LUNG CANCER

HC Deb 09 December 1966 vol 737 cc1727-803

11.5 a.m.

Dr. John Dunwoody (Falmouth and Camborne)

I beg to move, That this House, believing that the great majority of deaths from lung cancer are caused by cigarette smoking, urges Her Majesty's Government to take all possible steps to reduce cigarette consumption; and considers that a permanent agreement to limit cigarette advertising is now required and that special attention should be given to coupon schemes, and that in addition a nation-wide campaign of health education especially directed at school children and further encouragement for research into this form of cancer are required. Seven weeks ago today—indeed, seven weeks almost to this very hour—there occurred in South Wales the Aberfan disaster. That tragedy cost the lives of 144 people and shocked the nation. Since then about 4,000 people in Britain have died from cancer of the lungs—equal to more than an Aberfan disaster every other day.

There is a death from cancer of the lungs every 20 minutes and during this debate there will be a death for each hon. Member who speaks on the subject. This is an indication of the magnitude of the problem. The number of people killed by this disease is now more than three times the number of deaths on the roads in Britain and those who die from cancer of the lungs are not, by and large, old men and women at the end of their lives. The great majority of men, very many of them in the prime of their lives, are in their 40s, 50s and 60s; men with family responsibilities, men with young children, men who would otherwise have many years of useful work ahead of them.

My task in introducing this Motion, which I hope the Government will accept, is, first, to present the facts of the situation as I see them; secondly, to consider cigarettes in relation to cancer of the lungs; thirdly, to discuss some possible causes of this disease; fourthly, to consider ways and means by which we can reduce cigarette consumption—and I will especially consider advertising and health education; and, fifthly, to comment on medical research, particularly into lung cancer.

I have already outlined the facts of the situation. The number of people who will die from this disease in the United Kingdom this year will not fall far short of 30,000. For every one woman who dies from cancer of the lungs, five or six men die from this disease. The sex ratio is of this order. It is not just the magnitude of the death rate that alarms me, but the way in which it is going up year by year. Each year we have record figures. Every year more people die from this disease than have died from it before in any previous year.

Just 10 years ago the death rate from cancer of the lungs in the United Kingdom was a little over 20,000. Twenty years ago it was only just over 10,000. In the last 10 years our diagnostic abilities have not changed much, so that it is not a question of our having missed these cases in years gone by. There is undoubtedly a real increase in the number of deaths from this disease and the medical tragedy of it is that far too often, by the time the first symptoms present themselves, the patient is already incurable and beyond any effective treatment.

This is an alarming situation which the community as a whole does not appreciate. It is the major public health problem facing Britain and many other countries today. We are facing a situation in this country in respect of this disease that we have not had to face since the days when we had epidemics of diseases like cholera. Indeed, it could be suggested, in view of the figures over the last 20 years, that this new epidemic—this new pandemic, if you like—is truly out of control, because the figures rise year by year.

Now, cigarettes. There is no shadow of doubt that the great majority of cases of this disease are directly linked to cigarette smoking. We can argue about the percentage, but at a conservative estimate 80 per cent. of cases of lung cancer are caused, using that word in its popular sense, by cigarette smoking.

Some other basic facts must be accepted at the beginning of this debate. The risk of developing this disease is directly proportional to the number of cigarettes smoked per day. There is a linear relationship between the amount smoked and the chances of contracting the disease. Further, it takes a long time for the cigarettes to produce their harmful effect. The effect is not immediate. It is delayed for 20, 30, 40 years. These are significant figures, because it is necessary to look back this number of years to see the reason why the death rate has risen so rapidly in recent years.

Before the last world war cancer of the lungs was a comparative rarity in this country. The first time when large numbers of people started to smoke heavily was in the 1914–18 war. It was these smokers of the First World War, the young men of the 1914–18 war, who started smoking in the trenches of France, who formed the first wave of cases of lung cancer that occurred in the 1940s and 1950s. What rather frightens me now is that we are coming shortly to the time when the women who started to smoke to a somewhat similar extent in the last world war will also be at risk. It is significant that the sex ratio, the gap between the sexes which has been a striking feature of this disease, has tended to close in recent years.

A further fact is that the risk attendant on cigarette smoking does not seem to be present to anything like the same extent from the smoking of pipes or cigars.

Statistics are vital weapons in the fight against the disease, but statistics are not a subject that I intend to present at great length today. We could spend the whole debate going through the voluminous statistical surveys which have been conducted into lung cancer and allied subjects. I shall mention only two reports. The most recent report on this disease, issued in the very recent past, is the survey of the "Environmental and personal factors in lung cancer and bronchitis mortality in Northern Ireland, 1960–62". The survey confirms the facts that we already know from many previous surveys in other countries.

It shows, for example, that the heavy cigarette smoker—and in this report the definition of "heavy" is more than 23 cigarettes per day—is 20 times more likely to develop cancer of the lung than the non-smoker. The survey shows that cigarette smoking as a factor in the causation of lung cancer is way ahead of any other suggested cause. There are other possibilities; other things undoubtedly influence the appearance of the disease, but this survey confirms what many previous surveys have shown, that cigarette smoking is far and away the most important factor.

The other significant thing about this report is that the research work which produced it was initiated by the Tobacco Research Council, by a trade organisation of the tobacco companies. This will once and for all end some of the quite irrational criticism of the facts which have been made in the past. It is also a most encouraging indication of the serious view many of the tobacco companies take of the present situation.

The second report, a very important one, is that of the investigation by Doll and Hill into the mortality and smoking habits of over 40.000 doctors in this country. Doll and Hill followed 40,000 British doctors from 1951 to 1961. This survey has the advantage of being a prospective one. They did not just take people who had already died of the disease and then look back to ascertain why. They took the whole range of a particular section of the community and followed them through over this period, showing who died of the disease, and tying this up with facts which had been obtained before they knew whether these people would contract the disease. This survey also confirmed many of the facts revealed in other surveys.

An important point came out especially well in this survey. It indicated on a statistical basis the reduced risk accruing to the individual if he stopped smoking cigarettes. The survey showed, in round figures, that five years after someone stopped smoking cigarettes the risk of his developing lung cancer dropped to one-half of what it was before. Ten years after stopping smoking cigarettes, the risk has dropped to one-quarter of what it was before. This is important information, because far too many people say, "I accept that there is a risk, but I have smoked for 30 years. The damage is done and there is not much point in either stopping or reducing".

Further, during the 10 years which the survey covered, these doctors reduced smoking to a considerable extent. This is the only section of the community where this has happened. During these 10 years the death rate from lung cancer amongst these doctors dropped by 7 per cent., at a time when the death rate in the community as a whole rose by 22 per cent. This is very significant. It is impossible to explain this in any way, except on the basis of a direct link between cigarette smoking and lung cancer.

All the facts I have mentioned about the survey confirm the basic fact that cigarette smoking and cancer are linked. There are other possible causes, and they should be considered. The first is that there is an individual variation, A person could smoke 50 cigarettes a day for the whole of his life and yet live to the age of 90 and die of old age. The probability is that a person will not get lung cancer if he smokes very heavily for a long time. His chances are still perhaps only 20 per cent., perhaps 25 per cent.

We do not know why there is this individual variation. If we did know why one person developed cancer while the next did not, although they were both exposed to exactly the same risks, we should possibly have the key to the whole problem of malignant disease. We hope that this key will be found one day, but let us not pretend that it is just round the corner.

I turn to the question of air pollution. In nearly every survey which has been conducted into this disease there has been found to be a greater preponderance of cases of lung cancer in urban areas than in rural areas. The presumption has been that this is due in some way to air pollution. There is little doubt that air pollution is a factor; it plays a part. I do not think that we should go so far as to say that it is the explanation entirely of the difference between the urban and rural rates of this disease, because the urban/rural ratio is at least as great, and in some cases greater, in countries which have much less air pollution than we have —some of the Scandinavian countries, for example. Nevertheless, many of the surveys have revealed a ratio of 2:1 or 2½:1.

There is little doubt that air pollution plays a part, but it is a very small part compared with cigarette smoking. A heavy smoker living out in the countryside is many times more likely to develop lung cancer than a non-smoker living in the most heavy polluted area. Two striking examples which underline this fact are, first, that the only country whose death rate from lung cancer compares with ours—we have the highest—is Finland, which has little or no pollution.

Coming nearer home, nobody would suggest that there is much in the way of air pollution in the Channel Islands. The incidence of cancer of the lung is higher there than it is in England and Wales as a whole. The number of cigarettes smoked in the Channel Islands is higher than in England and Wales as a whole.

Sir John Langford-Holt (Shrewsbury)

Is the hon. Gentleman saying that the number of cigarettes smoked in Finland is higher than the number smoked in the United Kingdom?

Dr. Dunwoody

Finnish men, at any rate, are very heavy cigarette smokers, and this appears to be the explanation of this high incidence. There are other factors, of course, but these are some of the reasons why one can say that air pollution is a comparatively small factor. Another point is that, by and large, all over the world men and women tend to be exposed to the same amount of air pollution. If air pollution were to be a really major factor, it would be impossible to have five and six times as many men affected by this condition as there are women who are so affected.

Let me now turn to the question of motor vehicles. Diesel and petrol fumes have been suggested as possible causes. Indeed, this is an attractive hypothesis because we have been using more diesel and petrol vehicles in recent years. But when we go into the matter it is almost impossible to produce any worth while statistical evidence to confirm this theory. Those who work in occupations where they are exposed to a greater extent than the average to diesel and petrol fumes do not have a higher incidence of this disease than we would otherwise expect. Surveys have been carried out of transport workers, police officers and so on. Indeed, neither diesel nor petrol contain large quantities of known carcinogens. Diesel oil, which has frequently been suggested as a possible cause, has not been in use in the community for long enough to have this malignant effect. We have not had very large numbers of diesel vehicles during the 20, 30 and 40-year period which is necessary for this disease to develop.

Other possibilities are suggested from time to time, but we can dismiss all of them as being of complete insignificance compared with the factors which I have already mentioned. The basic facts are not in dispute. We can argue as to precisely why these facts are so. We can argue, so far as cigarettes are concerned, whether it is the tobacco or the way the cigarettes are made or the way that they are smoked. We can argue about the significance of filter tips and so on. But the basic facts are there for everyone to see. If we can cut the consumption of cigarettes we shall reduce the incidence of lung cancer and we shall save lives in this country.

I quoted the figures relating to doctors in this country over a 10-year period. If we had been able to convince the general population to the same extent as we were able to convince the doctors in the early 1950s that they should cut their smoking or stop smoking altogether, we would have 10,000 fewer deaths per year in this country by now. If we had seen the same reduction in cigarette consumption and, therefore, the same reduction in the death rate from lung cancer among the general population as there has been among those doctors, we would have reduced the toll by one-third, and this would have been a significant achievement.

How shall we do this? Successive Governments in the last 10 or 15 years have been trying to do it or have been thinking about it. It is foolish to suggest that it is an easy problem to solve. We have to convince people of the case. We have to convince the general public, in the same way as the medical profession, by and large, has already been convinced. We must do this because in the population of Britain there are probably 3 million or 4 million people who at the moment either are or will be at risk of dying from this disease if cigarette consumption goes on as it has been going on in recent years.

I want to mention the question of advertising, partly because it is topical in view of the Minister's discussion, and partly because it is a matter which requires serious consideration. The cost of cigarette advertising—and here I include coupon schemes—has rocketed even more quickly than the incidence of lung cancer. In 1955 £3½ million was spent on advertising. The estimate for this year is that £36 million will be spent compared with 11 years ago. There is the same upward gradation as we see with the incidence of lung cancer. A year or so ago cigarette advertisements came off television. This was a welcome step forward, and I was pleased that the tobacco manufacturers agreed to this step. At the same time, however, we have seen a mushroom growth in coupon schemes.

It is estimated that in this year, of £36 million which has been spent, £24 million—that is two-thirds—will be spent on coupon schemes. We must consider the effect of the expenditure of this large amount of money. It would be very attractive to suggest that we should by law completely abolish the advertising of cigarettes and that this would produce a dramatic reduction in cigarette consumption. If I thought this were so, I would advocate doing this, however strong the opposition and however unpopular it would be. But we would be kidding ourselves if we believed that this would happen, in view of what we have learned from other countries where cigarette advertising has been stopped.

The considerable and increasing expenditure on cigarette advertising tends to counteract the efforts which have been made by successive Ministers of Health, making it increasingly difficult for the real facts to be appreciated, but whether advertising has any real effect on consumption, I do not know. I do not think it has a major effect. Advertisers and manufacturers suggest that their advertising is merely brand advertising. I do not believe it all is. However, advertising has a particular effect on youngsters who may consider starting smoking. I think we should attempt to achieve a permanent agreement with the manufacturers along the lines of the agreement that we already have, an agreement that can be reviewed from time to time. We must at least set limits on coupons and consider whether we ought to try to end the issue of coupons with cigarettes. We should reject completely the suggestions that there have been in the last week or two that trading stamps might be brought into this field, because it would be a bad thing.

I now want to deal with health education. In terms of cutting the death rate, I consider this to be the most important field in which we can do something. There are two aspects of health education. There is the problem of those who already smoke, the adults. We must convince adults that it is worth while to reduce smoking if they cannot cut it out altogether. The sort of figures that I have quoted are the reasons for this. Then there is the problem of the youngsters who have not yet started, the school children and teenagers, We have to consider means of preventing them acquiring this habit. These two aspects are interrelated. Many youngsters start to smoke because of the example of their elders. If we can encourage their elders to stop or to reduce smoking, the task of discouraging the young people from starting will be much easier.

I have mentioned the sum of £36 million which has been spent by the cigarette industry on advertising its products. The amount that has been spent by the Ministry of Health on publicising the effects of the situation is, compared with this, woefully inadequate. When we compare it with the £1,000 million that the Chancellor of the Exchequer extracts from the purchasers of cigarettes, it is a mere drop in the ocean.

Nevertheless we must not belittle what has already been done. There are some encouraging facts. There has been an increase in the number of non-smokers in the 16 to 19 age group in recent years. This seems to have come about particularly since the 1962 Report of the Royal College of Physicians. We have also seen a somewhat similar increase in nonsmoking in the 60 to 65 age group. These are encouraging facts which show that there is a possibility of converting people. But this is not enough. We must do a great deal more, and it will need the expenditure of a considerably increased sum of money.

It will also involve a great deal of research. We must look into the reasons why people acquire this habit, and we must see why some people go from just a habit to an addiction to cigarettes. We want to do social surveys of all sorts to try to fathom the depths of this problem, and to use the advertising industry and its skills and talents on our side of the battle. Do not let the cigarette manufacturers have a monopoly of all of the good advertising techniques.

When we are thinking of youngsters in particular, we should try to channel our efforts into things that will be appreciated by them. The threat of cancer of the lung when one is 60 does not make a great impact on a 17 or 18 year old. We should also emphasise the more immediate disadvantages—the risk of one condition or another before then. I have deliberately refrained from going into the question of other diseases caused by cigarettes, and I do not intend going into it today, but we could mention this in publicity to youngsters.

Let us let everyone know what the doctors know. The death rate could be considerably reduced if we succeeded in doing this. I believe that we must and that we will. We shall then face other problems—social, economic and industrial—because cigarette manufacturing is a big industry in this country today. If we are going to reduce the incidence of cigarette smoking in the way I think we should, we shall be faced with problems and we should start thinking about them now.

The industry is already beginning to think about this, and some manufacturers are branching out in other directions. This is a growing tendency and I hope that they will be intelligent enough to continue to do this. Diversification into potato crisps is one example. We should think of the future of workers in the industry and should bring new industries to towns and cities which are dependent on the cigarette industry. There needs to be redeployment in exactly the same way as in other declining industries, such as coalmining.

I have mentioned some people with vested interests in cigaretes. I now turn to my right hon. Friend the Chancellor of the Exchequer, who gains about £1,000 million from the cigarette smokers every year. That is the biggest vested interest in cigarettes in this country. We have reached a stage where there is a very strong case for differential changes in taxation on tobacco. I would welcome a considerable increase of tax on cigarettes, with a simultaneous reduction of tax on pipe tobacco and cigars. If one can encourage people by tax measures to stop smoking cigarettes and take up cigar or pipe smoking, one will be giving them a very much bigger chance of survival in the years ahead.

We must do a great deal more in re-reach, not only in social research but in general cancer medical research. It is not right in a society like ours—and we must question the morality of it—that we are prepared to obtain £1,000 million in tax from this source and yet spend a mere pittance on medical research. I would like to see us not only spending more but making the money available in a more flexible way to those engaged in this research, so that if they see avenues that need to be explored they can go ahead as quickly as they want to.

That is my case. That is the basis on which I present my Motion. I have earlier quoted from the latest report, the latest statistical survey on the effects of cigarette smoking concerning cancer of the lung. I would like to close by quoting from the earliest report I could find, a quotation from King James I—perhaps we should call him King James VI of Scotland—in 1604. Talking about smoking, he said that it was: is a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lung—and, in the black stinking fume thereof, nearest resembling the horrible Stygian smoke of the pit that is bottomless. I think that now we are at the brink of that pit that is bottomless. This may be our last chance to draw back. Let us take it and take it now.

11.35 a.m.

Mr. Laurence Pavitt (Willesden, West)

My first words must be those of the whole House in congratulating my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) not only on his good luck in drawing his name in the Ballot but on the superb way in which he deployed his case this morning. It was comprehensive and lucid and at the same time showed the depth of feeling which in an almost prosaic kind of way, he was able to convey to all of us who heard him. The difficulty in following my hon. Friend is that inevitably one finds oneself treading in his footsteps, though one cannot do it half as well.

I want to add my voice to his. I had the good fortune previously of raising this matter when I introduced a Ten-Minute Rule Bill which had two Second Reading debates—quite an unusual occurrence—when I sought to get the House to agree to put a notice on the side of cigarette packets telling of the health hazards of smoking, especially to the younger generation. On that occasion, as today, I started by trying to get away from the moral attitude which most people take up on this subject. There is a tendency for people who smoke to feel a bit guilty about it and to feel that they must defend it, and for people who do not smoke to be a little bit priggish and to think that somehow or other they are rather strong-willed in not smoking.

My hon. Friend the Member for Falmouth and Camborne did not take up either moral attitude this morning but gave us straight away the health reasons why smoking leads towards death from lung cancer. It is along those lines that the House should consider the matter, and it should refrain from saying that smoking is a good thing or a bad thing, and that nice people do or do not smoke.

Mr. Speaker

Order. Would the hon. Gentleman turn and address the Chair? It helps the reporters.

Mr. Pavitt

What we are trying to say is that we seek to prevent lung cancer and deaths from it. This is a matter of taking certain preventive action and not a question of moral attitudes about whether or not one smokes.

My hon. Friend brought to the notice of the House in passing the fact that other diseases can result from smoking. In a report fairly recently on lung cancer by Richard Doll it was estimated that about 10,000 coronary thrombosis deaths and about 15,000 bronchial deaths per year also could be directly attributed to smoking. My hon. Friend talked about the increase of lung cancer, and one person will die of it every 20 minutes during our debate. That means that in the few days before the House rises for the Christmas Recess, if every hon. Member was in that category, the whole House would be dead before we adjourn.

How can one explain this issue and make its importance felt? In 1931, 2,200 people died of lung cancer, and the figure was 10 times greater 25 years later, at 20,000. In the past 10 years the figure has increased to 30,000. When my right hon. Friend the Minister of Health replied to a Question of mine on the number of deaths from lung cancer that were not recorded, which was prompted by the recent report of the Registrar-General, the Ministry of Health's estimate was that one should add 15 per cent. to the figures published at present in the annual report.

In other words, there are now 30,000 deaths a year from lung cancer. Put another way, in 1900 there were eight deaths per million and in 1962 there were 348 deaths per million. That is not just an increase of twice or three times, but a colossal increase. Since I first started discussing the subject in the House the increase has been at the rate of nearly 1,000 a year. The alarming fact is that so many of those who die are in the 45–64 age group. When one tries to discuss this matter with young people, as most of us do with our own teenage children though sometimes with very little effect, it is so difficult to convey to them what one really means, because to die at the age of 45 is, for them, to die an eternity away. It means very little. But, of course, it is not just the fact of death; it is the agony of dying that matters.

I serve on my local hospital management committee, and one of the most soul-searing experiences I have had, is in going round the medical ward with the consultant and seeing some of the people there. I see a man in his forties who talks cheerfully to me from his bed, but, as we pass, the consultant whispers that he has no more than 10 days to live, for his condition proved inoperatble. I see men coughing their hearts out because they cannot get their breath owing to cancer of the lung. The consultant says of one such man, "I have investigated his smoking habits. He has been smoking all his life, after starting at 20 years of age, and before he came into hospital he was averaging well over 40 a day".

We must try to educate young people to realise that what matters is not the fact of death but the process of dying. There is a certain risk of the expectation of life being reduced. If a young man starts smoking at the age of 15, every 24 hours of his expectation of life is likely to be reduced by 5 hours; he gets only 19 out of every 24 hours of his otherwise expected life span. This is the fact actuarially, for insurance purposes, if he happens to be a heavy smoker.

Also worrying is the changing pattern of the incidence of lung cancer among women. In 1948, female deaths from lung cancer were 1,759 and in 1963 they were 3,677. The trend is now rising in a rather alarming curve. In this connection, it is interesting to note, none the less, that although the fear of cancer in general is reckoned to be a female preoccupation, in the five years 1960–64 deaths from all cancers among men exceeded the number among women by 37,000. In this figure, lung cancer is a large factor.

There have been attempts to find other scapegoats—I shall not weary the House by going again over the points made by my hon. Friend—but the fact is that there is no other principal cause but smoking. The Government were satisfied of this. The then Minister of Health, the right hon. Member for Thirsk and Malton (Mr. Turton), made his announcement on 7th May, 1956. The right hon. Member for Reigate (Sir J. Vaughan-Morgan) declared the Government's acceptance of the Medical Research Council's Report in June, 1957. But, nearly 10 years later, we are still not making an effective inroad into the number of people smoking and the consequent number of deaths. During his time as Parliamentary Secretary, the hon. Member for Essex, South-East (Mr. Braine) was able to step up some of the Ministry's efforts. Each Minister has tried to do something, but on each occasion it has been inadequate. The great courage of my right hon. Friend the present Minister in deciding to stop television advertising of cigarettes on 1st August last year caused a good deal of controversy, but it was, perhaps, one of the most striking pieces of evidence that the Government were really serious in trying to tackle the problem.

It is interesting to note, none the less, that expenditure on advertising on television and in the Press has risen from £16 million to £17.6 million although for six months of that time there has been no television advertising. In other words, although we were able to have an effect in one medium, the manufacturers increased their effort elsewhere in order to compensate for that reduction.

I suggest that the Minister should look again at the whole question of television advertising which encourages the smoking habit. Although television advertising refers now only to cigars and smoking other than cigarette smoking, smoking is still projected as a socially acceptable habit, and, of course, if people cannot afford cigars they buy cigarettes. The Minister might consider whether the time has now come to enable the television authorities to stop the inculcation of the idea that smoking is a socially desirable thing.

I have here an interesting photograph of some advertising—I have sent a copy to my right hon. Friend—which shows one of his excellent posters—"Cigarettes Harm Your Health"—but alongside it there is a cigarette advertising poster four times as large and far more attractively done. This other poster shows a £5 note, the indication being that if a person smokes, not only will he have the pleasure of smoking but also, with a bit of luck, he will have a £5 note at the end as well. Perhaps my right hon. Friend will consider whether there is a deliberate campaign by the manufacturers to ensure that, wherever a Ministry poster is exhibited which discourages smoking, there is shown alongside it a manufacturer's poster four times as large to encourage people to smoke and persuade them in the opposite direction.

I hope that the Ministry will look again at its propaganda and the manufacturers' propaganda on the question of social acceptability. At the moment, it is deemed to be socially acceptable and desirable to smoke. It is true that the worst excesses of advertising which came in the early 1960s and the end of the 1950s are no longer indulged in—the efforts to create the impression that, if only a man smoked, the most glamorous blonde from Hollywood would fall in love with him the next day—but it still seems to be the idea that the cigar smoker can have either a blonde or a brunette fall in love with him very readily.

How will the Minister put over the fact that, instead of the cigarette being "with it", the person without it is "with it"? This is the point we must aim at. We must persuade people that it is rather foolish and not socially acceptable to smoke, that it is not the manly thing to take out a cigarette. This will, of course, create a number of problems. I should very much regret the loss of the hand of friendship which goes with the offering of a cigarette. A man feels that, if he approaches someone as a friend, someone whom he likes, an immediate communication of goodwill is made by taking out and offering a cigarette. I am not sure that the offer of a lozenge or something else would have the same effect. This is one of the customs which, I suggest, the Ministry should think about, in order to find an acceptable alternative. I very much welcome the research which the Ministry has already undertaken, but I wonder whether the Medical Research Council is doing all it might to co-ordinate its work with that of the Ministry. Is the research limited to social surveys? Is enough money available, and is the research being done in depth?

In his further consideration of the problem, will the Minister take into account the object of my Bill in 1964 which did not achieve sufficient progress in the House? A similar measure has now become law in the United States of America. On 27th July, 1965, it became the law of the United States that no cigarettes could be sold without a warning notice of the hazard to health being printed on the side of the packet. I recognise that a little bit of small print will not do a great deal to persuade people not to smoke, but at least it would be an indication of the seriousness with which the Government regard the subject.

Britain exports some cigarettes to the United States. In the factories in the constituencies of my hon. Friend the Member for Bristol, South (Mr. Wilkins) and of my hon. Friends from Nottingham, cigarette packets for export to the United States will already need be marked with such a notice. Why cannot the same printing machine do the same for packets produced for sale in this country?

We shall soon be looking with horror at the figures for road deaths over the Christmas period. There is always a sharp increase, yet during that holiday three times that number will die from lung cancer. My hon. Friend the Member for Falmouth and Camborne gave a graphic description of the effect of smoking and its connection with lung cancer when he drew the comparison with the shocking tragedy at Aberfan. We must use all the imagery and telling comparisons we can to persuade young people not to start the habit.

If this Motion focuses attention on the whole subject and increases the amount of effort which the Ministry puts into it, if it leads to an increase in the amount of money which my right hon. Friend can extract from the Chancellor for this purpose, if we can prevent youngsters from getting "hooked" and so stop them smoking for the rest of their lives, the debate will have done great service and been well worth while. I hope that the House will give the Motion not just nominal assent but will at the same time acknowledge that all the measures available to us must be used. We must make the campaign effective so that our congratulations to my hon. Friend the Member for Falmouth and Camborne on his effort today are translated into the kind of backing over the months ahead that he deserves.

11.50 a.m.

Mr. Peter M. Jackson (The High Peak)

I, too, should like to begin by congratulating my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) on the admirable way in which he introduced his Motion. He demonstrated clearly that we are dealing with a problem of considerable magnitude. My hon. Friend began his speech by referring to the tragedy at Aberfan and the number of children and adults who were killed. He suggested that that tragedy pales into insignificance when we look at the incidence of deaths from lung cancer.

I, too, should like to quote a figure which indicates the true magniture of the problem. I read in the British Medical Journal last year that, given the present trend of smoking, something like a quarter of a million of the children who are now at school will die from lung cancer. I begin, therefore, by referring to that part of the Motion which deals with health education among the young.

We would all accept that it is much easier not to start smoking than it is to stop. It is obvious, therefore, that money spent on health education among younger people is likely to be more effective than money spent on health education among the older.

The first thing which we find when we look at the problem is that very little in the way of research has been done into smoking habits among young people. The surveys which have been undertaken reveal somewhat conflicting information. I find, for example, when I refer to the Nursing Times that 85 per cent. of the young people in a limited survey have had smoking experience at the age of 14 or earlier. Other surveys, in America, indicate that many children begin smoking at the age of 10, while others in Australia suggest that the habit is acquired between the ages of 12 and 14.

My first point to the Minister is that more money should be spent on financing inquiries by university sociological departments and departments of health into the reasons why young people take up smoking and the age at which they take it up. This is important educationally, because if we find that young people in large numbers acquire the habit at the age of 10 and not at, say, 14 or 16, the kind of educational material which we put out to combat the habit will be very different. The first thing to be done, therefore, is to establish the age pattern when young people take up smoking.

Work has already been done in this direction and I should like briefly to refer to some of the conclusions which have been arrived at. One of the most significant and obvious points which has been established is that the incidence of smoking among children is higher when their parents smoke. It is obvious that in such families smoking is regarded as a normal part of growing up. I therefore appeal to my right hon. Friend the Minister in his educational work to consider this point and that he should suggest to parents that they have certain responsibilities.

Another point of interest which has been established by the survey to which I have referred, undertaken by the London School of Hygiene and Tropical Medicine is that children in secondary modern schools tend to smoke more than children in grammar schools and that the children of working-class parents tend to smoke more than children of middle-class parents. Here, therefore, are sociological factors which should be looked at in greater detail.

We are all aware of the pressure upon young people to feel that they are grown up. Children want to feel a certain affinity with their peer groups and to establish a degree of social acceptance. They regard smoking as a way of establishing this social acceptance. I suggest to my right hon. Friend the Minister that some of his propaganda and education should be designed to counter this appeal. As other hon. Members have suggested, smokers feel "with it". Children want to feel "with it". Consequently they take up the habit. Some of the propaganda should attempt to suggest that they are not really "with it" if they smoke.

A further factor which has been brought out in the research is that there is a higher incidence of smoking among children living in towns, particularly in London, than in the countryside. I cannot offer any explanation for this fact, which has been established by various studies, not only in Britain, but in America. This, again, is a point which is worth looking at.

I suggest that the educator in this subject has a problem and that the techniques which are used should be a little more sophisticated than those which I have seen so far. What the educator attempts to do is to suggest to children that habits in which they find their parents and teachers indulging are socially dangerous and unacceptable. This presents conflicts in children's minds. They take their parents and teachers as examples and they tend to follow the examples set by them, and yet they are told by those who teach health education that their parents are acting foolishly.

I suggest that the approach should be somewhat more sophisticated and that we should suggest to children, "Very well. Your parents and teachers smoke, but, nevertheless, they would not have smoked had they known what we know now about the dangers to health of smoking". I have never seen this done in school. I suggest that it should be done, because I am told by people engaged in this kind of education that children experience this kind of conflict.

I urge my right hon. Friend the Minister to enforce more rigidly the law governing the sale of cigarettes to young people. I understand that according to the law, cigarettes should not be sold to children under the age of 16 but that this law is not rigidly enforced. I do not know how many prosecutions there have been. They are probably very few. I suggest, therefore, not only that the law should be more rigidly enforced, but that the age should be increased to 18.

I turn now to those who are already addicted. Some local authorities have shown considerable responsibility in this matter and have set up clinics for smokers who are addicted. Other local authorities are much more laggard in this respect in that no clinics have been set up. I commend those local authorities which have set up clinics and I urge them to announce the existence of these clinics more widely. I know of only one town —Cardiff—which announces such information on its buses. This is important. It is no use setting up a clinic if people do not know that it exists. I would like my right hon. Friend the Minister to consider issuing a circular to local authorities urging them to set up such clinics.

I am following my hon. Friend the Member for Falmouth and Camborne and my hon. Friend the Member for Willesden, West (Mr. Pavitt) in suggesting that the problem can be tackled effectively only if we change the whole climate of opinion. The position today is that, because I am a non-smoker, I am thought to be a social deviant. It is the people who smoke who are "with it" and who regard their conduct as socially acceptable.

How can we change this climate of opinion? The first thing to do is to extend the provisions for non-smokers. I am very pleased to see that London Transport, for example, has increased its provision for non-smokers, and the Southern Region has done the same on its trains. There should be an extension of this practice and I suggest that we might start in this place.

I am a new Member and I was appalled when I came here to find that there was no provision for non-smokers in the allocation of desk rooms. I do not know how many other hon. Members feel conscious of this, but I suffer very considerably from the fact that I have two colleagues who sit in close proximity to me, one of whom smokes cigars and the other smokes a pipe.

Secondly,—and on this point I go further than the hon. Member for Falmouth and Camborne—I think we might consider very seriously a complete embargo on tobacco advertising. I suggest that the Minister acknowledged the principle of embargo when he took the very courageous and proper step of deciding to prohibit advertising on television. I should particularly like to draw to his attention the law passed by the Italian Senate on 10th April, 1962, which forbade the advertising of cigarettes.

Again, I should like to take issue with my hon. Friend the Member for Falmouth and Camborne when he suggested that there was no evidence that cut-backs in advertising of tobacco indicated a fall in the consumption of tobacco. My evidence—and I have it only in respect of Italy—is that the figure of tobacco consumption in Italy is one of the lowest in Europe. I believe that Italy and perhaps Sweden are the only two countries which have this legislation on their statute book, and I would suggest that there is evidence of the fact that such a step has been proved to be effective.

I am sure the Minister considers that it is his duty to encourage the public to give up smoking. He has a difficulty in that industry is pressurising people to continue smoking and, indeed, to take up smoking. My hon. Friends have already pointed out the phenomenal increase of the amount of money spent on forms of promotion. I should like to draw the Minister's attention particularly to the graph which appeared in a recent issue of the Sunday Times. It showed that in 1963 the industry spent £21 million on forms of promotion, and this figure had now rocketed to £36 million. I should also like to draw his attention to a statement which appeared alongside the graph, which said: According to a confidential survey now circulating within the industry, money originally earmarked for Press and T.V. adver- tising is now being channelled into coupon promotions. I hope that when the Minister replies he will refer to the whole question of coupons. It is all very well to restrict advertising on television, on hoardings, and in the Press, but, while people are being encouraged in this way, the habit and incidence of smoking is increasing and is being retained. I hope that the Minister's conversations with the industry will include not only the level of straight advertising expenditure, but will be wider in scope and will cover expenditure on all forms of promotion.

I should now like to turn to another point, which I hope the Minister will consider seriously, namely, the duty-free concession which is given to members of Her Majesty's Forces. I consider it ludicrous that in this day and age, when we all accept that there is an association between lung cancer and smoking, we are prepared to encourage Service men, by a tax free concession, to smoke. I very much hope that the Minister will take up this matter with the Minister of Defence and that this duty-free concession will be withdrawn.

I can understand Service men who smoke being incensed by this, in that they might feel that this would mean a cut in their income; but nevertheless I hope that other measures could be worked out which would compensate them for the loss of this concession.

Finally, I should like to draw the attention of the Minister of Health to the report of his Chief Medical Officer, Sir George Godber, in which he said: Lung cancer deaths in 1965 totalled 26.398—the melancholy toll of cigarette-smoking. The increase will go on so long as this undoubted causes of death and illness are sold to a gullible public. The hope of anyone who faces the facts must be that cigarette smoking will come to an end in Britain.

12.5 p.m.

Mr. Raphael Tuck (Watford)

May I, first, congratulate my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) on the lucid and cogent presentation of his case, with which I almost entirely agree. Particularly do I agree with his observations about pipe smoking. One of my headmasters, when he bade farewell to his students, used to say to them, "I have two pieces of advice to offer you: if you must drink, drink beer; if you must smoke, smoke a pipe." I thoroughly endorse what he said.

Regarding advertising, may I voice my agreement with my hon. Friend the Member for The High Peak (Mr. Peter M. Jackson) that cigarette advertising should be cut down. I would like to see it banned entirely. I am an extremist in this and consider that legislation might be brought in to ban the advertising of cigarettes completely.

That is the negative side, to which I might draw the attention of my right hon. Friend the Minister of Health. But there is a positive side. Advertisements showing how harmful cigarettes are could be made a little more colourful. I have a barrister friend, Mr. Gershon Ellenbogen, who every time he offers anyone a cigarette says, "Here, have some cancer of the lung". Perhaps we could have some advertising along these lines. We might have a threefold advertisement showing on the left-hand side a person being offered a cigarette with the accompanying words, "Have some cancer of the lung". It should be a coloured advertisement. The centre piece could show a person who has smoked, coughing and spitting blood. Let the advertisement, by all means, be a gory one, showing the harmful effects of cigarette smoking. The right hand section of the advertisement could show a person having a sheet thrown over his head, or perhaps a coffin, or something equally attractive! Perhaps the Minister will consider a suggestion of this kind.

The heading of the Motion is "Increase in deaths from lung cancer". May I bring to the attention of my right hon. Friend that there are other causes of lung cancer besides cigarette smoking. There is one that I particularly wish to mention, and here I know that I have the support of the hon. and learned Member for Darwin (Mr. Fletcher-Cooke), who is not here this morning. I refer to the pollution of the air from filthy diesel oil fumes.

I am the Member for Watford, and I often travel to Watford three or four times a week. When I do so, I literally take my life in my hands every time. Lorries travelling towards the M.1 and returning from it emit this filthy black smoke all the time. It has two effects. First, sometimes it is almost blinding. The air is blue and then black and one cannot see where one is going. One is therefore in danger of knocking into the car travelling in front. Secondly, if one has one's window open, as I do, the smoke enters the cabin and the air, besides blinding one, causes one to cough and sneeze—and when one sneezes while driving one is in danger of losing control of one's car. That goes on all the time.

If one manages to get in front of the vehicle and stops the driver to tell him what is happening, in most cases one receives a flood of invective and no satisfaction whatsoever. I am not an expert on internal combustion engines, but I am given to understand that it is merely a question of an adjustment of the carburetter and that if the carburetter is adjusted properly this filthy smoke is not emitted. I ask my right hon. Friend to make strong representations to the Minister of Transport that a much greater deterrent should be enforced than just a fine on prosecution. Sometimes, it is not the drivers who are responsible but the lorry owners, and when the police observe a sufficient intensity of smoke perhaps it would be possible to impound the lorry for two or three weeks. Owners might then feel that it was not worth risking, because they would lose not a fine of £50 or £100 but three weeks' use of the lorry. We would not have to do that very often before everyone would be most careful about how the carburetters of his vehicles were adjusted.

I am given to understand by a friend of mine, an eminent consultant physician —Dr. M. F. Gross—that if one lives in an area of pollution by diesel fumes that is equal to an intake of 200 cigarettes a——

Dr. Dunwoody

indicated dissent.

Mr. Tuck

I see my hon. Friend shaking his head——

Dr. Dunwoody

Perhaps, as the——

Mr. Speaker

Order. The hon. Gentleman must address the Chair. This is not pride on the Chair's part but to help the reporters to hear what is said.

Dr. Dunwoody

Surely my hon. Friend is not suggesting that the risk to health from cancer of the lung is equal to 200 cigarettes. If he is, I would tell him that every piece of evidence which we have is completely contrary to this.

Mr. Tuck

I am only reporting what I heard from this consultant physician.

I am not a doctor. He gave me this information.

However, it is clear that this is an evil which we could eradicate. We can, by advertising and by other means, lessen the incidence of lung cancer if we have the will. I think we have, and I am asking my right hon. Friend to take effective measures as soon as possible to implement that will.

12.13 p.m.

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

I am amazed at the apparent reluctance of many hon. Members to take part in the debate. We all seem to be waiting for one another: we have to hear what is said. For example, I am certain that my hon. Friend the Member for Swindon (Mr. Francis Noel-Baker) would like to know what I am going to say before he speaks. However, so as not to miss the opportunity, I feel that I ought to speak now.

When I came into the Chamber, I counted about 14 hon. and right hon. Members who belong to what may be called the "anti-smoking lobby". Working on this assumption, apart from my hon. Friend the Member for Watford (Mr. Raphael Tuck), with whom I agree in some respects, I imagine that mine will be the only voice raised slightly in opposition to the Motion—not entirely because there is much in it with which I have sympathy. I wonder whether I might have 14 times the amount of time to speak to put this case as the only representative of the opposition in those terms.

I begin by declaring my interest as a smoker, though I am wiser than some of the people who will have to implement this Motion if it is passed. I smoke only a pipe and others who will have responsibilities in this matter smoke cigarettes. From that point of view, at least, I am on reasonably safe ground.

First, I sincerely congratulate my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) on his very forceful and skilful presentation of the case. I cannot answer it. I have no medical knowledge, apart from a few matters, and I would not attempt to argue this case on the same medical grounds as my hon. Friend. My objection to this is precisely the same as it has been on all other occasions when this matter has been raised in the House —rootedly against what I regard as an anti-smoking lobby, represented at the moment by 30 names, numerically and intellectually powerful and with considerable influence in the House.

In a sense, this agitation is an importation—like many other things—from America. This tremendous scare arose there, Mr. Speaker, as I am sure you know——

Mr. Pavitt

Does my hon. Friend recall that it was in the 1950s that the first report, the Bradford Hill Report, came out, and that it was not until 1962 that the Surgeon-General's Report of America achieved attention throughout the world?

Mr. Wilkins

I did not interrupt my hon. Friend when he was speaking, as I know that this can be very disconcerting when one is trying to keep an argument in sequence. He must be aware that every newspaper in America carries sponsored advertisements heavily paid for by independent and private interests to try to scare the lives out of the people about the consumption of cigarettes. This is not deliberate; it has just happened.

Hon. Members who have travelled in the United States have come back with the same ideas which infected them there. Anyone who has visited that country knows that life in the United States is dominated by what one might call the three Cs—first of all, capitalism, which is revered almost to the point of idolatory, second, communism, which is abhorred almost to the point of hatred and third, cancer, of which they are scared almost to the point of psychophantic phobia. This is the position, and it seems to have got into the bones of a good many of my hon. Friends.

It is with some reluctance that I find it necessary to argue with my hon. Friends on the essential points. I want it to be absolutely clear that no other hon. Member is more anxious than I to see the scourge of cancer conquered. I have seen three deaths from this in my own family. I have seen my sister-in-law, who never put a cigarette between her lips, undergo the most amazing suffering and die a very nasty death from cancer. This is what I want to try to bring home to the House.

I have been studying carefully the Ministry of Health's publication on the state of the nation's health for 1965, which I gather is the latest one available. According to this document, there are 28 sites for cancer in the body and another line refers to "all other and unspecified". It follows that there must be many more sites for cancer in the body than simply that of the lung. I do not want to weary the House by reading out all the sites which are enumerated in the Ministry of Health's document. The only two we hear debated in this House usually—although they are, of course, very important—are lung cancer and cervix cancer, which has suddenly gained some notoriety in this country. I would like to think that cancer is preventable and when we are told about the increasing incidence——

Mr. Pavitt

Both those forms are preventable.

Mr. Wilkins

You keep on side-tracking me.

Mr. Speaker

Order. That is a serious charge to level against Mr. Speaker.

Mr. Wilkins

I humbly apologise, Mr. Speaker. You are the last man I would expect to side-track me. It was just an aside.

We hope that all these conditions will be eliminated, which is the important point. I was for ten years a member of the Health Committee of the Bristol City Council, and I never ceased to try to persuade my colleagues to increase expenditure on preventive medicine. I have always thought that we conduct our medicine the wrong way round. I am ready to agree or acquiesce in the expenditure of any sums of money required to try to discover the causes of disease. This must be done in the first instance, after which we may be able to see our scientists and doctors discovering cures. I am not, therefore, in any way arguing with my hon. Friend the Member for Falmouth and Camborne about the need for research, and I was delighted when he mentioned this as one of the first priorities.

Sir Harmar Nicholls (Peterborough)

I am following the hon. Gentleman's speech with interest. I know he would not like to leave a wrong message on the record. I do not think that the research departments claim that they are being hindered by lack of money. Of course they always want more, but I do not think they would wish to suggest that what they get is not sufficient to allow them to conduct their researches within reasonable limits.

Mr. Wilkins

I do not think that I would completely accept that. I believe that more money could be used. But my point is that no one, no industry, in this country has shown greater concern than the tobacco manufacturers about lung cancer and the linking of it with smoking. They have good reason, because their business is imperilled. It is a fair and legitimate reason. They have, in the protection of their own interests, made available £250,000 for cancer research. The sum may be more now, because I secured this figure at least two years ago. They are anxious that the cause of cancer should be discovered or isolated, and I have no doubt that they are prepared to go on assisting research of this nature.

A number of my hon. Friends have signed a Motion on the Order Paper and have quite cleverly persuaded my hon. Friend the Member for Falmouth and Camborne to include the terms of their Motion within the ambit of the Motion he has moved today. I think that he probably made a mistake in allowing himself to be persuaded. He would have done better to have stuck to his original proposal to discuss lung cancer and smoking alone.

I want to challenge my hon. Friends, as I have done in the past, as to why it is that they single out this industry for this purpose. We have known in fairly substantial numbers alcoholics and drug addicts. We believe that they are sick, and we treat them as patients, seeking to cure them by non-compulsive means. But my friends of the anti-smoking lobby who are always so active in this House seek to achieve their ends by compulsive means. That is one of my rooted objections to them. The measures they suggest should be taken by the Ministry would, in almost all cases, necessitate compulsive application. They are chasing him all the time about it. They say, in effect, that this product should not be advertised.

Never have I noticed them saying that we should prevent the advertising of liquor. At the moment, a Standing Committee is considering a Bill on road safety, the main burden of which is the deaths caused on the roads by drunken drivers. This is something we have known for years and years and have only just begun to take action upon it—compulsive action. But let us be frank—this is an antismoking lobby, and has been all the years I have been in this House.

Dr. Dunwoody

indicated dissent.

Mr. Wilkins

With every respect to my hon. Friend, he has not been here for 21 years or he would have seen this lobby in action. It is an anti-smoking lobby, and they have always taken every opportunity to try to impose their will on whoever at the time happened to be Minister of Health.

Mr. Francis Noel-Baker (Swindon) rose——

Mr. Wilkins

No. I am sure that you are going to make a speech.

Mr. Speaker

Order. The hon. Gentleman must address the Chair.

Mr. Wilkins

I want now to come to the Doll-Hill findings. I have read the book referred to, which quotes Doll-Hill frequently. The book was written to try to prove conclusively the relationship between smoking cigarettes and lung cancer. But it is interesting to note that in this book, where one may not expect to find it, it is stated that there are many other causes. This is where I agree with my hon. Friend the Member for Watford. It is even suggested in the book that central heating has been put forward as a cause. [Laughter.] Yes. It does not say that it is the cause but that it has been put forward as a cause.

Diesel oil is mentioned two or three times. The truth is that the medical profession is as bemused as anyone else about what may be the causes of lung cancer. I assure my hon. Friend the Member for Falmouth and Camborne that a doctor in practice near where I live is absolutely convinced that diesel oil fumes are the cause of lung cancer. He believes this not as a result of researches by the B.M.A. but because of his observations of the lorry drivers among his patients. This doctor is convinced that diesel fumes are a substantial cause of lung cancer.

Sir Harmar Nicholls

I hope the hon. Gentleman will appreciate that although cigarettes are made in his constituency diesel engines are made in mine. I hope that in defending his own constituency he will not make attacks on mine.

Mr. Wilkins

I would attack anything which I regarded as a danger to public health. I mentioned the Road Safety Bill in this context. I do not make an attack on the grounds adopted by my hon. Friend the Member for Falmouth and Camborne. It is not possible for me to do so, because I do not have the necessary knowledge.

My complaint is that for many years some of my hon. Friends have singled out this industry for attack. The hon. Member for Peterborough knows it. They have had some success and, encouraged by their success, they have now returned to try to impose even greater restriction on the freedom of the individual to please himself whether he smokes or not.

I said that I was on the Bristol Council before the war. The leader of the Labour group in those days was a member of the Co-operative Political Party to which my hon. Friend the Member for Willesden, West (Mr. Pavitt) has some attachment. He was a very fine man named Arthur Cox. I remember that when the council was considering the siting of two public houses the temperance advocates on the council became very violent so that there was quite a showdown in the council and Arthur Cox said, "The most intemperate people are the temperance advocates." So, in this example, the most fanatical and obstinate objection to people smoking if they wish to do so comes from the people who do not smoke. It is time that some of my hon. Friends showed a little more tolerance toward those who like to have a pipe of tobacco.

Mr. Raphael Tuck

Let them go to hell in their own way.

Mr. Wilkins

Why not let them go their own way?

I notice that my hon. Friend the Member for Falmouth and Camborne had very little to say about the effect of smoking on one of the greatest killers in the country—bronchitis. It is claimed that cigarette smoking encourages or develops bronchitis. In this book called "Chronic Bronchitis in Great Britain" written by Leslie H. Cape, M.D., M.R.C.P., and Maxwell Caplin, M.D., M.R.C.S., which has been sent to every Member of Parliament, it is said: The demonstration of the influence of air pollution and cigarette smoking on health"— many people believe air pollution to have a substantial responsibility for the incidence of lung cancer— is one of the achievements of British medical research during the last decade…. In Great Britain more deaths are attributed to chronic bronchitis than in any other country…. Chronic bronchitis maims before it kills. If excessive air pollution"— again air pollution— is associated with chronic bronchitis mortality, is it not also associated with excessive chronic bronchitis disability? The book goes on to analyse the situation.

What I am trying to establish is that while it is not denied that medical evidence may substantially support and even prove the assertion that the smoking of cigarettes increases liability to lung cancer, side by side with that there are many other agencies which also increase liability to lung cancer.

My hon. Friends have linked the increase in lung cancer with what they call the coupon advertising campaign. It is not true. This is the one thing about which I can be definite. Let me quote: It has been suggested that coupon trading is undesirable because:—

1. (a) It influences total consumption.
2. (b) It strengthens the wish to smoke, and
3. (c) It appeals to young people".

This view has been put in the House almost as though the use of coupons was something new, but coupon trading in cigarettes is not new. When I was a young man—and in saying that I go back forty years—I regularly used to buy Ardath cigarettes, which had coupons. There were other brands which had coupons. Coupon trading is not new.

Mr. Peter M. Jackson

But it is increasing.

Mr. Wilkins

But that is denied. I sometimes feel that my hon. Friends have come to this subject without having done adequate research. The tobacco companies deny that coupon trading is necessarily causing an increase.

Mrs. Gwyneth Dunwoody (Exeter) rose——

Mr. Wilkins

I always give way to a lady.

Mrs. Dunwoody

Would my hon. Friend mind telling us from what he is quoting?

Mr. Wilkins

I am quoting from a memorandum which I have obtained from the Imperial Tobacco Company. [Laughter.] Are not its sources authentic? Is anyone questioning the accuracy of the statement made by a company which has a tremendous interest in this matter and which, I imagine, would not dare to circulate wrong information? I would like to know if anyone is suggesting that it would. Is it said that one can challenge the accuracy of a statement from a company of that calibre? I suppose that only the sources of my hon. Friends are accurate. Is that it? Do they say that the facts are quite different? Do they want to challenge what I have been told? If so, they had better tell me and I will try to obtain more information about the sources from which these things are taken. It says: Between 1961 and early 1966. a period of rapid growth in coupon trading—the market increasing from 4½ per cent. to 40 per cent. (and it is now, of course, over 48 per cent.)—the total consumption of tobacco dropped from 240 million pounds per annum to 220 million pounds per annum…"— a full 20 million pound drop in the consumption of tobacco.

Dr. David Kerr (Wandsworth, Central)

Is this pounds sterling or pounds weight?

Mr. Wilkins

Pounds weight. I think that I am right about this. I hope I am.

I do not want to take time quoting all this, but it is clear enough evidence that coupon trading is not increasing the consumption of tobacco.

Mr. Francis Noel-Baker

What is the proof of this?

Mr. Wilkins

I will give you it in a moment or two.

Mr. Speaker

Order.The hon. Gentleman must address the Chair.

Mr. Wilkins

That reprimand was directed to my hon. Friend the Member for Swindon (Mr. Francis Noel-Baker) and not to me.

Mr. Speaker

Order. I am addressing the hon. Gentleman the Member for Bristol, South (Mr. Wilkins).

Mr. Wilkins

I do not want to delay the House unduly, but it seems that I shall be the only voice to put this point of view, and I am doing it because I have a constituency interest. There are 10,000 people employed in the W. D. & H. 0. Wills factories in Bristol. All of the factories are in my constituency, and it is believed that 6,000 families reside in my constituency. One hears about it immediately if 2,000 aircraft workers or motor car workers are made redundant There is a tremendous shout. I am here not to defend the interests of the Imperial Tobacco Company but the people for whom I am responsible in this House. I have a right to do it, and I am going to do it, and if my hon. Friends provoke me they must put up with the fact that their time will be cut as a result.

If my hon. Friend the Member for Falmouth and Camborne has read the Report of the Monopolies Commission on the supply of cigarettes and tobacco and cigarette and tobacco machinery, he will know that as a result of this inquiry the Imperial Tobacco Company was told that it ought to divest itself of its control of Gallaher's. It also said that, despite the fact that Gallaher's were members of the Imperial Tobacco combine, it was nevertheless in serious competition with other brands produced by the combine. Some of us might have doubted this, but the Report says so.

Having divested itself of its controlling interest of Gallaher's the Imperial found itself in very severe competition with what is probably one of the most popular brands of cigarettes. I will not name it, because I do not think that we ought to advertise. It is a fact that even today the Imperial Tobacco Company and, I think, Players have only one brand of cigarettes for which coupons are issued. Surely the individual who wants to go on smoking has a right to decide whether he wants to smoke the coupon brands? Coupons are simply deferred dividend. I smoked a coupon brand 40 years ago and liked receiving the presents.

One can say that this is deluding the public, but there is only one brand of coupon cigarette marketed by the Imperial Tobacco Company. I heard someone refer to Green Shield stamps. I know that one of my hon. Friends has some in his wallet at the moment. Why should not Green Shield stamps be given for cigarettes if they are given for petrol and other commodities? My hon. Friend should stick to the scientific arguments. Here I must say that if there is one section of the community which has practised what it preaches it is the medical profession. I have been quite surprised at the number of doctors who have given up smoking.

One cannot ignore these things. They are to be commended for this, because they have put into effect what they are trying to persuade others to do. I am not arguing the scientific aspect of this, but I am saying to my hon. Friends, who always take the opportunity to fasten on to debates of this kind in order to express views which we know are mainly prompted by their personal habits and the fact that they are not smokers, that they should not seek to impose their will upon others. If our public, educated as it is, has not got the good sense to decide whether something is good for it, it is not our business to tell it what it ought to do.

12.46 p.m.

Mr. Bernard Braine (Essex, South-East)

If I rise now it is not because I expect this interesting and thoughtful debate to conclude shortly, but because I believe that it might be helpful to have an expression of view from this side of the House. May I begin by warmly congratulating the hon. Member for Falmouth and Camborne (Dr. John Dunwoody) upon his success in the Ballot, on his choice of subject, and on the reasoned and compelling way in which he argued his case.

I have never had any doubt about the association between smoking and lung cancer. I arrived at the Ministry of Health in 1962, a few months after the publication of the report of the Royal College of Physicians. With great respect to the hon. Member for Bristol, South (Mr. Wilkins), whatever he may think about his colleagues, I would hardly think that we would be prepared to describe the Royal College—a most distinguished body—as being part of an anti-smoking lobby. The College's report made perfectly clear that cigarette smoking, is the most likely cause of the worldwide increase in deaths from lung cancer, that it is an important factor in the development of chronic bronchitis, and that it probably increases the risk of dying from coronary heart disease, particularly in middle age. Only this morning the current issue of the British Medical Journal refers to a further series of studies indicating that male cigarette smokers are about 1.5 and 2 times more likely to die of arterio-sclerotic heart disease than non-smokers.

I recall that the report of the Royal College said that one in three of men aged 35 who were heavy smokers was likely to die before the age of 65 compared with only one in every six of non-smokers. At that time this country had the highest death rate from lung cancer in the world and it still has. Every year that passes, the Minister's Chief Medical Officer, reporting on the state of the public health has the same melancholy tale to tell.

In 1964 cancer of the lung killed over 25,000 people—56 per cent. more than 10 years earlier. In 1965 it killed well over 26,000 people. There is no doubt in the mind of the Chief Medical Officer that cigarette smoking is the major cause of these deaths. He says, in the latest report: The mortality from lung cancer continues its inexorable rise. …. There is no doubt that the major factor responsible for this is cigarette smoking. This is about as powerful an authority as one can get.

In fairness, however, it must be said, as the Royal College pointed out, that there were a few facts which seemed to conflict with the conclusion that cigarette smoking is a major cause of lung cancer. namely that the disease occurs only in a minority of smokers, that the death rates from it are lower in some countries than might be expected from their consumption of cigarettes, that there is some conflicting evidence on the effects of inhalation of smoke, and that no animal has yet been given lung cancer by ex- posure to cigarette smoke. But none of these contradict the conclusions reached by responsible authorities, not only in this country but in the United States, that cigarette smoking is an important cause of lung cancer, and that if the habit ceased the number of deaths from the disease would fall steeply in the course of time. There cannot be any shadow of doubt about that.

Cancer is one of the oldest diseases known to man, but, as the hon. Member for Falmouth and Camborne rightly pointed out, lung cancer was thought to be relatively rare until recent times. There is, I fear, no escape from the fact that it has become increasingly common in the last three decades, and that the increase has followed in the most remarkably uniform fashion the rise in cigarette consumption. I want to be fair, since the House has a duty to put these matters into perspective; the increase also follows the rise in atmospheric pollution.

Nor is the connection purely satistical. Fifty years ago two Japanese scientists, Yamagiwa and Ichikawa, succeeded in deliberately inducing cancer in rabbits by painting their skins with tar. They did this at regular intervals over a period of months. Some years later it was discovered that the cancer-inducing chemical in the tar was 3.4-benzpyrene, which is also found in cigarette smoke. It is not too much of an exaggeration to say that every day millions of people in this country and elsewhere are unwittingly painting their lungs with exactly the same material which those two scientists deliberately used to induce cancer in rabbits. They are literally gambling with death. Many get away with it, the majority get away with it, but some do not.

This poses for us and for all those responsible for public health a number of difficult questions. If smoking is harmful to health, should it be prohibited? It has long been considered dangerous by a few enlightened people and offensive by others. The hon. Member for Falmouth and Camborne quoted his late Majesty King James I—and, of course, the VI of Scotland—who vainly attempted to warn his misguided subjects against the noxious weed. You will recall, Mr. Speaker, that his late Majesty was decribed by Henri IV of France as "the wisest fool in Christendom" and that his exchanges with this House from time to time, were, to say the least, intemperate. I do not doubt that he failed, as some of us may fail, because for a vast mass of people there appears to be a psychological and social benefit in smoking which they value and which they find it hard to give up. They derive pleasure from smoking and do not care to be lectured about it by either princes or commoners.

It is significant that the Royal College of Physicians, in its report, did not call for prohibition. It even recognised that smoking is a habit which most smokers enjoy without injury to their health". But it felt that both social custom and commercial pressure outbid the voice of caution and concluded that there should be more intensive education on the subject, especially among children and adolescents, and a restriction on advertising.

Despite one or two remarks today, especially by the hon. Member for Watford (Mr. Raphael Tuck), I judge that most of us in the House would agree that the only practical course to follow in a free and adult society is to ensure that the voice of caution is properly heard so that the individual can balance the pleasures of smoking against its known dangers. By all means let us consider the effect of cigarette advertising and whether it offsets or even renders nugatory the work of those concerned with warning the public against the dangers. The hon. Member for The High Peak (Mr. Peter M. Jackson) has suggested that it renders their work nugatory.

I was interested to see the Minister's reaction to this at Question Time last Monday. I would, however, agree with the hon. Member for Bristol, South in one respect. I do not think that the facts support the more extreme views advanced, especially about coupon advertising. It simply is not correct to say that coupon trading has had the effect of increasing total consumption, that it has strengthened the wish to smoke, and that it is making a powerful appeal to young people who should be discouraged from smoking. I am advised that in the last five years, the period during which coupon trading has increased most rapidly, the total consumption of tobacco in this country has fallen from 240 million lbs to 220 million lbs.—a decline of 10 per cent.

But much more important is the fact that the total number of smokers fell during that period from about 20 million to l9½ million, although in the same period the adult population increased by about 1½ million. I gather, too, that the gifts offered are not of a type likely to attract very young people. But I would wholeheartedly agree with the Minister's view expressed from time to time that it is desirable to reduce the amount of cigarette advertising.

Mr. Francis Noel-Baker

I should like to put a question to the hon. Gentleman before he leaves that point, which is important. I hope later, if I catch your eye, Mr. Speaker, to say more about coupon advertising. Surely the fact that cigarette smoking has declined during this period, and that fewer young people are becoming addicts, is not directly connected with the coupon business. Surely the coupon campaign, which got going when television advertising was banned, is designed to increase the consumption of cigarettes. If it is not, what is its purpose?

Mr. Braine

I am not prepared to enter into a lengthy argument on this, because I should have thought that the figures suggested that what was happening was that coupon advertising is being used to ensure that particular firms retain their share of the market. The important thing from our point of view is that the market appears to be declining. I went on to say that, I would welcome a reduction of all forms of advertising. I agree therefore, with the suggestion of the hon. Member for Falmouth and Camborne that the right approach is to press the Minister to secure a voluntary reduction by agreement with the industry. The industry is a responsible industry, as has been made clear, and the Minister has clearly not shirked his responsibilities in this matter, to find a basis of agreement. This is what, in an adult society, we should press for.

This leads on to two very important questions. If all cigarette advertising stopped tomorrow, we should still have a lung cancer problem as longaspeopleremained unconvinced of the danger. My two questions are these. First, if we are to approach this subject intelligently, and if we are to persuade the sceptical that we are right, should not we consider all the possible contributory causes? Even if cigarette smoking is the major culprit, what about atmospheric pollution? Secondly, if we are convinced that cigarette smoking is harmful to health, vastly greater efforts should be made in health education. While we are about it, should not we embark on an intensive campaign on cancer education generally? For the truth is that over the whole field of cancer scepticism, doubt, ignorance and fear combine. If, as I hope to show, the barriers of scepticism, doubt, ignorance and fear can be swept away, there is high hope of ending this dreadful scourge.

I turn, first, to the question of atmospheric pollution. What sort of contribution is it making to the problem? It is a fact that industrial smoke, diesel and petrol fumes contain the benzpyrene which is the principal cancer-producing agent in tobacco smoke. It is a fact that research has shown a close relationship between the degree of atmospheric pollution and the lung cancer mortality rates.

There is certainly a link between the morbidity of chronic bronchitis and atmospheric pollution. Tests have shown that smokers have from nine to forty times as much lung cancer as nonsmokers, whereas persons exposed to community air pollution have from one to three times as much lung cancer as people not so exposed. This has been scientifically established. It is, therefore, no use dismissing atmospheric pollution as a factor particularly in this country, where it is heavier than almost anywhere in the world.

Nor is there any comfort to be derived from pointing to the welcome reduction in industrial smoke, for there is evidence, I regret to say, that pollution by sulphur dioxide, which many authorities regard as a carcinogen is actually increasing. The truth of the matter is that continuous absorption of carcinogens from whatever the source, is cumulative. It may take years to build up a cancer-forming quantity of them in the human body. It may take years more before this proves fatal; and it is this long process which so often accounts for the cheerful boasting of the heavy smoker, "Look at me. I have been smoking 30 a day for the last 30 years and it has not done me any harm." Yet often, with our personal friends, looking back afterwards, one can say that the harm had already been done when that statement had been made. If the smoker had been honest with himself, he would have admitted that the signs were already there, and that some action could have been taken. If he could have been convinced at an earlier stage that the symptoms he was experiencing were leading to lung cancer, what a different story it might have been.

What research is being conducted into the possible contribution of atmospheric pollution? Last Monday the right hon. Gentleman said, in answer to a Question by my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight), that the effects of air pollution had already been exhaustively studied in medical research. He did not say—and at Question time one would not expect him to say—exactly what conclusions had been reached, but I hope that the right hon. Gentleman will be able to comment on that aspect today. I understand that useful research is being undertaken at the Warren Spring Laboratory at Stevenage in conjunction with the Motor Industry Research Association and the Medical Research Council. What progress is being made? Are there any promising lines of inquiry?

I raise this point because it is known that petrol-driven vehicles are now emitting about 6 million tons of carbon monoxide annually. Some of our congested streets are becoming like gas chambers and I entirely agree with the remarks of the hon. Member for Watford on this point. We have reached the point where anti-pollution devices should be fixed by law to the exhaust pipes of motor vehicles. This is already done in some parts of the United States and eventually it will spread to the whole of that country. What is being prepared here in regard to this matter?

I am told that new power stations under construction in Britain which may have a capacity of 2,000 megawatts may emit from one chimney as much sulphur dioxide as a very large town. Is this so? Is it true that it is now feasible to extract about 90 per cent. of sulphur dioxide from flue gases? If so, how long will it be before the Government make this mandatory?

When considering health education, I hope that, as a result of this debate, we shall grasp the fact that there is a link between the extent of awareness of the dangers of lung cancer and the general public ignorance about other forms of cancer. I was grateful to the hon. Member for Bristol, South (Mr. Wilkins) for directing the attention of the House to this aspect of the problem. Although a layman on this subject, I have been advised about the nature of cancer and its treatment. In his book "Cancer Explained" Dr. Maurice Sutton, a young and very distinguished consultant in this sphere, goes on to the core of the argument when he writes: The fear that surrounds the word cancer is based to a large extent on the misguided belief that it is inevitably incurable and fatal. This is quite untrue, for many types of cancer are completely curable. Many thousands of people are alive today, fit and healthy, cured of a so-called incurable disease". We should register with joy that there are 25,000 cancer sufferers who are cured annually in this country. We should proclaim that fact from the rooftops—yet because of a persistent combination of fear and ignorance, at least 20,000 other people die each year, and die needlessly, because they may have been saved had they reported their symptoms and secured treatment earlier.

I am advised that if cancer of the breast is treated earlier—that is, at what doctors call stage one—75 per cent. can be cured but that if it is left until a late stage—until stage four—only 10 per cent. can be saved. With cancer of the larynx, 75 per cent. can be cured if treatment is given at an early stage, when the disease when it is confined to the vocal chords, but only 5 per cent. can be cured when the disease has spread beyond that. The cure rate for cancer of the cervix is 70 per cent. when caught at stage one and 10 per cent. when caught at stage four, when it has gone beyond the confines of the cervix. For patients picked up on a cervical smear test—a matter with which the House has been much concerned—at the earliest or pre-invasive stage, the cure rate is 100 per cent. A consultant radiotherapist wrote to me on the subject and said: Yet many patients still keep the disease to themselves for a long time and report late to the doctor, with unhappy results. I know, because my whole professional life is concerned with the treatment of patients suffering from cancer. The commonest reason for this delay is that the public in this country are inadequately educated about cancer. There is a crying need for cancer education in Britain today; the people are ready for it and the country cannot afford to be without it. How apt in this connection is Emerson's observation: Knowledge is the antidote to fear".

Sir Harmar Nicholls

When my hon. Friend refers to the early stages of cancer, would he comment on what attitude a smoker should take in this matter; in other words, what cure is there for lung cancer?

Mr. Braine

The way to avoid getting lung cancer is to stop smoking. The way to reduce one's chances of dying from lung cancer is to reduce one's smoking—better still, to eliminate it altogether. The vast majority of smokers do not die from lung cancer. It is, therefore, a matter on which the individual must be educated so that he can make a proper judgment the undoubted pleasure he gets from smoking with the possibility that he is ruining his health in the process. Off the cuff, I cannot answer my hon. Friend's question, except that the figures are going up sharply every year, faster than any other form of cancer.

Sir Harmar Nicholls

The reason I asked my hon. Friend that question is because one meets many people who have considered this matter, because of the nationwide publicity which takes place and also because of debates in Parliament, and they say, "We have been smoking for 30 years. It is too late now". How can one say to people who adopt that attitude, "If you stop smoking now, you may well not face the risk of dying of lung cancer"?

Mr. Braine

I cannot answer that question, because it would depend entirely upon the individual.

Dr. David Kerr

May I emphasise that all the research has shown that the cessation of smoking, at however late an age, reduces the chances of subsequently contracting a lung cancer?

Mr. Braine

Yes, but let us be clear about it. It reduces it, but it does not eliminate it. This is the point I made earlier about the build-up of carcinogens in the system. This is why it is so important to ensure that there is an attack upon all fronts. This is why I hope that the Minister will take very seriously the requests we are making to him in regard to further investigating the question of atmospheric pollution.

Returning to my point about the conquest of ignorance, what we must get over to the country is the knowledge that advanced cancer is a preventable disease and that early cancer can be treated and cured. If this debate does nothing else, I hope that it will send that message out to the nation. I hope that it will do more than that. It is astonishing to reflect that this country, which has made such a great contribution to the conquest of disease, has fallen behind other countries in educating the public about cancer. In a recent study of cancer education programmes in various countries, the International Union against Cancer commented: The painful fact is that no national scheme of public education about cancer exists in Britain, although the Ministry of Health has since 1952 encouraged county and city local governments to promote health education about cancer in their own localities.' It goes on to mention the admirable Manchester Regional Committee on Cancer, which can only be referred to in terms of the highest praise.

How different is the attitude in the United States, where the disease is regarded more realistically and where gloomy fatalism is replaced by a more reasoned and optimistic view, largely as a result of the very splendid work of the American Cancer Society, which uses every conceivable kind of mass media. and operates at every level of human activity, and with the fullest co-operation of the medical profession. It is true that we have splendid organisations in this country, like the British Empire Cancer Campaign and the Imperial Cancer Research Fund, but they are concerned, I think I am right in saying, solely with raising money for research.

My hon. Friend the Member for Peterborough (Sir Harmar Nicholls) put his finger on. a very good point. Perhaps the Minister will comment on this when he replies. I do not think that what we lack is money for research, although there is always a need for more money for that purpose, so much as a lack of promising new leads, of co-ordination of existing research, of co-ordination of research—that is, the acquisition of new knowledge—with the education of the public, and also—American experience bears this out—education of the medical profession itself. I hope that the Minister will have something to say about that.

The American Cancer Research Society is concerned, not merely with research, but also with education. I wonder how many hon. Members have been struck as I have been by those massive billboards seen at the entrances to American towns and cities displaying the words: 1,400,000 cured of cancer—fight cancer with check-up and a check. They are not frightened of talking about cancer in the United States. People are terrified of talking about it here. Until we can reduce that fear, we shall not be within sight of getting rid of this dreadful scourge.

I believe, too, that this is a tremendous challenge to us all, especially to the Minister. I believe, with my radiotherapist friend, that the nation is ready for a new look at health education, particularly in the field of cancer.

I consider that the hon. Member for Falmouth and Camborne has today performed a notable service. Right at the very beginning he set the tone of the debate with an informed and carefully reasoned speech. What he and others have said since, and what no doubt others have said since, and what no doubt others will say later, should cause both Parliament and the nation seriously to reflect on this terrifying problem. I shall look forward very much, as we all will, to hearing what the Minister has to say later. I hope that the whole House will endorse the Motion.

1.16 p.m.

The Minister of Health (Mr. Kenneth Robinson)

It may be convenient if I intervene at this stage to express the Government's view, without in any way wishing to curtail the debate. I am sure that the whole House is most grateful to my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) for his initiative in providing us with the opportunity of debating a subject of such importance today. I should like also to congratulate him on the most powerful and convincing speech with which he introduced his Motion.

This health problem and the measures which can be taken to deal with it are matters of concern, not only to the House and to the Government, but to every thoughtful person in the country. In thanking my hon. Friend for choosing this subject for debate, I want to make it clear at the outset that the Government accept the terms of the Motion.

The official record of this debate will look, in part, like a statistical digest but perhaps it will be not inconvenient to those who are interested in this subject if I, too, make my statistical contribution. Looking back to the beginning of this century, between 1900 and 1920 deaths in Great Britain attributed to cancer of the lung averaged about 400 a year. In the decade from 1921 to 1930 registrations of deaths from cancer of the lung averaged 1,000 a year, two-thirds of them men. This later figure represented on average about 2 per cent. of the total deaths attributed to all forms of cancer and not more than one-fifth of 1 per cent. of all deaths in the country.

In 1935 there were nearly 4,000 lung cancer deaths, but by the early 1950s the number of deaths assigned to cancer of the lung and bronchus had leaped to an average of 15,000 a year. As has been said, in 1965 they reached a total of 29,377, of whom 24,720 were men. Thus, in stark contrast to the proportions in the 1920s, these represented 25 per cent. of the number of deaths from all forms of cancer, as against 2 per cent. earlier, and 5 per cent. of deaths from all causes together, as against one-fifth of 1 per cent. A recently published statistical study suggests that even the total I have just given may under-state the true position by some 15 per cent., bringing the figure for 1965 up to about 35,000.

If I may trouble the House with just one more set of figures, I should like to look at this alarming rise from another angle. Allowing for the changing age structure of the population, in 1965 there were 173 deaths from cancer of the lung and bronchus for every 100 deaths assigned to this cause 15 years earlier. Over this 15-year period the rate for all deaths, corrected for changes in the age structure of the population, fell by 12 per cent. However—and this is a point relevant to something said by my hon. Friend the Member for Bristol, South (Mr. Wilkins)—the rates for all cancer, other than lung cancer, fell by 7 per cent. Deaths from lung cancer, as I have shown, increased by 73 per cent.

Mr. Wilkins

Does my right hon. Friend recall that we used to get these sorts of statistics given to us at the time when tuberculosis began to decline for other reasons?

Mr. Robinson

If I may say so, that is one of my hon. Friend's less relevant observations. In the course of his speech he suggested that cancer generally was increasing. What I have shown is that over 15 years cancer other than lung cancer fell by 7 per cent., during which period lung cancer increased by 73 per cent. These are irrefutable statistics.

It is difficult to determine the precise extent of this increase in deaths from lung cancer. Certainly improvements in diagnostic standards, more frequent postmortems of younger patients and the problem of determining the principal cause of death, especially among elderly patients, are among the factors which affect estimates of lung cancer. Though improvements in diagnostic methods have taken place particularly in the 1930s and 1940s, as my hon. Friend the Member for Falmouth and Camborne said, there is no doubt that this factor on its own could account for only a small part of the very steep increase. There can be no doubt that most of these deaths are due to cigarette smoking. It is, as many hon. Members have said, not the only cause of lung cancer, and many who smoke cigarettes do not develop lung cancer, but the evidence points clearly to the conclusion that the association between lung cancer and smoking is one of direct cause and effect. The evidence, as the House knows, is statistical but it is none the less convincing on that account.

My hon Friend referred to the main studies in this country which lead to that conclusion. Statistical research is still going on under Medical Research Council auspices and elsewhere into the relationship between smoking and lung cancer and many other diseases. I can assure my hon. Friend the Member for Willesden, West (Mr. Pavitt) that the Medical Research Council is fully co-operating in this work. Research is also being undertaken into the chemistry of tobacco and tobacco smoke and into other possible causes of lung cancer. Clinical and experimental research related to various aspects of lung cancer, including treatment, is being carried out in Medical Research Council and other research establishments as well as in hospitals.

My hon. Friend referred to the Report of the Northern Ireland study recently published by the Tobacco Research Council which is financed, as he said, by the industry. I think it is right that I should acknowledge, as he did, the degree to which the industry accepts responsibility to probe as deeply as it can into the effects upon health of the products that it is selling. We hope that this wide range of studies will increase our knowledge of the mechanism and the causation of lung cancer, but we do already know that the chief incriminating agent is cigarette smoking. It has been estimated that about nine-tenths of lung cancer which will otherwise attack our younger generations in the course of time can be prevented if only they can be persuaded not to smoke cigarettes.

A number of hon. Members, particularly the hon. Member for Essex, South-East (Mr. Braine) in the course of his thoughtful, and, if I may say so, helpful speech, have mentioned the possibility of the contribution of air pollution and diesel fumes to the increase of lung cancer. Research into the physical and chemical characteristics of air pollutants and of their relationship to lung cancer and to chronic bronchitis forms the major part of the work of the Medical Research Council's air pollution research unit. Results so far—there is no finality in these matters—suggest that the part played by air pollution in causing lung cancer is a relatively minor one compared with cigarette smoking. I know that diesal exhausts in particular have often been held to be associated with lung cancer if only because they are known to contain benzpyrene. However, a number of investigations which have been carried out have shown that diesel fumes do not play a part in the causation of cancer.

I confirm that work is going on at the Warren Springs laboratory under the Ministry of Technology, but I have no information about any recent results of work done there. Atmospheric pollution is, however, almost certainly a contributory cause of chronic bronchitis, and clearly a polluted atmosphere aggravates the condition once it has developed. Here again a good deal of research is going on at the Royal College of Physicians which has a committee at present studying the general effects of air pollution on health. Lung cancer, as many hon. Members have pointed out, is not the only disease which is known to be associated with cigarette smoking, though it is the disease for which the evidence points most clearly to a causal connection. Smoking is also an important contributory factor—though not the only one—to chronic bronchitis which accounted for nearly 30,000 deaths in England and Wales last year. Cigarette smoking is also associated with coronary heart disease which is one of the commonest causes of death in middle age, and with less common diseases including cancer in other parts of the body.

It is a tragic fact that many of the deaths associated with cigarette smoking occur among men and women in the prime of life. It has been estimated that cigarette smoking may be killing each year more than 6,500 men under the age of 55. The death rate for men cigarette smokers between the ages of 25 and 65 is almost double that of non-smokers. I think we must take this relationship between cigarette smoking and lung cancer and these other diseases as accepted scientific fact, even though we do not as yet know exactly how the effects are produced. Our concern is to consider what action the Government and the public at large can and should take in the light of these facts.

My hon. Friend's Motion urges Her Majesty's Government to take all possible steps to reduce cigarette consumption, with particular reference to an agreement for the limitation of cigarette advertising and coupon schemes, health education especially for school children and further encouragement for research. I have already spoken about medical research and I shall say a little more in a moment about social and psychological research. On advertisements and coupon schemes I shall have something to say before I sit down.

First, I have one or two points to make on health education and about the general attitude of our society towards smoking and non-smoking. As soon as the report of the Royal College of Physicians was published in 1962, the Ministry of Health asked all local health and education authorities to use every channel of health education to publicise its finding in order to bring home to the public and to school children the dangers of smoking, particularly cigarette smoking. This was envisaged, as the hon. Gentleman knows, as a long-term campaign and a continuing one. The Ministry has supported it by producing publicity material for use locally, including films and posters, and by national poster campaigns and advertisements in children's and teenagers' magazines.

Comparisons have often been made—they have been made today—between the expenditure of the Government on this publicity and the expenditure of the cigarette manufacturers on advertising. I should like to deal with that point before going on to discuss the objects of our campaign and its results so far. The figures I gave on Monday in reply to a Question by my hon. Friend the Member for The High Peak (Mr. Peter M. Jackson) show that expenditure by the Ministry of Health on the production of films, posters and other paid publicity for the smoking and health education campaign is expected to be about £100,000 this year, more than in any previous year.

It would be quite wrong to regard that as the total cost of the campaign. The figure takes no account of expenditure by the local health and education authorities by whom the campaign is largely conducted. Moreover, most of the work of the campaign involves no special identifiable expenditure. Local authorities place posters mainly on their own. premises, such as public libraries, and that involves no hiring charge. They show our films, which are lent to them free of charge, and other films mainly in schools. Talks in schools and to women's organisations are usually given by local authority staff in the course of their normal duties. Doctors advise their patients, and teachers talk to their pupils. That is how the campaign is conducted, and in that way it can reach every new generation of school children throughout the country.

It is less easy to reach adults. Children are a captive audience—even in these days—in their classrooms. Adults can be reached easily only through mass media. They see the posters displayed by the local health authorities and also our own national poster campaigns. They also read the newspapers, watch television and listen to the radio.

One of the better features of our Press and broadcasting coverage is the interest taken in scientific and medical topics. The publication of the Royal College of Physicians' report in 1962 and the later report of the Surgeon-General in the United States aroused great interest and generated much comment in the Press and on radio and television, as have later developments. In all these ways, the subject is continuously kept in the public consciousness.

Mr. Francis Noel-Baker

My right hon. Friend gave a figure of £100,000 for central Government expenditure and then referred to local authorities. Could he give an estimate, even if it is a rough one, of the total expenditure other than central Government expenditure on antismoking publicity?

Mr. Robinson

I would find it very difficult for the reasons I have already given, because, even if I could get figures from each local authority, add them up, and give my hon. Friend a total, much local authority expenditure is not separately identifiable, as it is undertaken in the normal course of their health and welfare functions.

We believe that the first object of our health education campaign, to get the facts about the health risks of smoking known to the public, has been largely achieved. The Social Survey division of the Central Office of Information has conducted extensive surveys to assess the extent of people's knowledge of these facts, as well as their attitude to these questions. The surveys show that most people are now aware of the health risks of smoking.

There is naturally a very wide variation in the extent to which the campaign has got across, but all but 6 per cent. of the people among whom the surveys were carried out had heard or read about the connection between smoking and lung cancer. A large proportion of smokers as well as non-smokers are in favour of public health education on the health risks of smoking. In getting the facts across, therefore, we feel that the methods we are using have been successful. They will of course continue. The subject must not be allowed to fade from the public consciousness, and health education in the schools must continue for every succeeding generation of children as they pass through the schools. There is no excuse for our children today to grow up in ignorance of the dangers of cigarettes, as we ourselves did.

But people still smoke cigarettes. And every year thousands of children and adolescents start smoking, in spite of the health education in the schools. But there has been some change, a comparatively small but welcome increase in the number of non-smokers, to which more than on, of my hon. Friends referred. Between 1961 and 1965, despite an increase in the population of 1¼ million, the number of smokers fell by half a million. If the same proportion of people in each age group over the age of 15 had been smoking in 1965 as in 1961, between 1 and 1¼ million more people would have been smoking than were in fact doing so.

In those four years the proportion of non-smokers rose from 43 per cent. to 46 per cent. of this adult population. Among men, the increase in the proportion of non-smokers between 1961 and 1955 was substantial, occurring at all ages; among women there was no marked increase, except in the 16–19 age group. Tire total number of adolescents in this age group increased by over 500,000 between 1961 and 1965, but the number who smoked by less than 10,000; the proportion who do not smoke increased from 38 per cent. to 49 per cent. among young men and from 55 per cent. to 61 per cent. among young women.

The House will understand that I am not claiming that those changes are wholly attributable to the health education campaign, but I think that it is quite fair to say that it has been one—possibly a major—factor influencing smoking habits, particularly as the in- crease in the proportion of non-smokers has been greatest in the 16–19 age group.

Our social surveys have been designed to produce information on, or at least pointers towards, the influences which make smokers try to give up cigarettes and the counter-influences which make it difficult. I expect to receive fairly soon the full report on that material. It constitutes a major piece of research into the social and psychological aspects of smoking. On the factual side, it will show the sort of defences which smokers throw up to justify their own smoking habits—for example the prevalence of attitudes such as that of the man who believes that smoking can damage other people's health, but only because they smoke more than he does.

The material will need full and careful study, but I hope that it will give us valuable pointers to the form our efforts should take in the future. But as things stand now, it is clear that although most people acknowledge the health risks of cigarette smoking that awareness has so far had only a very limited effect on smoking habits.

One thing is abundantly clear. It is really self-evident, but the surveys support it with facts and figures. One of the greatest influences leading young people to start smoking is that smoking is an accepted social habit. Our long-term aim, must be so to influence public opinion that the general attitude of society turns decisively again smoking.

That brings us back to the problem of how to convince people that it is better for them, and not just better for other people, not to smoke. There are many difficulties. The first is that even heavy smoking does not always lead to lung cancer. It does for one heavy smoker in 10, and one may gamble on being one of the other nine. But it is a pure gamble and we have somehow to get that across. If it were a known fact that one aircraft in 10 would crash with no survivors I think that most people would imagine themselves among the victims and decide not to fly. But with smoking people see themselves among those who get away with it. That is understandable, but it is very dangerous.

Mr. Braine

The right hon. Gentleman is on a most interesting point in discussing the psychological approach to smoking. Is he aware that there is substantial evidence on a worldwide scale that propaganda which uses fear of contracting lung cancer as a means of inducing smokers to give up the habit is largely ineffective? In this connection, is he aware that the Manchester committee to which I referred has been much impressed by the Dutch approach, which is to try to switch people away from cigarettes to other forms of tobacco smoking which we know to be less likely to cause cancer? Could he say something about that? We have got to carry people with us.

Mr. Robinson

I entirely agree, and I was coming to that. Particularly for the young, fear is not a very successful line of approach. Death at 40 rather than 70 does not seem to make all that difference if one is not yet 20.

Mr. John Ellis (Bristol, North-West)

In thinking of switching people away from the smoking habit—with which I agree—we must be concerned at the same time, as my hon. Friend the Member for Bristol, South (Mr. Wilkins) and I certainly are, about the people already employed in the industry. If this is to be part of policy, people in the industry must have an assurance that the Government will at the same time set about providing alternative forms of employment for the people working in the industry and for the companies which are contributing the £1,000 million a year to the Exchequer about which we have already heard. For these reasons, it must be understood that State aid will be given so that the companies can diversify and so that other industries can be brought into the area to maintain employment and give a secure future to the workers.

Mr. Robinson

As my hon. Friend knows, those are not matters for me, but I can assure him, on behalf of my right hon. Friends, that the Government as a whole will be most concerned to mitigate the effects on workers in the industry of any Government policy of this kind.

We do not want to over-stress the frightening aspects of illness to anyone, particularly to the young. We do not want people to grow up with the idea that all cancer is fatal, because, as the hon. Member for Essex, South-East so eloquently pointed out, it is not, although lung cancer is a particularly difficult form of the disease to cure. This is really the short answer to the hon. Member for Peterborough (Sir Harmar Nicholls), who has now left the Chamber. We must get young people to take these warnings seriously.

Young people are, above all, more likely to be influenced by example than by exhortation. Those who are in contact with children and young people have a special responsibility to set an example. This applies particularly to parents, teachers, doctors—whose record in this is excellent, I agree—youth workers and all those in charge of young people when they start work, because this is a critical time for acquiring the habit. For those who cannot drop the habit, the only honest thing to do is to admit openly that they want to stop but cannot. This will have a powerful influence on the young, bringing home to them that smoking can become an addiction or habit which is fatally easy to start and fatally difficult to stop—often fatally indeed.

We know very little about the techniques of influencing established social habits even when all rational arguments show them to be harmful. We need such knowledge not only in relation to smoking but in relation also, for example, to obesity, a subject mentioned by my hon. Friend the Member for Wolverhampton, North-East (Mrs. Renée Short) at Question Time not long ago. The social surveys I have mentioned will add to our knowledge here. The work being done in the anti-smoking clinics is relevant also. The result at most of these clinics, whatever methods are used, is an immediate success rate of about one-third, with a considerable number of relapses within one year.

A conference was held only last week under the auspices of the Medical Research Council, the Social Science Research Council and my Department to review the work which has already been done, including work on the pharmacological aspects as well as the work of the anti-smoking clinics, the social surveys and various other studies, and to discuss what other work might usefully be done. We hope that research of this sort will lead to a clearer understanding and better techniques of health education.

Meanwhile, we must do all we can to remove the incentives to smoke and to encourage positive public opinion to accept non-smoking as the norm.

The Government have already brought cigarette advertising on television to an end in the belief that advertisements on this most persuasive of the mass media must have a strong influence, especially on the young. There have been suggestions about limitations on smoking in public places. These also are under consideration by the Government, and I hope to make a statement in the near future.

We reached an interim six-months agreement with the manufacturers last June for a voluntary limitation on Press and poster advertising and for the cessation of advertisements on radio and in cinemas. This agreement, for reasons which may become apparent before I sit down, excluded the question of coupon offers with cigarettes, but it was agreed that there should be further discussions about the arrangements to follow this interim agreement, which came formally to an end on 30th November, and that the problems associated with coupon schemes should be included in those discussions.

I have listened with very great interest to what has been said about advertising and about coupons, and I am sure that the manufacturers also will have careful regard to the views expressed. I ought to say that it has been put to me, as, quite clearly, it was put to my hon. Friend the Member for Bristol, South, by the largest manufacturer of coupon cigarettes that coupon trading is not a promotional device on a par with advertising through mass media but more in the nature of a deferred price reduction. The coupon value, the argument goes, is costed into the product and is part of the price paid by the consumer. The same manufacturer maintains that there is no evidence that this form of trading has significantly affected the totality of consumption.

I find it hard to accept this argument. It seems to me prima facie that advertising of brands as coupon brands is an added attraction and the prospect of a gift is an added inducement to smoke. Such statistics as I have seen do not convince me that coupons have no effect on smoking habits. On health grounds, therefore—I confine myself to those—it seems right to regard both mass media adver- tising and coupon promotion as matters which should in the public interest be dealt with together, if possible, in seeking any voluntary arrangement.

I can give the House only a brief description of the negotiations I have had on this matter with the principal cigarette manufacturers. They have been prolonged and searching. The industry was represented at a high level. There have been talks with my officials, and I myself have had full discussions with the firms, separately and collectively.

It was my impression that there was a genuine desire on the part of the industry to reach voluntary agreement on limitation of promotional expenditure. But conflict of commercial interests between the companies and their anxiety about their share of the market frustrated all efforts to devise a formula for agreement. Broadly, the difficulty was that the formula eventually put forward by us as, in our view, fairest all round, though acceptable in principle to two of the three was unacceptable to the third on the ground that it would have eliminated coupon trading. Similarly, though this company would have accepted agreement to limit total expenditure on mass media advertising in predetermined proportions as between the three manufacturers, this solution—which I would have accepted as a useful if only partial limitation on promotional expenditure—is unacceptable certainly to one and probably to both of the other companies unless accompanied by abolition of coupon trading.

This failure to reach agreement is bitterly disappointing to me, and, though I remain ready to consider any proposals on which the industry can agree, I should be deceiving the House if I expressed any great hope of achieving success. The positions of the two firms I have mentioned appear to be irreconcilable because of the commercial risks which each believes it would have to face relative to the other according to which method were adopted. The deadlock which we appear to have reached produces a situation which clearly the Government will have to consider. The House will appreciate that I cannot say more at this stage.

It seems to me that today's debate demonstrates that this House recognises that society as a whole should face its responsibilities in relation to this dangerous social habit. Government action may help, but people cannot be coerced into changing their social habits. We can, and we must, seek to influence public opinion. The House can do so, and each of us individually can do so, quite apart from anything that the Government can do.

It is also important that people should realise, as, again, has been pointed out during the debate, that giving up smoking immediately reduces the health risks, even among those who have been heavy smokers. In men who have given up cigarette smoking, the death rate from cancer of the lung falls substantially and increasingly as the years pass. A reduction in coronary disease also follows the giving up of smoking, though with a delayed effect.

I have already pointed out that nonsmokers are now very nearly a majority among the adult population. Smoking is abnormal, dangerous, messy, expensive and contrary to reason. I assure the House that the Government will keep these facts continually before the public and will press forward with their health education campaign.

1.52 p.m.

Mr. Reader Harris (Heston and Isleworth)

The Minister has said enough at least to convince me that the Government have done all they possibly could on this most important subject. The aspect on which I would like to say a few words is the important question of education in the schools.

My impression is that the Government, in the sense of Whitehall, has probably done all that it possibly can in the way of issuing circulars to the right levels in the education authorities and, no doubt, the education authorities have given the necessary instructions to head teachers in the schools. I wonder, however, whether what the Government propose is working out in practice. I fully appreciate that what I am saying may be the responsibility of the Secretary of State for Education and Science rather than the Minister of Health, but this is a vastly important subject.

My hon. Friend the Member for Essex, South-East (Mr. Braine) referred to the approach to the subject in America. I have never been in an American school, but friends of mine in America have told me that the amount of propaganda and education which goes on in the average American school is colossal. The pressure is tremendous. As much attention is given to anti-cigarette smoking propaganda in an American school as is given to the periods for corporate worship.

I am told that every week American schools have films which are almost of a horrifying nature. The result is that, whatever may be said about fear, it has the effect of turning a large number of of American children away from smoking. I am told that in about 20 or 30 years' time it is confidently expected that cigarette smoking will be almost unknown in America, so great is the pressure in the schools.

I wonder how this is working out in practice in British schools. On the whole, I hear very little about it. I seldom hear children featuring in it. I wonder whether it is done with the same enthusiasm in British schools as in American schools. Is it left to the discretion of a head teacher? What happens if the head teacher is himself a cigarette smoker? It must be difficult for him to put his heart and soul into telling children in his school that cigarette smoking is a bad thing.

I wonder whether there is any form of survey of this subject and whether the Minister has had any report on how these things work out in practice. Is it, as I suspect, that in some schools there is reasonable propaganda on the subject, whereas in other schools there is little or none? Obviously, these things must sometimes work on an ad hoc basis and they vary between different parts of the country. Is it the responsibility of the Minister of Health to keep an eye on this, or is it the task of the Secretary of State for Education and Science?

I would like to make a plea for greater supervision of this subject. For instance, is education in the schools on this important subject given every week, once a month, once every few months or simply when there happens to be a free period and a teacher has nothing else to do? I would like to know how these things work out in practice. I have a feeling that not as much is being done in the schools as could be done.

Among all my friends, I notice that it is the younger people who smoke more than the older people. In my constituency, when I go to a Young Conservatives' dance there is more smoking than at a dance run by the senior part of the Association, because we still have not got to the point where cigarette smoking is unacceptable for young people. At present it is still very much the thing to do.

Mr. K. Robinson

The responsibility for health education in the schools rests, of course, with the local education authorities. I think that the detailed information for which the hon. Member is asking could only be obtained, if at all, from the Secretary of State for Education and Science. As to the statistics which I have given about the increase in the number of non-smokers in the 16–19 age group, surely this is at least prima facie evidence that however intensively the campaign is being carried out in the schools, success, at least of a kind, is attending it.

Mr. Harris

I am obliged to the Minister. I am sure that he is having some success. Among friends of my own generation I am surprised at the number who say that they have given up smoking. This is obviously encouraging. One of the obvious things is to keep up the pressure until the cigarette manufacturing companies diversify to an extent when cigarette manufacture becomes a smaller part of their activities. For instance, they now manufacture potato crisps, which, I am sure, is a much more useful occupation than the manufacture of cigarettes.

If only we can encourage the big cigarette companies, which by now have amassed millions of £s and could well afford to do it, in other directions, much less time and attention would he devoted to the advertising of cigarettes. I am told that in America the rate of cigarette smoking is falling even faster than in this country. The work in the schools is really beginning.

The question of obesity has been mentioned. An enormous number of women whom I know smoke because they think that it will make them slim. They are much more frightened of being fat than they are of dying of lung cancer in three years' time. The impression is very much abroad that it is much better to smoke, partly, apparently, because it takes away the appetite and therefore women do not eat so much. This is a line on which the Minister might regard it as worth while to produce propaganda. He could, perhaps, produce propaganda to persuade women that being a little bit fat is better than to die of lung cancer in a few years' time.

I am slightly at variance with other hon. Members on the subject of coupon advertising. I do not think that the placing of coupons in packets of cigarettes necessarily makes people smoke more. There are very few who seek to buy an occasional packet of cigarettes to get a coupon. The main object of coupons in packets of cigarettes is to enable a cigarette mainufacturer, having once got a customer, to keep him very largely with that brand.

The danger which I foresee is that a cigarette manufacturer might put Green Shield stamps in his packets of cigarettes. All sorts of people collect Green Shield stamps. That may be a bad thing, but I would not have thought that ordinary competition made people smoke more. It merely makes them faithful to one brand.

Mr. Ellis

I have some experience of this. I am constantly attacked by my wife for smoking. I suggest that it is some answer to her to say, "Here are the coupons. Get yourself a gift." The pressure would be off. If it works with me in this way, it must work with many other people.

Mr. Harris

That may be so. I would not argue with the hon. Member. I do not smoke cigarettes. I smoke cigars, and unfortunately they do not put coupons in those. I am looking forward to the day when they do.

I am sure the Government is doing all they possibly can. I do not expect an answer, because it must be a delicate subject, but I am wondering whether all the organisations who are researching into this difficult question of cancer are, in fact, all pulling in the same direction, and whether there is not a certain amount of pulling in opposite directions, a certain amount of competition, a certain amount of rivalry, and a certain amount of factiousness—which come to my ears on occasions.

I hope that the Ministry will keep its eye on the whole question of research and will see that the efforts of all these different bodies are channelled in the right direction. Is it a good thing that so many different bodies should be researching into cancer? Is there any waste in money, effort or administrative staff? These are questions to which I do not know the answer, but some of the things that I hear from time to time are not particularly pleasant. One hears of rivalry between organisations raising money for cancer, and this is something which the Government might look into. Meanwhile, I congratulate the Minister for all that he is doing.

2.2 p.m.

Mrs. Gwyneth Dunwoody (Exeter)

I have listened to the debate with great absorption. Hon. Members on both sides of the House have contributed such informed and reasoned speeches that it has been a fascinating debate to listen to.

I should declare my interest straight away. I speak as a doctor's wife, which in these days seems to be one of the lower forms of human existence. I therefore have the double disadvantage of being not only medically ignorant but also, on occasions, of having to deal with the effects and the consequences of other people's medical ignorance.

I have three children, and this is perhaps my more vested interest in the Motion which appears on the Order Paper. Beginning with the hon. Member for Willesden, West (Mr. Pavitt), and going on from one hon. Member to another, there has been this constant reiteration of the theme of the need for more and more health education, because surely this is the important point. Those of us who are anxious that the general public should realise the difficulties and the dangers involved in smoking are not saying to them, "You must not smoke"—although we would very much prefer them not to. What we are saying is that, "You must know the enormous risks involved before you indulge in this habit", a habit which has a very easy chance of becoming a very strong addiction.

The hon. Member for The High Peak (Mr. Peter M. Jackson) particularly stressed the importance of the child. He said that smoking was a socially acceptable habit. This is one of our major difficulties. It used to be socially acceptable to use a spitoon, but we got rather beyond that stage when we decided that there was a certain amount of health risk involved and it became the thing not to do. I look forward to the day when the thing not to do is to be a smoker.

When I started in the theatre, it used to be a truism that a good "Rep" actor could offer all the spectrum of emotions simply by carrying around a cigarette. He could show great agitation, emotion and nonchalence. He could do everything he wanted to do simply by carrying a cigarette. Perhaps that is one reasons why I had to learn rather more about acting, because I did not smoke. Mass media, whether concerned with television or newspapers, constantly use people and cigarettes in juxtaposition in all sorts of advertisements. Cigarettes are shewn as being a symbol of sophistication, a symbol of adult behaviour. I should like to see those people who are genuinely concerned about this matter putting some pressure on all advertisers not to use advertisements in this way.

The hon. Member for Bristol, South (Mr. Wilkins) seemed to recognise in his fellow Members a group that I have not yet come across—a fanatical antismoking lobby who have been indoctrinated in America. Some of his remarks rather surprised me because, although I am myself a non-smoker, I feel that there is a definite medical case made out. We have heard more than once today about the statistics involved, and I do not think we can continue to ignore the part played by cigarette smoking in the incidence of cancer of the lung. It was mentioned that the statistics showed that deaths occurred from other forms of cancer, such as cancer of the cervix. Although medical statistics show that people die from many other forms of cancer, it should be remembered that until we are quite clear on how cancer is caused we must take all precautions. This is what we are endeavouring to do by cutting back on the amount of smoking.

Many hon. Members mentioned the question of air pollution. One hon. Member said that our streets were becoming like gas chambers. There can be no doubt that air pollution is something about which we should all be concerned, particularly because of the difficulties it causes in such diseases as bronchitis. Nevertheless, statistics were quoted both by the Minister and the hon. Member for Falmouth and Camborne (Dr. John Dunwoody) which proved that this was a very small complicating factor. Whilst it must not be ignored, it should not be used as a red herring by those people who have a vested interest in pushing for more cigarette smoking.

Several hon. Members raised the question of advertising. The Minister said that fear was ineffective. This might very well be true, but I think that the Ministry and the local health authorities deserve great credit for all they have done, because although fear may, in the final analysis, be ineffective, it does bring people up with a shock. It makes them think, and this is, after all, what we are anxious to do.

One of the posters which we had displayed in our surgery for a long time was a very effective one. I do not know whether it was a Ministry poster, but it showed a large coffin, with the words, "The big flip-top box for the smoker". This poster occasioned much ill-feeling among patients, who complained that it should not be displayed in the waiting room because they had to sit and look at it for a long time. However, this was a clear indication that it was doing the job effectively. It was highly effective, because it made them sit up and think, and they did not like what they were thinking about. We should have a great deal more publicity along this line.

We have a most important job to do in the schools. Children do not have closed minds. They can be convinced by argument and by example. I would like to see a great deal more done, in science lessons and in general teaching, to bring home to our youngsters the great dangers that are involved in cigarette smoking. It is very simple to say that this is a job which parents ought to be doing. The hon. Member for Falmouth and Camborne did not tell the House that he used to be quite a heavy smoker and that he himself made the decision to give it up because someone said that a doctor who smoked was rather like a bishop who kept a mistress, and because it makes it much easier to say to one's children and to one's patients, "I have taken all the facts into account. I have come to this decision myself, and therefore I am prepared to give up what I believe to be a noxious habit." I hope that the debate will not simply be a useful airing of opinions which is then allowed to pass quietly into the records of the House, to be referred to again next year when we debate this subject again. If one thing has come out in speeches today, it is that this is an urgent subject.

My hon. Friend the Member for Bristol, South seemed to feel that we had some sort of "killjoy" idea in mind in wishing to restrict the pleasures of others. But if there were a plague at large in the land, every hon. Member would have a bounden duty to rise to his feet and cry aloud, "There is danger abroad. We should do something about it." This is a more subtle, invidious and dangerous long-term peril. Sometimes people think that by simply rising to our feet at Question Time and drawing the Minister's attention to it we have done all that is needed.

I feel strongly that, until we have convinced the general public that this is a dangerous problem, we shall not have succeeded. I would, therefore, like to thank all hon. Members who have spoken for the tone of their speeches. But, more than anything in the world, I hope that what has gone on here today will be heeded outside in every home and particularly in every school and that our words will be taken, at least to save some lives in the immediate future.

2.12 p.m.

Mr. John Ellis (Bristol, North-West)

I should like to follow the comments of my hon. Friend the Member for Bristol, South (Mr. Wilkins), with much of which I agreed. He was honest and sincere when he pointed out that 10,000 people in his constituency worked in the industry and 6,000 of them lived in the constituency. I also come from Bristol, and some of those who work in his constituency probably live in mine.

When the Government say that smoking is harmful and has serious health hazards and should be discouraged, I fully support that argument. I am one of the few cigarette smokers who have spoken in the debate. I am very suspicious very often of doctors and statistics, but I have heard enough evidence—certainly in the dissertation of my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) coupled with that of both Front Bench speakers—to make it clear that there can be no doubt about the harmful effects of smoking. I agree that it should be Government policy to dissuade people from this habit.

However, I still think that the point of my hon. Friend the Member for Bristol, South was an honourable one, about what will become of the people who work in the industry. The Minister seemed to shrug aside the point which I made in an intervention, saying that it was a problem for a different Ministry. When he has read my speech, I hope that he will reconsider this attitude and point out that his policy may have social consequences on the people in the industry.

A total of £1,000 million a year in indirect taxation is gained from this industry. The Government should accept their responsibilities and the wealthy tobacco companies should be encouraged by every means to make alternative industries available in those areas, so that the people with a genuine interest, whose families and livelihoods depend on the industry, will know that, while we say that the case is proved and that smoking is a bad habit, we will also accept our social responsibilities so that the people whose jobs will be in jeopardy will not find that their livelihood and that of their families are at stake. Having decided to take these measures, we should ensure that their future is not jeopardised.

2.18 p.m.

Mr. Francis Noel-Baker (Swindon)

I join all other speakers in warmly thanking my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) for raising this subject in a brilliantly documented manner and also for the appropriate time that he chose. He managed to get an answer from the Minister of Health himself; we were lucky to have the Minister present for the debate. We know how busy he is.

The right hon. Gentleman gave us some interesting and up-to-date information on the course of his conversations about advertising with the tobacco industry. This is the point on which I wish to speak. I greatly appreciated the speech of the hon. Member for Essex, South-East (Mr. Braine). I remember that, when he was at the Ministry of Health, he took a progressive view when I and others concerned with the advertising of the industry, in the company of distinguished members of the medical profession, discussed this difficult problem with him. He has always taken an enlightened view, as anybody in the Ministry is bound to take. The medical facts about cigarette smoking and cancer have piled up so that no one who lives with them can have any doubts.

I am sorry that the right hon. and learned Member for St. Marylebone (Mr. Hogg) is not present, because, in the past, when the hon. Member for Essex, South-East was at the Ministry, the right hon. and learned Member was a powerful force in the then Conservative Government in spurring on his colleagues to do more about the dangers of cigarette smoking.

I am interested in the absence of a number of other hon. Members who, in previous debates, have taken a contrary view to that of my hon. Friend. I can only assume that this means that public and Parliamentary opinion has been moving rapidly during the last few years and months. I suppose that the emptiness of the benches usually occupied by the supporters of the "tobacco lobby" must be a cause of some distress to those who have been seeking to manipulate public and political opinion in the interests of the tobacco manufacturers.

It is significant that the only voice which directly contradicted the opinions of my hon. Friend was that of my hon. Friend the Member for Bristol, South Mr. Wilkins). We all appreciate his constituency difficulties. I have a similar problem in Swindon, where there is a cigarette factory, and I wish in no way to dodge this issue. I have a number of constituents whose jobs are affected by the manufacture of cigarettes. I am glad to say that I have always had very happy relations with the trade unions in this industry and I hope that these will continue. But I am sure that the right line for an hon. Member to take in this dilemma is to talk frankly to the people employed in manufacturing cigarettes and point out the mounting evidence, which is overwhelming, that they are making a killer and that any responsible Government must intervene to try to stop the habit being adopted by young people in particular. We must point out that we have to do something about cigarette smoking and, therefore, it is up to the industry and the unions to press ahead with diversification.

There is at present no medical evidence against cigars or pipes and the first thing that the industry must do is to put all the emphasis in its publicity campaign in that direction. The Government can help greatly by increasing taxation—I hope they will—on cigarettes and making it more expensive to smoke cigarettes than other types of tobacco.

The industry is, indeed, diversifying. It is going into other businesses as well as tobacco—potato crisps, for example. I hope that this trend will continue. But even if the present trend away from cigarette smoking is accelerated, a little intelligent planning and discussion between unions and managements would make it quite easy to absorb men and women affected by the decline in cigarette smoking into some other activity engaged in by the tobacco industry. I do not think that the constituency difficulties of my hon. Friend the Member for Bristol, South and the problems which face his constituents who make cigarettes really justify the arguments he was using.

My right hon. Friend referred to air pollution. We are grateful for his announcement that intensive research is going on. But the conclusions to be drawn are still puzzling. As has been said, there is curious evidence which tends to show that the level of air pollution does not have a great effect on lung cancer. Finland, for example, has a very high rate of smoking and a high rate of lung cancer, but it has an extremely low rate of air pollution. There is similar evidence from the Channel Islands and elsewhere. My hon. Friend the Member for Watford (Mr. Raphael Tuck) rather exaggerated certain aspects of diesel fumes. I have an interest in transport, as any hon. Member from Swindon must, and certainly, on grounds of traffic safety and amenity, the evidence is that diesel fumes are a major menace. They are a great danger on the roads. But the medical evidence is incomplete.

The diesel engine has only been on the roads in any numbers for a relatively short number of years and it is not possible yet to work out the effect of a fairly low concentration of carcinogenic substances coming from the fumes, although the evidence on benzpyrene from the exhausts of motor cars tends to show that this is a relatively minor contributory cause of lung cancer and other diseases. I was interested to hear about the devices that can be fitted to exhausts, but I must say that when I was in California earlier this year, where the use of these devices is compulsory—

Mr. Deputy Speaker (Sir Eric Fletcher)

Order. I remind the hon. Gentleman that there is nothing about air pollution in the Motion.

Mr. Noel-Baker

With the greatest respect, Mr. Deputy Speaker, the hon. Member for Essex, South-East and many others have dealt with the subject at some length. So did my right hon. Friend the Minister of Health.

Mr. Braine

Perhaps I can assist, Mr. Deputy Speaker. It was said by the Minister and by those concerned with this that air pollution is a factor. There may be a difference of opinion as to how important a factor it is, but it is a factor and it would be fair to permit the hon. Gentleman to develop that aspect, especially as I was allowed, I think quite properly, licence to refer to the matter.

Mr. Deputy Speaker

I do not deny that it is a factor and it is reasonable to touch on it. But it should not be pursued.

Mr. Noel-Baker

I bow to your Ruling immediately, Mr. Deputy Speaker. In the argument as to whether air pollution is a major cause of lung cancer as compared with cigarette smoking, the medical evidence tends to show that it is not. As far as we know, it is a minor cause.

Mr. K. Robinson

indicated assent.

Mr. Noel-Baker

I see that my right hon. Friend is nodding his head and, therefore, I shall move on to the next point.

My hon. Friend the Member for Bristol, South seems to have developed a kind of phobia about what he calls the "anti-smoking lobby". I am glad to say that, when we were in Opposition, my right hon. Friend the Minister of Health was also a very active and valuable ally in what my hon. Friend has called the "anti-smoking lobby". No responsible hon. Member who has studied the medical evidence, whatever his constituency interest may be, or whatever may be the other implications of dealing with the problem, can fail to treat this as a very serious national problem affecting the health of the nation, particularly young people.

With respect to my hon. Friend the Member for Bristol, South, when he asks why do we not do anything about the advertising of drugs or drink, the answer is that we do. Those who are worried about the impact of the advertising industry, and many of those who have been associated with me in the Advertising Inquiry Council, of which I am Chairman, and in the activities which ended triumphantly with the termination of television advertising, are also interested in other aspects of the problem.

On drink, we published in two editions a long report on advertising campaigns by the brewers and distillers, on which we had the support of my hon. Friend. Certainly the position of advertising of drugs is a serious subject and, indeed, the advertising of dangerous drugs is now prohibited by law.

I assure my hon. Friend that what he calls the "anti-smoking lobby" intends to continue its activities. I hope that it will go from strength to strength and will result in legislation which will, if not abolish altogether, at least greatly diminish the volume of advertising which is at the moment trying to encourage the smoking of cigarettes.

No one can argue in face of the medical evidence, which is overwhelming, and the figures and statistics my right hon. Friend gave us—which have made it even more convincing—that smoking is not a very dangerous habit. It is a major cause of cancer of the lung. It is a large cause of bronchitis and coronary thrombosis and it is a very unpleasant killer. Death comes in a spectacularly horrible way.

Those of us who are concerned with trying to see that the Government do something about the problem are not killjoys. We are not suggesting legislation to forbid cigarette smoking. We are not suggesting putting manufacturers out of business overnight. What we are saying is that this is something that the individual is entitled to make up his mind about when he has considered the problem. It is a subject on which vested interests are not entitled to spend millions of pounds on persuasion. Some figures have been given in the debate and I should like to give a few more about expenditure on advertising.

First, I do not accept, any more than my right hon. Friend does—and I am glad he does not—the argument that the coupon business is not a part of advertising. Of course it is. It is an integral part of promoting the sales of cigarettes and it is humbug and eyewash to pretend that it is not. Indeed, the figures show that it has been treated by the cigarette manufacurers as a substitute for television advertising. That this was so is shown by the fact that as the threat of a ban on television advertising grew so did expenditure on coupon promotion, and after the ban became effective expenditure on coupon advertising grew even faster.

In 1963, the industry was spending £8.75 million on coupon advertising; in 1964, it spent £10.25 million; in 1965—the ban on television advertising became effective that year—the figure was £12.95 million and, by the end of 1966, the figure will have shot up to the spectacular total of £24.5 million—twice what it was last year.

In that context, although my hon. Friend the Member for Bristol, South spoke rather proudly of the cigarette industry spending £250,000 on research, taken against £24.5 million on coupon advertising and a total on advertising this year of £36 million, it is a drop in a rather disreputable bucket. The amount of money spent on promoting the sale of cigarettes has increased enormously during the past four years, even in spite of the television ban. Between 1963 and this year the total has gone up from £21 million to £36 million.

I have said in the House before that I feel it to be totally illogical for the Government to have been sufficiently convinced of the undesirability of cigarette advertising as to ban it on television, and then to sit back and do nothing about it on other media. It is even unfair to the owners of the other media. Why should commercial television stations be penalised and the Press and the poster industries and the people involved in the coupons be allowed to continue to draw very large sums of money from those sources?

I hope that in his talks which will follow the breakdown of the conversations with the tobacco industry my right hon. Friend and his colleagues will pay particular attention to the Press. I cannot help thinking that if he made an appeal to Lord Thomson of Fleet and Mr. Cecil King and the other newspaper owners and explained to them that the medical evidence was now incontrovertible and that the cigarette advertisements which they were carrying in their newspapers were contributing to this problem, Lord Thomson of Fleet and Mr. Cecil King and the other newspaper proprietors would respond favourably. I hope that my right hon. Friend will consider that. It seems quite illogical, having accepted the need for the television ban, not to extend it to other media.

I detected a note of great disappointment in my right hon. Friend's voice when he referred to his conversations with the tobacco industry.

Mr. Robinson

indicated assent.

Mr. Noel-Baker

The industry was unco-operative, obstructive and unrealistic and I hope that it will take note of the feeling in the House of Commons, one voice taking its part and every other hon. Member in the debate, on the Opposition benches, on the Government benches and the Minister himself, agreeing with everything which my hon. Friend the Member for Falmouth and Cambborne has said.

I was always a little doubtful whether the talks with the tobacco industry would have any practical results. At all events, my right hon. Friend has taken a long time and has been very patient and I am glad to know that his patience is now exhausted. We shall expect effective measures to be taken by the Government, as the industry will not do it, to curb and reduce cigarette advertising.

I want to say a few words about an argument which I know that my right hon. Friend does not accept but which the advertising industry keeps pressing. It is that the purpose of cigarette advertising is not to increase consumption, but merely to switch the confirmed smoker from brand to brand. Frankly, I do not believe it. If one looks at the advertisements and the content of the advertising being put out by the agents of the tobacco manufacturers, one sees that this argument does not stand up.

If the tobacco manufacturers are sincere and if the only purpose is to encourage the confirmed smoker to change from one brand to another—although it will make precious little difference to him and he will probably not be able to detect the difference in the cigarette if he does not know what is on the outside of the packet— then the only way in which to do this is at the point of sale, because when the confirmed smoker gets into the shop, if he has not decided which brand to buy, it is perfectly fair to persuade him to buy one brand against another. I do not believe that these enormously expensive campaigns outside the shop, in the Press on the hoardings and through coupons, have their stated purpose.

We have had a long and very interesting debate and I should like to conclude by again congratulating my hon. Friend the Member for Falmouth and Camborne and by thanking the Minister very warmly for what he has said. We are greatly encouraged and we shall look forward to action being taken very soon.

2.35 p.m.

Dr. David Kerr (Wandsworth, Central)

Perhaps it is not inappropriate that this excellent debate which was opened by one of my medical colleagues should be closed, presumably with a few well chosen words, by another medical M.P. I should like to add my personal thanks to my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) for giving the House an opportunity to publicise these clearly agreed views about the relationship between cigarette smoking and lung cancer.

Throughout the course of the debate we have heard a great deal about the measures thought to be necessary to convince these poor sinners who continue to indulge this disgusting habit of the errors of their ways. Nobody has referred to the undoubted fact that one of the most important bits of the programme of health education against cigarette smoking this year will prove to have been this debate, and it is not only the House which therefore owes a considerable debt of gratitude to my hon. Friend for having given us the opportunity to say these things.

My hon. Friend the Member for Swindon (Mr. Francis Noel-Baker) said that we owed a considerable debt of gratitude to my right hon. Friend the Minister for being here and, above all, for delivering to us in that dry dispassionate voice of his the most exciting and stimulating story of what is going on behind the scenes with this vexatious problem of how to make people change from their evil ways. If I might misquote from one of the little poems of my childhood which helped me to become the man I am. I am sure the world is so full of a number of sins, I am sure we should all be as happy as kings and, as one American author added, we all know how happy kings are!

More seriously, the contribution of cigarette smoking to the ill health of the nation does not in any way stop short, as other hon. Members have said, at the problem of lung cancer. Lung cancer is dramatic and, as my hon. Friend the Member for Swindon said, spectacularly horrible. But I assure him from my own personal experience that the spectacle and the horror of lung cancer find equal rivals in the painful wheezing progress of the chronic bronchitic up his own back stairs, or the terror of coronary thrombosis which perhaps strikes the middle-aged active man looking forward hopefully to rest and respite in a long and happy retirement. Those are the things which we should be thinking about in the horror and blood and scare of lung cancer. But these problems, manifold though they are, find their salvation in this great and steadily eroding health problem.

I assure my hon. Friend the Member for Bristol, South (Mr. Wilkins) that we are not expecting in the course of the next 10 or even 20 years to see all the tobacco factories shut. Indeed, as he said, there is a good argument for seeing them turn over to the manufacture of cigars and pipe tobacco. But, at the same time, even if we were able to secure a very rapid reduction in the number of smokers in the community, it must be clearly understood that the epidemic of lung cancer will be with us for years to come and that the numbers will continue to rise even while the number of smokers continues to fall, as we hope.

Several hon. Members have referred to the problem of air pollution. I want to read the conclusion of a report which appeared in the Practitioner in 1963 and which said: There is no reason to expect this dread disease to have but one cause and, regrettably, we have not yet seen the end of this rise. It may well be that some subtle combination of cigarette smoking and air pollution is especially dangerous to us in Britain. . The prudent man will not wait for the further elucidation of the mechanism by which his tumour may arise; he will stop smoking as a safeguard to himself and as an example to others. This brings me to a most important point. We are a little rash and hurried about accepting the difficulties of changing the habits of people when before our very eyes in this Chamber we have such evidence of the ability of the more gross of our smoking colleagues to curb themselves.

No one would ever dare to expect you, Mr. Speaker, to sit languorously back in your Chair, puffing away at a "fag". Clearly the opportunity which a brief spell in the Chamber offers to the smoker to reject his habits should be a reminder that, for all of the strictures of my hon. Friend the Member for Bristol South, we do impose a pattern of behaviour which is accepted by people. Why do we exaggerate the difficulties of accepting similar impositions on social patterns—not a legal imposition I hasten to add—and why not change the social patterns elsewhere?

Mr. Wilkins

I have always likened the objections to smoking because of lung cancer to the subject of drink. I cannot understand why my hon. Friends who are so persistent about this first matter are not equally concerned about alcohol. We have allowed drinking and driving to go on for years without any compulsive action. Even now, when we are to do something, random checks are being withdrawn from the Bill.

Mr. Speaker

Order. This is becoming a speech on a new topic rather than an intervention.

Dr. Kerr

I want to assure my hon. Friend that I am equally concerned about the problem of alcohol. The relationship between drink and the body one trips over in the hall as one comes in on Saturday night is much more evident than the relationship between smoking and the development, 20 years' hence, of some crippling or fatal disease.

Mr. Francis Noel-Baker

My hon. Friend was unfortunately not in the Chamber when I mentioned this at some length. He was one of those who applauded a long report on drink advertising, published by the Advertising Inquiry Council, to whose report on tobacco he took such exception. It is quite incorrect to maintain that there is any narrow view on this.

Mr. Wilkins

I apologise for not being in the Chamber. I was asked to go to the HANSARD quarters.

Dr. Kerr

I want to bring this debate rapidly to a close because we have almost exhausted the subject, and very largely agreed upon it. There are three points with which I wish to leave the House. First, the incomprehensible gap between knowledge and action. My right hon. Friend the Minister has paid tribute to my colleagues in the profession who have given up smoking and has recorded his admiration of our record. What is more puzzling to me is that doctors, who know better than anyone the relationship between smoking and disease, continue to smoke. How on earth are we to overcome this gap?

How is it possible for certain Ministers of the Crown, whom I will not presume to name, to subscribe to the whole conception of the relationship between smoking and disease and, at the same time, to indulge the habit, perhaps not in a very public way but in a way which undermines the very lead which we are expecting from Government Ministers, as much as from teachers and doctors. This chimerical rôle of leadership in this area was brought to light in the course of the survey referred to by my right hon. Friend.

Secondly, let no one make the mistake of blaming the poor, weak, smoking sinner for his sins. We must face the fact, we have heard it from hon. Members, that there is a very wealthy and powerful vested interest in the tobacco industry, which is anxious to continue the habit of smoking among the general population. Let me cite one recent example of how powerful the industry can be. The Central Council for Health Education had planned to send one of its small bands to Northern Ireland to publicise the dangers of smoking, as it has done in other parts of the country.

The local authorities in Northern Ireland accepted the offer, but later withdrew their invitation to this band and the suspicion—I can say no more than that—is that pressure was brought to bear upon the local authorities by the tobacco interests in Northern Ireland, sufficient to discourage them from taking part in this important public health measure.[HON. MEMBERS: "Shame."]

I want to appeal to my right hon. Friend to put the present jumbled and disordered house of health education into order. It is far too long since the Cohen Committee on health education published its report. I appreciate the difficulties facing my right hon. Friend in bringing its recommendations to friution. It is no good having so unco-ordinated and insubstantial a health education programme. One needs a programme embracing not only smoking and lung cancer but the whole area of public health problems which involve the individual's response if they are to be solved. The old Central Council for Health Education lies on the scaffold waiting for the guillotine, but the new organisation has not yet been brought into existence.

This is a most unsatisfactory state of affairs, by no means compensated for by the excellent work done by the Ministry in the design and application of posters and other forms of discouragement to cigarette smoking. More we all disappear rapidly for a quick "puff and a drag", may I reiterate my warm thanks to my right hon. and hon. Friends for their presence. May I add a word of commendation to the hon. Gentleman the Member for Essex, South-East (Mr. Braine) for his performance? I would give him eight out of ten.

Question put and agreed to.

Resolved, That this House, believing that the great majority of deaths from lung cancer are caused by cigarette smoking, urges Her Majesty's Government to take all possible steps to reduce cigarette consumption; and considers that a permanent agreement to limit cigarette advertising is now required and that special attention should be given to coupon schemes, and that in addition a nation-wide campaign of health education especially directed at school children and further encouragement for research into this form of cancer are required.