Mr Lincoln) No, we are not putting any emphasis on
that at all. To refer back to the previous point, our view is
that the labelling of low, mild, light cigarettes is misleading
and, and if I could refer back to the consumer research that we
have also submitted in evidence which we commissioned this year,
we have evidence from that that the public is confused. Seventy-seven
per cent. of light smokers switched because they believed it was
less harmful than regular cigarettes, and 28 per cent. believed
it was a step to quitting, and this is of a very significant sample
size.
73. Would it be fair to say, then, that you
think it is a cynical trick by tobacco companies to rebrand their
cigarettes as mild or somehow lighter in order to con smokers
into believing that they are somehow improving their health by
switching?
(Mr Lincoln) We believe it misleads the public, yes.
It does have an incorrect perception as far as people are concerned
and our evidence points to that.
74. But would you go so far as to say it is
a deliberate attempt to mislead the public?
(Mr Lincoln) I would like to refer back to a previous
point, if I may. I think that will depend on what it is that the
industry knew at what time and what marketing strategies they
pursued. What did the industry know, and we do not know whether
they did, about the health impact of their product and how did
that relate to their marketing strategy and their discussions
in terms of voluntary regulation with the Government? That is
something really for Parliament and Government to take on board.
Dr Stoate: I feel we are coming on to a future
inquiry. Thank you.
Mr Austin
75. Could I follow that up because you have
been very clear in your statement about that. Presumably the Health
Education Authority has made that view known to the Government?
I would like to know what response you have had from the Department
of Health?
(Mr Lincoln) We have provided that view in evidence
to the Committee and at the same time to Government, yes.
Chairman
76. What are you going to do? Professor Donaldson
said it should be reviewed.
(Mr Lincoln) Our belief is that there should be regulation
in terms of the labelling, marketing and packaging of cigarettes
that does not mislead consumers, and that there are not implied
claims made and there should really be a compulsory review of
messages and warnings. You could, for example, include things
like smoking cessation helpline numbers on cigarette packs and
things like this but it needs proper evidence-based review and
there are all sorts of other lines of inquiry, such as referring
back to your previous point about tar and nicotine. I think with
nicotine one has to tread very carefully because there are therapeutic
dimensions as well but it should come within the same regulatory
framework as nicotine replacement therapies. Clearly it would
be useful to have the ratio of tar to nicotine, which is far more
meaningful because of compensatory smoking, probably total toxicity
to nicotine or particular carcinogens to nicotine and properly
set limits that should be progressively reduced over time, and
it would be good to mandate the industry to move in that direction.
Clearly this may well come because of the European Directive and
we would hope that the UK Government is going to take the strongest
line on this and if it is not, hopefully to strengthen the Directive
at this stage where it is just about to be discussed—I think
it is going to be discussed by the health ministers on the 18th—but
to ensure that there are appropriate derogations to ensure the
maximum public health interest.
77. Presumably the Chief Medical Officer will
respond to that advice which you are giving to the Government
and presumably it will be advised to the Government?
(Professor Donaldson) I have given my view and I have
listened with a very sympathetic ear to what has been said on
that.
Audrey Wise
78. Mr Lincoln, you said you had given your
evidence to us and it is very clear what you said, and at the
same time you gave similar advice to the Government. Did you not
give similar advice at any earlier stage, and if not, why not?
(Mr Lincoln) Yes. The first piece of evidence that
we provided was the consumer research, of which we have a copy
here. This was some research on the consumers' perceptions about
cigarettes generally and particularly light and mild cigarettes
and the like.
79. When was that?
(Mr Lincoln) Secondly, the Department in its submission
to this Committee is supporting, and we were party to, the production
of a paper which is referred to in the Department's submission,
which supports a lot of what I have just outlined, which was a
paper produced by Dr Anne McNeil, one of the HEA staff and advisers,
and other people such as Clive Bates and the like within the UK
about how the European Directive could be massively strengthened
to show that there is regulation of the industry with respect
to these matters in terms of tobacco labelling, marketing and
content and the like. That paper has been published in Tobacco
Control this year specifically to help the debate about the
regulation of tobacco within the EU context. So that advice has
been provided through the system and the initial response from
the Department is to support the direction indicated in this paper.
But I should say that there are lots of very technical dimensions
that are contained within this paper that need expert scientific
discussion and advice. There are some quite complex areas here
which I would not like to get into as I am a lay person, such
as the issue of nicotine.
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