Tampons (Safety) (Hansard, 28 June 1994)

§ Ms Primarolo

I beg to move, That leave be given to bring in a Bill to make provision for tampon packaging and advertisements for tampons to carry certain warnings and information, and to require the Secretary of State to make regulations for these purposes; to lay upon the Secretary of State duties with respect to research into, and publicity for, tampons and health; and for connected purposes. Toxic shock syndrome was defined by doctors in the USA in 1980 as a severe infection of the blood, identified by a collection of symptoms, including sudden high temperature, vomiting, diarrhoea, headaches, confusion and low blood pressure. Without treatment, the infection can rapidly cause fatal respiratory and kidney failure. Toxic shock syndrome strikes men, women and children.

The infection is caused by the production of toxins by common bacteria that are present on all of us. The aspect that has attracted the most attention is the fact that, in half the cases, young women have been struck by toxic shock syndrome who have been using tampons.

The bacteria are carried by 35 to 50 per cent. of adults. They are harmless, move freely over the body frequently and are not connected with how often we wash ourselves. However, when suitable conditions arise, the bacteria have the ability to produce toxins or poisons which enter the bloodstream and circulate around the body, attacking the vital organs.

The presence of the toxins in the blood stimulates the body to make antitoxins, which have the power to neutralise the poison, but in young people that immunity may not have had the opportunity to develop, so the body is overwhelmed. Most tampon-related TSS infections occur in the age group 15 to 25, and most TSS infections from wounds and bites occur in men and children.

The bacteria do not always produce toxins during menstruation, but when they do, it is almost always associated with tampon use. The exact link between the tampon and the toxin is not known. There is no simple cause and effect; if there were, prevention could be specific and easy. Tampons have not been found to cause TSS—any one of a combination of symptoms could trigger the toxin production, but the link with tampons appears to be clear.

There are more suggested links, but what is known is that all types and brands of tampons have been linked with TSS. A particularly high absorbency tampon called "Rely" was linked to an upsurge in TSS deaths in the United States of America in 1980. The brand was withdrawn from the market, and has never been on sale in the United Kingdom, because of the recognised links.

There is currently no way of testing whether one is immune to the toxins. There is no way of carrying out checks on the levels of bacteria and their likely consequences. It is possible to avoid that form of TSS by not using tampons, but many millions of women wish to use them. My Bill seeks to make clear the precautions that 684 women should take to minimise the risk. It calls on the Government to take specific steps with the manufacturers to make the situation clear to women.

Three young women have died from tampon-related TSS in the past seven months. It is a rare disease, but that is no reason not to act. In Bristol earlier this year, a young woman of 32, with two small children, died tragically from TSS. Her mother wrote to me to support my Bill. She said that her daughter felt unwell on Friday, was vomiting and had a high temperature on Saturday, and had dramatically low blood pressure on Sunday. She died on Monday, after six cardiac arrests, and nobody made the connection between her illness and TSS.

Toxic shock syndrome is treatable with antibiotics, as long as it is identified early enough. Scores of women who have survived the illness and suffered the results of severe blood infection are receiving counselling. Many women have had their legs, toes or fingers amputated as a result of the disease. But the Department of Health refuses to send out leaflets to doctors, on the grounds that the illness is not a high enough priority.

Many general practitioners fail to recognise the illness, perhaps understandably, because of its rareness. Two doctors took no notice of Jane Grant when she suggested that the tampon that she was wearing might have something to do with her feeling unwell. She spent 10 days fighting for her life after her symptoms were wrongly diagnosed. That is simply not acceptable.

At present, tampon packets carry voluntary warnings, but they are so tiny that many people miss them. We need to ensure that the symptoms are well known, that women are provided with the necessary health warnings, and that the Government give priority to researching the disease.

A father who wrote to me about the death of his 15-year-old daughter in 1989 from TSS, connected with the use of tampons, sums up the situation perfectly: We have no complaint about those who attended our daughter. All of those who treated her clearly wanted her to survive as much as we did. No apparent stone was left unturned. She died however because a few well-established and simple facts about TSS were not widely known to any of us who were in a position to influence her treatment in those crucial early hours of her illness. Even the manufacturing industry understands the difficulty. My Bill seeks clear prominent warnings on packaging, an alert card explaining what the symptoms are and what one should do, research and information to doctors, and to ensure that the Department of Health makes TSS a notifiable disease so that we can start collecting the information truly to understand what the disease is, why it strikes women and how we can eradicate it.

§ Mrs. Cheryl Gillan (Chesham and Amersham)

I am rising to oppose the Bill, although it seems an eminently attractive proposition. The hon. Member for Bristol, South (Ms Primarolo) has highlighted an important issue, but it needs to be represented accurately. I am not associated with the tampon industry in any way, other than having discussed the matter with its representatives.

It is important that the items under discussion, which have improved the lives of so many women, should not be misrepresented, and that the hon. Lady's actions should not be allowed to scare women unnecessarily throughout the country.

In the detail of her notice of motion, the hon. Lady has called for Government regulations to make provision for 685 certain warnings on packaging and advertisements. I do not believe that any such legislation is required. The tampon industry has already made adequate provision for warnings about toxic shock syndrome on its packaging. Indeed, as early as 1980, warnings appeared on instruction leaflets inside the boxes and since the beginning of 1993 on the outside. They are quite clear. I shall read the warning: Attention—tampons are associated with toxic shock syndrome. TSS is a rare but serious disease that may cause death. Read and save the enclosed information". I cannot understand how the hon. Lady believes that placing warnings on advertisements, presumably even television advertisements, can contribute to health understanding.

Toxic shock syndrome, its symptoms and risk reduction factors, comprise a complex condition believed to be better dealt with in a more educational environment. I wonder whether the hon. Lady has seen the Tambrands Education Service literature or the Marion Cooper Advisory Service literature, which cover TSS, not in isolation, but in relation to the whole picture of an individual's health, including details on TSS.

Inaccurate information and misleading statistics have been circulated on TSS, and the Association of Sanitary Protection Manufacturers, which represents the majority of United Kingdom manufacturers of sanitary protection products, has compiled a detailed fact sheet on the known and established facts, which is widely circulated to GPs, among others. As GPs rarely see the condition, the ASPM has made provision to notify the clinical definition, arid has recommended questions for GPs to ask patients to reduce the chance of misdiagnosis.

TSS is a very rare illness, and, as the hon. Lady said, can be contracted by men, children and women—both menstrual and non-menstrual. There were only 18 confirmed or probable cases in 1992 and 16 in 1993, out of a total population of 58 million, and of those cases five, sadly, resulted in death. The Public Health Laboratory Service indicates that, of those, one or two deaths are associated with tampon use.

The Medical Research Council is not supporting any specific research into TSS, but rather basic research into staphylococcus aureus, the bacteria which causes TSS. The bug lives quite harmlessly in more than 35 per cent. of the population, but can be triggered in a minute number of cases into producing toxins. I agree with the hon. Lady that research into this organism and its effects is desirable and should be encouraged, as it affects men and children as well as women, but highlighting its relationship to tampons alone could distort the research, which needs to be more widely based.

I want to get the matter into perspective. A report in The Guardian on 21 June stated that more than 100 people a year die of paracetamol-linked kidney failure, and between 630 and 676 women die annually in the United Kingdom as a result of complications in pregnancy and childbirth, so 686 the risk is far greater in these cases than the one in 15 million chance of woman contracting TSS related to tampon use and subsequently dying.

This Bill is a regulation too far. As the hon. Lady is a Front-Bench spokesperson for her party, British industry should be aware that, based on her proposal, it can expect even more regulation were there to be a Labour Government.

I felt very sad, as we all did, for the families who have had someone die from possible TSS that could be tampon-related. I do not want in any way to minimise their loss. However, I must say that the tampon industry takes its responsibilities very seriously, and works to a voluntary code of practice that was developed with the Department of Trade and Industry.

Tampons have made a real and positive contribution to the way in which women can live their lives. More than 5,000 people are employed in the industry, including union members of USDAW, TGWU and AEU. The Bill could not only threaten their jobs but send the wrong message to women who choose to use tampons. While I do not for one minute underestimate a very rare, unpleasant and sometimes deadly condition, it is necessary for someone to underline the safety of the product and to set at rest the minds of millions of women who use it with no adverse effects. I am sure that some of those women are in the Chamber right now.

I do not want to make this a party political matter, so I shall not press it to a vote. However, it is important that excessive intervention such as is envisaged in the Bill should be highlighted, and that unnecessary scaremongering by the Opposition should not go unchallenged on such an important health issue for women.

Like the hon. Lady, I want more research into TSS for the sake of women and also for men and children, but not at the expense of the peace of mind of women throughout the country who use or wish to use tampons.