HC Deb 12 February 1964 vol 689 cc511-22

Motion made, and Question proposed, That this House do now adjourn.—[Mr. R. W. Elliott.]

10.13 p.m.

Mr. Laurence Pavitt (Willesden, West)

This is the second time today that I have had the good fortune to be able to address the House on a small facet of a large problem. On the first occasion, I was well aware that I had only ten minutes in which to speak. About 7.30 this evening, for a glorious quarter of an hour, I thought that I should have unlimited time at my disposal, but I now speak with the usual enemy, time, standing behind my shoulder.

I do not have to convince the House about the facts on the added hazards to health from smoking. These things are common knowledge, but I seek to persuade the Minister for Science that there is urgent need for an increased appreciation of the value of research into the reasons why people smoke, the difficulties they have when they stop smoking, and the whole background to the basic problem of the increasing number of people who are suffering illness because many years ago they contracted the habit of smoking.

The figures which hon. Members keep giving in this Chamber on the subject are becoming and. I gave daily and weekly figures earlier in the Session of the number of deaths from lung cancer. The fact that there were 26,383 last year is sufficiently frightening to make us realise the gravity of the situation. I should like to quote from a Report on "Smoking and Health" by the Surgeon-General of the United States Public Health Service, which was published recently. The Report states on page 302 that Cigarette smoking is the most important of the causes of chronic bronchitis in the United States … In this country, 30.8 million days were lost to production through bronchitis, much of which was caused by smoking. From the same Report, page 327: "It is established that male cigarette smokers have a much higher death-rate from coronary diseases." These facts are common knowledge, and I do not think that the Minister queries them; and in Britain last year we lost 31.3 million days of production through people being absent because of disorders of the circulatory system.

It emerges clearly from the American Report that so much clinical and medical research has been done on the subject that it is no longer necessary to tackle the problem from that angle but there is need for social and psychological research. The Report says that there is overwhelming evidence pointing to the conclusion that smoking—its beginning, habituation, and occasional discontinuation—is to a large extent psychologically and socially determined. It is to that area that the Minister should address the minds of people who are engaged in research, because in that area results might be forthcoming.

I would mention to the right hon. and learned Gentleman the kind of thing one comes across if one is a member of a hospital management committee. There is the recent example of a man whom I shall call Michael X, a postman aged 49. A report on him says that In April, 1963 he developed a hoarse cough, A routine chest X-ray and subsequent special tests showed that he had lung cancer. It was inoperable. He began smoking at about 14, and smoked approximately 15 to 20 cigarettes a day. He married late in life, he had two children, a son aged 2½ and a daughter 1 year old. As his health failed their future support and care caused him much concern. He died within four months. I have many reports which I cannot give to the House but which I should be only too pleased to give to the Minister. I have a report on a Mr. H, which concludes: At 69 he is a man who for the last four to five years has been an invalid entirely dependent upon his wife and his medical advisers in his struggle with his shrinking lung capacity and vitality. It is in these circumstances that the Guardian on 22nd January said: The proper aim of Government is to reduce the number of deaths caused by the cigarettes that are smoked at present. I remind the Minister of the statement made on behalf of the Government on 27th June, 1957, when Government policy was laid down. This is the point we have reached by today's debate, and the question now is what kind of action the Government can take in face of all the existing prejudices and set attitudes on this subject. I would ask, in particular, whether it is possible that by added research into what causes people to smoke and to continue to smoke we might find the answer to the question of how we may find acceptable substitutes.

First, I suggest, that we must have research to find the causes. What happens, for instance, at the stress of adolescence? We all know of the reports which reveal the amount of smoking at school. What serious research is being undertaken into this aspect of the matter, particularly in the light of the fact that it is Government policy to prevent young people smoking?

Next, what can replace the social gesture which, in some way, is of value to the smoker? What are the psychological origins of smoking? A smoker meeting a stranger for the first time is able to offer a cigarette and immediately they are en rapport. What can one do, in overcoming the smoking habit, as a substitute for what seems to be a necessary social gesture? What kind of behaviour patterns should be developed? How far is it habituation and how far is it addiction? What kind of results can be achieved on these factors, and what are the mental and physical consequences of being deprived of smoking?

One particular field of research which calls for attention relates particularly to women and the terrific upset which occurs in a woman who has been a habitual smoker and who, at the time of the menopause, gives up smoking. What evidence do we have of the mental reactions taking place then, with all the other changes going on and the additional stress of trying to give up the smoking habit? Sometimes, of course, the reactions are such that women have to have treatment in the psychiatric wards of our hospitals and in some circumstances it may be a doctor's duty to advise continuation of smoking.

There is, then, the question of occupational needs and urges. The long-distance lorry driver smokes, on average, 30 or 40 cigarettes a day. Why? Is not this a proper subject of research in a study of social behaviour and needs, so that we may make further progress in solving the problem at its root?

How does a person, once having acquired the habit, break it? The Minister of Health told us the other day that there are about 30 anti-smoking clinics established. I have the good fortune to have one in the hospital with which I am connected. How many research assistants has the Minister for Science allocated to look into what is going on? What kind of results are being achieved, and why? What is the assessment of the information gained, and how much exchange of information is there among all the various research units? Does this side of it come under the Minister for Science and the Medical Research Council, or does it come under the Minister of Health?

Why is the only project promoted by the Government promoted by the Central Office of Information which is now studying what happens as a result of stopping the smoking habit? Does the Minister allocate resources to the Central Office of Information for this purpose? How many people are there in the research team at work? What kind of link does this project have with his Ministry and with the Ministry of Health?

The right hon. and learned Gentleman gave me a reply on 21st January, which I thought quite staggering. He said: I am quite satisfied that there is adequate research. What I am not sure about is that there are adequate answers."—[OFFICIAL REPORT, 21s January, 1964; Vol. 687, c. 905.] The whole point of research is to find answers. If one knows the answers, one needs no research. The right hon. and learned Gentleman has the wrong approach to the problem. Research is needed in the first place to find out what are the best lines to pursue.

I recall some comments made on the book Science and Politics which the Minister himself wrote. In a review of it, Professor Haddow, one of the outstanding figures in cancer research in this country, said that the Minister in his book is right in saying that science is not something to which rulers can dictate, that while they can repress or starve it they cannot make it live … While perhaps technically correct, the last argument could be used as a dangerous anodyne for inaction. I suspect that the Minister is, in fact, suffering from inaction in this matter.

Should not the Minister influence the policy of the Medical Research Council? Or is he adopting the policy of just playing the favourites? Is he putting all the emphasis on projects most likely to succeed? He knows as well as I do that there is an enormous amount of pharmacological research now going on into oral contraceptives. Indeed, the work being done on this subject is probably greater than any other medical research now proceeding; it must be duplicated almost a hundred times. But, as my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) said so well on the B.B.C. yesterday, the most neglected field of research is that directed to the psychological and mental factors leading to illness. It is precisely in this field that there is need for research in connection with smoking.

We are so often bogged down in a mass of prejudice and argument. I have no doubt that the right hon. and learned Gentleman himself has come across this in his own experience. One has a group of people trying to discuss the subject scientifically and rationally, but two hardened smokers among them who have a guilt complex about it feel that they must defend smoking to the last.

We are neglecting this research at a time when stress and nervous strain are, perhaps, presenting the greatest problems in illness which our country faces today. There has been a complete change from the old illnesses to the new. Part of the "brains drain" about which we hear so much results, I suggest, from the rather stultified approach of this Government to research in new and sometimes difficult fields.

I suggest that it is because of the Government's failure to play a positive part in some of these "off-beat" areas that the initiative has been lacking and the areas of need neglected. One such area, I submit, is the one I put to the Minister in the Question which I asked on 21st January, namely, that there is a need for research into the compulsive urges to smoke to find out what people get out of smoking and to examine ways whereby any real needs which emerge can be satisfied in a less harmful way. I hope that the Minister, who I know is not unsympathetic to this cause, will have second, third and fourth thoughts about ways and means of giving some effect to research in this field.

10.25 p.m.

Mr. W. A. Wilkins (Bristol, South)

We are always interested to hear the views of the people who represent the anti-smoking campaign in this House. It is not for me to deny either their right to put them or, in their opinion, the necessity to put them. I do not wish to be unduly critical about the attitude which they show towards smoking, and especially its effect on health. I wish to complain, as I have done before, that in their fanatical attitude towards smoking they forget other things which, in my opinion, are equally damaging to the human constitution.

I can never understand why they single out this one industry for attack when they never come here and attack the brewers and tell us how many thousands of people—and I have a figure in mind, which I will not quote, because I am not certain that it is accurate—are the victims of alcoholism every year in this country. I believe that it is a very substantial figure. They always quote in aid what is happening in the United States. Anyone who has visited the United States knows quite well that Americans are absolutely obsessed with what I call the three "C"s—capitalism, Communism and cancer—and run a vast campaign in their newspapers sponsored by all sorts of extremely wealthy people. They single out smoking for their line of attack.

These victims, who may never have taken alcohol at all, are, in my judgment, encouraged to take alcohol by what I believe to be advertisements which very often verge on the fraudulent. No attack is ever made on them in this House.

Mr. Francis Noel-Baker (Swindon)

Nonsense.

Mr. Wilkins

This is my complaint about my hon. Friends. They never come here and make complaints of this character. They quote the case of a lorry driver into whom they think research should be made because he smokes thirty cigarettes a day, and they want to know the reason for it. The reason is simple of explanation. It is for the same reason that I smoke a pipe. I often find it a great companion when I am on my own. I do not know whether other smokers feel the same. It very often relieves monotony.

I wonder to what extent we have a right to try to dictate to people what their habits should be. Why should my hon. Friends tell me that I should not be able to smoke my pipe? It is my business, and it will be my funeral if as a result I kill myself. But surely I have a right to exercise my own judgment about whether it is doing harm to me. I ask my hon. Friends a simple question: why do they want to dictate to other people what they should do, not only with their lives but with their money? If they propose to attack this section of industry in this country, why do not they attack other sections which, in my opinion, are equally lethal?

Many years ago I worked with a gentleman on one of the Bristol newspapers who used to boast to me that every night and lunchtime he had his two pints of beer in the "pub". Saturday night was his great night out. This was the night that he had a real "go" and he had nine pints. He was always demonstrating to me how healthy he was until, as suddenly as a clap of thunder, he found himself in hospital. He had to be operated upon for a very serious condition, and he died. The surgeon said that his kidneys—I think it was his kidneys, but it may have been his liver—had been entirely destroyed.

Mr. Robert Cooke (Bristol, West)

Are there no breweries in the hon. Member's constituency?

Mr. Wilkins

That is an exceedingly insulting remark when I am trying to put a sincere point of view. If the hon. Member had been here for the rest of the debate his remarks might have been relevant.

I ask my hon. Friend, why does he not attack many other things which are causes of death?

10.31 p.m.

The Lord President of the Council and Minister for Science (Mr. Quintin Hogg)

I thought that when I answered this debate I should be answering an attack upon the failure either of myself or of one of the Research Councils to research adequately into the psychological causes of smoking. I was a little surprised to hear the hon. Member for Bristol, South (Mr. Wilkins) say that he had never heard an attack in this House made upon the brewers or alcoholism. In this reincarnation I am a relatively new Member, but I recall that some years ago things must have been very different. Attacks on alcoholism and brewers were by no means unheard of when I was here before.

I would say to the hon. Member for Bristol, South that the fact that alcohol may do you a lot of harm does not mitigate from the fact that smoking cigarettes undoubtedly does do you a lot of harm too. There is a difference between alcoholism and smoking. The evidence—and—I am simply repeating the evidence of scientists rather than expressing my own opinion—is that even small numbers of cigarettes add appreciably to the risk of a number of pathological conditions, whereas I do not think there is anything like the same evidence against small quantities of alcohol, provided one avoids driving a motor car after having recently imbibed them.

Mr. Wilkins

Why must one do that?

Mr. Hogg

In some people it impairs the judgment, or at any rate appears to do so to other users of the road.

May I return to the hon. Member for Willesden, West (Mr. Pavitt). I wish that I could persuade him, although I have apparently failed to do so on two previous occasions, that I am on his side. It is true that all human motivation is a legitimate subject for scientific research, medical research and psychological research, which would be quite within the terms of reference of the Medical Research Council, and for demographic research and social survey, which would and does come under the Central Office of Information. I am sorry that I cannot tell him much about the survey to which he referred, although I have a copy of it in my papers.

This is a legitimate field of research. Let me tell the hon. Member this straight away. If he has a project for research, if he knows of a project for research, if he knows of a promising line of advance, a promising lead as it is called, which is not being adequately pursued, if he knows of a properly designed ex- periment or series of experiments, which have not been properly examined by the Research Council, I will certainly see that they are examined. And if the Research Council in its scientific judgment backs those projects, I shall be delighted to see that funds are available to pursue them.

But I must make this general point before I pursue some of the other topics which he raised. One does not make out a case for scientific research of any kind simply by establishing the social relevance and desirability of knowing the answers. One must find a person who is interested in carrying out that research. One must find a promising lead and must have a reasonable prospect—not a certainty but a reasonable prospect—of an advance in knowledge what that particular set of experiments is likely to achieve. It must, of course, be fitted inside a properly balanced and integrated programme of research devised by the Research Council. That is why we have the Research Council.

The hon. Member asked me whether I always take its opinions as gospel. Of course the answer is "No". I belong to an extremely sceptical profession. But the whole tradition of the Research Council as it has developed over 50 years, devised by very prominent members of the party opposite, such as Lord Haldane and Lord Addison, has been that the Minister on the whole does not bring political pressure to bear on matters on which the Council's scientific judgment is definite.

I tell the hon. Member frankly that I have not only had first and second thoughts, but third and fourth thoughts as well, because each time he has raised the matter I have raised it again with the Council, and the Council has been round conscientiously today to all the leading psychiatrists it can find, but its scientific judgment remains the same, namely that the level of research is adequate. Although I still say that the answers are not altogether happy, and although I would agree with the hon. Member that the absence of answers is no conclusive reason why one should not research, I say that some hope of an advance in knowledge is at any rate a prerequisite before one has very much reason to override a scientific judgment which says it is not worth researching.

I think that the hon. Member has to some extent underestimated the amount which is known about this, partly by common sense and partly by actual scientific work which has been done. The Report of the Royal College of Physicians lists a bibliography of about 30 different items in this field, some of the most distinguished done in this country, on the subject of smoking and its motivation and the way of giving it up. The American report lists about 39 items, many of them the same, some of the work done under the auspices of the Medical Research Council, some done under various other auspices.

I am afraid that some of the answers are a trifle obvious. This is the point upon which I should like to leave the subject this evening. We must always be careful, however much we may be in favour of scientific research, never to use it as an alibi for not acting. I was extremely grateful to the tobacco manufacturers for putting at the service of cancer research a large sum of money. I was less grateful when it was used in another place as a reason for not accepting the Report of the Royal College of Physicians and not taking action upon the assumption that it was true.

In this matter of smoking and what motivates smoking, a number of facts are known. It is as well that we should remember what they are. In the first place, the power of example is enormous. It is all very well for the hon. Member for Bristol, South to say that it is really my business if I choose to adopt a deleterious habit. That in a sense is perfectly true. But the power of example is enormous. Twenty thousand people die of lung cancer every year, I do not know how many of bronchitis and a lot of coronary thrombosis, all of them states with which smoking cigarettes is associated. This is done very largely by the power of example. Smoking is a vice, if that is the right word—I use it in no pejorative sense; it is a common term in this sense—of initiation. One starts because somebody shows one. It is idle to pretend that we do not owe a duty to our fellow creatures to refrain from doing it as much as we can.

One of the facts which these very learned surveys establish is that children whose parents smoke, and presumably whose teachers smoke, are much more likely to learn to do this than any other children. Also, it is very much more difficult—this is a scientific fact—to give it up when one has learned young than when one has learned old. It is a social habit. The pressures to smoke are social pressures. After all, we know very well—I think that this appears in one of the learned disquisitions—that cigarettes were invented only about 100 years ago. Before then people had to do without them. I do not discount and I do not endorse the various ingenious psychological theories about infantile memories and other even more exciting possibilities. But the essence of smoking is that it is a social habit. It has to be learned.

No one smoked cigarettes much before the First World War, and then it was the combination of fear and boredom—the accompaniments of war in the trenches—that led me to smoke. Women did not smoke very much until between the wars, and then I have no doubt that it was the force of advertisements aimed at women that led it to be regarded as a socially acceptable habit. It was not a socially acceptable habit in women before, and was hardly a socially acceptable habit in men.

All this that I have been saying is very obvious, but we have to face the fact that the decisions, although difficult, all revolve around the question: how far in a free society are we entitled and bound to create an atmosphere in which smoking cigarettes, which has hitherto been socially acceptable, is no longer a socially acceptable habit? It is a political question, and it is not for me to answer this tonight. I doubt whether members of any one political party would answer the question in the same way.

When I came into the Cabinet Room after having made a speech on this subject in another place, the then Prime Minister pointed to me, after £25 million had gone off share values on the Stock Exchange, and said, "The biggest 'bear' in history." I am a non-smoker speaking in a Parliament of smokers and in a Cabinet of smokers, and with an electorate of smokers. Many people take the view of the hon. Member for Bristol, South that we have to make up our own minds about these things. I find it easier to condemn smoking because I gave it up a long time ago.

At the same time, I will promise on behalf of the Research Councils that there is no research which their scientific judgment endorses that I will not back up. This I will promise, but I am also quite confident that we know enough about the scientific and social basis of smoking to realise that the issues of policy we have to face are not scientific problems.

Question put and agreed to.

Adjourned accordingly at seventeen minutes to Eleven o'clock.