Examination of Witnesses (Questions 440-459)
PROFESSOR SIR
LIAM DONALDSON
24 NOVEMBER 2005
Q440 Mr Amess: I am a
bit disappointed that you have decided that you cannot be precise.
I would have thought that at least to shut me up you would have
given me two or three. Are you familiar with the study conducted
in California by Professors James Enstrom and Geoffrey Kabat,
which suggested there is no link at all between second-hand smoke
and ill health?
Professor Sir Liam Donaldson:
Yes I am.
Q441 Mr Amess: What is
your view of their research?
Professor Sir Liam Donaldson:
Firstly, the study was carried out by the researchers who were
partly sponsored by the tobacco industry, so there was a clear
conflict of interest there. Secondly, it was using data from the
American Cancer Society. The American Cancer Society subsequently
disowned the study and criticised it on the fact that the methods
used were unreliable and misleading. Quite honestly, I do not
think that study stands up to any scientific scrutiny whatsoever,
leaving aside the conflict of interest in the funding which to
me is tantamount or comparable to a research study on organised
crime being funded by the Mafia.
Q442 Mr Amess: Why do
you think the study reported that there was no adverse effect?
Professor Sir Liam Donaldson:
Because they carried out a study with a flawed methodology which
led them to the wrong conclusions.
Q443 Mr Amess: I am delighted
that you are aware of that study which helps the argument in terms
of the ban. It is just a bit surprising and disappointing that
you cannot refer me to any studies to reinforce your view.
Professor Sir Liam Donaldson:
You have had all the detailed documents. I can refer you in detail
to individual reports which have synthesised the research evidence.
I did not expect that we would use up all our time going through
their research evidence in detail.
Mr Amess: This is a Select Committee.
It is up to us to ask the questions. It is not for the Chief Medical
Officer to determine which questions he would feel comfortable
with or not. I am very disappointed and surprised that you cannot
refer me to any scientific evidence base in terms of this inquiry.
I would have thought it was an obvious question.
Q444 Chairman: You were
presented last November with the Scientific Committee on Tobacco
and Health's (SCOTH) Report.
Professor Sir Liam Donaldson:
Yes.
Q445 Chairman: Has that
been challenged by anybody?
Professor Sir Liam Donaldson:
No, it has not. That is one of the expert reports that I was referring
to.
Q446 Mr Burstow: We have
read your Annual Report for 2004 with great interest. In the report
you say that the proposals for smoke-free public places set out
in Choosing Health did not go far enough. I wonder if you
could tell us how we could go further to meet your concerns.
Professor Sir Liam Donaldson:
I think the case for widening the present proposals to all enclosed
public places and workplaces is a very strong case both on health
grounds, on grounds of public opinion and I think even on economic
grounds, looking at the data from other countries which I analysed
in my 2003 report.
Q447 Mr Burstow: So widening
would mean a ban more along the lines of the Irish ban or something
else, would it not?
Professor Sir Liam Donaldson:
Yes it would.
Q448 Mr Burstow: Can you
also say a bit more about what you think the effects of a partial
compared to a comprehensive ban would be in terms of health inequalities
and health outcomes?
Professor Sir Liam Donaldson:
The present proposal, which is a partial ban, I think is unsatisfactory
for a number of reasons. Firstly, it leaves those most exposed
to second-hand smoke unprotected. Secondly, it loses out on the
opportunity to reduce the prevalence of smoking and ill health
from second-hand smoke as a consequence. Thirdly, in my view it
will actively increase health inequalities for two reasons: first
of all, pubs and bars in the northern part of England which already
have high levels of inequalities are more likely to be pubs that
do not serve food; secondly, I think pubs in similar areas which
currently serve food may stop serving food in order to allow smoking
to take place. It also signals to the public that a drink and
a smoke go hand-in-hand when all the efforts on smoking and tobacco
control have been aimed at de-normalising smoking and I think
it puts Britain amongst the laggards of public policy health making
internationally rather than the global leaders. Finally, I think
the extension to the licensing laws will increase the period when
bar workers will be exposed to second-hand smoke.
Q449 Mr Burstow: It has
been put to us from some sources that we should not be so worried
because only 1% of the workforce will remain unprotected after
the ban as currently envisaged is implemented. Is that a fair
way to characterise the policy insofar as that 1% are likely to
be the ones at most risk of exposure in the first place?
Professor Sir Liam Donaldson:
No, I do not think it is fair and I do not think we can be clear
either about the numbers because at this stage we do not know
what the policy of the pub and leisure industry will be to continuing
to serve food or not serve food.
Q450 Mr Burstow: In the
Annual Report you make reference to the—at that point—"upcoming
consultation on the proposed consultation to create smoke-free
restaurants" and you talk about that providing an opportunity
to strengthen the approach originally planned. What did you have
in mind when you wrote that?
Professor Sir Liam Donaldson:
The point I was making there was that the proposals for this hybrid
arrangement of smoking and non-smoking bars and pubs would be
subject to consultation. My own feeling, having read already the
public opinion surveys and the views of experts, was that the
consultation would persuade the Government to widen the proposals
in the way that I had recommended.
Q451 Mr Burstow: Would
you say that the evidence around this hybrid policy was what you
might call sound evidence-based policy?
Professor Sir Liam Donaldson:
No, I do not think it is and that is why I strongly recommended
a different approach.
Q452 Dr Stoate: Can I
first of all compliment you on your wonderful clarity and your
directness in the answers because you have put your position extremely
clearly and that is very helpful to the Committee. Given that
you are the Chief Medical Officer and you advise ministers in
exactly the same tone as you have advised us, why do you think
ministers are nevertheless deciding to go for a partial rather
than a total ban given the strength of your evidence?
Professor Sir Liam Donaldson:
I think it is rare for the Government to ignore the advice of
its Chief Medical Officer or to fail to act on it. This is the
first situation I have encountered in the seven years I have been
in post when this has happened. I think I probably have to point
to the fact that the policy that is currently being run with was
in the Labour Party manifesto before the election and I guess
on political grounds there are some difficulties in a party departing
from its manifesto commitment, but I could not, and should not,
be part of the political process that led to the manifesto being
drafted, so I do not know why that proposal was put in so firmly
in the way it was.
Q453 Dr Stoate: As far
as you are concerned, on purely health grounds and the protection
of health force grounds, there is absolutely no argument whatsoever
for anything other than a total ban, is there?
Professor Sir Liam Donaldson:
No argument whatsoever. Other countries are falling like dominos
into that position.
Q454 Dr Taylor: Thank
you very much for being so clear. When we were in Dublin the experts
said that to introduce a partial ban would be an absolute disaster
because it would make it much more difficult to go on to a total
ban. Do you agree?
Professor Sir Liam Donaldson:
I do not know whether it is more difficult to go on to a total
ban. I think it is an unworkable situation. The Norwegians introduced
not exactly this form of ban but a hybrid arrangement in the mid-1980s
and they found that it was unworkable and it was regularly flouted
and as a result they brought in a total ban in 2004. Mr Arculus,
the Chairman of the Better Regulation Task Force, also has commented
to us that he thinks it would be extremely difficult to regulate.
Dr Taylor: We have just heard from the
previous witnesses that enforceability would be very, very difficult.
Q455 Mike Penning: In
the seven years you have been in post clear medical advice to
our ministers has been ignored completely. Does that not put you
in a very difficult position?
Professor Sir Liam Donaldson:
It has put me in a difficult position and I have had to think
hard about what I want to do about that position. There are some
areas where if your advice is ignored and it damages the public
health you would have to consider resignation if you were in my
position. I have thought very, very carefully about that. My feeling
is that I have championed this so far. When I produced my first
Annual Report in 2002 nobody was calling for this to happen. I
have pushed it so far. I have re-emphasised it in my 2003 and
2004 reports. I have spoken publicly in opposition to the Government's
policies on this one area, which is an unprecedented position
for a Chief Medical Officer, and therefore my feeling is that
this will eventually come and it is more likely to come if I stay
in my post and continue to champion it.
Q456 Mike Penning: If
they introduced the legislation as it is at the moment we would
have a robust debate in the Commons. If they push forward with
the proposal for a partial ban, which would not bring the medical
benefits that clearly you passionately believe the public need,
would you then have to consider your position again?
Professor Sir Liam Donaldson:
I think I would continue to champion the need for a change in
whatever law happens to be eventually produced.
Q457 Dr Naysmith: Like
everyone else, Sir Liam, I am very impressed with your frankness.
This is one of those kinds of electric moments that happen from
time to time and I think we are all recovering a little bit from
the shock. I was going to ask some rather mundane questions about
the National Health Service and I will come to those in a moment.
Given everything you have said, why do you think this was treated
as a public health policy rather than a Safety at Work Act policy
and overseen by the DTI rather than the Department of Health because
this is where much of the problem comes from really, is it not?
Professor Sir Liam Donaldson:
I think there have always been two principal objections in most
countries. One is the economic argument that the leisure industry
and the hospitality industry would lose profits, it would harm
them. I think that is largely refuted by the experience of other
countries and some of the economic analysis. The second one is
an ideological one, which is really that you should preserve the
freedoms of the minority to smoke. I suppose linked to that is
that you do not want to be branded with being part of a "nanny
state" and that is then a matter of opinion about whether
such an argument should hold sway.
Q458 Dr Naysmith: Some
would say that the reason they have gone so smoothly is because
it is seen as a health and safety at work issue and once you use
that argument there is no argument against it.
Professor Sir Liam Donaldson:
Certainly when we talked to the people in New York City who, as
you know, were one of the earliest authorities to go into this
territory, the campaigners used some very interesting tactics.
They sent a questionnaire to all the people who were going to
be standing for elected office and they asked them if they would
fill out a questionnaire stating trade union by trade union whether
they were in favour or against protecting the health of the workers
in that trade union. If they refused to answer the questionnaire
their name was to be published in a newspaper. When those officials
were elected, including Mayor Bloomberg, they called in the questionnaires
that they had got signatures on. They very much pushed the position
of the worker as predominant in these arguments. On the question
of freedom, as I have said in my Annual Report, for those who
have not seen the little paragraph that I wrote, when I went to
California on holiday three years ago, where it is completely
smoke free, I spoke to a female bar worker on the West Coast and
I asked her how she was enjoying the change and the smoke-free
atmosphere and I said, "But you're a great country that puts
a great deal of store on freedom of the individual. Hasn't this
been a problem?" and she said, "Your freedom ends where
my nose starts." I thought that was a very good way of putting
it.
Q459 Dr Naysmith: That
brings us in a rather round about way to what you think the policy
should be in National Health Services' premises which you have
some responsibility for.
Professor Sir Liam Donaldson:
The previous Government in 1992 set out a policy that the NHS
should be smoke free. That was never implemented. We now have
a policy to make NHS premises smoke free by the end of 2006. I
think it should have happened a lot earlier, but there we are.
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