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Smokeless Tobacco

1.30 pm

Paul Flynn (Newport, West): Since the House last met in late December, the number of Britons who have died from smoking is twice the number who were killed in the terrible attack on the twin towers. We have a dreadful toll of 120,000 deaths every year, and we are not reducing that number. The last report of the National Institute for Clinical Excellence on Zyban and nicotine reduction therapies tells us that the number of people smoking has not decreased since 1997, and has probably increased. Some 25 per cent. of 15-year-olds now take up smoking.

The Government are to be congratulated on many of their initiatives. They have plenty of conviction, have made resources available and are determined to reduce that toll. Looking at past records, there is a little room for optimism. This Government will be the first to ban tobacco advertising. The ban will have a substantial effect in terms of discouraging new smokers, although the maximum change will probably be 2 or 3 per cent. fewer new people taking up the drug. There is another good campaign for nicotine replacement therapies, which is imaginative and resourced, and will have an effect. The Government will campaign, advertise and provide education programmes more energetically than previously.

However, one example of a campaign shows what the Government are up against. It is likely that many campaigns, unfortunately, will fail because of the enormous power, resourcefulness and greed of the mendacious lobby from the tobacco industry. It will stop at nothing to sell its products. A campaign in Wales in the mid-1990s, known as Smokebusters, was designed to reduce smoking among young people and was judged a success at the time. It was very energetic and involved a lot of initiatives. Many young people were contacted, and the general feeling of those who launched the campaign was that it was a great success.

Unfortunately, a 50 per cent. increase in smoking among teenage women coincided precisely with that campaign. I have told that story in various countries, as a member of the European Health Committee of the Council of Europe. The response each time—in Malta, Ireland and Canada—has been that there was a similar increase in smoking among teenage women in those countries at that time. The reason was not that campaigns had failed or been counter-productive, but that young women were taking up smoking because they were presented with the idea that smoking was good because it helped them to slim. Peer pressure and role models gave them that ideal of smoking.

We have seen that Governments, with all the best intentions in the world, have had very little success in reducing smoking levels. I can tell the Government that I read their policies and agree with all that they are doing, but we must look at what is happening elsewhere, including an example that has been largely unknown or disregarded: the extraordinary experience in Sweden during the past 20 years of a product almost unique to that country. Known as snus, it is a form of moist snuff. It is interesting that snuff is the only form of tobacco that we are offered freely in this House. It is available from the Doorkeeper, although now little used.

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The amazing result of that product has been an extraordinary reduction in smoking in Sweden and an equally extraordinary reduction in cancers and other health results of smoking. To understand why, we must challenge our preconceptions about the effects of tobacco. Tobacco is not a killer—nicotine is about as dangerous as caffeine. It becomes lethal when we set fire to it. As Martin Jarvis of Cancer Research UK said, 300 lethal toxins explode in a cocktail of carcinogens when a cigarette is lit. The smoke causes problems in our lungs and the carcinogens cause difficulties such as bronchitis, heart disease and so on.

A method that would take nicotine into our bodies and deliver the fix that smokers want without the health risks would be the holy grail. A solution seems to have been found by accident—not by some genius working it out—in Sweden. The result is that the number of male smokers in Sweden has dropped from 36 per cent. in 1980 to 17 per cent.—a bigger reduction than any other country has achieved. However, Sweden still has a level of tobacco use similar to that of other countries because 19 per cent. of males use snus. There is very little use of snus by women in Sweden. On examining the statistics, we find that the level of nicotine-related cancers among males in Sweden is half the European average, while the level for women is almost exactly the same as the European average.

Everyone who studies the effects of moist snuff comes up with the same conclusion. Two distinguished American researchers from the university of Alabama, Brad Lodu and Phillip Cole, have taken a pessimistic view of the health consequences of snus—no product is entirely safe—yet have calculated that the life expectancy of someone who uses snus from the age of 35 would be reduced by only 15 days, whereas the life expectancy of someone who smokes from 35 onwards would be reduced by eight years. The smoker might live to 73, but a non-smoker or a snus user would have a life expectancy of 81.

We cannot ignore the extraordinary evidence from Sweden. For good reasons, the European Union believed that snus should be banned because of the risk of mouth cancers. It seemed a logical and persuasive argument. However, the matter has now been investigated at great length. A Swedish researcher found one case of mouth cancer among 200,000 snus users. Other researchers make similar claims for similar tobaccos in America. It is absolutely certain that the incidence of mouth cancers among smokers and drinkers—alcohol can cause mouth cancer—will be far higher than among snus users. It is significant that those who use moist snuff run virtually no risk of other health ill effects such as lung and larynx cancer, emphysema and all the other problems that result from smoking. Every report on the matter comes up with the same conclusion.

As I said, the EU banned snus because of the risk of mouth cancer. Even if we wanted to, we could not use it. When Sweden joined the EU in 1995, it was given a special derogation to allow the continued use of snus. Every year, more Swedes use snus because of its health benefits.

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The problem that smokers and ex-smokers face is the virulently addictive nature of tobacco. Many people can give it up, but their bodies and brains are dependent on the fix that it provides. The main reason for returning to cigarette smoking after quitting is to reward oneself for having given it up in the first place. Unfortunately, many people who give it up for short periods return to it. If they could experience the same feeling of satisfaction and gratification from other sources by causing the endorphins to work in the brain in the way that they do when they get a shot of nicotine, and could avoid the health problems, that would be fine. That is what all the independent research indicates is happening in Sweden. However, Britain is in the extraordinary position of allowing the almost unfettered sale of tobacco.

The Select Committee on Health referred to the controls on the sale of tobacco as pitiful. Almost anything can be put into tobacco, including addictive substances. Tobacco kills almost half the number of regular users. If there is a case for banning anything, it should be tobacco. We also allow the sale of other chewing tobaccos. Several relatively new tobaccos of questionable provenance have joined gutkha and paan from the far east in being legal and on sale. Snus, however, is banned. There can be no sense in banning a substance that has a proven record of reducing health problems and deaths.

The Government have followed the simple policy of "quit or die": one must carry on smoking or give up altogether. There is a "third way"—to coin a phrase—that has been effective. There is a case currently before the European courts that snus should be removed from the list of banned tobaccos, which is a decision that the British Government and other Governments will have to take. I discussed this at some length with Swedes who have an ambivalent view of what is happening in their country. They are not naturally attracted to the idea of harm reduction but take an absolutist line in many of their policies on drugs. However, we cannot afford to do that when there is a possibility of achieving the sort of health improvements that the Swedes are achieving. Most of the organisations in the field in this country and throughout the world support renewed consideration of the ban and new ways of reducing the problems caused by tobacco.

On 10 December, the Royal College of Physicians produced a report in which it joined the call made by the Health Committee in 2000 for a regulatory authority to protect public health from the problems associated with tobacco. We are failing to give smokers sufficient protection from cigarettes, and there is much to be done. However, we are banning what is probably the safest form of oral tobacco, and allowing other forms of tobacco into the country that potentially are far more dangerous.

We need a body to decide which of the tobaccos on offer are the most carcinogenic and toxic and to give advice. It may be necessary to ban some chewing tobaccos, but the difference between snus and the others is that snus is absorbed in a way that does not involve chewing and so does not cause the lesions inside the mouth that other forms of tobacco might cause. It is taken in a safe way in which there is no direct contact between the skin and the tobacco.

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The Royal College of Physicians says that tobacco is a uniquely dangerous consumer product that kills more than 120,000 people a year in the United Kingdom when used as intended by the manufacturer, yet it is not as highly regulated as are prescription drugs and food. It recommends a regulatory authority, as it did in its report "Nicotine Addiction in Britain", and complains that the Government largely ignored that recommendation. It also says that new reduced-risk cigarettes and smokeless tobacco are being designed. How will the Government handle issues such as relative risk, analyse the claims of such products and decide what information would be helpful to smokers? We need to encourage the development and production of new nicotine products. They face much stricter regulations than cigarettes. How can that make sense? How can it be rational to turn our back on the terrible dangers of cigarettes in many cases and allow them to be freely sold? They are available even to young people. Yet we still have a ban on a product that could well be a lifesaver for half the present smokers in the country.

I am grateful to Action on Smoking and Health, the organisation that has done so much over the years on this issue. It takes a line that is similar to the one that I want to present today. It has courageously taken on the smoking lobby over many years and achieved many victories against them. I have no commercial axe to grind on this or anything else. A company is manufacturing this product and although we would not necessarily want Britain to become involved in Swedish Match's products, we should learn the lesson from this. When we look ahead we must realise the truth of all our anti-smoking campaigns. A hard core of millions of smokers cannot and will not give up. They will be addicted to tobacco to their early graves. We can offer them an alternative of using a form of tobacco that will spare them that early grave and will give them the same type of life expectancy as non-smokers.

The evidence is overwhelming. I hope that the Government will take it into account. What will they do when Swedish Match seeks a judicial review of the ban that can no longer be defended? When it comes to court, the European Union, or other countries in the EU, must defend why snus should be so uniquely difficult, poisonous, and carcinogenic that it must be banned while other products are not. I believe that no case can be made on those lines.

Will the Government act now to do what many organisations, including the Royal College of Physicians, have suggested and set up a regulatory body that will decide on the toxicity and carcinogenic properties of all forms of tobacco? Close members of my family died tragic premature deaths as a result of smoking: my father was 43 and my brother was 57. Others will have had similar experiences. We owe it to all those who are smoking now to give them all the alternatives that are available, so that they can escape from the tyranny of their addiction and into using products that will guarantee them a normal full lifespan.

1.48 pm

The Parliamentary Under-Secretary of State for Health (Mr. David Lammy) : I welcome the opportunity to speak today on the health aspects of smokeless tobacco. I recognise the efforts of my hon. Friend the Member for Newport, West (Paul Flynn) in highlighting

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this serious subject. On his last point, my father died from throat cancer caused by the effects of tobacco. I have felt this personally. My hon. Friend refers specifically to the case that is currently before the UK courts. He will understand the conventions of this House and why it would not be appropriate for me to comment on the specifics of that case or to put the Government's position here.

My hon. Friend spoke passionately about the Swedish snus, but I should like to talk more generally about oral tobacco. It would be remiss of me if I did not put the Government's case and declare our commitment to tackling tobacco addiction. Tobacco has been with us for about 400 years and it remains with us for the simple reason that nicotine is addictive. There are many ways of taking nicotine, but smoking is by far the most efficient and the most dangerous. As the 1998 White Paper starkly put it, "Smoking kills". It is as simple as that.

In any one year smoking is responsible for about 120,000 deaths in this country—one in five of all deaths. It is the principal cause of inequalities in death rates between the rich and the poor. The treatment of its consequences is staggering: it costs the national health service £1.5 billion a year. The addictive properties of nicotine and the range of cancers and respiratory diseases associated with smoking are universally acknowledged. If cigarettes were to be introduced today, I have no doubt that their production and sale would be banned without delay. Unfortunately, with a 400-year history of social acceptance we cannot seriously consider doing that. However, we will continue to make every effort to warn people of the dangers of the habit and to help those who are addicted to break free.

Much that my hon. Friend is suggesting would mean that the Government would take a step-down approach to nicotine, but we should take a step-off position. We want people to break the addiction or not to take up the habit in the first place, and that is where we should concentrate our efforts.

The addictive properties of nicotine ensure that tobacco users find it difficult to break free from its influence, but the crux of the debate is that the delivery route—the tobacco itself—presents the health dangers. There might appear to be benefits in persuading tobacco users to switch from smoking, the most dangerous manifestation of the habit, to the less dangerous, oral tobacco, but no form of tobacco is completely safe. We firmly believe that the only sensible course is to persuade people to give up tobacco and to provide them with the help and support necessary to do so. It must be right for the Department of Health to be in the business of health promotion.

I am not sure that it is correct to suggest that there are no known health consequences of oral tobacco. We are spending a considerable sum on a comprehensive programme designed to inform the public of the damage caused by smoking and to provide a range of services helping those smokers who want to give up. The services include free telephone helplines, counselling and support and the provision of nicotine replacement therapy and Zyban on NHS prescription. We began those services in the poorest communities and they are

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now available nationwide. Our approach is not just about getting people to quit smoking but ensuring that people, especially the young, never start.

The £59 million that we have invested in the past four years in anti-smoking advertising is making a difference. Seven in 10 smokers say that they want to quit and it is our job to help them to do so. After years of obstruction in the courts and in Europe, we now have legislation banning tobacco advertising and promotion. From the middle of next month, press and billboard advertising of tobacco will be a thing of the past in this country—a fact which we should all be proud of and grateful for. By October next year, all cigarette packets will carry new and much starker health warnings on the front and back. The misleading doublespeak of "mild" and "light" will also disappear.

My hon. Friend gives the Government some credit in this regard. We have more than good intentions. The financial investment that we have made suggests that, as do the early results.

Paul Flynn : I should like to measure the Government's ambition with regard to their policies. They say in their response to the Health Committee's report that their ambition is to get smoking levels among males in the poorest areas down to 26 per cent. by 2010, but in Sweden currently the level of smoking among males is down to 17 per cent. as a result of the use of snus. How on earth can we say that we are doing the right thing or the only thing when, even by our own ambitions, we will not get anywhere near the improvement that has been achieved in Sweden over the past 20 years?

Mr. Lammy : I am grateful to my hon. Friend: he makes the case for me. Sweden is unique in Europe in having the very specific habit of using oral tobacco. That has been the case since the second world war.

Paul Flynn : For centuries.

Mr. Lammy : My hon. Friend corrects me: the Swedish habit of using oral tobacco has existed for centuries, whereas we in this country have smoked tobacco. The banning of advertising and our investment in smoking cessation—Zyban is available on the NHS

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to help people to stop smoking—are relatively new. In fact, it is a two-and-a-half-year programme, but we are on the journey. My hon. Friend will forgive me for wanting to allow the efforts being made to bed down and for questioning ever so slightly—I do not want to put this too strongly—the emphasis on what is happening in Sweden, when that has gone on for some considerable time. As I have suggested, cultural habits in Sweden are different from those in this country. Here, only coal miners, who could not smoke in the pits, and some seafarers were in the habit of using oral tobacco. That is relevant.

Let me return to our achievements. Smoking rates have fallen, and the fall has been greatest among those in manual occupations. The newly established NHS cessation services have helped almost 220,000 smokers to kick the habit for good. Let us consider the figures for England in the past year. The figure for teenage girls is now 11 per cent. vis-à-vis 15 per cent. in 1998, and the figure for boys is 8 per cent. vis-à-vis 18 per cent. in 1998, so things are moving in the right direction.

Many smokers recognise the dangers of a smoking habit, but either have no wish to give up nicotine or find it too difficult to do without it. They have therefore sought alternative means of delivery of the drug. That search has resulted in various forms of smokeless tobacco—tobacco products that are designed to be chewed or sucked. In this country, the phrase "oral tobacco" used to mean simply the old-fashioned chewing of tobacco, normally in the form of a plug.

Another category consists of products that are available in the south Asian communities, to which my hon. Friend drew attention. Tobacco is mixed with a number of other substances to produce paan. Those products vary in content and presentation, and some, which masquerade as sweets, appear to be designed to appeal to younger members of the community. I assure my hon. Friend that that is the subject of an inquiry by trading standards officers, and the Government are keeping a close eye on it. Although legal, all those products carry health risks, such as various oral and dental disorders and, most seriously, cancers affecting the jaw, tongue and oral cavity. We are therefore developing particular strands of our tobacco information campaign to address the various ethnic differences.



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