Examination of witnesses (Questions 308
- 319)
THURSDAY 9 DECEMBER 1999
PROFESSOR JOHN
BRITTON, DR
JENNY MINDELL,
SIR ALEXANDER
MACARA and DR
BILL O'NEILL
Chairman
308. Thank you for coming this morning. We are
most grateful to you for the evidence that you have already submitted.
I wonder if I could ask each of you to introduce yourselves briefly
to the Committee, starting with you, Dr Mindell.
(Dr Mindell) I am a medical doctor. I have spent much
of the past 20 years looking after patients suffering from the
effects of smoking and dealing with the problems that causes their
families as well. I have spent around 15 years being involved
with tobacco control, including being Director of a Cancer Prevention
Campaign and I have published research on tobacco control. I am
trained in epidemiology and public health and I am a member of
the Faculty of Public Health Medicines and on their Policy Committee
and on their Cardiovascular Working Group.
(Dr O'Neill) My name is Bill O'Neill. I am a medical
member of staff of the BMA. I was previously a consultant in palliative
medicine and prior to that a general practitioner and I have,
amongst other things, responsibility at the BMA for our policies
on tobacco control, including an EC funded project called the
Tobacco Control Resource Centre, working with medical associations
across the European region, encouraging the involvement of other
medical organisations in tobacco control issues.
(Sir Alexander Macara) Sandy Macara, immediate past
Chairman of the BMA. I have a particular continuing function in
relation to tobacco control in that I chair a tobacco action group
jointly between the European region of WHO and an organisation
called the European Forum of Medical Associations which is representative
of the whole of the WHO European Region and this activity is directly
serviced by Dr O'Neill's Tobacco Control Resource Centre which
was set up in the Association when I was the Chairman. I am also
Chairman of the National Heart Forum. I am also anxious to remind
people that it is heart disease as well as cancer which is very
importantly involved in all of this.
(Professor Britton) I am John Britton. I am a consultant
physician in respiratory medicine and I work in Nottingham. I
chair a group which advises the Royal College of Physicians on
tobacco related issues and I am here today representing the College.
309. Could I begin by asking you, Sir Alexander,
a point I have raised with a number of our previous witnesses
in earlier sessions which is that we are now 50 years on from
fairly significant evidence of the harmful effects of tobacco
on health. I mentioned in the previous session that we had the
Health Minister in 1954 speaking in the Chamber of the House of
Commons about the knowledge at that stage. Since this time we
have had six million deaths arising directly from tobacco use
in this country. 120,000 people die every year. Why on earth has
it taken so long, after all these years of detailed knowledge,
to address this matter seriously?
(Sir Alexander Macara) That is a very good question.
There are a number of starting points. The group of people who
responded most rapidly and most effectively to the evidence which
our colleagues Richard Doll and others were producing all that
time ago were the doctors and other groups who were able to understand
and access the information followed suit. Unfortunately that message
has not been taken and applied to the same extent by people as
a whole. I think there are a number of reasons. One must be that
as doctors and scientists we are concerned to base everything
we do upon evidence and I think we have been excessively optimistic
in our expectation that when we have produced the evidence people
will act on it. By "people" I mean government, I mean
consumers and I mean the tobacco manufacturing industry. The fact
is that none of these groups acted at all in a sufficiently responsible
manner to the evidence which we had produced. Perhaps we were
insufficient zealots, dare I use that word. Perhaps we should
have been stronger in our advocacy about the implications of the
evidence which we were producing.
310. There might be another interpretation and
that interpretation was implicit in Dr Yach's earlier evidence,
which is that governments have been corrupted by the tobacco industry.
Would you apply that interpretation to the UK?
(Sir Alexander Macara) I have been concerned for some
time that a number of Members of Parliament whom I have known,
whom I have admired and respected greatly seem to be prepared
to take the Queen's shilling from the tobacco manufacturing industry
so that they receive retainers. They did not have to declare this
interest. I know that some of them are at pains not to declare
that interest. I would not claim that that was corruption, but
it does seem to me to be unfortunate.
311. Were these people who had some influence
in terms of government policy?
(Sir Alexander Macara) I certainly had the impression
that the exercised influenced beyond that which you would expect
the average Member of Parliament to do because they were obviously
so very well informed by the misinformation put out by the tobacco
manufacturing industry who have always, at least until very recently,
sought to rubbish the evidence by suggesting that it is a matter
of controversy. There is no controversy about it because the facts
are clearly demonstrated.
312. I think you have been unduly modest about
the efforts made by your profession in respect of convincing politicians
on the health dangers of smoking. Do you have any view on the
advice given by successive Chief Medical Officers on the issue
of smoking and health to successive secretaries of state and successive
governments and how that advice has been acted upon or not acted
upon and, if so, why it might not have been acted upon in view
of your earlier comments about connections between tobacco companies
and Members of Parliament?
(Sir Alexander Macara) The four countries of this
kingdom are uniquely well served by their Chief Medical Officers
because there is no equivocation about their position, they are
the Government's advisers. There are other countries, notably
in Europe, where the Chief Medical Officer is a political appointment
and so he does not have the same credibility. Our Chief Medical
Officers have consistently sought to advise Ministers at the time
of all the implications of the evidence which the professions
have produced. I am bound to say that one gets the impression
that Government has been only too happy to use Chief Medical Officers
to distance themselves from the possible unpopularity of having
to advise people against something that they want to continue
doing and where they do not want to face the effect upon their
health. Of course, the tobacco manufacturing industry is only
too happy to use both the CMOs and their governments as a cordon
sanitaire between themselves and the consumers. We should
have required the manufacturers to admit they are producing a
product which will kill half of all those who become addicted
to it.
313. Looking back over the 50 years that we
have talked about when all the information was emerging, at what
point do you believe that had we had an open system of government
and been aware of all these influences government could have acted
to save lives? At what point do you feel we might have seen some
much more significant action than has been taken over this period?
(Sir Alexander Macara) I would put as the crucial
date 1962 when Professor Britton and my Royal College of Physicians
produced its first report on smoking and health. It could not
have been more authoritative without being authoritarian. It projected
all the evidence in a thoroughly convincing way and on which,
as I have indicated, doctors at least acted. If your predecessors
in all parties had taken this matter up at that time we could
have saved millions of deaths and a great deal of preventable
disease.
314. Can I just focus for a moment on one or
two of the issues that we raised with the previous witness to
do with the records of the various tobacco companies. I wonder
whether any of the organisations represented here have accessed
the documents of the depository in Guildford or are aware of relevant
information in those documents that has a bearing on what we are
looking at or a bearing on the concerns that we have just been
expressing about the amount of time it has taken to address this
issue politically?
(Sir Alexander Macara) Dr O'Neill has looked at this
particularly.
(Dr O'Neill) At the BMA we have not made a direct
attempt to get access to the information because of its inaccessibility.
What does one do when faced with a warehouse of documents that
are not adequately indexed? I think Dr Yach has made the case
very well for the need for electronic access to that information
and that point has been made by other witnesses to this Committee.
(Dr Mindell) I represent a very small organisation and
we do not have the resources to go there and try to look for needles
in haystacks.
315. I think one of the impressions we have
from having met a number of people in the States who were very
interested in this point is that collectively there is a lot of
interest and a willingness to look at what this archive contains
and the implications of the archive on future policy. Do you have
any thoughts from your knowledge of that archive and other archives
that may have come to light on steps that we may be able to take
through this inquiry or procedures that we may bring about to
move forward on the knowledge of information that clearly was
retained by the tobacco companies going back many many years?
(Sir Alexander Macara) I do not know what my colleagues
think, but I was impressed by Dr Yach's replies to your questions
about this and, in particular, the way in which electronic access
might assist us here. Clearly we do need some assistance to enable
the basic work to be done. When we do have some information then
we can proceed.
(Professor Britton) Whilst the contents of archives,
such as the Guildford archive, will be fascinating in the insight
that they provide to what has gone on in the past, I would say
that in many other ways we have perfectly adequate evidence to
make sensible public health policy for the future without spending
hours and years trawling through dusty archives.
Mr Austin
316. I think Dr Yach was suggesting that $2-4
million may be the cost of accessing that information. Do you
feel that that would be public money well worth spending?
(Sir Alexander Macara) It depends on whether one is
thinking in absolute or relative terms. It may not seem to be
as useful as other measures that might be taken, but in absolute
terms one would have thought it is a very small amount of money
to find as against that which is involved in the whole tobacco
manufacturing market.
Mr Gunnell
317. You would think that most of the health
consequences of smoking are known beyond reasonable doubt. Where
would you say there is still genuine scientific controversy about
them? Do you not agree, since there is no doubt about the issues
and the consequences of passive smoking and that there ought to
be action taken by Government on a very firm basis in connection
with that, that they should be prepared to legislate and not to
rely on the voluntary agreements of companies involved?
(Professor Britton) In terms of active smoking, there
is no doubt that smoking causes lung cancer and a long list of
diseases which I think probably everyone here is familiar with.
What is not known is how long that list is and which associations
have not yet been detected. In terms of passive smoking, I think
there can be no question that passive smoking is associated with
an increased risk of lung cancer, respiratory symptoms in young
children, and passive smoke exposure of the unborn child with
an increased risk of death in the utero. This is imposed on children
by smoking adults, which I think is unacceptable in public health
terms.
318. Do you think that a much firmer line should
be taken by Government to make it clear that they are not going
to rely on the voluntary agreements of the companies involved
or the restaurateurs or public opinion anymore?
(Professor Britton) I want to come back to the question
the Chairman asked earlier about who is at fault for the failure
of public health measures in tobacco controls. In my view a great
deal of fault lies in Government for not grasping the obvious
facts and acting on them. The voluntary agreements are part of
the reason that tobacco control is still so low. Although it is
better than many countries, it is inadequate in this country.
50 years have gone by because of prevarications by Government.
319. So that would indicate that it should be
made compulsory through legislation, would it not?
(Professor Britton) Yes.
(Sir Alexander Macara) Which could well apply to workplaces
because just as we should be protecting children, we need to protect
workers and not every employer is as responsible as they might
be in that regard.
(Dr O'Neill) I think that is unquestionably true.
I think one should distinguish between voluntary agreements with
the tobacco industry and voluntary agreements with other groups
and one would not want to criticise the restaurant and pub industry
for the initiatives they have taken, but I think one has to draw
a clear distinction between groups such as this ,and the tobacco
industry, based on the behaviour of the tobacco industry over
the last three or four decades.
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