Examination of witness (Questions 177
- 199)
THURSDAY 25 NOVEMBER
1999
MR CLIVE
BATES
Chairman
177. Good morning everybody. Can I welcome you
to this session of the Committee and particularly welcome you,
Mr Bates, and thank you for your very helpful written evidence
to this inquiry? Would you like to briefly introduce yourself
to our Members?
(Mr Bates) My name is Clive Bates. I am the director
of ASH, Action on Smoking and Health, a charity formed in 1971
at the behest of the Royal College of Physicians, who were concerned
that not enough was being done to popularise the understanding
developed in their reports and not enough action was being taken
to deal with the epidemic of smoking related disease. That is
a role we continue to have to this day. We are a small organisation.
About six of us work in the ASH office. We provide information
on all aspects of tobacco and smoking. We have a very busy website
that takes around 13,000 hits a day. We work to explain, promote
and defend policies and ideas that would help to reduce the burden
of smoking related disease. That is the role of our organisation
and I am in charge of it.
178. Who funds you? Where do you receive your
income from? How much of it is coming from the public purse?
(Mr Bates) We get a grant from the Department of Health
of, last year, around 130,000. I can provide a detailed statement
of where it all comes from for the ASH operation in London. We
are also funded by the British Heart Foundation, the Cancer Research
Campaign, the Imperial Cancer Research Fund; we have a small grant
from the European Commission. This year, we have received some
funding from the World Health Organisation to help them with the
development of their framework convention on tobacco control.
We receive money from the public membership, subscriptions, and
from purchasing of publications.
179. In your evidence you state: "By 1950
it was clear that smoking was a likely cause of serious illness
and premature death—in the 1950s the link was established
beyond reasonable doubt." We mentioned last week that the
evidence put before the Committee is that some six million people
in this country have died from tobacco related disease since that
time. 120,000 currently die prematurely every year in this country.
How would you sum up the reasons why, after all this time, the
lifetimes of many of us here today, it has taken so long to get
down to addressing what was clearly known way back in 1950?
(Mr Bates) That is a big question. Tobacco products
really do not fall conveniently into any pre-existing regulatory
framework such as for pharmaceuticals or food and drink. In a
sense, that makes them very anomalous and they have always been
problematic for governments or regulators to deal with.
180. Knowing what we are looking at in this
inquiry, would you say that that is a key area this Committee
needs to address, defining the problems in terms of category and
regulation?
(Mr Bates) Yes. Regulation for tobacco products would
have to be invented afresh. Tobacco products bear some similarities
but mostly differences to pharmaceuticals and food, which on the
whole are designed to have a beneficial effect. They do not have
anything like the mortality or morbidity risks that tobacco products
have. If you had foods on the market that led to the untimely
death of one in two users of the foods, they would be taken off
the market. We can see the way pharmaceuticals are regulated incredibly
tightly. Every single claim, every single ingredient, has to be
backed up by very substantial trials, evidence and justification
presented to a very sceptical and arduous regulator. Tobacco products
have very complicated designs and very sophisticated engineering
and they face none of those kinds of regulations or tests of evidence.
They are difficult to regulate. The concepts applied in food and
pharmaceutical regulation do not work with tobacco, so you need
to do something from scratch. Sadly, governments round the world
have not stepped up to this challenge. That continues today. Tobacco
products, particularly in the light of how harmful and addictive
they are and what a pervasive public health and health quality
problem they cause, are extremely under-regulated.
181. One of your concerns is that the tobacco
companies have known for a long time the dangers of their products
and also have known about ways and means of alleviating some of
these dangers. Would you say a little more about how long they
have known that and what is in the public arena about what they
know in this country currently and in the States? We will be in
the States in the next few days.
(Mr Bates) The tobacco companies continue to this
very day to remain evasive about the health consequences of smoking.
That is the most polite term one can use about it. If you as a
Committee put simple questions like, "Does smoking cause
lung cancer? Yes or no?" you will not get straightforward
answers to that, even today, even though the answer yes to that
has been established in the scientific community beyond any reasonable
doubt for about the last 30 years. The companies have had access
to all the information that governments and the public have, plus
more of their own. They are still trying to hold the line on very
evasive language on the links between smoking and lung cancer.
When you get into wider questions of smoking and health—heart
disease, lung/respiratory illness, asthma and some of the other
conditions now known to be associated with smoking—there
is hardly any acknowledgement of any of that from the tobacco
companies. There are probably over 20 fatal conditions associated
with smoking. Most of the debate with the tobacco companies still
focuses on lung cancer. A very sceptical government back in 1954
and the Health Minister, Ian McLeod, felt they had to acknowledge
that there was a serious presumption acknowledging the causal
link between smoking and lung cancer.
182. I see from your evidence that in 1954 the
Health Minister made a statement in this place indicating that
there was key evidence at that point of some form of link.
(Mr Bates) That is right. From the point of view of
the government at the time, there was a strong presumption that
that link was causal and the association was definitely demonstrated.
One must remember how close the governments were to the tobacco
industry at that time.
183. Do you think that has changed?
(Mr Bates) It certainly has, yes, for the better and
mostly in the last couple of years. There has been a gradual change
since the 1950s. Governments do not lightly go down the route
of declaring the product of a major industry in Britain as deadly.
It is very clear from the research done in the Public Records
Office by David Pollock, former director of ASH, that they were
very reluctant for the government of the day to make those kinds
of statements. They did it because the evidence at the time was
unassailable. The epidemiology was very strong indeed and very
credible. Yet, we still have, right up to the present day, fudging
about these issues from the tobacco companies. There have been
some recent changes. In 1998, BAT changed its stance on smoking
in health and did finally acknowledge the inevitable. They finally
gave up intellectual territory that was indefensible and acknowledged
that there were these links. Even that conversion is comparatively
recent. By and large, they have sought to cast doubt or uncertainty
over the links between smoking and ill health as far as they can,
right from the time when the evidence first became clear. Their
own advisers internally were telling them that the game was up
and that these links were demonstrated. We have presented one
or two statements from the companies in our evidence that show
that internally among the tobacco companies they had acknowledged
this while they were maintaining, politely putting it, a sceptical
stance in public.
184. You are obviously aware of the implications
of the American litigation, particularly as far as BAT is concerned,
and the information in the documents in the depository in Guildford.
I wonder what your views are on access to that information and
also what you believe may exist in respect of the archives of
other British companies that may be accessed possibly by this
inquiry in an attempt to look at what was known at the time?
(Mr Bates) The settlement of the State of Minnesota
against the tobacco companies required BAT to keep their document
depository in Guildford open for the next ten years starting back
in November 1998 and allow public access to it. That is primarily
for American plaintiffs to have access to that store of documents.
Also, it was felt a public interest matter in the court in Minnesota
that that depository be kept open to the public. Since that has
been open, BAT has quite systematically reduced access to it by
changing the opening hours and by making it as difficult as possible
for public interest organisations such as us to use the archive
and access that material. I can understand why they do that but
it is certainly against the spirit and probably the letter of
the Minnesota judgment. I think it would be good if the Committee
could assert that there is a British public interest in having
access to that archive and that the archive ought to be operated
to the same standards that the American tobacco companies operate
their archive in Minneapolis, which has opening hours from eight
to eight and 12 desks, decent indexing and so on. There is a great
deal of information in those archives that relates to smoking
and health, the research programmes, the kind of things that they
were looking at over time. One can see the evolution of the internal
company approaches in those archives. There is also extensive
material about the companies' business practices in Latin America,
Asia and Africa which are revealing about the way multinational
tobacco companies operate. We have been researching that and we
will be publishing findings in due course. Given the very special
status of this industry with a six million person death toll and
such important public interest and public health issues at stake,
the British public should have proper access to that archive.
It would be good if BAT, as they almost certainly have, will have
prepared some of that material into an electronic form with proper
electronic indexing and they have probably scanned many of the
documents. It would be good if that information was requested
from them and placed in a place like maybe the library of the
House of Commons or some other place where the public can have
access to it. The other tobacco companies were all basically in
the same business, facing the same concerns about smoking and
health, marketing a toxic and addictive product. They all must
have had some approach to dealing with the public controversy
around that and conducting research, taking certain decisions
about what kind of products they were going to make, what kind
of responses they would make to the concerns being aired by the
Royal College of Physicians and others. I believe very strongly
that it would be in the public interest to see that material.
Just as the American public and media have become much more sceptical
about the conduct of the tobacco companies as a result of the
disclosures in the United States, I believe we would get a similar
effect here. I have not seen the documents they have. The discovery
process in Mr Day's litigation did not go far enough for those
documents to be exhibited in court and made public. We do not
know what is in there but we know that in those documents will
be revealed their approach to smoking, health, addiction, passive
smoking and all the rest of it.
185. Do you think that this Committee might
have persuasive powers to encourage them to bring forward these
documents?
(Mr Bates) I defer to the Committee on that. The Committee
has powers to call for people and papers, as I understand it.
One of the most effective pieces of work done by the American
Congressional Committee in the United States, Thomas McBrierley's
committee, was to reveal and place on the Internet some 39,000
documents for which the companies were erroneously claiming privilege.
That has been of great public service. That was taking a parliamentary
route to the disclosure of those documents rather than a judicial
route. Those documents contained some very explosive revelations
that the companies were trying to hide behind privilege claims.
Mr Gunnell
186. You have already indicated that the tobacco
companies here have not yet publicly acknowledged the dangers
of smoking.
(Mr Bates) There is a sort of grudging acceptance
of a statistical link. They express it precisely in their evidence.
They accept that there is a statistical link between smoking and
lung cancer. What they have tended to claim is that the causal
link is not established, so while smokers are more likely to get
lung cancer, it is argued, you cannot necessarily attribute the
lung cancer to smoking. It may be some other third factor that
is more prevalent in smokers that is causing the lung cancer.
I put a quote in from Sharon Boyse of BAT, one of the most disingenuous
things I have ever seen in my whole life, which was presented
in Sri Lanka and which suggests that the kind of statistical association
is the same as the association between driving licences and car
crashes, which is a piece of thoroughly disreputable work.
187. It is clearly an attempt to downplay what
links they believe the public will have. They must accept that
the public have a suspicion about this and what they do is seek
to present it in such a way that they mitigate people's concerns.
(Mr Bates) That is correct, and the creation of doubt
and that it is not properly proven and that there may be other
factors. Plus there is a general climate of health scare stories
that crop up and there has been to some extent an attempt to position
smoking as yet another of those. To some extent, the feeling I
get from the public posture of scientists is that the jury is
still out on some of these things. They are completely distracting
arguments. The links between ill health and smoking are proven
beyond all reasonable doubt.
188. There is no individual tobacco company
which differs from any other on the British scene, as far as this
is concerned?
(Mr Bates) They are all essentially in the same camp.
In my experience, generally, the companies avoid going on the
record on health matters. They have a very well funded trade association,
the Tobacco Manufacturers' Association, and a number of front
groups funded by the tobacco manufacturers who make the arguments
for them on tobacco and health. To be honest, you can see from
a public affairs point of view why they would wish to have a broadly
consistent stance on that. BAT has perhaps been more forthcoming
in setting out its views on smoking but BAT is a multinational
and it needs to have its position clear around the world and consistent.
You can see perhaps why they would not operate under the auspices
of the Tobacco Manufacturers' Association. Take Gallaher. We revealed
a document from inside Gallaher written in 1970 in which their
top research scientists essentially acknowledged the causal link
between smoking and lung cancer on the back of the smoking beagles
research done around that time by Auerbach. Last year, in response
to that revelation, Gallaher said, without really giving any explanation,
that those views were preliminary and discounted and did not represent
the company's opinion. To me, that said that although their research
managers concluded that the link was proven beyond reasonable
doubt, they still do not really accept it in 1998 and they are
still defending an untenable, indefensible position.
189. Why do you feel that American companies
are, in a sense, less dishonest on this matter? Is it because
of the way in which they have been pressed there?
(Mr Bates) I am not sure they are less dishonest.
I just think they are better at public relations.
190. If this Committee has the British companies
in front of it or their representatives, how would you phrase
the questions that need to be put to them?
(Mr Bates) I would be asking some very blunt questions.
I have made this as my first recommendation to the Committee.
It would enormously clear the air if the companies would accept
some basic facts and realities about smoking and health. It is
not going to put them out of business; everybody knows it anyway.
It will just mean that we do not have to expend a lot of effort
arguing over things that were resolved in the legitimate scientific
community 30 years ago. Can we accept that smoking causes lung
cancer, heart disease, emphysema and vascular disease? Can we
accept that tobacco and nicotine are addictive, not in the sense
that they have argued as an addiction to shopping and the Internet
but addictive in much the same way that cocaine and heroin are,
because, you will hear from the Royal College of Physicians, that
is the current state of the best available scientific thinking
on nicotine and tobacco. If we could get those things clear, it
would start to create a framework in which we could have a sensible
debate about where to go in the future with the tobacco industry.
Dr Stoate
191. You are absolutely right on what you said
earlier. The Health Committee does have the power to call for
people and papers. Once we have either written or verbal evidence
from people, it is in the public domain and we can publish it
in full, as we see fit. The obvious question is, if there are
all these papers that seem to be around in their archives, how
would we know what to call for? It is all very well saying, "We
are calling for BAT to reveal their papers"; they will say,
"Which of the several miles of shelves would you like us
to start with?" We cannot look at all of it. What papers
have they got that we can specifically call for which they would
then have to reply to?
(Mr Bates) BAT has already released seven million
pages and I do not think we would want to pack that into the Commons
library. One of the most important things to ask the archive companies
to do would be to provide the indices that they have to their
documents. For preparation of litigation, whether it is in the
United States in the case of BAT, or litigation that folded earlier
this year in the United Kingdom, companies will have assessed
the universe of documents which they wish to be considered and
subject to the discovery/disclosure process. They will have created
indices of those documents that will give a map of what is actually
in there. There is not an easy answer to your question except
maybe requesting for starters what is in the indices they have
in electronic form and then taking the matter from there, once
it is clear what documents they have. The index to the seven million
documents at BAT's depository is extremely poor and I cannot believe
that they do not have a far more sophisticated electronic index
than the one that is available to the public to use in Guildford.
Gallaher and Imperial, in preparing for litigation in the United
Kingdom, must have created indices to their documents. Those would
be the first things to go for and that would give you some insight
into where to go next. Searching these archives is a laborious
process of trial, error, following instinct, detective work, following
particular individuals through the trail of documents and so on.
192. That makes it very difficult because the
Health Select Committee cannot be expected to be expert in sifting
through seven million pages of paper. What we could perhaps do
to facilitate that is to make certain facts available, but we
would need to know what facts to call for so that we can put them
in the public domain and, if necessary, on the Internet so that
people can have access to the right information.
(Mr Bates) I would like to give a considered response
to that question. Maybe I should take it away and think about
it a little more and write to the Committee.
193. That would be helpful. I wanted to come
on to low yield cigarettes which you describe in your memorandum
as a consumer scandal. When did tobacco companies first become
aware of compensatory smoking, which we all understand is where
smokers perhaps try to get every last ounce of substance out,
and when was it obvious that low yield cigarettes might not be
safer than the ordinary brands?
(Mr Bates) We can only go on the documents we have
seen from inside the companies. The first signs of documents start
to discuss this issue in the mid-seventies, 25 years ago. The
addictive nature of cigarettes was acknowledged in the early sixties
inside the companies, certainly not publicly and certainly not
even today. The extent to which compensatory smoking undermined
the low tar product was a subject of controversy, but I feel that,
knowing how dangerous the product was, the onus should have been
on the company to get absolutely to the bottom of that and reach
the conclusions that have recently been reached by the regulators
in the United States, the Federal Trade Commission, the Food and
Drug Administration and the National Cancer Institute, that the
benefits previously thought to be associated with low tar cigarettes
do not exist. It is hard to say from the documents how certain
they were about this but they certainly had strong, good insights
into compensatory smoking in the seventies which really regulators
are only just catching up with now. The scientific committees
made reference to it but downplayed its importance, favouring
analysis of low tar cigarettes through the epidemiology.
194. The marketing implications as far as the
companies are concerned are that low yield cigarettes are somehow
safer. That is certainly the impression that they would like to
convey, even if not in as many words. In your opinion, are they
safer? Are they as safe or are they less safe than conventional
cigarettes?
(Mr Bates) They are less safe, not necessarily because
each cigarette is more dangerous—although there are some
scientists who believe that they are responsible for adenocarcinomas,
which are a more dangerous form of cancer, but they are dangerous
because they foster delusions among smokers that there is a safer,
more healthy alternative cigarette that is substantially safer.
If you move from a 15mg tar cigarette to a 5mg tar cigarette,
a reasonable person would expect that they are taking in around
a third of the tar, but they are probably taking in around 80,
90, possibly even 100 per cent of the tar. These have been used
to take the health concern that there is about smoking and channel
it into a different type of tobacco. Therefore, they may well
have mitigated the motivation to quit. Certainly the research
conducted by the Health Education Authority, which is presented
in their memorandum, does show that consumers are misled by the
branding and by the numbers which they are generally confused
about. The branding suggests that lower tar cigarettes are not
as dangerous as so-called full flavour cigarettes. One of the
interesting things in the European Commission's proposal for a
directive is to ban branding such as "light", "low
tar", "mild", "ultra" and so on because
it is misleading. The presumption in the Commission's proposal
is that Member States of the Community will have to decide themselves
whether to permit that branding. It will be an interesting question
for the government here as to how that particular Article of the
Commission's new Directive is handled because there is no evidence
that they can present today to substantiate the implied health
claim that low tar, light, mild and all the rest of them make.
Without any evidence, we are not saying they should be definitely
banned; we are saying that, unless they can present real evidence
that there is a real health benefit proportional to the implied
claim in the branding, they should be off the market, so no more
Marlborough Lights; no more false reassurance of these cigarette
brands, because they are really seriously misleading consumers.
Mr Austin
195. You have clearly set out that the public
is misled by this. My experience is that the majority of smokers
that I know do think that low tar cigarettes are safer. You have
identified one area where action might be taken through the European
Directive, but what is being done to inform smokers that there
is no such thing as a safer cigarette or that these may in fact
be more harmful?
(Mr Bates) Nothing really. Part of our mission as
ASH, with the Imperial Cancer Research Fund and other health organisations
like the British Medical Association, is to try to do what we
can to boost awareness and understanding of these issues. We released
a file of documents from the tobacco companies. We undertook tests
at the laboratory of the government chemist. We have done our
best. In the United States, the Federal Trade Commission is publishing
an advertising campaign which says essentially, "Do not believe
the numbers. They are misleading." The Federal Trade Commission
was essentially the midwife of this whole testing methodology
and it is often referred to as the FTC methodology, but they have
completely turned their back on it and have gone to the point
now where they are advertising about believing these numbers.
The first thing that could be done is simply to take the numbers
off the pack. The second thing is to stop the branding based on
the numbers. The third and more substantive point is to start
to require meaningful changes that would make the cigarettes safer.
We have presented some evidence on that. There are technologies
and techniques available that would reduce the harm caused by
particular cigarettes. We think the regulators should be looking
at those and requiring the companies to do it.
196. In terms of public information, have you
had discussions with the Health Education Authority or others
about getting the message to people?
(Mr Bates) Yes. The HEA conducted that rather good
piece of research and publicised it using a media launch and everything.
The responsibility for mounting a large scale public advertising
campaign rests with the Department of Health which would have
to approve funds for something like that. The HEA acts, as I understand
it, as an agency implementing government policy. Government policy
at present is not to withdraw those numbers and low tar branding.
The government, as I understand it, is open minded and is looking
carefully into it and I think that marks a big step forward. I
am glad they are doing it.
197. Although you recognise the importance of
informing and educating the public, do you nevertheless feel that
the key issue is regulation and control of the market?
(Mr Bates) Yes. If the government's White Paper "Smoking
Kills" tobacco policy is successful, by 2010 smoking prevalence
among adults will have reduced to 24 per cent. That 24 per cent
will be overwhelmingly concentrated in the poorest, most deprived
groups of society, where smoking cessation is very difficult.
It is very difficult to persuade people in that group in society
to quit. As far as their health and smoking is concerned, any
benefits that there would be would come from a mixture of reducing
consumption, if possible—that proves to be difficult—and
reducing the harm caused by each cigarette smoked. We believe
there are things that could be done to cigarettes that have not
been done that would make a genuine difference to them. There
is an American company, Star Scientific, which produces tobacco
with no nitrosamines in. They have a very straightforward microwave
process during curing which removes nitrosamines. Nitrosamines
are implicated in causing cancer. This technology is not rocket
science, but it could and should be used to remove nitrosamines
from cigarettes as a precaution.
Chairman
198. We are meeting with them next week.
(Mr Bates) I am glad. That is a very different tobacco
company in terms of its approach, and it is probably the only
one in the world that has really taken on the health agenda whilst
recognising that people are free to continue smoking, an inspirational
development and very threatening for the other tobacco companies.
Mr Amess
199. As my halo appears, I have never smoked.
My wife was a chain smoker until the first time she became pregnant
and now she is the worst kind of reformed smoker, although she
did not give a damn when she was smoking Silk Cut endlessly. Is
the overall objective of your organisation to ban smoking in this
country?
(Mr Bates) No. It is often said that it is but it
has never been said by us. We do not want bans on smoking. We
have around 13 million nicotine users. Nicotine is a legal drug
in society. People like using it for whatever reason. We are not
prohibitionists. We do not want that banned. We just think that
the harm associated with smoking can be reduced.
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