§ 3.22 p.m.
§ THE EARL OF ARRAN rose to call attention to the effects of smoking on health and to move for Papers. The noble Earl said: My Lords, I rise to move the Motion standing in my name. To-day we debate a solemn subject. What we are to talk about is literally a matter of life and death— and death in its most odious and painful form. I trust that your Lordships will not think it presumptuous of me, a layman, to initiate this debate, but it is something which affects us all— men and women, old and young, particularly the young— and I thought it might be best for someone with no special knowledge and quite removed from the disputes which, alas!, still persist, to give a short and, I hope, unbiased introduction to the weighty things which we are to hear from the experts. It is with great pleasure that I note that we are today to hear speeches from no fewer than five distinguished doctors. It is no exaggeration, I think, to say that they are, or that they represent, the best medical brains in the country.
My Lords, I have said that I am a layman, and I do not propose to enter into controversy on medical matters. Nor, I think, do I need to do so. The evidence is before your Lordships; and you will have read the Report from the Royal College of Physicians. May I quote a few of their major findings?
Cigarette smoking is the most likely cause of the recent world-wide increase in deaths from lung cancer".
20,000 people died in 1960 from lung cancer and each year 1,000 more
Heavy smokers may have 30 times the death-rate of non-smokers".
If smoking ceased, the deaths from lung cancer should fall to perhaps one-fifth or even one-tenth among men".
Various independent authorities, the Ministry of Health, the Medical Research Council, the Dutch Health Department, the United States Health Service, the World Health Organisation, have all examined the evidence of the relationship between lung cancer and smoking and have all agreed that it is established".
That is what the Committee reported. It is good enough for me. It is also, apparently, good enough for Her Majesty's Government, for the Minister
of Health has said in another place [OFFICIAL REPORT, Commons, Vol. 655 (No. 73) col. 888]:
The Government certainly accept that the report demonstrates authoritatively and crushingly the connection between smoking and lung cancer and the more general hazards to health of smoking".
My Lords, in the face of this evidence, who except a blind or a prejudiced person will dare to say that the case against cigarette smoking is not proved beyond reasonable doubt? I should not like to have the conscience of such a person. Doctors may be wrong in individual diagnoses or treatments— they often are— but is anyone seriously going to suggest that the whole medical profession throughout the world has gone mad and has reached conclusions as erroneous as they are irresponsible? Are we to hear this afternoon a lot of sophistries and quibbles aimed at undermining the power and the logic of this most authoritative Report? Are we going to burke this most straightforward and simplest of issues? It is, of course, not so easy. We are attacking a strong and, until now, an impregnable citadel. The vested interests are vast, and they are not by any means evil interests. There is, first of all, the State— and by the State I do not mean any particular Government. The most benevolent and humane of Administrations would find itself hard put to it to do without the revenue that smoking brings in. The figure for 1960 was about £ 825 million— and this, by one of those ironic paradoxes, was almost the exact cost of the National Health Service. In other words, we killed many people in order to heal many more.
§ Then there are the shareholders. My Lords, whatever our politics, let us not despise the shareholders. They are mostly small people, and they rightly put their money where they think it will bring in the most. A heavy drop in the value of tobacco shares would hit them hard. Last of all, but very far from least, there are the employees, the people who work in the industry— some 40,000 of them. What would happen to them if cigarette smoking were suddenly to be forbidden or to become taboo? Could they, overnight, find new jobs? Are they to be victimised for something, which is not their fault? No, my Lords; it is not so easy.637
§ Then there is the moral issue. Suicide is no longer a crime in this country and, although I should deplore it on religious grounds, I would not question the inalienable right of any adult to do away with himself or herself if he or she thought fit. But the operative word here, my Lords, is "adult". For in this matter we are dealing not so much with grown-up people as with children. For most of us, the die is already cast: if we have been heavy smokers we shall or shall not die of cancer, though the chances of our dying will be less if we give it up now. It is the children who matter; and they can still be saved. According to a tobacco manufacturers' report, 40 per cent. Of their regular customers have acquired the smoking habit before the age of sixteen. Do these young people realise what they are laying up for themselves? Has anyone talked to them about it? And, without the direst and most awful warnings, can any child be expected to take seriously a threat, a risk, which is so remote?
§ The Government have, I repeat, accepted the Report of the Royal College, particularly in regard to children, and the Minister of Education has said that he will circulate local authorities and provide them with publicity material. That is fine, so far as it goes, and I should like to congratulate the Government for coming out so forthrightly and openly in this matter. But is that all we and they are going to do? Surely the need for a major campaign against cigarette smoking is evident and urgent. A circular and a few pamphlets will have about as much effect as a wet sponge. What is wanted is something to impress, to jolt—and, yes! to frighten: for example, a horror film to be shown in every school in the country; compulsory lectures for school children, blinking no facts, omitting no details and portraying cancer in all its grim reality; and above all, intensive and continuing Government-inspired publicity, in the Press and on the hoardings, on the wireless and on television.
§ My Lords, it is no good being tactful or mealy-mouthed about this business. Because the thought of cancer is such an appalling thing, we tend not to men- 638 tion it; we tend to treat it as a dirty word, to sweep it under the carpet. I believe that what we should do is to shout it from the housetops, to blazon it on the hoardings, to say it and to print it, till every man, woman and child in the country is aware of what it is, what it means, and understand how it is likely to be caused.
§ Some people, of course, will say that publicity is not enough, and that the Government should go still further: that they should make cigarette smoking illegal, or tax cigarettes until hardly anyone can afford to buy them. I am not sure about this. Prohibition introduced worse evils into the United States than the liquor which it forbade; and rationing by the purse, even of something bad, is distasteful to me. One practical thing, however, which we can ask the Government to do is to forbid the sale of cigarettes in slot machines. If a boy or girl, of any age, has half-a-crown, there is nothing to prevent him or her from buying cigarettes and "cocking a snook" at the law.
§ So much for Government action. Other noble Lords will no doubt have other practical suggestions to make. But one thing, at least, of which we want to be assured this afternoon is that this time the Government really mean business. But, of course, the Government are only one of the instruments. Much— indeed, probably more—can be done by non-official bodies and individuals. The fact that neither The Queen nor the Duke of Edinburgh smokes is a prime example. Then I think particularly of the youth movements; the leaders of the Boy Scouts, the Church Lads' Brigade, the youth clubs, and Services, too. Will not some of our distinguished ex-military men give public warning to the Services of the dangers? I am sure that they would be listened to. And, perhaps most important of all, there is the great and noble army of teachers and clergy. With them, I would suggest, there lies a very special duty and responsibility.
§ Now, my Lords, for the others—the interested parties: the tobacco companies; the shareholders; the newspapers and the advertisers. For all of these it is largely a matter of conscience. They have to decide what they feel they ought to do; and because they are interested parties, their loyalties must necessarily 639 be divided. But I suggest that they ask themselves same straightforward questions, and answer them honestly. First, the tobacco companies. Do they feel— can they feel— that they are doing right in encouraging and stimulating the sale of a product which, far all practical purposes, has been shown to kill? Is it not their duty, in common humanity, to try to divert their sales, at any rate to young people, from the lethal cigarette to the more innocent 'pipe? Should they not devote far more money than they propose from their enormous resources to research into smoking and its relation to cancer? Above all, will they stop being insincere and openly admit that their criticism of the Report is based on prejudice?
§ Next I appeal to the shareholders and to those who may be contemplating buying shares. To them I would also say: Do you think it right that you should make money out of killing people? If they say, "How about armaments' shares, for example?", I would answer that in this country we build arms for defence and not for aggression.
Now the newspapers and the Independent Television Authority. To them I would particularly appeal. It has been said, I know, that tobacco advertising is directed exclusively to persuading people to smoke one brand more than another. My Lords, I do not believe this. I believe that the purpose and the effect is to make people and especially young people smoke more. Why else this concentration on romantic couples strolling along beaches and kissing in woods? Did your Lordships know that the tobacco retailers are organising an exhibition in Manchester in September, the purpose of which, according to the tobacconists' retail magazine, is
to project the image of smoking, and to make Christmas 1962 a Smoker's Christmas "?
A charming thought, my Lords! I devoutly hope that this exhibition will not take place.
§ No, my Lords, the tobacco makers want us to smoke more, and that is all there is to it. Will the newspapers and the Independent Television Authority therefore pay great attention to the advertisements which are put before them, particularly those which are aimed at young people? Will they further 640 openly agree to print all reasonable advertisements from the anti-smoking bodies? One of these organisations told me recently that an advertisement was refused by a newspaper. That is quite wrong and does no credit to the Press. In general, I would say that the newspapers have done well in giving full publicity to the Report of the Royal College. Let them continue the good work. Let them not make it just a "nine-day wonder".
§ Last of all, I appeal to noble Lords who are going to speak to us this afternoon. It may be that some of them are going to attack the Report or put up a diesel smoke screen". It may be that some of them will be so bold as to say that a lot of fuss is being made about very little. I ask them to look into their hearts and to consider that what they say may affect the lives of, and cause the deaths of, many thousands. Ours is a truly deep responsibility.
§ My Lords, I hope that I have not wearied you with these far-flung appeals and exhortations. Yet in the last resort, of course, it is mostly a matter of the public conscience, of asking people to do certain things and not to do others. Again, in the last resort it will be popular opinion, not that of the Governments or of the vested interests, which will decide. Meanwhile, let us not cloud the issues with clever arguments, or seek to delay what is right with obstructive tactics and manœ uvres. Cancer is with us, my Lords, and though for many years we have been told that a cure is just around the corner, the "prime mystery" (as Lord Cohen of Birkenhead called it) remains. Let us face it squarely, without fear, if possible, and certainly without favour. My Lords, I beg to move for Papers.
§ 3.38 p.m.
§ BARONESS SUMMERSKILL
My Lords, I should like to thank the noble Earl for having initiated this debate on what is an important aspect of preventive medicine. He has enabled the House, and indeed the whole country, to focus attention on a Report which I believe, when medical history comes to be written, will be regarded as a milestone in social medicine. I am sure that the whole House would also like to thank the Royal College of Physicians, and particularly the Committee of 641 eminent men, who gave of their time, their energy and their knowledge, to preparing this Report. I hope that everybody in this House who has not yet read the Report will look at it. They will see there what I regard as a fine example of a scientific Report designed to be read by the lay public. It is simple, concise, easy to understand, and presented in such an attractive manner that I understand it has become a "bestseller", and I believe that at the moment it is very difficult to obtain a copy.
I should like to thank the Royal College of Physicians for the effort they have made in this important field of preventive medicine. I think that every fairminded person, whether smoker or non-smoker, having read the Report would decide that it would not be rejected by an independent jury. There are certain individuals who write for the Press irrational articles of a critical kind, for reasons best known to themselves. But I think it is significant that the most violent objection has come from the tobacco industry, which has a pecuniary interest in perpetuating the smoking habit.
Of course, this Report has not revealed an entirely new field. We have been talking for many years about the high mortality rate from lung cancer and its association with tobacco smoking. Evidence of the harmful effect of cigarette smoking has been accumulating gradually over the last twenty years, I would say, and we ought to regard this Report as a final indictment. The noble Earl has told the House precisely what the figures are. Briefly, it is estimated that one out of eight heavy, life-long smokers develops lung cancer, while non-smokers have a one in 300 chance of developing the disease.
I have said that for many years this matter has been under consideration by the medical profession. Eight years ago, in 1954, the Minister of Health accepted the view of the Standing Advisory Committee on Cancer and Radiotherapy that there was a strong presumption that smoking could cause cancer of the lung. Three years later, in 1957, the Minister agreed that the advice of the Medical Research Council that smoking played a major part in the increase of deaths from lung cancer should be known to all those who had responsibilities for health education. Despite these authori- 642 tative warnings, little has been done, except, as the noble Earl has said, the publication of a few pamphlets and posters and the sending of lecturers to schools.
The effectiveness of this effort—or perhaps I should say the ineffectiveness of this effort— can be judged from the fact that, while local authorities bought about £ 3,000 worth of material from the Central Council for Health Education in the years 1956 to 1959, in the same years the tobacco industry spent £27 million upon advertising their goods. In 1960 local authorities spent £ 200 with the Central Council, while tobacco interests spent £ 11 million upon advertising. How can we hope to educate our youth while we have this powerful enemy, with its great wealth, cancelling out the effect of the posters and lectures and the efforts of the teachers in our schools?
The tobacco industry is not without powerful friends in many quarters. One striking poster, showing the smoke issuing from a cigarette spelling the word "cancer", was boycotted by the British Poster Advertising Association. Two years ago, in 1960, the Minister of Health said:There is good evidence that people in Britain are widely aware of the risks involved in smoking. The health education measures are largely directed to the young and ought to ensure that this awareness is maintained and intensified.Despite these pious hopes, which have been expressed over many years, cigarette smoking has continued to increase, particularly among schoolchildren.
Again, on the publication of this Report, the Minister has stated that he is asking health authorities to use all their channels of health education to publicise it. In the Printed Paper Office just now, I picked up one of the circulars which have been issued by the Minister of Health and the Minister of Education. But this kind of work has been done for years, with little effect. I say that this is not enough. The public is waiting for a strong lead from the Government. Any failure to take action now will be interpreted as a lack of confidence in this Report. If this authoritative document is not accepted by experts and by Government Departments, and if authoritative action is not taken, people will ask themselves 643 why they, as people who are not supposed to have any knowledge of these scientific matters, should observe the warnings and recommendations. I believe that there has been a conspiracy of silence for too long.
I was impressed by the delightful, short statement of the physicians in the Report, in which they sum up the position as follows:At present both social custom and commercial pressure outbid the voice of caution and the balance must be redressed.To-day a number of speakers come to your Lordships' House to ask us to help to redress the balance. Of course, statisticians employed by the tobacco interests have sought to discredit evidence based solely on statistics, and I am sure that noble Lords who wish to discredit this Report will mention this point this afternoon. Undoubtedly, there is a strong statistical association between smoking, especially cigarette smoking, and lung cancer, and I would remind your Lordships that it is supported by laboratory and pathological evidence.
May I give your Lordships three instances? Substances known to be capable of producing cancer have been detected in tobacco smoke. Secondly, cancer has been produced in the skin of animals exposed to repeated applications of tobacco tar. Furthermore, microscopic examination of the bronchial epithelium, the lining of the membrane, of smokers reveals changes of a kind which may precede the development of cancer. Surely all this is scientific evidence, which has been produced by some of the finest brains in our research laboratories. Can anybody afford to disregard this evidence?
The terms of reference of the Committee include other illnesses related to smoking. Let me remind your Lordships that in recent years investigations have revealed association between the smoking habit and death from coronary diseases. Although association with smoking is clear, nevertheless, there are other factors, such as mental strain, sedentary occupations and over-eating, particularly over-eating of fatty substances, which may increase liability to coronary thrombosis. Therefore, it is not possible to assert, as it is in a case 644 of lung cancer, that the association between coronary diseases and smoking is causal.
Let me say something about the incidence of chronic bronchitis in the community, which is also mentioned in this Report. While cases of cancer of the lung and coronary diseases are universally recognised, the association of smoking with chronic bronchitis and, indeed (although I say this very gently) the association of smoking with a chronic cough are not regarded seriously enough. But I think it must be obvious, not only to the medical fraternity but also to lay people, that, with age, the chronic cough insidiously changes into something else.
For some years I was the Member for Warrington, where the mortality rate for chronic bronchitis was one of the highest in the country. I recognise that the pollution of the air in Warrington was very high, but at the same time, smoking is very heavy in the industrial towns. This distressing disease provides one of the major causes of disablement and death, particularly among middle-aged and elderly men. Another factor which should be borne in mind by the Government and the Ministry of Labour is that bronchitis is the cause of 10 per cent. of the loss of working time in this country.
The fact— and it is a melancholy fact— is that the expectation of life of men of 50 is little better to-day than it was 50 years ago. I would remind your Lordships that I am taking a figure of 50, not from birth, because the expectation of life from birth has increased; but the expectation of life of a man of 50 is little better to-day than it was 50 years ago. The main reason for this is the increasing mortality from heart and chest diseases.
I think it is generally agreed that the smoking addict who has conditioned himself to 20, 30, or 40 cigarettes a day presents a problem not only to himself and his family, but to his doctor; and it is a problem which often proves insoluble. Therefore, I feel that our primary object should be to advise and help young people not to acquire this dangerous habit. We were all young once, and we cannot expect youth to heed the warnings of adults who tell them that if they continue smoking they 645 might develop a malignant disease or coronary thrombisis, because we all know that the lure of the forbidden has always exercised a fascination on the young. The average boy or girl is more concerned with the present and the impact that his personality makes on his friends. The tobacco advertiser is fully aware of this and places great emphasis on smoking as a mark of manliness in the boy and of sex appeal in the girl.
For this reason, I think the advice given in the Guardian in a letter by an education officer is sound. He said:The eventual aim must be to make smoking unfashionable for young people. Only when to smoke cigarettes means to be 'not with it' can we expect to see any dramatic results. Star footballers, cricketers, young pop singers and other contemporary heroes will have to make their rejection of cigarettes known loudly and continuously.I should like to add one other category to this list— namely, the non-smoking girls, who should seek to project the image of the young men they admire. We must remember that to-day boys are in the majority, and the consumption of cigarettes, in my opinion, would fall in a spectacular manner if a girl made non-smoking a condition of "going steady" with her boy friend. After all. I am speaking to a male audience who in their time have known something of love and I am glad to know that in that love there was a sympathetic acceptance of that approach.
May I deal quite briefly with the recommendations in the Report? The Report advises that education should be undertaken among school children with great energy and imagination. What I would do if I were head of a school would be to pick out the masters who are non-smokers; who are the most popular; who are good sports and, we hope, good at lessons as well, and ask them to direct the propaganda. If these people were not available, then I would ask the boys in the top form and give them the responsibility for teaching the young ones.
It is recommended that there should be restriction of the advertising of tobacco, which means that the Minister of Health must face up to the powerful and ruthless tobacco lobby in the interests of public health. I say, more in sorrow than in anger, that the cigarette manufacturers to-day must know that they are guilty men, although they har- 646 bout a curious notion that they can absolve themselves from this guilt by devoting some of their ill-gotten gains to research. My Lords, this is a little like the housebreaker making a contribution to the police orphanage. If the tobacco industry were quite sincere in this matter, then the correct scientific approach would be to stop the manufacture and sale of cigarettes until such time as they have succeeded in producing a safe product. Indeed, if I may refer to the Question that I put down for today, I said— and I am sure all thinking people here agree with me— that the pharmaceutical industry should not distribute drugs unless they have had a proper clinical trial, because the people of the country should be protected. In precisely the same way, if the tobacco industry believes that these cigarettes contain a carcinogenic, then they should say, "We will withdraw them until we can market another product."
The next recommendation is that there should be wider restriction of smoking in public places. I am glad to learn that the London County Council and other local authorities are considering how to implement this recommendation. This is important, because it will serve to emphasise the anti-social nature of smoking among people who have a right to object to a polluted atmosphere. I hope that the Ministries will be bold and imaginative and will lose no time.
It is suggested that there should be higher taxation on tobacco. I am a little dubious about this. If we are to accept the fact that the tobacco addict must satisfy his craving for nicotine at all costs, I feel that higher taxation may in the poorest homes result in the necessities of the rest of the family being sacrificed for the smoker. That, of course, would be tragic.
The next recommendation I think is excellent. It is recommended that the amount of nicotine, tar and volatile irritants contained in each cigarette should be printed on the packet. I attach great importance to this, because if it is made clear that each cigarette represents a dose of harmful substance, then this must induce some serious speculation in the smoker. It is suggested also that there should be antismoking clinics to which doctors could send patients. I am not sure that men 647 would consent to visit these clinics publicly, because it might indicate that they were lacking in willpower. I think that in conjunction with these measures there should be advertisements in the newspapers stating that these clinics were available and that men could visit them without any undue publicity.
Finally, if these methods fail, then the time must come when the Government should take stronger action. Let us recall that cholera, typhoid, smallpox and tuberculosis have been checked in the first place only by strong central action. It is the Government of the country who have the power and the duty to guide and protect the people, and they must not be diverted by the clamour of commercial interests.
§ 4.0 p.m.
§ LORD AMULREE
My Lords, when I first saw the Motion which the noble Earl had put down on the Order Paper, my mind was taken back to a warm July afternoon in Paris in 1950, when I was taking the Chair at a Session of one of the meetings of the big Cancer Congress that was being held at the Sorbonne at that time. As I say, it was a hot July afternoon. We had been given a very good lunch, and there were not many people present at the meeting, but the speaker was Dr. Wynder from New York. It was there, I think, that he first read a paper which suggested that there was some connection between cancer of the lung and cigarette smoking. Although one felt a bit drowsy at first, those of us who were there soon began to wake up and realise that something important was being said. Since then there have been a number of surveys which have confirmed what Dr. Wynder put forward rather tentatively, and finally the Report which has led to this debate. The Report of the Royal College of Physicians has summed up the situation extremely well; and when the Committee say that deaths from cancer of the lung are thirty times as many among those who smoke as among those who do not, then we come into the realm of things which are really significant.
I quite agree that the evidence at present is almost entirely statistical, but I do not think one need take any great exception to it for that reason. Not so long ago, in 1853, Dr. John Snow, by 648 taking away the handle of a pump in Broad Street, did a great deal to check the cholera epidemic; and showed that cholera was caused by drinking contaminated water. That was a long time before the bacteria which caused cholera had been discovered. The report he wrote then is a masterly example of statistical figures assembled very properly, with a good bit of deductive logic which has never been proved wrong. Therefore, I do not think we can despise the evidence because it is purely statistical.
Another matter which I think is very important is to get proper proof that cancer of the lung is increasing to the extent that it is said to be. It is mentioned in the Report of the Royal College that, whereas the standardised death rate for cancer for all sites— that is, standardised for the age and sex distribution of the population in 1951— has been falling for quite a long time, the standardised death rate of lung cancer is showing a sharp and steady rise. The more evidence one acquires, the more one finds that it is among those people who are heavy smokers that this great increase occurs. I agree entirely that it is extremely difficult to find proof of a purely pathological or clinical nature, partly because the animals upon whom experiments are done do not readily develop spontaneous lung tumours, and partly because (apart from the fact that, as the noble Baroness, Lady Summerskill, quoted, a certain amount of cancer of the skin has been developed) no cancer of the lung, so far as I know, has been introduced by treating mice and other experimental animals with cigarette smoke. I think it is because we do not go about it in the right sort of way, and we may not be able to get that evidence until animals can be taught to smoke in the same way as human beings, which I think would be an extremely difficult thing to accomplish.
An argument which is raised in opposition to this statistical evidence is that a large number of people who are really heavy smokers do not develop lung cancer. I do not think this is a very significant observation. If a certain number do, then you have to get a great deal of evidence to show that that kind of argument is a really significant one.
649 It has been suggested that some curious congenital condition, or some defect in people's lungs, makes them more prone to diseases of the lung: and that the mortality from tuberculosis of the lung has fallen at the same rate as mortality from lung cancer has gone up. Again, I do not think that is a valid argument, because there appears to be no connection between the two. Although some people have said for a long time that there was some curious link between pulmonary tuberculosis and lung cancer, I do not think there is a great deal of evidence for that.
One question which I think is a serious one is of atmospheric pollution, which probably serves to produce lung cancer. One has to agree that this is almost certainly another cause, but it is a cause which is nowhere near as great as that of cigarette smoking. When one compares mortality among non-smokers on, say, Merseyside, with the mortality among non-smokers in the rural part of North Wales, there is a significant difference, but it is not nearly as big as the difference in mortality between those who smoke and those who do not. Among males of 35 to 74, the death rate is about twice as great on Merseyside as in the rural parts of Wales. When one takes adult non-smokers who emigrate from this country to countries with a rather purer atmosphere, like New Zealand and South Africa, it is found that the incidence of lung cancer is greater among those people who come from our own country. Indeed, one finds in many countries where, so far as one can see, the pattern of smoking is about the same, that there is quite a big difference in the incidence of the disease.
There was one occasion, which the noble and learned Viscount may possibly remember, when he gave an extremely charming tea party in his flat to Marshal Bulganin and Mr. Khrushchev. I sat on the sofa talking to Marshal Bulganin, and was surprised to find that I was talking to him about lung cancer in the Soviet Union. He told me that although the people in Russia were heavy smokers of cigarettes, he did not think there had been that large increase in lung cancer which we had experienced over here. Therefore, possibly there may be something in the 650 atmospheric pollution which, combined with cigarette smoking, sets off something really lethal in a country like this, where the figures are, I think, higher than in most countries in the civilised world.
I think most of your Lordships would agree that the amount of pollution in the atmosphere is not as bad as it was 50 or 60 years ago. There are not so many fires burnt for domestic heating, and one certainly does not get those thick "peasoup" fogs which I remember so well when I was a child living in this part of the world. On the other hand, there has been a considerable increase in the amount of fumes from petrol engines, and a certain blame has been attached to the diesel engine. There one has to be very careful, and I think my noble friend Lord Colwyn may have something to say about that later on. But it is a fact that when one has found the cause of a cancer, and this is known for quite a number of occupational and industrial cancers, one has usually to allow a very long exposure before the actual cancer develops. I have no figures to give your Lordships, but I should have thought that the great increase in diesel fumes has dated from since the war rather than before the war. It is a comparatively short time for an agent that might be held to be carcinogenic in its origin.
I accept, as indeed the noble Earl and the noble Baroness accept, what is said in this Report: that heavy cigarette smoking leads to lung cancer. What can we do about it? In the first place, I do not want to suggest that anything should be done in panic, or too quickly, because one of the things that is more frightening than cancer itself is the fear of cancer. One has seen too many people 'who have this dreadful complaint called cancer-phobia and who have nothing wrong with them at all. It is a dreadful thing to say, but it would almost be better if they were suffering from cancer rather than from cancerphobia. One thing we have to be extremely careful about is to do nothing to encourage that.
There are certain simple things which could be done now and which would cause no trouble at all. This, I believe is one of the few countries in the civilized 651 world where people are allowed to smoke in cinemas and certain theatres. Certainly people cannot do so in the United States, and certainly not in France and a great many other European countries. I can see no reason at all, therefore, why it should not be firmly stopped here; although whether it would be done by the Government or local authorities I am not quite sure.
Moreover, I can see no reason why people should smoke in public transport. There are double-decker buses in London in which no smoking is allowed down below, but people can smoke on the top deck. I should have thought a great deal of good could be done by stopping this. I am not quite sure, but I believe it has been done in trams in the city of Glasgow, and that has passed off without any great trouble or difficulty. The same applies to underground railways. It is bad enough, in all conscience, if you have to go underground and breathe the fumes you get down there. I do not see why it should be made worse by people puffing pipes and cigarettes. You cannot smoke on the Underground either in Paris or in New York. I also think that smoking should be prohibited in shops, particularly those which sell food. That has been done in Continental countries to quite a big extent, with no particular trouble, rioting or difficulty, and I think that in this country the big firm of Marks and Spencers do not allow people to smoke in their shops.
I should like to refer to the rather insidious advertising in illustrated papers by fashion houses, both for men and women. Frequently one sees a male or female model, wearing attractive clothes, with a cigarette in one hand. That, I am sure, encourages people to smoke. There are probably various other places, too, where one can see these advertisements. Then one comes to the tobacco advertisements themselves. There we are in great difficulty and I am not quite sure what the Government can or should do. It is very difficult to interfere too much in what people care to advertise, but one would like to make an appeal to the tobacco companies, and I believe that this need not necessarily fall on stony ground, because they have done a great deal of work to find out about this association between lung canner and tobacco. They have spent a great deal 652 of money on research of all kinds, and I think they might, in view of this debate and of the great interest shown, cut down some of their advertisements, because although these are said to be merely to advertise one brand against another, I agree with the noble Baroness that they are shown for another purpose altogether—to encourage young people to smoke. One would like to see that kind of thing stopped.
Finally, there are two points I want to make. People talk of the soothing effect which tobacco can have on those who are worried and nervous. I do not believe the effect comes from the tobacco at all; I believe it comes because they have something to do. It is because they like something to play with or something to hold in their hand. It is not the tobacco smoke which has the soothing effect, it is having something to do when feeling nervous and worried. That is an important point for the general public to know. Much has to be done by teaching, education and example.
There was a time when, travelling round the country, one used to see terrible exhibitions showing hobnailed livers and the dreadful effects that drinking had on people. A lot of drink was consumed by a great many people who became very sick from it. People do not drink as much now, partly because of better education and partly because drink costs more than it did. But I am not at all sure that education has not done more to get people drinking at the right time, and not at the wrong time. If people want to smoke, I should like to see them do so at certain times of the day, and not regularly from the time they rise in the morning until they go to bed at night. I am sure that if that change were to occur, the incidence of that particular form of cancer would drop over a period of years. I have great pleasure in supporting the Motion put down by the noble Earl this afternoon.
§ 4.18 p.m.
§ LORD SINCLAIR OF CLEEVE
My Lords, at the outset I must declare an interest. Since 1919, with the exception of the war years, I have been concerned with the manufacture and sale of tobacco. Throughout that period, and for seven years before it— for I started to smoke when I was 19—I have been 653 a fairly heavy smoker. I recognise, therefore, that whatever I say on the subject before your Lordships to-day may be represented as more than a little tinged by some prejudice or bias in favour of smoking. On the other hand, I feel that my experience enables me to speak on this subject with some knowledge and I shall endeavour to be as factual and objective as it is possible to be.
I felt glad when the noble Earl put down this Motion. I felt glad on two counts. First, because I hoped that it might give an opportunity for an objective review of this problem, which is of great public interest, and also because I saw that it could give me an opportunity for refuting conclusively, and, I hope, convincingly to your Lordships, some of the baser allegations that have been made against the reputation of an industry which I, for one, have been proud to serve. I propose to relate my remarks to the basic and fundamental problem of the alleged causal connection between smoking and lung cancer. As for what the noble Earl referred to as the commercial aspects— that is to say, advertising, marking of packets and so forth— my noble friend, Lord Ampthill will deal with them when he speaks.
I should like, in the first place, to say something about the attitude of the manufacturers towards this basic problem and to describe what they have done and are doing; and then, in the second place, to state and comment on some of the facts on those facets of this basic problem of which the manufacturers have knowledge.
From the time (and this is now some twelve years ago) that some medical statisticians of this country published the prima facie evidence which might point to the causal connection between smoking and lung cancer the manufacturers have endeavoured to keep in the closest touch with the statistical inquiries and with the medical, physical and chemical research on the subject. It was some three years later, as the noble Baroness, Lady Summerskill, reminded us, that the Standing Advisory Committee on Cancer and Radiotherapy reviewed the evidence of the statistical association as assessed by the panel set up by the Chief Medical Officer of the Ministry of 654 Health. That Committee endorsed the conclusion of the panel that there was a strong presumption that the connection was causal.
There were, however, then, as there still are, a number of facts that seem inconsistent with that theory. It was, moreover, at that time very clear, not only that there was no scientific proof of a causal connection, but also that the amount of research that had been done was very limited. Manufacturers felt, as indeed at that time did some medical authorities, that although the statistical association might be considered strong, until science could show how or why smoking could cause lung cancer the causal connection could not be considered proved. And their first and natural reaction was to set out to help in finding the truth so that if there was in tobacco or tobacco smoke anything that could cause the disease it could be eliminated.
The manufacturers then did two things— this is in 1953– 54. First, after consultation with the Minister of Health, they placed at the disposal of the Medical Research Council a sum of £250,000 to assist research, in any way which that Council might deem appropriate, into the cause or causes of lung cancer. Secondly, they intensified their own research work on the physical and chemical side. They informed the Medical Research Council of what they were doing, and they made it clear that they were anxious to follow up within their own field any lines of research which the Medical Research Council might consider could usefully be pursued.
Although research into the whole problem was going on in many countries, progress seemed slow. It had been limited, I believe, to some extent by lack of knowledge as to which are the most fruitful lines to follow. To some extent in this country it has been limited by a lack of people who were both qualifield and available to undertake it. In 1956 the manufacturers set up the Tobacco Manufacturers' Standing Committee. That Committee had as its first advisers in the statistical and scientific fields two men of great eminence in their respective spheres, Sir Ronald Fisher and the late Sir Alfred Egerton.
The function of that Committee was two-fold: first, to give financial assist- 655 ance to medical research into the effects of smoking on physical and mental well-being and to subvent the follow-up on the medical side of any lines which the research undertaken in the manufacturers own laboratories showed to be likely to throw light on the cancer problem; secondly, to keep in touch with all the research work, statistical or medical, going on in various parts of the world in relation to smoking and health. The Committee have in the last five years accumulated a great deal of information. I will deal with some aspects of this with particular reference to the conclusions of the recent Report prepared by the Royal College of Physicians when I come to the second part of my remarks.
I trust that no one will infer from what I have been saying that availability of money for research is all that matters. In our present state of incomplete knowledge it is very important. I think it is true that neither medical nor chemical research into this question has been, at least in the last decade, restricted by lack of funds. It is also true that, apart from the financial assistance which they have given to medical research, the manufacturers themselves in their own laboratories have conducted a very large part of the chemical research that has been done on this subject in this country; and in all this they have worked in the closest cooperation with the medical authorities, and all their research work in this field has been available to the Medical Research Council and its appropriate committees. In short, my Lords, the manufacturers have consistently done everything in their power directly and indirectly to assist in establishing the facts of this highly complex and baffling problem.
I now come to the second part of my remarks. There are, I think, certain facts which should not be overlooked if the conclusions of the Royal College of Physicians' Report are to be seen in true perspective. In bringing these facts to your Lordships' attention I need hardly say that the last thing I would wish to do is to try to minimise the gravity of the problem or fail to recognise the distressing seriousness of the disease itself. Within the limits of a 656 reasonable demand on your Lordships' time and patience it is not possible to cover the whole ground, but I will try to deal with at least some of the most important aspects. May I say here, so that I should not appear to be sailing under false colours, that I am neither a professional statistician nor a scientist, but I have read and studied over the years a great deal of the evidence on this problem on both sides?
It would be crude to the point of cynicism in this context to say that man must die of something and if medical science were to find, and there were freely available, the means of prevention and cure of every disease save one, then man would die either of that or of old age. Yet that contains an element of truth that bears on this problem. Since it has been said that the most reasonable interpretation of the statistical evidence is that the relationship between smoking and lung cancer, and probably particularly so in the case of heavy cigarette smokers, is one of direct cause and effect, we ought to look at the figures. To some extent, as is brought out in the Report, the increase in lung cancer deaths has been accentuated over the years by improvement in diagnosis. This, however, would not greatly affect the comparative figures over the last ten years.
It is noteworthy that the average annual deaths in England and Wales in the last three years of men aged 45 to 64, for which statistics are available, compared with the corresponding three years ten years earlier, show this for the three principal respiratory diseases— cancer of the lung, bronchitis and tuberculosis: first, no significant increase in total, despite a rising population and greater longevity; secondly, bronchitis remaining practically the same; and, thirdly, a large increase in lung cancer being matched by a corresponding decrease in tuberculosis. The same is broadly true if the figures are taken for men and women together in the same age groups. The sharp decline in tuberculosis mortality is, as the Report says, largely attributable to modern treatment. Yet it has been shown that some people who otherwise might have died from T.B. are dying of lung cancer. In this connection it is relevant to note that, although there is a good deal of 657 medical evidence to show that tuberculosis scars may in some cases increase the susceptibility to lung cancer, statistical evidence on this is as yet far from complete.
I now come to a somewhat different point. The Report admits that most smokers suffer no serious impairment of health or shortening of life as a result of the habit. But there are as yet no certain means by which the minority who are more likely to be affected can be identified. The evidence quoted in the Report suggests that, in so far as smoking may cause lung cancer, it is primarily, at any rate, excessive cigarette smoking that is the cause. Yet the very great majority of heavy cigarette smokers do not contract the disease. I would, incidentally, venture to suggest that the Report does not adequately examine the theory that in some of the cases of heavy cigarette smokers who contract the disease "chain smoking" may be symptomatic of the susceptibility rather than itself a direct cause.
Apart from that, however, there remains this important factor of individual susceptibility to the disease. Some years ago Sir Heneage Ogilvie produced some interesting theories on the ageing of tissues or cells. A good deal of work is being done on the question of susceptibility, but much more remains to be done. I suppose that every now and again we hear or read a phrase which has a peculiar ring of truth, even though it is cloaked in some fantastic guise. When I was preparing my notes for this speech to-day I recalled an article written by Sir Heneage Ogilvie which I had read some years ago and which had impressed me at the time. I found it in the Lancet of July 6, 1957, and I should like, if I may, to read a short quotation from it.
After talking about the "ageing" of tissues or cells— for example, how at a certain stage the respiratory epithelium tires in its ceaseless war against inhaled bacteria—and then asking what it is that suddenly turns a patch of "cancer in situ" which has long been dormant into a malignant tumour, Sir Heneage went on to say:Like most general surgeons, I have treated and watched many cases of cancer. Some were relatives; many were friends; others, coming as patients, died my friends. I have 658 slowly come to frame in my mind an aphorism that can never be stated as such, because no statistics can be advanced to support it: 'The happy man never gets cancer '.He went on to say—Very often—indeed so often as to suggest that if the true cause could be discovered the problem of cancer treatment might be solved—the signal for renewed growth seems to have been some unhappy event.Then there is the question which has already been touched on this afternoon, of atmospheric pollution— whether, along with cigarette smoking, that may contribute to the cause of the disease, or whether, indeed, atmospheric pollution may not be the major reason for the increase. If individual intake could be accurately measured, there seems strong presumptive evidence that a statistical association could be established between atmospheric pollution and lung cancer. The striking differences in the incidence of lung cancer and bronchitis between urban and rural areas, and between one country and another, reflect in varying degrees the effects of air pollution. To take only one example, Dr. Stocks's research has shown a 7 to 1 variation in male lung cancer mortality rates between certain urban and rural localities in Northern England and Wales. I think that was the investigation to which the noble Lord, Lord Amulree, referred.
Another inquiry, covering the whole country, has shown a range of variation between town and country of 4. 2 to 1, but in this case "country" included some people who spent most of their time in towns, so there may be little disparity between the results of these two inquiries. There is no comparable difference between the amount individually smoked by those men who live and work in towns and those who live and work in the country. Much more research is clearly needed into the constituents and effects of air pollution. The Report has recognised the importance and complexity of this factor, but has deferred its examination into it until a later date. That may be inevitable; yet if one is to be objective I am afraid that the conclusion must surely be that the present assessment of the problem is incomplete.
There have been a great many statistical inquiries. I am not qualified to offer expert criticisms of them; nor 659 would I in any way impugn the ability or sincerity of those who made them. Yet an objective appraisal cannot ignore the fact that eminent statisticians on both sides of the Atlantic have disagreed about the conclusions to be drawn from them. Sir Ronald Fisher in a publication in 1959, said that the change (he was referring to the increase in lung cancer) gives not the least evidence of being due to increasing consumption of tobacco. In 1961, he expressed the view that genotypic factors, combined with changes during the present century in the nature and extent of air pollution and in the relative exposure of men and women to air pollution adequately account for the incidence of lung cancer.
Dr. Joseph Berkson, of the Mayo Clinic, and Professor of Statistics at the University of Minnesota, has expressed the view that, on the present evidence, it is unlikely that either smoking or air pollution contributes to lung cancer. In Dr. Berkson's view there is no valid evidence of physiological mechanism by which either factor would induce lung cancer, and all experimental work has failed to confirm the theory. The only evidence is statistical in nature, and this evidence contains too many conflicts and has left too many unanswered questions to be accepted as conclusive evidence of a causal relationship.
There have been many references recently to diesel fumes. The result of a small-scale investigation published in 1957 of the incidence of lung cancer among certain employees of London Transport, seemed to acquit diesel fumes. Perhaps they are not a prime cause, but they must be a factor in air pollution, and there can be no question that the relevance of air pollution to this problem urgently requires more examination.
Since the Royal College of Physicians' Report was published there has appeared the result of an investigation into smoking habits in Southern Ireland. I must not weary the House with detailed figures, but, in summary, this is the result. The consumption of cigarettes per head of the population aged sixteen and over per day in Southern Ireland is almost exactly the same as in England and Wales, although a higher proportion of the population in Southern Ireland 660 is rural. In 1959 (which is the last year for which statistics are available) the mortality rate per 100,000 for respiratory cancer in men was 33 in Southern Ireland as compared with 87 in England and Wales. That would appear to be striking confirmation of the theory that air pollution in this country is an important factor.
To come back to the general argument, it is, of course, natural that some people should feel that, since a statistical association is not of itself proof, to take that as the basis for incriminating cigarette smoking in general, or heavy cigarette smoking in particular, as one of the causes of the increase in lung cancer might conceivably be un-warranted. It could also divert research effort from other possible causes, and thereby delay the discovery of the truth. It could cause increasing alarm, or even instil fear. But I must make it clear that the manufacturers have never stressed that point; nor have they sought to defend excessive smoking, for no one can claim that excess in any form is good. What the manufacturers have said is that the case, as presented by the Report of 1957 and this latest Report, leaves too many important questions unanswered; that, while there is no lack of publicity for, and awareness of the public to, the possible risks, the thing that matters most from every point of view is that there should be more and more research to establish scientifically whether and, if so, how and why, smoking can cause lung cancer.
They have suggested that perhaps the three most fruitful lines of further research— though by no means the only ones— are, first, further investigation into the chemistry and biological effects of tobacco smoke; secondly, research into the circumstances which cause individual susceptibility to cancer generally or to lung cancer, in particular; and thirdly, research into the harmful constituents of air pollution in this country. The first is perhaps a logical extension of work of which the greater part has been, and is being, carried out already in the manufacturers' own laboratories; but, as I have said, they are ready and anxious to follow up any lines that may be suggested by medical authorities as worth pursuing. The Report refers to the fact that tobacco smoke is extremely complex 661 in composition. Some 300 compounds have been identified in it. Included in this are 16 different substances capable of initiating cancer in experimental animals, but most of them have been found in infinitesimal amounts in smoke; nor has any experiment so far resulted in exposure to tobacco smoke producing lung cancer in animals. Against this background manufacturers are setting up laboratories at Harrogate, where large-scale bio-assay work will be undertaken under the direction of a pathologist with long experience of cancer research.
The second suggestion is founded on the theory that since only a minority of heavy smokers develop cancer, it would be a constructive approach to seek means of identifying the individuals who constitute this minority. There, is, I believe, a growing body of evidence to suggest that certain personal and environmental characteristics are to be found more frequently in lung cancer patients than others— in a word, individual susceptibility. This research could, I feel, be abundantly worth while.
As regards the third suggestion, that of atmospheric pollution, I am aware that this is an extremely complicated subject, but it is none the less highly important and very relevant to the whole problem. I can assure the noble Viscount the Leader of the House, who, in his capacity of Lord President of the Council, is responsible for the Medical Research Council, that if there is any further stimulus and aid to further research on these or other fruitful lines which can be given to that body, the manufacturers would welcome it and would themselves co-operate to the utmost.
Before I leave the subject of further research, I should like to touch very briefly and objectively on the benefits of smoking. The Report says that they appear to be psychological and social and are hard to express in quantitative terms. It concludes that the pleasures of smoking must be now be weighed against its dangers. Perhaps it might have been fairer to say that the pleasures and benefits of smoking must he weighed against the possible risks. There can be no doubt that many smokers feel that they find benefit as well as pleasure from it. It certainly can ease tension; some find it an aid to concentration and think it has a stimulating effect on the brain; and to those who indulge in it, it is a 662 pleasurable and sociable habit. The pharmacological effects have so far been the subject of little scientific study, but the observations of Professor Burn, Emeritus Professor of Pharmacology at Oxford, show the need for further research on what I may call the positive side of this problem as well as on the negative side.
There will, I think, be many who are not convinced by the argument in the Report, although they are impressed with the weight of medical opinion behind it. Let us look at the conclusion of the Report, paragraph 41 part of which was quoted by the noble Baroness, Lady Summerskill. It says:The strong statistical association between smoking, especially of cigarettes, and lung cancer is most simply explained on a causal basis. This is supported by compatible, though not conclusive, laboratory and pathological evidence—namely (a) the presence of several substances known to be capable of producing cancer in tobacco smoke; (b) the production of cancer of the skin in animals by repeated application of tobacco tar; and (c) the finding, in the bronchial epithelium of smokers, of microscopic changes of the kind which may precede the development of cancer.Taking that point by point, I have shown, first, that there are eminent statisticians who do not agree that the causal connection is proved by the statistical evidence; second, that no substance known to be capable of producing cancer has been shown to be present in tobacco smoke in quantities sufficient to cause cancer of the lung in human beings; third, that despite a great deal of experimentation no amount of exposure to tobacco smoke has caused cancer of the lung in animals; and fourth, that of the microscopic changes found in the bronchial epithelium of smokers it apparently can be said only that they are "of the kind which may precede the development of cancer". That statement seems to imply that it is in the bronchial epithelium of smokers that these changes occur. Yet research by Professor Cunningham of the Royal College of Surgeons, among others, has shown, I believe, that it is by no means uncommon to find no abnormal changes at all in the bronchial epithelium of individuals who have smoked heavily and who also have been exposed to polluted air for many years.
To anyone who has read only the R.C.P. Report, I think the case for the assumption of the causal connection 663 could appear very convincing. May I here give a personal view? This is an opinion; it is not an argument, but I should be less than frank if I did not say it. I sincerely and honestly believe that the case is not proven. I admit I am influenced by my own experience—and I do not mean by that merely the pleasure I personally derive from smoking—and I am influenced by having attempted over many years to study and assess the evidence as far as I could. Until we know how or why smoking may cause lung cancer in certain cases—and they clearly cannot be more than a small minority of smokers—or until the real or major cause is found elsewhere, I think the case for further and intensified research is unanswerable. Were this not my personal conviction, I could not support the attitude of the manufacturers as I do.
In conclusion, my Lords, clearly no one can say to-day that smoking cannot be, in certain circumstances, a contributory cause of lung cancer. That could be established only if it were proved that the real cause lay elsewhere. From the time, however, that various medical authorities began to accept the probability that the statistical association pointed to a causal connection, manufacturers have done everything in their power to assist the establishment of scientific proof one way or the other, so that if in tobacco or tobacco smoke there were found any substance in quantities sufficient to cause cancer of the lung in human beings, steps could be taken to eliminate it. No such substance has so far been found. Moreover, the statistical evidence is questioned by many authoritative people who are as disinterested as those who accept it. It is in these circumstances that manufacturers have stated the case as they see it for still more research.
§ 4.48 p.m.
§ LORD COHEN OF BIRKENHEAD
My Lords, I, too, must declare an interest in this debate. I come from Merseyside, an area in which there is the maximum incidence of cancer of the lung in this country. I have been associated with a hospital in Liverpool for over forty years, and each year I have seen in the wards and in the autopsy room of our hospital the increasing inci- 664 dence of cancer of the lung, until now hardly a day goes by without one having to condemn to death one of the patients who enters our wards because of this disease. Nearly one hundred years ago in Battersea Park Disraeli declared that the health of the nation is the surest foundation upon which its power and happiness as a State depend. Those who subscribe to Disraeli's doctrine will be grateful to the noble Earl, Lord Arran, for having initiated this debate and having once again alerted the Government and the public of this country to the grave and increasingly alarming hazards of smoking.
We have had this afternoon a remarkable tribute to the Report of the Royal College of Physicians. It has been said in the Press by the Tobacco Manufacturers' Standing Committee that it contains nothing new. That is true. But what it has succeeded in doing is marshalling the facts with such cogency, such power and authority, that for the first time the Government in this country have accepted that conclusion, which it regards as an" authoritative and crushing conclusion", that cancer of the lung and smoking are causally connected. Therefore, I do not propose to deal in detail with evidence which is in the College's report.
The College has rightly criticised the Government for not having taken earlier action; and, indeed, the noble Baroness, Lady Summerskill, and the noble Lord, Lord Sinclair of Cleeve, have referred to advice given to, the Government earlier. I would add just one line of history to theirs. In 1955, the Standing Medical Advisory Committee of the Minister urgedthat appropriate action should be taken constantly to inform the public of this connection, and of the risks involved in heavy smoking.Each of these public announcements, whether by the Medical Advisory Committee, the Standing Committee on Cancer and Radiotherapy, or the Medical Research Council in 1957, has had a temporary effect on the sale of cigarettes and on the price of tobacco shares. But, regrettably, it has been very short-lived, because there has been no adequate follow-up with the pressure which should have been exerted. However, the Minister has stated the Government's present 665 attitude and it is much more promising. We look forward with keen anticipation to what the noble Viscount the Leader of the House will tell us of the Government's intentions. I think it is significant that the Minister of Health has accepted these conclusions so avidly, for the Guardian said a week ago of the Minister of Health that hiswhole attitude was positive, and that of a man who might even go to breathtaking orsignificant words—breathgiving lengths of action.I can but hope that the Minister of Health's attitude has inspired and urged the other members of the Government to a similar attitude of mind.
As I said, my Lords, I do not propose to reiterate the arguments. And let me say at once that any attempt to rebut or refute the arguments of the Tobacco Manufacturers by vituperation or abuse is quite useless. They must be rebutted by rational argument; by presenting the results of investigations which have been carried out; by examining their own statements— the statements of the Tobacco Manufacturers' Standing Committee—on the scientific aspects of the College of Physicians' Report, which have been reiterated cogently and clearly by the noble Lord, Lord Sinclair of Cleeve, this afternoon; and also (although I do not propose to discuss this aspect) by examining the arguments which have been put by the Tobacco Advisory Committee, and which tend to rebut the commercial recommendations on the commercial aspects of the College of Physicians' Report. But if the tobacco manufacturers wish to avoid an accusation of undue self-interest, they should not claim thatmanufacturers have approached the problem of smoking and health, since they first became a matter for concern, with a full recognition of their responsibility to the public",because that is not so.
Let us test their protestations by the statement of their own case, as made this afternoon by the noble Lord, Lord Sinclair of Cleeve, and the statements which have been made by others in the past week, not necessarily on their behalf, but certainly supporting their interests. First, may I say this? The theory of genetic susceptibility, which has been propounded by Sir Ronald 666 Fisher, is not accepted by any other statistician in this country. Secondly, it is a theory which moulds itself to the circumstances. When it was shown, for example, that giving up smoking tobacco lessened the risk of cancer of the lung, what happened? The explanation was given that there was a genetic propensity, not only to smoking, but also to the ability to give up smoking. So the whole of the argument became one of those vague scientific generalisations, which no scientist of note would accept.
The noble Lord mentioned Sir Heneage Ogilvie's impression that a happy man never gets cancer. Sheer unadulterated nonsense, my Lords! Anyone who has seen thousands of patients suffering from cancer, as I and my noble friends in medicine have, knows perfectly well that happy men can get cancer. Sometimes the happiest of men is struck in a moment as it were, overnight, and found to have a grave cancer. How many of us have known men of courage, men of great courage? I recall, particularly, the head of a great Oxford college, and the head of a great provincial university, who, knowing that they had cancer, remained happy men. That, my Lords, was courage. There is the rebuttal of what Sir Heneage Ogilvie, in his generalisations, has asserted.
Lastly, my Lords, on this point, may I say this? Dr. Berkson, of the Mayo Clinic, who was quoted by the noble Lord, Lord Sinclair of Cleeve, is refuted and rejected by almost all, if not all, of his medical colleagues in the Mayo Clinic; and I think rightly. There is no proposition in this world for which it is impossible to find someone scientifically trained, particularly if he happens to be a member of an organisation whose commercial interests are involved, to support a particular point of view. So I hope that we shall not accept the ad hominem and ad verecundiam type of argument which has been propounded by the noble Lord, Lord Sinclair of Cleeve.
Now, my Lords, let us test the Tobacco Manufacturers' protestations. They assert that only a minority of even heavy smokers contract lung cancer or chronic bronchitis. But, it has already been said this afternoon that 1 in 8 of heavy smokers 667 —that is, smokers of 25 cigarettes or more a day—develop lung cancer; whereas, the chances against a non-smoker developing it are some 200 or 300 to 1. In 1960, 22,000 people died in this country of lung cancer, and the number will increase unless we do something about this. Have the tobacco manufacturers, in their recognition of their public responsibility, ever announced such figures? It has, indeed, been left to others.
My Lords, the second point, which was made by the noble Lord, Lord Sinclair of Cleeve, was that the Royal College of Physicians had presented only a partial argument. It should have presented the argument for atmospheric pollution as a factor in the causation of cancer. As President of the National Society for Clean Air I have an interest in the abolition of atmospheric pollution. I have often stated publicly the evil effects of the belching of millions of tons of smoke, from domestic fires and factories, and of dusts and the like into the atmosphere. I would run parallel to all that Lord Sinclair of Cleeve might have said about the evil effects of atmospheric pollution, except on one point; and that is that it in any way rivals, as a pathogenic agent, cigarette smoking in lung cancer.
The facts are clear, and they are indisputable. It is true that the incidence of lung cancer is greater in industrial urban areas than in rural areas. It is true that, at the centre of a large industrial area, the incidence of lung cancer is at its greatest. But the independent role of cigarette smoking is made clear by a multitude of facts in addition to those mentioned in the Royal College of Physicians' Report— which is, indeed, sufficient for most people to accept.
First, the incidence of lung cancer in an industrial area shows the same discrepancy as between the non-smoker and the heavy smoker. Secondly, as the Chief Medical Officer pointed out in his 1960 Report, in the Island of Jersey, where atmospheric pollution is perhaps less than anywhere around our islands, smoking is at its heaviest and the incidence of lung cancer is even higher than in this country. In Iceland, where no one can indict the atmosphere and where 668 cigarettes were introduced only during the Second World War, we are now beginning to see, as the Report showed last December, the development of cancer of the lung. In Israel to-day (I happen to know something of what goes on in Israel) the incidence of lung cancer is not unlike that in this country, except among the Yemenite Jews, who smoke through a water-filtered pipe. They do not use cigarettes; and in the last three years there has not been a single case of cancer of the lung amongst Yemenite Jews.
My Lords, such evidence as is available (and, as the President of the National Society for Clean Air, I have gone into this with great care) would suggest that a ratio of between 6 and 8 to 1 is the kind of significance which cigarette smoking has to atmospheric pollution. But, my Lords, is it not idle to argue that, unless we can remove all the causative factors of disease, we should do nothing to remove one? After all, with a bridge which is breaking under the strain of six tons when it can hold only five-and-a-half, you do not worry about removing the whole load; you remove such vehicles as will bring it down below its maximum strain.
A point which the noble Lord, Lord Sinclair of Cleeve, emphasised on several occasions is that no specific carcinogen has been isolated from tobacco smoke. My Lords, I concede him that: no specific carcinogen has yet been isolated, although there are potentialities in many. But as the noble,Baroness, Lady Summerskill, pointed out, we should not have controlled smallpox in this country; we should not have controlled cholera or typhoid; we should not have controlled a very large number of diseases, if we had waited until the specific, necessary ætiological factor had been unmasked. Indeed, I think it was the noble Lord, Lord Amulree, who mentioned John Snow. And although it is nice to feel that, like King Alfred's cakes and King Canute's waves, he still believes in John Snow's Broad Street pump handle (and, although there may be some truth in that, it is very doubtful whether the handle was ever removed), what is true is that John Snow showed statistically 669 what Edward Chadwick had shown nearly 120 years ago: that there were factors in life—poverty, under-nutrition, overcrowding, dirt and so forth—all of which made a significant contribution to the development of disease. They did this by statistical measures— and, indeed, by statistics which were far less satisfactory than are the statistics presented to us in the Royal College of Physicians' Report.
A parallel argument is the one I have mentioned: that the College's Report has issued a general condemnation of cigarette smoking, and that this is not a constructive approach to the problem. But, my Lords, is saving thousands of lives a year not a constructive approach to the problem? I need hardly stay for an answer. Now, with the noble Lord, Lord Sinclair of Clceve— and, indeed, with all others— I believe that there is clearly a need for further research. I doubt whether money is the determining, inhibiting factor. There is a need for further research into the chemical and biological aspects of the problem, into the epidemiological and personal aspects and into the genetic factors, which may indeed ultimately tell us why some people who smoke cigarettes to excess develop cancer and others do not.
We are beginning to understand some of the interesting features of our genetic make-up. For example, it has been shown that if you are blood group "O", you are about 50 per cent. more likely to develop duodenal ulcer than if you are any of the other blood groups. Again, if also you happen to fail to secrete the blood group substance in your saliva, you are about 250 per cent. more susceptible to the development of duodenal ulcer, and so forth. In other words, these genetic markers might ultimately prove the determining factor as to whether we shall be able to tell our patients, "You may smoke with immunity". But, until we can do that, what is the prudent step? It is to advise nobody to smoke to excess.
My Lords, I said that there had been other supporters of the tobacco manufacturers in the last week: Mr. Chapman Pincher, in the Daily Express on Saturday last, and, in this week's Sunday Express, Mr. Colm Brogan. Now Mr. 670 Chapman Pincher is a distinguished scientific correspondent, and I fear that his scientific objectivity must have been extraordinarily hard-pressed last Friday, or whenever it was that he was writing his article. He told us what in fact has been said by Lord Sinclair of Cleeve this afternoon: that the incidence of cancer of the lung is rising in inverse proportion to the fall in tuberculosis. That has happened, it is true, in the last few years, but nobody who knows the facts attributes the statistical correlation to cause and effect. Tuberculosis has fallen because in 1949 we discovered chemical agents, drugs, which control the tubercle bacillae— streptomycin, isoniazid, PA5 and the rest. These are the drugs which have been responsible for the fall in tuberculosis.
Mr. Chapman Pincher suggests that we are getting better at the diagnosis of cancer of the lung, and that is why it has increased. But, my Lords, we are no better at diagnosing cancer of the lung in the heavy smoker than in the non-smoker; yet we find in the heavy smoker 15 to 30 times the incidence of cancer of the lung than in the nonsmoker. We are no better in diagnosing cancer of the lung in the age group 35 to 55 than we are after that age; yet we find a significantly increased incidence in that age. Indeed, as your Lordships know, the techniques of the diagnosis of cancer of the lung have become extremely exact: X-rays; bronchoscopy— that is, the insertion of an instrument to look down into the lung itself; exfoliative cytology— that is, examining the sputum for cancer cells; and thoracotomy, actually opening the thorax, if there be need to establish the diagnosis.
Again, Mr. Chapman Pincher suggests that the studies are really at fault, because they deal only with doctors, who normally have less than the average life span. That might be a suitable argument to the Royal Commission on the Remuneration of Doctors, but it is perhaps not wholly relevant to the present argument. Take simply one study—and it is an important study—that by Doll and Bradford Hill on the occurrence of cancer of the lung in doctors who confessed several years ago to the quantity of their smoking. Subsequently their death certificates were examined. Since 671 Doll and Bradford Hill started this investigation 2,000 male doctors and over 100 female doctors have died. Their deaths through cancer of the lung have been compared as between the smokers and the non-smokers, and again we find that deaths of smokers of 25 cigarettes per day in that period were twenty times those of the non-smokers.
Another argument which Mr. Chapman Pincher puts forward is that, if you stop smoking, you gain weight. He alleges (and I quote his words) thata 35-year-old man who is 1½ stone overweight has a life expectation of eight years less than normal "—and I insert that that is, of 27 years, compared with 35. He also alleges that:a 45-year-old woman who is 3½ stone overweight halves her life expectation "—and I insert that that is of 15 years, instead of 30 years. But, my Lords, these increases bear little relation to the overweight which occurs after giving up smoking. Of course many people put on weight. On average it is about half a stone, but gradually they lose this weight. It can be easily controlled by a little care, even in the rare instances in which there is significant overweight. Mr. Chapman Pincher goes on to make this, for a scientist, remarkable assertion:Of ten fat men "—but he gives us no definition of "fat", which I think is scientifically deplorable!—aged 30, only six survive to the age of 60: whereas of ten slim men "—and again there is no definition of "slim"—aged 30, eight survive to 60".In other words, the slim man has a 33⅓ per cent. better chance of surviving than the fat man—whatever those terms may mean.
But the figures we have been given this afternoon—the fact that, at 35 years of age, a man who smokes 25 cigarettes has a 1-in-23 chance of succumbing during the next decade (that is, before he is 45), whereas the non-smoker has only a 1-in-90 chance of succumbing before that age—show that the nonsmoker is not 33⅓ per cent. more likely to survive, but over 400 per cent. More 672 likely to survive. These facts have not been challenged. They must undoubtedly be taken into consideration, and I would suggest that for those who value life the choice is self-evident. It is not a risk either of being fat and becoming a non-smoker, or of being a heavy smoker and slim. Members of your Lordships' House who think that, if they look round, they will find their memorial, if they do look round may well find in this House over the days evidence of the truth of the proposition which I have mentioned.
I think I ought to deal with one other point, which is that in experimental animals no one has yet produced evidence of cancer by the inhalation of cigarette smoke. I can but say that smoking might be regarded as a somewhat unnatural procedure for laboratory animals. But is it not true that practically throughout the whole of experimental medicine, particularly in infectious diseases, we have to find the susceptible animal? In 1922, the whole of research on influenzal virus was changed because, by chance, it was found that the ferret— none of the usual laboratory animals, but the ferret—was susceptible to the influenzal virus, and then there was remarkable progress in our studies of influenza. It was with the discovery of the Cynomologus susceptibility of the monkey in poliomyelitis that our real advances in poliomyelitis began. It might be that we shall find a susceptible animal, and then I hope we shall have an 'admission, even by the noble Lord, Lord Sinclair of Cleeve, that statistical evidence was sound.
One piece of evidence which was put forward by Mr. Chapman Pincher to rebut all this was that, in one cigarette factory, observation over nearly 15 years revealed that of 11,000 cigarette smokers, one-third smoked over 20 cigarettes a day, and the death rate was well below the average. But, my Lords, this happened in a tobacco factory, and one wonders whether the observers in tobacco factories can approach the problem with the Olympian detachment which is necessary for a proper assessment of this problem.
In Sunday's Express Mr. Colm Brogan beseeched Mr. Powell to "call this scare campaign off."But, my Lords, this is not a campaign to frighten people to death; it is a campaign to frighten 673 people into life. So far, since the publication of this Report, one suicide has been reported, due, it is said, to the scare of cancer of the lung—a man of unbalanced mind. Every day since the publication of this Report, 63 human victims have died from cancer of the lung, and so I hope that that will not delay the campaign which I think should be inaugurated.
Mr. Colm Brogan mentioned another factor, that the heavy tea drinker was subject to dire catastrophy, and he quoted Chambers' Encyclopædia of 1867. But he forgot to verify his references, which is one of the great pitfalls of all publicists. Because what was described as the symptoms of what Mr. Calm Brogan says was heavy tea drinking was in fact in a single experiment, in Which the equivalent amount of theme or caffeine in twelve cups of tea was given to one man in one dose. My Lords, twelve cups of tea! After all, that is hardly equivalent to heavy tea drinking.
I must apologise for keeping your Lordships so long but in fact this is a subject in which, as many of your Lordships will know, I have been interested for many years, and about which I have ventured to make certain public pronouncements at different times. I am also Chairman of the Standing Medical Advisory Committee of the Central Health Services Council, which has from time to time made recommendations to Ministers on this topic.
The noble Lord, Lord Sinclair of Cleeve, underlined the fact that the evidence is statistical. It is perhaps worth while recalling why cigarettes were indicted in the first place. It was because it was found, in certain industries in which there was exposure to irritative dusts and certain chemicals, that cancer of the lung developed, and when an attempt was made to try to unmask the cause, or one of the causes, or one of the contributing factors, which, if removed, might lessen the incidence of cancer of the lung, attention was drawn to this fact; and then started a series of skilful investigations which have led to the present situation.
Statistics, it has been said, might be made to tell anything. But few people complete the quotation, which is, "Statistics might be made to tell anything, even the truth." Walter Bagehot 674 said that life itself "is a school of probability". Good statistical evidence is as good as any other evidence; but it must be good statistical evidence and supported by a large number of reputable workers. The insurance companies of this country flourish on the basis of statistical evidence of life expectancy. And I have little doubt that the noble Lord's Tobacco Manufacturing Standing Committee and other bodies have not increased the expenditure in the last five years on tobacco advertisements by nearly four times without having had some statistical evidence to support the expenditure of that sum of money.
I know that statistical correlations do not necessarily indicate cause and effect. When I was a young man, the kind of argument one had to counter was that the relative frequency with which a physician visited a patient was statistically correlated to the likelihood of that patient's dying—which is, in fact, quite true, but there is something else to which both factors are more clearly related: again this type of evidence would show that bed is the most dangerous place in the world because more people die in bed than anywhere else. The fact relevant to-day is that the whole corpus of statistical evidence on this problem points to one irresistible conclusion: that excessive cigarette smoking is responsible in a considerable measure for cancer of the lung and that we could lessen the incidence to 10 to 15 per cent. if excessive cigarette smoking were overcome. It seems to me that it is sheer folly to neglect the implications of a statistical correlation, the chances of which being accidental are millions to one. That is the case which I think refutes what has been said by the noble Lord, Lord Sinclair of Cleeve.
As I say, I have detained your Lordships far too long, otherwise I should have had something to say on the measures which might be taken to overcome this grave sore on the life of the country, but I do not propose to go on much further. All I would say is that I believe that some of the measures proposed in the College of Physicians' Report are sound; others I do not think are sound—certainly not the punitive penal deterrent of a tax on cigarettes, but I will not elaborate that now. I might do so on another occasion.
675 I think that health education has to play a part. As your Lordships know, the Minister of Health and the Department of Health for Scotland have set up a Joint Committee on Health Education, which has now been sitting for several months, under my chairmanship. I hope we shall be able to make positive, useful recommendations, but in the meantime I think we must be grateful to the Minister of Education for the circular which he has sent and to the Ministry of Health, because they will make some contribution.
If we were dealing with a more orthodox public health problem than that of tobacco smoking and cancer of the lung, we should have taken action on half the evidence which has now accumulated. This is not solely a personal problem. I agree with the noble Earl, Lord. Arran, that it is personal to decide what you should do, but I wholeheartedly disagree with the suggestion in the leader in this morning's Daily Express which states that it is anyone's right to go into a public place and offend others by smoking, because all of us who have practised medicine have been careful to exhort our patients to keep away from smoky atmospheres. Anyone susceptible to any bronchial irritation knows the effect which a smoky atmosphere can have.
The public is beginning to realise that in this conflict, on the one hand we have the voice of medicine—and I would remind your Lordships that 50 per cent. of doctors who smoked a few years ago have now given up smoking, and, after all, there are few judges more qualified to judge than they—we have the voice of the doctors, who are inspired by the dictum, salus populi suprema est lex—the good of the people is the supreme law—and, on the other hand, we have the tobacco manufacturers, who, I believe, will have to surrender to public opinion in this conflict.
A week ago there appeared in one of our daily newspapers this paragraph:If the Government is at last to launch a campaign designed to inform the public about the risks they run by smoking, the tobacco companies will inevitably find themselves in an unhappy position. Anxious as they may be to protect a means of livelihood, which until recently seemed both respectable and slightly dull, they can hardly argue that the information put about by the Government and Local 676 Authorities is simply untrue, nor can they claim that the spate of highly flavoured advertising into which they have been driven by competition affects only the relative success of particular brands; if it is effective for each brand in particular, it is effective in promoting the sale of cigarettes as a whole.That is not a quotation from an antismoking pamphlet; it is not a quotation from an anti-smoking newspaper, if such there be; it is a quotation from a leading article of the Financial Times of March 14.
This is a conflict which the public must be helped to resolve. We have the tobacco manufacturers, with their commercial interests, threatened by the advance of medical knowledge. It is not as if they were meeting a normal necessary need of mankind. They offer for sale a potentially dangerous, habit-forming drug which, though it may give pleasure to hundreds of thousands, yet kills tens of thousands. And the giving of money for research is not a sufficient answer to this problem, which needs action. I hope that we shall all join in taking more active measures to ensure that the harmful effects of tobacco, if not eliminated, are at any rate minimised.
I hope that the Government will propose other effective measures. We cannot any longer delude ourselves that nothing in this field is certain. No man who is objective can refrain from asking himself, "Do I stop smoking, or do I continue to smoke conscious of the risk which I run?" I know that there is a sectional interest, but sectional interest must not be allowed to overrule the public good. If there is money to produce the tobacco tax, then there will be money to produce taxation to run our national economy from other sources—I hope health-giving sources. Finally, I would say this. If the financial stability of this country depends in large measure on a product with potentially grave, crippling and killing propensities, then it reflects little credit on us. I end as I began with Disraeli's dictum, that the health of the people is the surest foundation upon which their power and happiness as a State depend.
§ 5.31 p.m.
§ VISCOUNT STUART OF FINDHORN
My Lords, I think this is the most unbalanced debate to which I have ever had the pleasure of listening in either 677 House of Parliament. So far, we have had three eminent but biased Members of the medical profession "shooting their line", one Earl from the other side who moved the Motion, and one noble friend of mine speaking on behalf of the manufacturers.
§ VISCOUNT STUART OF FINDHORN
Yes. I said, one against three of the medical profession. I am not representing either side. I am inundated and almost overwhelmed by the amount of statistical information to which I have listened and by the number of long-sounding words of whose meaning I have not the slightest idea. So I hope I may be permitted to revert to normal English, after being submerged by this weight of information of a very specialised kind. There is one thing of which I can assure your Lordships, and it is that all they have done to me so far is to make it much more urgent that I should, as soon as I am in a position to do so, leave this Chamber and light at least one cigarette, and probably several more. They have certainly driven me to that. Unfortunately, I woke up this morning with a sore throat. But one must not pander to these things, so the first thing I did on getting out of bed was to light a cigarette, just to show my throat that it must not expect any sympathy from me. I may say that I am one of those confirmed believers in the words of the old music hall song, thatA little of what you fancy does you good.I really have not a lot of time for this stuff we have to listen to, trying to make us better people. I am not contradicting (I am not in a position to do so) what the Royal College of Physicians say; they know a great deal. But I am not by any means convinced that the conclusions of these eminent doctors have been substantiated by facts. I know some doctors, too. I was in Edinburgh last week-end and I talked to a number of eminent physicians. One of them said to me (and this has been referred to) that improved diagnoses during the course of my lifetime have made a great deal of difference; that they can now diagnose much more efficiently, and so on. I think there may be truth in that, because when I was young cancer of the lung was not, to 678 my knowledge, a fashionable disease; it has just taken over from the slipped disc.
An eminent surgeon in Edinburgh said to me, "If you want to go into statistics"—and I agree with what the noble Lord, Lord Cohen of Birkenhead, has just said, that you can produce statistics of all sorts—" if you ever go to the theatre you will find the first six rows of the stalls are largely filled up with ageing gentlemen with bald heads, from which you might deduce statistically that sitting next to the footlights is bad for the scalp." But that in truth is not the fact: it is no doubt due to the fact that they take the trouble to book their seats early, because they are deaf, which is very wise.
§ THE LORD PRESIDENT OF THE COUNCIL AND MINISTER FOR SCIENCE (VISCOUNT HAILSHAM)
Why are they bald?
§ VISCOUNT STUART OF FINDHORN
Because they are old and deaf. It has nothing to do with the ladies of the chorus. I agreed with my very commonsensical taxi driver the other day. I was rather surprised, because he was flourishing a very rich-looking, gold-looking cigarette holder of some length and smoked with it as we drove along, while I was just smoking in the ordinary way inside the cab. When we got to the end of the journey I said to him, "Are you quite satisfied that that holder of yours will safeguard your lungs against these evils of which the Royal College of Physicians have been informing us?" He said: "No. It has nothing at all to do with that; it is merely that the holder enables me to smoke down to the bitter end and I do not waste any".
I trust that this Government, for whom I have always had a high respect—and I do not want to lose it—are not going to try to "governess" the nation. I do not object in the least to stopping smoking in places like the theatre, because there is an interval and one can go out and have a smoke. I do not object to prohibiting slot machines, because it is obvious that the young people, the under-sixteens or whatever you call them, can put the money in the slot and buy cigarettes at any hour of the night. I may say that I was first caught smoking a good deal earlier than 679 sixteen by my father, who seemed to object particularly to the fact that I was smoking his cigarettes. I hope the Government will remember the fiasco which occurred under Prohibition in America. I worked there for eighteen months at the height of Prohibition, during 1921–22, and I can assure your Lordships that there were two great dangers from which I suffered as a young man. One was the risk of getting drunk perpetually, because my friends always said: "We had better have another drink, in case we do not get one at the next place"; and the other was that one might be killed in the process, because there was such a lot of wood alcohol and poison going around.
I have talked with a number of these eminent medical gentlemen, because I have always been interested in their profession, and I am told that over-eating kills a good many more people than lung cancer does. If that be the case, why do not the Government take an active interest in over-eating? They might recruit my noble friend Lord Woolton again and institute rationing and see how the public enjoy that. But I hope to goodness they will not do so.
I do not think the case against smoking has been proved, and doctors will no doubt soon change their minds about the reason for lung cancer, just as they changed their minds, over a decade or so ago, about diet. My father was always much more sensible and said: "Always eat what you feel inclined to eat, and do not eat anything else." That is wise advice.
§ VISCOUNT STUART OF FINDHORN
Yes; if you can get it, of course. But as to statistics, it is not smoking that affects me or makes me ill; it is the smog and dust. About seven years ago, when I was in the Scottish Office, I was walking up Whitehall from the other place—it was the year when a cattle breeder from the North was putting handkerchiefs or face towels soaked in whisky over his beasts at Earl's Court to help them to breathe, but, strange to relate, I had not any whisky in my handkerchief. I said to my friend, "I cannot breathe." He said to 680 me: "Put your handkerchief over your month." I did that, but it did not seem to help. I then said: "I am going to be sick "—and I was. There is no doubt that I smoke heavily. I would not mind telling your Lordships how many, but it would not interest you; and the Lord President would only think more poorly of me if I told him. But smoking does not make me ill; it is this bad atmosphere.
Whatever people say about statistics, in Southern Ireland, in the rural areas (I know that the noble Lord, Lord Cohen of Birkenhead, has just contradicted this by talking about Jersey or some other place, but I am going to talk about the rural area of Southern Ireland) the death rate per 100,000 is 22, against the England and Wales figure of 87. It is almost exactly one quarter. I think that proves a good deal—that it is the bad, polluted, dirty atmosphere, and that is certainly the stuff which gets me down. I will not say any more, because I know the time is getting late. As I say, we have had four very hostile speeches to myself and my hobby or habit of smoking. I see that the noble, most reverend and learned ex-Primate is going to follow me. I do not really know whether I am going to get much support from him. My side have been having a pretty bad afternoon.
§ 5.40 p.m.
§ LORD FISHER OF LAMBETH
My Lords, I should say that the battle over our bodies has been decisively won already, both by the Report and, as a final shot, by the noble Lord, Lord Cohen of Birkenhead. What remains is the much more interesting battle, from my point of view, over the mind. The last speech has very properly introduced us to that side of the problem. I think we all have a sneaking sympathy with the noble Viscount, because he said—I was going to say, "To hell with these experts!". We all have that instinctive feeling that if too many scientific guns are brought up they must be wrong.
Having said that to my noble friend, I must now go on to the battle of the mind and say, first, in a sentence, that there is, of course, a Christian approach to this problem, as to every other problem. It can be put extremely shortly in one sentence: "Be on your 681 guard against greed of every kind." The old translation was "covetousness", but the modern translation is greed of every kind". The Greek word for "greed" is [...] wanting more, over-indulgence, excess and covetousness of every kind. I was very interested to see that no less a person than the Chairman of Barclays Bank has recently restated this New Testament teaching in these words:It is a little, not a lot, of what you fancy that does you good.I imagine that if it could be taken for granted that every citizen would do only a little by way of smoking instead of a lot, no problem would arise at all, but that is an aspect of personal and private morality. But the Medical Report has elevated smoking to a prominent position in the field of public morality and social welfare.
§ LORD FISHER OF LAMBETH
A new public sin. I was a schoolmaster for 21 years, and I am very familiar with the problem of what to do with smoking. In boarding schools it was never itself regarded as a moral offence, but in the interests of welfare it was forbidden; and to break the rule was an offence. One had some sympathy with the people who broke it, but the offence remained because it revealed a spirit of lawlessness.
But, if I may confess it, there was always a contradiction in the teaching profession about this matter. Smoking was not a moral offence, and there was no reason why masters should not smoke, off the premises, in their private capacity. Yet at once a real moral dilemma presents itself. It is not satisfactory for a teacher and exemplar of good behaviour to have a double standard of behaviour—one open and official, which is free from all censure; the other, not before the boys; not on school premises; to have another double standard by which he could do in private those things which he was not allowed to do or expected to do in public. This applied not only to smoking but to drinking, betting, swearing, and to every other form of social indulgence. This became acute in some cases, when masters did these things and smoked to excess, and when boys were forbidden to do it at all. Boys were perfectly well aware of 682 this contradiction between the conduct they were supposed to observe and what this or that master did, and thus an element of hypocrisy was introduced. I should say that there was among the boys an element of sympathy for the master who exceeded the normal limits when he was off duty.
I need not repeat the medical evidence. It is obvious, I think, to most people, that there is this connection between cigarette smoking and lung cancer. The Government accept these conclusions—indeed, they could not possibly do anything else. I suppose they could have taken the line that if people like to smoke to excess and so incur disease and hasten their death, that is their concern, and no concern of the Government's. But I wonder whether they could really hold that line. No man can live unto himself alone. What one man does, and does to excess, others will do, and will be encouraged to do, to excess as well. A private mischief always spreads very rapidly until it becomes a public mischief. The Government, therefore, rightly and inevitably, decided that they must do something to reduce this threat to the general health of the community.
What can they do? I am not going to refer to legislation of any kind, because I never think that is a good way of producing what is, in effect, an appeal to moral principle. It means only compulsion, of one kind and another, and punishment. It can only appeal, so far as I can see from the medical evidence, to a moral principle: setting the duty of self-control against greed, over-indulgence and excess—and that for the sake of the good of the community. In this affluent, acquisitive, aggressive and advertising society, many things are combining to compel people to see that, without a new measure of self-control and self-denial in many aspects of life, society cannot be saved, and the secret enemy presenting itself in manifold disguises, growing more attractive every day, is covetousness or greed. At the Guildhall last November, the Prime Minister, speaking of inflation, used these words:The indispensable condition for our prosperity is self-control.That is a grave warning from a grave circumstance, and is far-reaching, since it must obtain in every aspect of our lives.
683 I am sorely tempted to turn aside to show how many aspects there are of life to which this maxim directly applies, but I will not; I will stick to the one subject before us. What form shall the Government appeal for self-control take? The Government know perfectly well that there is no "bite" in a general appeal to people to practise moderation. It does not stir a single sentiment in anybody. There is no challenge in, "You must be careful", and any smoker knows that in brute fact the real choice is between continued bondage to the habit, the complete freedom of giving it up altogether or never forming the habit at all. I am speaking of my own experience—and in this matter our own experience is far more valuable than all the statistics put together. We know that. After being a very heavy pipe smoker for 40 years, by the mercy of Providence I gave it up for a number of reasons—none of them fear of lung cancer because I did not know that was a conceivable fear. There were two reasons, one of which was my own self-respect. I could not tolerate that I should be in complete dependency on a piece of self-indulgence like this; and in fact I was spending on it far more money than I had any right to spend as a mere personal indulgence.
My experience is that of Lord Samuel, published in a letter in The Times to-day, that when you give it up there is a positive freedom and a positive benefit that lasts for the rest of your life. The noble Lord, Lord Sinclair of Cleeve, talked about comparing the benefits. I should say that he would better take evidence from people like the noble Viscount, Lord Samuel, myself and others. When he says that you cannot relieve tension without smoking, that is not true; you can, and I believe it wholeheartedly. It was not until I gave up smoking altogether that I understood how completely fallacious it was. My brain worked, quite frankly, better and more clearly after I had got rid of smoking than it did before.
What have the Government done? Of course they have gone to the teachers and said to them, "You must teach the children about this." That is always the first move of any reformer, to lay it on the children. This is what the Minister of Education says to the teachers: 684A positive effort must be made to discourage smoking among children and to prevent the formation of the smoking habit.I think everybody will agree. But the Minister cannot conceivably stop there. He goes on to ask that teachers and non-teaching staff as well as visitors to the school will not smoke anywhere in school in front of the children. There you are once again: this double standard. It is all right to do it when you are out of sight of the children, but you must not do it while in sight of them. A double standard of that kind is unhealthy far anybody. "We must not smoke before the children" has to my mind an extraordinarily Victorian and hypocritical sound about it, and, of course, it really stultifies the efforts of the teacher to train children, because if he is going out straight away from the school to over-smoke he is not really going to put his heart into teaching the children to avoid this dangerous and hazardous practice.
We must remember that if he gives up smoking himself altogether in order to fulfil his duty as a teacher he may raise a real barrier between himself and his friends and members of other professions by having a totally different social habit from theirs. That is not unsolvable. There are a good many things in which I have different social habits from some of the people I consort with. One can stand it. But it is putting a great deal on teachers, regarding what has been accepted as a perfectly legitimate indulgence, to say to them that if they are really going to do their duty in answer to the Government's appeal they must give up what ordinary people do easily and to excess.
My Lords, the Minister cannot stop there. His circular goes on to ask for support from the parents; for parents and teachers to make common cause. He says:Success in any campaign to reduce smoking among schoolchildren depends upon many factors; chief among them are what kind of example adults are prepared to set.This is the point I want to make. We must not dodge it. It is not a question of what the Government will do by legislation. If the Government were right in making this appeal to schools and teachers, if the Minister of Health was right, then the only decent thing for the community to do is to back them up, even though it affects its own self- 685 indulgence and self-discipline; and that is the heart of this whole matter. Can any of us make out a very good case for ignoring the whole of this? I do not believe it. Nothing will overcome that except the feeling that when the Government call for self-control in a matter of real national importance there is a need that every thoughtful citizen should back them up.
Is it a quite intolerable demand that every thoughtful citizen should give up smoking altogether? Is it intolerable? Whenever I go to Oxford or to Cambridge I always make the same inquiry. I ask undergraduates there how many of them smoke at the university. In my day we all did. The answer I get is always about the same: 50–50—fifty smoke, fifty do not—for various reasons. If that can happen among the youth at a university, not always notorious for their self-control and self-discipline, is it intolerable that thoughtful citizens should say, Well, I will be in the right half of this division"?
My Lords, I mean this quite seriously. Great spiritual renewals are often started over very trivial things. Somebody sets the tide going in a different direction. The great renewal needed in all aspects of our social life—and the Lord President himself has said this very movingly on many occasions—for our prosperity and salvation as a people, is the substitution of self-control and self-denial for covetousness and self-indulgence; and it spreads into every corner of public and private life, into moneymaking, sex, social habits and personal decisions.
I think it is good that this clear issue, this clear call to self-denial, is presented to our people in what is, in truth, a mere physical indulgence, easy to be dispensed with when one has made up one's mind to do so. But if it is allowed to become a tyranny, a real destroyer of self-respect and a threat to life, it is right, my Lords, that the Government should take this issue seriously. I think it is right that every citizen should take it seriously as well.
§ 5.58 p.m.
§ LORD COLERAINE
My Lords, I hope that your Lordships, and especially my noble friend the Lord President, will 686 acquit me of discourtesy if I have to leave the House before the debate concludes because I have an engagement which I cannot easily put off. In this debate it is important, I think, that we should declare our interest. My own interest is the same as that of my noble friend Lord Stuart of Findhorn. I am, and have been, a very heavy smoker; I am not connected with the tobacco industry; I am not a shareholder in the tobacco industry; I do not grow tobacco. But I think that, together with my noble friend Lord Stuart of Findhorn, I have been in the years since my noble friend Lord Sinclair of Cleeve joined the industry in 1919, one of his steadiest and most reliable customers.
I do not think that that is anything to boast about. I think I differ from Lord Stuart of Findhorn here, in that I rather wish I had smoked less, though I must confess that when I did stop smoking for a period of three years I felt very much worse. I assure myself— though perhaps my wife would not agree with me; my doctor would not agree with me and certainly Lord Cohen of Birkenhead would not agree with me— that if I had not taken up smoking again I should by now have been dead because of over-weight and the strain that that imposed upon my heart. Nevertheless, I think that I have smoked too much; I think the noble Viscount, Lord Stuart of Findhorn, has. Probably it would have been better for both of us if we had smoked less. And if I am critical of this Report of the Royal College it is not because its intention is to make people smoke less; it is because I think its intention will not be realised.
The noble Lord, Lord Cohen of Birkenhead, in what was a very powerful speech, if he will allow me to say so, said how disappointed he had been because when this subject first came up there was a momentary reduction in the consumption of cigarettes, and a momentary reduction in the trade the tobacco companies were doing, but that then it was all forgotten and the old pattern repeated itself. My criticism of this Report is that there is nothing in the Report that will prevent that from happening again. Some of the recommendations are good in intention rather than bad.
I myself believe that there is far too much advertising of cigarettes, but in 687 particular I think that the sort of combination of romance and moonlight on television with these cigarette advertisements is tasteless and ineffective. I feel that the tobacco companies would have nothing to lose, and very much to gain in public esteem, if by some self-denying ordinance they limited the quantity of advertising and controlled its quality. But I do not believe that advertising has as much effect on consumption as either the tobacco companies evidently do or the authors of the Report of the Royal College do. I think the problem is something far more fundamental and far more difficult than that.
Again, I support wholeheartedly the idea that there should be no smoking in cinemas and on public transport. That would make both cinemas and public transport very much more comfortable. But in my view we are deluding ourselves if we suppose that by prohibiting smoking in public places we shall reduce the consumption of tobacco and cigarettes. I do not agree. As we know, in the United States people are not allowed to smoke in cinemas or on buses; and yet the consumption of cigarettes, we are told, is higher in the United States than in this country, where we are allowed to smoke in public places. So I do not think that any great result will be secured from that recommendation if it is adopted—and I should like to see it adopted.
I am very doubtful, too, about these educational proposals. I do not think they will have the effect on young people, on children, that is expected of them. I do not know whether other noble Lords saw an account in the Press to-day of a child of nine who was a chain-smoker. The boy's mother objected very much, not because he was a chain-smoker but because, when he had finished his own cigarettes, he went through hers. If that is the kind of attitude of the parents over quite a wide section of the community, I do not think these measures of education in the schools are likely to have any great effect.
The most reverend and noble Lord, Lord Fisher of Lambeth, spoke of the thoughtful citizen, and asked: could he not give up smoking himself? Well, I suppose he could. But I wonder how much good it would do; because I am 688 afraid that the great majority of the citizens are not thoughtful citizens but thoughtless citizens, and those are the ones I think one needs to get hold of.
I should not for a moment dispute the statistical evidence of the Report. I am not a statistician. I know something of the weakness of statistical correlation. Nevertheless, I am reasonably satisfied, to the extent of 80 per cent., at any rate, that there is a direct connection between cigarette smoking and cancer of the lung. What I am not satisfied about is that this Report makes any serious attempt to deal with it, and I fear that it may succeed only in deflecting attention from the real core of the problem.
I have no doubt that my mind on this matter has been coloured by the same experience as Lord Stuart of Findhorn had, that of living for a couple of years in the United States during the Prohibition experiment. And what I should like to impress upon your Lordships is the possibility, at least—and I think it is a probability—that this problem of smoking is not so very different from the problem which faced the prohibitionists in the United States after the First War. Prohibition did not work there, and it will not work here. Of course, the Report does not ask for prohibition, and I think that is its weakness. Because again I would refer, if I may, to what the most reverend and noble Lord, Lord Fisher of Lambeth said: that in fact it is no use suggesting to a heavy smoker (and I think this is particularly true of a heavy cigarette smoker) that he should smoke moderately. All you can do is to make him give up. In other words, the logic of this Report is prohibition.
§ LORD COHEN OF BIRKENHEAD
Surely the logic of this Report is to change from cigarettes to the less serious and injurious forms of tobacco, such as pipe and cigar. And even if cigar smoking may bring joy to the heart of Fidel Castro, and diminish our friendship with the United States, yet the Report makes that specific suggestion, 689 and, indeed, bases an enormous amount of its recommendations on that change of habit.
§ LORD COLERAINE
I realise that that is what the Report says, but again I do not feel that that is the kind of result that you are going to get by exhortation. You may get it from the thoughtful citizen. I do not believe in fact you are going to get it from the population as a whole.
I said a moment or two ago that I thought the Report would do very little good, and might even do harm, by deflecting attention from the core of the problem. Here I should like to say how impressed I was by the moderation and the fairness of the speech of my noble friend, Lord Sinclair of Cleve, and how impressed I was, in particular, by one part of his argument. That was on the importance of research. It seems to me that the real difficulty here is that, roughly speaking, one smoker in fifteen is going to die of cancer of the lung. That means that fourteen people are not going to die of it. I think that by whatever method of reason or persuasion you approach people and try to get them to adopt more rational methods of smoking, they are going to say, "I am sure what you say is right, but I am not the fifteenth man".
§ LORD COHEN OF BIRKENHEAD
My Lords, I think I ought to correct the noble Lord. It is 1 in 8, and not 1 in 15.
§ LORD COLERAINE
I observed that the noble Lord, Lord Cohen of Birkenhead, said one in 8 in his speech. I think he said that 1 in 8 who smoked more than 25 cigarettes a day. I believe that the figure for cigarette smokers as a whole is one in 15. But for the sake of my argument it is relatively unimportant whether it be the eighth or the fifteenth man, and I should have thought that the most constructive purpose that could be pursued in this problem is to try to identify that eighth or fifteenth man, according to how one looks at it. That can be done only by research.
This Report, I think, makes this serious omission, that it pays little attention to research. Indeed, the criticism which it makes of the Government in the past is one which, in an 690 other slightly different connection, one could level at the Royal College itself. The Royal College say, "How can you expect people to take seriously what we say about smoking when the Government do not endorse it?" I think that the tobacco manufacturers, and indeed the public, are entitled to ask, "How can you expect anyone to treat research seriously when the Royal College of Physicians does not endorse it in this Report?" I think that is a most serious omission.
If I differ from the recommendations of this Report and from the tenor of the conclusions of the Report, and if I differ from the noble Lord, Lord Cohen of Birkenhead, it is not because I am not conscious of the reality of the scourge and of the need somehow to bring it under control—like all noble Lords, I was much moved this afternoon by the reference of the noble Lord, Lord Cohen of Birkenhead, to his visits to the wards in the Liverpool hospital—but simply because I take a different view from that of Lord Cohen of Birkenhead and, no doubt, from that of other noble Lords about the possibilities of political action. I do not think you can solve this problem by political action; nor, I think, does the most reverend and noble Lord, Lord Fisher of Lambeth. He thinks it can be resolved by renunciation. I believe it can be resolved by research. I am quite certain that, except in the long term, it will not be resolved by the publication of the Report of the Royal College of Physicians.
§ 6.14 p.m.
§ LORD JAMES OF RUSHOLME
My Lords, I want to speak very briefly indeed about one single aspect of the problem that we have been discussing to-day—namely, the educational aspect. The duty of the teacher is, of course, often mentioned when we are talking about this subject: the duty to prevent young people from smoking by all the means in his power, and not least by example. As one who has been a schoolmaster for 28 years. I should like to look a little more closely at what the teacher can really be expected to accomplish in this way. I am assuming, of course, in what I say that in fact heavy smoking, and particularly heavy cigarette smoking, can be said to shorten life. With all respect to the arguments that can, and will, be 691 produced in numbers on the other side. I do not believe that that is any longer an assumption. It may not have been scientifically proved up to the hilt with every loophole stopped that there is this casual connection; but for ordinary men in the way they act in life, even for ordinary scientists in the way in which they produce their beliefs, I would have said that this thing was proved.
The truth is that we have to look at this matter in a far cruder way than we sometimes do and just say to ourselves, "Here we have something, smoking; it is a form of drug addiction that is in fact shared by many of us." We sometimes defend ourselves by saying that it is a kind of addiction that is silly rather than immoral. Now we know—as of course we do know—that, in addition to being silly, it is dangerous. I am a heavy pipe-smoker and it is quite possible—I do this myself—to weigh the risk against the pleasure and to accept it. But that judgment, that weighing of risk and pleasure, is the judgment of an adult man. Knowing the risk, I simply cannot but feel that the young and immature must be protected and discouraged from the habit.
Exactly how much responsibility has the teacher got in this respect? A good deal is put on him in the pamphlet. He certainly has some. Like so many bad habits there is little doubt that smoking often begins with young people. It is one that schools should discourage, and of course they do discourage it. Schools in fact are about the only places where smoking has been consistently discouraged over the years. I know of no school, except perhaps one or two extremely progressive ones, where smoking is not discouraged—often drastically. But we have to be realistic about this, because I think there are here general questions of even greater importance than the one we are discussing this afternoon. I think it is easy for the community to shuffle off its sense of guilt on to the school and on to the teacher, and to say. "That is his responsibility; he must behave well; he must stop smoking. We can enjoy ourselves and surrender to this mild addiction and, if we are lucky, we can even make money out the habit that we expect him to deplore."
692 If we are taking examples, the most potent of examples is of course the home. Yet I wonder how many schoolmasters when they have remonstrated with a boy for smoking have found that his cigarettes were actually supplied by one or other of his parents. More important than that, I think it is illogical and even dishonest for us to allow the young to be bombarded by every kind of propaganda, whether it is by posters or newspapers or, most important and potent of all, commercial television, and then to demand of the schools that they should counter all this or remedy what is done, and appeal to the teacher to set a good example by stopping smoking himself. Even a newspaper as distinguished for honesty and integrity as the Guardian, and now even more distinguished, fell into this kind of disingenuity the other day when it had a leader exhorting teachers to do their duty and to stop the young smoking, and yet it itself draws part of its income from commercial television advertisements designed to make people smoke more. That sort of disingenuity is a symbol of a great deal that runs right through our society.
The schoolmaster feels a sense of cynical amusement, if not indeed of frustration, when he receives pamphlets and is exhorted to use his power to save people from this habit, while at the same time he knows that a sum of about four-fifths of our annual Government grant to universities is spent on advertisements devoted to confirming them in it.
My point is a very simple one. We must not expect more from formal education than it can perform, particularly when we allow it to end at the age of 15. At the age of 15—and 15 is not a great age—the great majority of our children are turned out into a society often with more spending money than they will ever have again in their lives. They are bombarded with skilful propaganda, backed by market research and aided by all kinds of statistical investigation, that associates smoking with manliness, romance, companionship and success. The schools, try as they will, are fighting a very uphill battle. This is an important point, because there are worse things that they try to fight against than lung cancer, which the teacher feels 693 are wilfully and successfully encouraged by society.
By all means let us do our best in schools, by exhortation, by films, by lectures, by whatever you will, which we will do; but if we are serious about this, we must take other steps as well. I am afraid that some of those steps must be legislative, because I cannot agree with the most reverend and noble Lord that a change of heart in society is likely to occur without some kind of legislative control. Tobacco addiction is manifestly not serious enough to make it necessary to prohibit cigarettes as we prohibit heroin. It will be unrealistic to suggest abolishing cigarette advertisements, although one hopes that one of these days some of the techniques of those and other advertisements will receive a longer and colder look than hitherto. But I think myself it would not be an improper invasion of liberty to insist that all such advertisements contain a plain statement that cigarette smoking is in fact a dangerous habit.
I think it would not be improper to make the price of cigarettes so prohibitive that young people would find it much harder to become really addicted—I should like to discuss this idea with my noble friend Lord Cohen of Birkenhead if he does not think that would work. I think it might be useful in preventing addiction. It would then be a matter of a few cigarettes rather than a number, which makes them addicts for life. It would not be an invasion of liberty to make smoking in public places the exception rather than the rule and "Smoking" carriages a good deal rarer than non-smokers. The specific protection of the young would be made more of a reality by abolishing the slot machines—which make nonsense of the law.
I am sure that such methods would encourage those who try to stop smoking in schools, for they would be sure that the community was on their side. Such methods, I think, would show a realisation of something that we too easily forget: that education is not something simply carried on in schools, but is the responsibility of the whole of society; that the battle to inculcate right attitudes and rational behaviour in the schools is apt to be a losing one—and will be a losing one—if it is all too clear that 694 powerful sections of society are pursuing quite different ends, not unsuccessfully.
§ 6.25 p.m.
§ LORD SALTER
My Lords, like several other noble Lords, who have spoken, though I think a minority, this evening. I speak purely as a layman, having no expert qualifications, medical or industrial, nor as one with special responsibility for the young, like the noble Lord who has just sat down. I want to give your Lordships the impressions made on me by this Report, preceded as it has been by much authoritative evidence from previous years, including evidence from other countries, and followed as it has been by the statement of the Ministry of Health last week and by What has been said this evening.
I listened with great interest to the careful, responsible and impressive speech of my noble friend Lord Sinclair of Cleeve. There are some things upon which I find myself in agreement with him. But I confess that nothing he or anyone else has said, or anything that has been said in the Press, for that matter, changes my main conclusion after reading this Report. What it recommends, the evidence it produces, seems to be sufficiently certain and serious to be a proper guide to personal conduct and to public policy. I do not for a moment contend that excessive smoking is the only cause of cancer. There are doubtless other causes and it may be the effect of smoking itself is chiefly in combination with those other factors. But, after the evidence to which I have referred, that in the present situation the smoking of many cigarettes a day—cigarettes as they are now, whatever may be the possibilities of making them less dangerous in the future, and in the present environment, both psychological and physical—may contribute to that danger, I cannot avoid the conclusion that if we could remove or substantially reduce this one particular habit we should make a substantial contribution towards removing one of the most horrible afflictions of man in our time.
I do not contend that we have absolute proof. I certainly agree with my noble friend that the continuance of research is desirable. I would only say that, pending the results of further knowledge or some further change in the situ- 695 ation, I think we ought to act on the assumption that this is sufficiently certain to be a basis for action. I would add this about research. I think it is highly undesirable that any research into whether or not cigarette smoking is a serious danger should be directly financed by the trade itself. It should be otherwise financed. Not that I doubt the good faith, either of the manufacturers or of those who undertake the research, but it is not a good psychological factor to those who conduct the research that they should know that those who are financing them would greatly prefer to have answer A rather than answer B. And, certainly on publication of the results of the research, its effect is likely to be to some extent discounted if it has not been originally initiated by a disinterested party.
Nor do I contest the probability that there will be certain adverse effects for certain individuals in the sudden cessation of smoking, or of heavy smoking. Perhaps there will in some cases be obesity affecting the heart, perhaps a great increase in nervous tension, and I would not say that it would be to the advantage of every single individual who has long been an addict to heavy smoking that he or she should now give it up.
As regards the general conclusions which I suggested just now, I think the evidence is now sufficient for us to act. I do not think that either the sale or the smoking of cigarettes should be treated as a vice, in the sense in which the smoking of opium is treated, and made a penal offence. I do think, however, that there are some things which can and should be done by us individually, by us in our many public and collective capacities, and also by the Government, too. I will suggest some of these in a few moments, but, by way of preface, I should like to remark that we must not underestimate the extreme difficulty a very great number of people who have been addicts for many years would find in substantially reducing or stopping smoking. The noble Lord, Lord Fisher of Lambeth, told us that he has been able to do so and the noble Viscount, Lord Samuel, said the same thing in The Times to-day, but they are not quite average people. There are, indeed, many people, less excep- 696 tional than they, who also have been able to give up smoking. But for a very large proportion of longterm addicts, it will be extremely difficult and perhaps impossible.
Non-smokers have often said to me: "Why don't people make a strong effort of will and end this bad habit? In a short time the urge would go." I always thought they were wrong, but I had no conclusive answer until the experience of the last war, when we had a human experiment of a very rare kind and on a very large scale. Millions on the Continent of Europe were forcibly prevented from smoking at all for some years and it might have been expected that by the end of that time the urge would have gone. Yet when cigarettes became available, but in scanty supply there was hardly any other commodity which was so eagerly sought after. You could buy almost anything with a packet of cigarettes. I say that, not to suggest that many people cannot and should not abandon smoking, but to show that it is not as easy as may have been suggested by the noble Lord, Lord Fisher of Lambeth, and the noble Viscount, Lord Samuel.
I should like to add that I think cigarette smoking—and I speak as one who has been an addict at times in my life—partakes of the nature of a vice, as distinct from a luxury, in the sense that most people smoke cigarettes at least as much to avoid the discomfort of not smoking them as for the positive pleasure they get. I myself find that, when I want to take a cigarette, that is what is mainly in my mind. I do not get much positive pleasure, but it is uncomfortable not to smoke one. On the other hand, when I smoke a cigar it is not because I have had a strong urge to do it; it is because I get positive pleasure. Now, it is very much easier to forgo a luxury than to cut clear of a vice, and, in this sense at least, I think that cigarette smoking is a vice.
I remember during a period of economic depression being in Paris and going to buy a packet of cigarettes from an old woman in a kiosk. I remarked: "Well, madam, I hope you are not suffering too much from these bad times", to which, in that epigrammatic wit which you often find in all classes of our French neighbours, she replied at once: "No, Sir, I am not doing so 697 badly. You see, I have the good fortune to have my business based upon one of the principal vices of man, and there could be no surer foundation". I think there is some truth in her remark.
At the same time, there are many people who could certainly stop or greatly reduce their smoking. When to the motive of improving their own chances of good health is added a certain special responsibility, whether as doctors, as teachers, or as parents of adolescents and young people, it is not unreasonable to hope and expect that, with proper advice and proper encouragement by the Government, and in other ways, a great number of people—particularly those who have responsibilities of that kind—will attempt to discipline their own smoking.
One of the most unfortunate facts which has come to light in this Report, as well as from other evidence, is that a large contribution to the increase in the consumption of tobacco comes from what is, relatively, the new addition of women as smokers—it is a phenomenon of the last forty years—and also the more recent, rapid increase of smoking by children. As regards children, it is obvious that that is particularly undesirable. I think, too, that the increase in the consumption of tobacco by women on the scale on which it has developed is specially undesirable. I say that for two reasons. First, I am inclined to think—and I should be glad to hear the opinions of other people on this—that a woman who is a really serious addict finds it, on the whole, more difficult even than a corresponding male addict to give it up. Secondly, women exercise greater influence bath on children and upon social custom and etiquette.
They probably bear a bigger responsibility than men for the development of what I think is the uncivilised habit of sometimes smoking through meals. I find it difficult to believe that anyone who smokes during the course of a meal can really have a connoisseur's appreciation of the quality of the food he is eating. I trust very much that that habit will not become as prevalent in this country as it is in some other countries. I welcome very much some of the institutions and rituals which we have in this country. For example, if you are at a public dinner, you do not smoke 698 until after the Queen's health has been drunk. We also have institutions like colleges where, of course, it is an un-heard-of thing to smoke until after dinner. I hope that those restraints will continue and become more effective when other influences are brought to bear.
What, in these circumstances, do I suggest should be done, my Lords? I will only mention, in order briefly to agree with them, some suggestions which have been made. I agree about the prohibition of smoking in such public place as cinemas and theatres. There is the additional reason there that, apart from any effect upon your own health, you are polluting the atmosphere for other people who are either non-smokers or who, at any rate, do not want to smoke there and then—and you cannot segregate them as you can in a railway train.
As to the very obvious suggestion that you should just put up the rate of taxation to make cigarettes more expensive, which is tentatively suggested, I think, by the Report, on this I am inclined to agree with the noble Baroness, Lady Summerskill, and also, I think, with Lord Cohen of Birkenhead: I am not in favour of it. That is partly because I think we know, after long experience, that it has very little effect upon the total consumption except for a short while after a rise is made, and partly because, as the noble Baroness suggested, it has the effect of diverting expenditure within a family from the nonsmokers to the smokers, with undesirable results.
But I have another reason which has not yet been mentioned. I do not think it is desirable that the finances of this country should be as dependent as they are, still less more dependent, upon a habit which is as deleterious as the Government have now recognised this habit to be. Such a new addition to taxation to help the general revenues of the country would, I think, do much more to corrupt Government than to reform the smoker. When I say "Government", I do not mean the present Government: I mean any Government and the whole system of government and the outlook in Whitehall.
We must remember that it is over £800 million, I think one noble Lord has said, that is derived from the taxation of 699 cigarettes. That means that the people who principally profit financially from the tobacco trade are not those who grow the tobacco—they profit least; they are not even those who profit a great deal more than the growers—namely, those who manufacture the tobacco and sell it as retailers. No. The Treasury is by far the biggest profiteer, and I think that that puts a very heavy responsibility on them. It was perhaps excusable so long as we did not know what we now know as to how little effect on total consumption any extra tax has, and so long as we did not know as much as we now know about the evil effects of cigarette smoking
My Lords, I do not say that we should have no extra taxation. I think it might be desirable to have extra taxation on advertisements of tobacco, so long as that is not added to the general finances of the State but is specifically allotted to dealing with this tobacco problem. I think that the taxation of advertisement may be a good thing if it is kept out of the general finances of the State, but I am very much against merely taxing it and adding that revenue to the general public revenue, for the reasons I have mentioned.
I do not propose to detain your Lordships further, except to appeal to the Leader of the House (from whom I do not expect or ask a substantial addition this evening to the statement of policy that we have already had from his colleague in the other place, the Minister of Health) to tell us that the useful but very limited measures that have been suggested will be only the first step, and that the Government will consider very seriously what further steps are practicable and likely to be useful. I would just return for a moment to this one suggestion of reducing, if not of stopping, advertisements of cigarettes, which must have the effect not only of achieving their first purpose—that of making you smoke, if you smoke at all, this brand rather than that—but of increasing smoking in general. In particular, advertisements may render ineffective any exhortatory measures that the Government may undertake and may even make them seem hypocritical. That is particularly so if we remember, as we must, that, of the £11 million which is spent on advertising now, the greater 700 part is at the expense of the public revenue, because it is, of course, a deductible expense from taxable profits. My Lords, that is all I have to say, but I would ask the noble Viscount who is to reply to assure us that every effort will be made to follow this first step later by other appropriate action.
§ 6.47 p.m.
§ LORD BRAIN
My Lords, after the comprehensive and eloquent speech of my noble friend Lord Cohen of Birkenhead, it might have been thought that there was very little more that needed to be said on the medical side of this question. But past experience shows—and, indeed, some of the speeches by noble Lords made since his have shown—that there we some things which do need to be said again and again. Naturally we have been very much preoccupied this afternoon with the tragic toll of lung cancer, but I think it is worth while to go back for a moment to the more general effect of cigarette smoking an health, and this is reflected in the mortality risks far British doctors published in the Report of the Royal College of Physicians.
This shows that between the ages of 35 and 44 the death-rate for heavy cigarette smokers, from all causes, is four times that of non-smokers; between 45 and 54 it is about three times; and at later ages it is about twice the rate for non-smokers. For one who dies, there are many whose illness is made worse or who are partially incapacitated. This applies not only to lung cancer but to duodenal ulcer, to chronic bronchitis and, perhaps to a less extent, to coronary heart disease. So, apart from the specific question of lung cancer, there is a serious general effect on health, a seriously increased risk to life, brought about by heavy cigarette smoking. And, although doctors are able to give the right advice to their patients who suffer from these disorders, I think it is a good thing that the general public as a whole should know that they may be making matters worse by continuing to smoke. Far not all people, I am afraid, always take their doctor's advice.
The question of research has been raised, and the noble Lord, Lord Coleraine, felt that the Report of the College should have said more about research. I am sure that the College would agree, and that all doctors would 701 agree, that there is great need for further research. It seems to me that where the noble Lord differs from the College and myself is in the fact that he thinks that further research is necessary before action is taken, and we think that the case is so far proved that no further research is necessary before we take action, however much further research may be needed to elucidate the problem further.
§ LORD BRAIN
Of course, research into lung cancer is part of the larger question of research into cancer as a whole, which, as we know so well, and as experience shows, is an extremely difficult problem. The one may be expected to throw light on the other. The suggestion has been made that it may be possible to discover by research which individuals are likely to develop lung cancer and which are not. This is certainly possible by some bio-chemical tests, or other investigations may settle this question, and it would clearly be of the greatest value if it could be solved. But I am not sure that the answer will come in that way, because one has to face the possibility that the reason why some people get lung cancer and others do not may be merely because it takes longer to develop in some than in others, and it may be longer than the normal life span of the individual. If that is so, it would not necessarily depend upon any test which could be detected by special investigations.
One difficulty which clearly troubles many people is the fact that some nonsmokers get lung cancer, and many heavy smokers do not; therefore, how can smoking be the cause of cancer? The fact is that in medicine it is very rarely that one disease has one cause. Causation is multiple. Many factors have to be present, and as a result of that, if a group of people are exposed to one causative factor, some of them may develop disease and others do not, because they who do not have not got the additional factors necessary. Let me illustrate that with a common disease which will be familiar to your Lordships, pneumoconiosis. That is the disease which is caused by dust and which is a hazard for coal miners. If you take 100 coal miners and expose 702 them for twenty years to the same concentration of dust, some will get pneumoconiosis and some will not. But I have never heard it argued that pneumoconiosis is not caused by dust, or that we should do nothing to prevent pneumoconiosis until research has shown why some individuals suffer from the disease and others do not.
Now I must say a word about atmospheric pollution. We have heard, it is true, that atmospheric pollution is, or appears to be, a factor in the causation of lung cancer, and that the incidence of lung cancer is very much lower in areas where the air is not polluted. Perhaps I may add one point to the one raised by my noble friend Lord Cohen of Birkenhead about Iceland. He told us that there lung cancer has begun to appear about twenty years after cigarettes were introduced. But there is one further significant fact. During that time they have introduced into the town of Reykjavik new methods of dealing with heating, and their air pollution has actually diminished. So there is a country in which a parallel rise in cigarette consumption and lung cancer has occurred at a time when atmospheric pollution has gone down.
I will not spend long in discussing what can be done about all this, but I should like to say that I agree very much with the noble Baroness and the noble Lord, Lord Cohen of Birkenhead, that this question ought not to be controlled by taxation. I hesitate very much to accept the idea that we ought to be taxed for our own good. If that principle is one which is introduced, it is very hard to know where to draw the line. If we knew that cigarette smoking inevitably did harm, there might be a case for it, but we know that that is not so. Moreover, it might, and I think it would, cause hardship to many people who, after many years of smoking, should not be expected, or could not be expected, either to give it up or to spend an increasing amount of their money on it. Similarly, I am doubtful about the wisdom of attempting to deal with this question by restricting advertising, again simply for the reason that if one starts to restrict advertising on the ground that the product advertised is bad for one, where is one going to draw the line?
§ LORD COHEN OF BIRKENHEAD
My Lords, may I just remind the noble Lord, Lord Brain, that we have in fact done this? We do not allow advertising of cancer remedies; we do not allow advertising of cures for tuberculosis; we do not allow advertising of a cure for venereal disease, and so forth. This has been done; it is no new feature. And although I should be the last to suggest that we should prevent advertising of all tobacco, I think there is a case for stopping certain types of advertising which not only offend the balance of good taste but in fact lure meretriciously a number of our young people to tobacco smoking.
§ LORD BRAIN
I appreciate the noble Lord's point of view. I think it is a matter for opinion and judgment, again, as I said, of where to draw the line. But I think we should all agree on the great importance of attempting in every possible way to prevent children and adolescents from smoking. There are many, perhaps obvious, ways of doing that—by education, and by example. But I think we still do not know nearly enough about what the causes of smoking are. I hope that the Government will be prepared to stimulate research into the whole question of the psychological and social causes of smoking in young people. Beyond that, I hope, as do so many other noble Lords, that the Government will be prepared to reiterate their acceptance of the Report and do everything that is possible to carry out the general recommendations of the College Report.
§ 6.57 p.m.
My Lords, I must first of all declare my interest in this matter. I have been a smoker of pipes for nearly 40 years, and during that time have smoked between 2 cwt. and 3 cwt. of tobacco, mostly produced by the noble Lord, Lord Sinclair of Cleeve. But I have also indulged in herbal mixtures, and have grown my own tobacco, too. I need hardly say that although I do not think that has so far given me lung cancer, my own tobacco certainly made me very sick. I also have a few tobacco shares, but not enough to influence my judgment in this matter.
It seems to me that when we approach this matter we must think of three background factors. We must remember that 704 certain foods, drinks and habits have in this nation always aroused strong passions. There are many people who regard it as their duty on earth to save man from sinful indulgence. That applies to tobacco, alcohol, white bread, tea, and I believe even coffee, at times. The Royal College of Physicians must be beyond suspicion as to their objectivity, but the Report which they have made, based not on their own researches, but on researches made by other people all over the world, has certainly been hailed with enormous satisfaction by all those people who regard it as their duty to save man from the sinful indulgence of tobacco.
Another basic factor is that medical knowledge is extremely imprecise. The certainties and the theories of one generation are flatly contradicted by the next in a most remarkable way. Thirdly—and this point has been mentioned—the great increase in the number of diseases which the medical profession can cure naturally leaves man at much greater hazard to those diseases which so far the medical profession cannot cure. As we see from some of the tables in the Report, pneumonia and tuberculosis of the lungs show sensational drops in mortality. Could it not be that those whose lungs are their weak spot, having survived these diseases, might have tended to fall victim to this other one about which we are talking? When one is considering cases in the past and present, I am told on good authority that twenty or thirty years ago many people who might have had lung cancer almost certainly perished of pneumonia. That was before antibiotics were invented to cure pneumonia.
When we come to the Report itself, it does not pretend to say that smoking causes lung cancer, but cencentrates on proving that lung cancer tends to attack heavy cigarette smokers. It admits that non-smokers get it, too. In fact, in my own small locality, I have heard of three cases of non-smokers who have lung cancer. The Report does not tell one in a very straightforward manner all these facts. They are wrapped up in graphs and percentages, drawn from surveys by various groups of people, and it is difficult to discover which table or graph is drawn from which survey of what people.
705 In one case, the class appears to consist of 500 British doctors; in another, of 187,000 American men; but somewhere else there is some question of 3,000 British doctors. I find it difficult to tell from where the percentages and graphs are derived. It seems to me that it could be misleading to deduce too much from too small samples. In one table it seeks to show that a large number of doctors have given up smoking for fear of lung cancer. It is a little difficult to reconcile Figures 4 and 5 in the Report, but it appears that whereas, in 1951, 200 out of 500 doctors were non-smokers, ten years later the number had risen to 250. The noble Lord, Lord Cohen of Birkenhead, and the Report hail this as proof of the wisdom of doctors in their fear of lung cancer, but I think that there is a much more ready explanation. Between the years 1951 and 1961 the inflation in this country bore most hardly on the income group to which doctors might be expected to belong and I have no doubt that a great many of those 50 doctors who gave up smoking gave up because they decided that they could not afford it any longer.
It would have been nice to be told, in Table 2, the percentages of the total number of deaths in the nation, instead of picking out individual diseases. When we turn to the figures of coronary diseases among, presumably, the same 500 doctors, we get some rather queer results. It would appear (I hope I have this right; I have shown the calculation to somebody else and he has checked it) that if you are a British doctor between the ages of 54 and 74—and a male British doctor, I may add, for the benefit of the noble Lady opposite—to avoid the risk of death from coronary diseases, you must smoke between 15 and 24 cigarettes or between ½ oz. and 1 oz. of tobacco a day. That is a large amount, far more than I have ever smoked. Surely this shows that some of these samples and surveys are of to. o small a span from which to make sound deductions for the whole of the population.
The Report admits that no one has caused lung cancer in an animal through causing it to inhale tobacco smoke, but says that nothing can be deduced from this fact. If the reverse had been 706 true, and somebody had produced lung cancer in an animal through causing it to inhale tobacco smoke, would it also have been said that nothing can be deduced from this? I think that the Report would have been much better to show the figures derived from the mass X-ray of the British people. Like many noble Lords, I have been "done", and millions of people must have been "done".
I was told that one object of the exercise was to discover lung cancer. Why can we not be told how many of these millions have lung cancer, and why cannot these cases be followed up and their smoking habits tabulated? That would have been far more valuable than graphs derived from samples of doctors. With all due deference, I do not regard doctors as the last word in the interpretation of the figures of mortality. I should prefer to go to the life insurance offices, and I understand that none of the big life offices, at any rate, offers any discount to the nonsmoker.
However, one must accept that the figures in these surveys, despite their limitations, show that lung cancer is more common among heavy cigarette smokers. But, of course, everybody has known for years that over-indulgence in anything, is bad, whether it is drugs, food, drink, tobacco or anything else. Tobacco has some good effects. It stops people getting too fat. It stimulates the brain in some, and it soothes the temperament in others and it helps move the bowels—and in a constipated country like this, that is not without merit.
Of coarse, over-indulgence in tobacco must he bad. We have all known that. When I was young, athletes did not smoke, and people used to ask, "Do you inhale?" Now it seems to he taken for granted that anybody who smokes a cigarette does inhale. I do not think that used to be so 40 years ago. As my noble friend Lord Fisher of Lambeth said, for the better-off classes in the public schools, smoking was absolutely prohibited, and the prohibition was enforced by the rod. It did not worry any of us, I must say, how much our masters smoked. We knew that it was bad for the boys and against the rules, and when we got 707 caught, we accepted our punishment with equanimity. We did not have any moral qualms about one law for the masters and another for the boys.
But now, when the better-off classes leave school, they find that they cannot afford to smoke, so many of them do not. None of my children smokes, nor any of my sons-in-law. They cannot really afford to. They have other things to spend their money on. But with the wage-earning classes at day schools, the masters may manage to stop them smoking on the premises, but they cannot possibly stop them once they leave the premises; and as they have too much pocket money they can indulge themselves liberally. Directly they go out to work, they earn the most enormous wages, with very small obligations, so that they have a tremendous capacity for affording smoking.
I think that we ought to do every, thing we can to discourage people from inhaling cigarettes. If they want to smoke cigarettes, let them try to smoke without inhaling—or preferably smoke a pipe. I mean the sort you put in your pocket, and not the "hubble-bubble" which the noble Lord, Lord Cohen of Birkenhead, appears to recommend, which is nice but rather impracticable. Moreover, we should encourage them to ration themselves to a given amount of tobacco a week, in order to obey the injunction of my noble friend Lord Fisher of Lambeth. We ought to discourage smoking in public places, in shops, cinemas and buses, because it is apt to be a nuisance to everybody else. I believe that there is more non-smoking in railway trains than there used to be before the war. I believe that this has nothing to do with fear of disease, but is due to the fact that the commuting classes have been hit by the inflation and cannot afford to smoke so much as they used to do. Even so, I think that we might increase the number of nonsmoking carriages.
At the same time, we must do much more research on polluted atmosphere, because there is some queer relationship between diseases of the lung and the atmosphere in some of the industrial parts of England. We must also spare no money or effort on research so that in the course of time we may 708 well achieve the great object of knowing what causes cancer, and then we shall know what we are talking about when we talk of lung cancer.
§ 7.12 p.m.
§ LORD CONESFORD
My Lords, this Report of the Royal College of Physicians struck me when I read it as a compelling and convincing document. I was delighted that the Minister of Health in his first reply in the House of Commons on the Report was quite definite that the Government accepted its conclusions and were equally convinced by the evidence. Had I been left in any doubt, I confess that those doubts would have been removed by the speech of the noble Lord, Lord Cohen of Birkenhead, which, if he will allow me to say so, was one of the ablest speeches that I have ever heard in Parliament. But the main conclusion of the Government announced by my right honourable friend the Minister of Health was to make the facts revealed by this Report generally known. That seems to me to be a quite admirable step. I think it was the noble Baroness who opened from the Benches opposite who said that that was insufficient, and more was needed. But I do not think we ought to under-estimate what can be brought about by the simple spread of knowledge of the facts.
One of the remarkable facts brought out in the Report itself is the great effect on the smoking habits of doctors that has followed their own experience. In my view, if the facts in this Report become more generally known, we may get an alteration of habit amongst the general public not dissimilar to the results that have already happened among doctors as a result of their professional experience. But the really difficult question, it seems to me, is not in deciding that this Report of the Royal College of Physicians is substantially right or that the Government are completely right in their first step of making the knowledge revealed in the Report more generally known, but what are the further steps that ought to be taken.
One of the suggestions, which I think has commanded the support of all speakers who have mentioned it—and I think it may encourage Her Majesty's Government to adopt it, or to encourage local authorities to adopt it—is pthe 709 restriction on smoking in public places and in public transport. I think that has received support in every quarter of the House from all noble Lords who have spoken. I think we are also all agreed that anything like prohibition would be completely out of the question; and that view, again, is held by the authors of the Report themselves. I thought for a time that the most reverend and noble Lord, Lord Fisher of Lambeth, thought that there was a quite strong moral case for something like total abstinence from tobacco, if it were voluntarily achieved. I confess that he did not convince me entirely. Of course, I belong to a class of smoker which the noble Lord pronounced to be non-existent. He said that everybody either smoked to excess or not at all. On an average, I smoke one cigarette in three days—which I am told is impossible—and it would not give me the least difficulty to give it up altogether, although I do not think that that would give me that great sense of moral responsibility which it seemed to give to the noble Lord, Lord Fisher of Lambeth, when he indulged in the same experiment.
Nevertheless, on this question of the prohibition of smoking (though nobody suggested it), it does not strike me that it would be so morally disgusting as the prohibition in America was. That seemed to me to be morally quite horrible. A lot of people said at the time that it might be all right and noble in theory, but it would not work in practice. But the exact opposite was the truth. It might conceivably, I suppose, have worked in practice, but in morals it was quite horrible. To give up such a splendid thing as wine because you cannot indulge in it in moderation seems to me morally horrible. I have pointed out before in this House that the tee-totaller shares with the habitual drunkard an inability to take wine in moderation.
We then come to another matter that has been suggested, and that is to do something about advertisements. Here I must say that I share the doubts expressed by many noble Lords, and particularly, I think, by my noble friend Lord Brain, who asked: If you stop the cigarette advertisements, where are you to draw the line? I confess that I see so many half truths or complete lies told 710 in advertisements of every kind that my own remedy, such as it is, is not to ban advertisements, but to try to teach the public to have the same utter disbelief in any advertisement they read that I think is the mark of the educated man. The general growth of scepticism that can be expected to follow education is perhaps the greatest thing we can hope for in this particular matter. For those reasons, I think the Government are quite right to put the spread of knowledge of this Report and the truth it contains in the very forefront of what they are doing; and I would repeat that we should not think that that step in itself may not have great results. I have suggested, as have other noble Lords, one or two other steps that might be taken.
I now come to the point where I find myself, I will not say differing from noble Lords who have already spoken, but at least expressing a sentiment which none of them has expressed. It is this. If, with full knowledge of the facts, an adult chooses to go on with this dangerous habit and thereby shortens his life, that fills me with far less horror than the thought that there are many who have their lives shortened, not because they indulge in any nasty habit, but because other people are permitted to indulge in dangerous habits, or even because the Government themselves indulge in habits injurious to health. I share, of course, the views that have been expressed on the horrors of lung cancer, but, as I say, if an adult, with full knowledge of the facts, runs that risk and dies prematurely, that fills me with far less disgust than the fact that there are hundreds of thousands and even millions of people who are suffering ill-health or sleeplessness from the thoughtless indulgence by others in unnecessary noise.
I very much hope that the Royal College of Physicians will follow their researches into these matters, by researches on the subject of noise, and by expressing themselves very strongly on the result. It so happens that this is a subject on which I suppose I have had most contact with distinguished members of the medical profession. I was the principal legal adviser of the first Lord Harder in his attack on the noise problem in the original Anti-Noise League, and there was a certain amount of legal reform that I was able to bring about. I think I was succeeded in the post of 711 legal adviser by my noble leader for a short time, who, I may say, on my advice was chosen by the Committee of the Anti-Noise League and asked if he would become our legal adviser. I am now talking about a matter very long ago, but he may possibly recall it.
§ LORD CONESFORD
Noise is relevant, as we know from recent interventions and questions and debate in this House. It is Her Majesty's Government themselves who are proposing the antisocial atrocity of a helicopter station in Central London, and the local authorities who are resisting it. I hope that if the Government are unable to go as far as some would wish in following up this Report and in preventing lung cancer, they will at least refrain from promoting ill-health by insisting on unnecessary noise.
Let me mention another matter. What about the consumption of sweets by children? I understand that the consumption of sweets is greater per head in this country than anywhere else in the world. I believe that our children have the worst teeth. But perhaps one of the eminent doctors will state whether that is right or wrong. Certainly the badness of our children's teeth at quite an early age is attributed by the medical profession to the excessive consumption of sweets.
§ LORD CONESFORD
I have not the slightest idea, nor do I suppose has the noble Earl. I think a good deal of ill health results from having bad teeth. When I was a boy at school, I remember some boys were unable to enter the Navy because their teeth were not good enough. The matter was considered a great disaster, because the Armed Services attached importance to the quality of people's teeth and, I suppose, with some reason. I disagree entirely with the idea that the condition of people s teeth does not matter; and the idea of teenagers having to have false teeth strikes me as disgusting.
§ LORD CONESFORD
I think my noble friend is attaching too much importance to dying. If a person dies perhaps in his sixties, because he has indulged, with full knowledge of the facts, in some habit which was bad for him, that seems to me a lesser disaster than that children should go through life with rotten teeth.
My Lords, may I suggest that one of the reasons why children have such rotten teeth is that they no longer have bone pen handles to gnaw at school? They have fountain pens, which they cannot gnaw.
§ LORD CONESFORD
I leave the reply on that point to the Minister for Science, who will no doubt have a great deal of learning about it. I have merely given the two examples of noise and sweet consumption as matters of which the Government might take notice, as well as this question of smoking, the importance of which I am not denying for one moment but which I think cannot be treated as the only thing which need worry us.
I was very much interested in the speech of the noble Lord, Lord James of Rusholme, who dealt with the question of the teachers. I was also struck by the circular and by some remarks I saw in the Press which were attributed, rightly or wrongly, to the present Minister of Education, who said that school teachers must take great care not to smoke in the presence of the children. I do not think they do. Just as, when I was at school, the children took considerable care not to smoke in the presence of the teachers. But the exact advantage which the Minister of Education sees from having the two lots smoking in separate rooms was not entirely obvious to me.
Then the most reverend and noble Lord, Lord Fisher of Lambeth, asked, "What about example?" If the adults gave up smoking, what a splendid example to the children in the home! I wonder whether he has met the modern child. It seemed to me that, if a child in the home saw that neither of his parents was smoking the only effect would be that he would say that they were both "squares". I do not believe the most reverend and noble Lord, Lord Fisher of Lambeth, has begun to consider the difficulties of this plan.
713 I want to associate myself with what has been said by my noble friend, Lord Salter, by the noble Lord, Lord Cohen of Birkenhead, and, I think, by others. It could be a weakness in the Government's position that the finances of the Welfare State are based as largely as they are on the taxation of this industry that we are considering. I have sufficient faith in the present Minister of Health, and in my noble friend who is to reply to the debate, to feed quite confident that this fact will not influence the Government when they come to consider what their duty is. I agree with the noble Lord, Lord Cohen of Birkenhead, that if this great source of revenue were denied us there would be others that could be tapped. But, of course, we are very far from any threat of losing that revenue.
If I admired enormously the speech of the noble Lord, Lord Cohen of Birkenhead, I must say I admired and enjoyed almost equally the speech of my noble friend, Lord Stuart of Findhorn, who expressed with great vigour the reply to the more extreme statements of those who would unduly curb our freedom. In conclusion, I would say that I naturally, as do the Government, fully accept what I think is the admirable Report of the Royal College of Physicians. I think that the Government have taken the right first step and I am glad they took pit so promptly. I think that even that first step, of giving information, will prove a good deal more effective than same people think, because—I gave this example when I think my noble friend the Leader of the House was not in the House—of the alteration of the doctors' own habits in recent years because they had knowledge of the facts that this Report has revealed, and so many other facts. But when the Government are asked to take further extreme measures I hope they will not do so without full consideration of all the consequences involved.
§ 7.32 p.m.
§ LORD AIREDALE
My Lords, it was interesting to hear the noble Lord, Lord Conesford, say that he is capable of smoking one cigarette every three days, because in the light of this Report the noble Lord is undoubtedly, in that particular respect, an unusual person. One of the passages of this Report which particularly interested and appealed to 714 me was the conclusion of paragraph 82, which reads:While many if not the majority of people enjoy alcoholic drinks on relatively infrequent occasions, however, there are very few occasional smokers. Most smokers consume a regular daily amount of tobacco. It appears that smoking is generally much more habit-forming than drinking.I feel sure that this is perfectly true, and that the great mischief associated with tobacco is really the habit-forming nature of it.
There is one aspect of this matter which, perhaps, it is rash, at this stage in a debate of this length, to say has not been mentioned so far; but, at any rate, I think I can say that this has not been emphasised, although perhaps it is so obvious that it need not have been emphasised. It is this: that for every patient dying of lung cancer there is more than one ordeal. There is the ordeal of the dying patients themselves; there is the ordeal of the people who have to look after them. I am not thinking only of near-relatives nursing people who ought, in many cases, to be in their prime of life, sinking slowly and inevitably towards a dreadful death; I am thinking also of the nursing profession. The question I ask myself is: what right has a man to subject not only himself but a young professional hospital nurse to the ordeal of nursing him through a long, distressing and painful disease, knowing that there is nothing that can be done about it, but that he is going to die, when he knew perfectly well that it was brought on by a dangerous habit which surely, with more thought, he could have forsworn?
I think it was the noble Lord, Lord Conesford, also who made the point (I hope I am paraphrasing this correctly) that it is for grown-up people to decide for themselves whether or not they run this risk. My Lords, it is not only the person himself who suffers this terrible distress if this dreadful disease attacks him: those who have to look after him also suffer. I do not think that point has been very much emphasised to-day in this debate, yet it is one that ought to be kept in mind.
That was not the tenor of the observations that I intended to make this evening. What I intended to speak about was the question of legislation, 715 whether or not further legislation is necessary. On the whole, noble Lords have expressed the view that further legislation is not entirely desirable, but I think that it might be worth while very briefly to look at the existing legislation concerning children and tobacco, and to see whether it is adequate, in the light of present-day thinking on the subject.
Legislation on this matter goes back to the Children and Young Persons Act, 1933, Section 7, and the first subsection makes it an offence to sell tobacco to a person apparently under the age of 16, with a proviso that no offence is committed if the seller had no reason to believe that the tobacco was for the child's own use. In my submission that proviso really undoes the whole of the good that the subsection does in the first instance. Surely all that happens is that the conscientious tobacconist asks the child, "Who are these cigarettes for?" The child merely says that it is buying the cigarettes for an older member of the family. The conscientious tobacconist then says to himself that he has no reason to believe that these cigarettes are for the child's own use, and the cigarettes are sold. It may be some use having this section so far as villages are concerned, where the shopkeeper knows his customers; but I believe that in towns children can, with impunity, ride the proviso, as it were, and buy cigarettes over the counter to their heart's content merely by saying that they are buying them for older members of the family.
Then one comes to the next subsection which deals with slot machines. I was very pleased to hear the noble Earl who opened this debate mention slot machines, as did the noble Viscount, Lord Stuart of Findhorn. I was particularly pleased to hear the noble Viscount mention slot machines and speak against them, because there was not so much that he said that was in sympathy with the speech of the noble Earl who opened this debate; and I think the noble Lord, Lord James of Rusholme, also added his name to those who spoke against slot machines.
The position under the Act of 1933 is that if it is proved to the satisfaction of magistrates that a slot machine is 716 used extensively—that is the word used, "extensively "—for selling to children, then the magistrates, if so satisfied, may make an order. But what does "extensively" mean in this connection? If one child buys one packet of cigarettes every day from a particular slot machine, is that machine being used "extensively" to supply children? Or if ten children buy one packet of cigarettes a week from a particular slot machine, is it being "extensively" so used? And is the criterion in this matter the same in Oxford Circus as it is in the outskirts of Chorlton-cum-Hardy? One wonders what this word means in this connection and how the police are going to enforce the law. Are the police, who, we all know, are already understaffed and overworked, to lie in wait near suspicious slot machines, compiling statistics to discover how extensively the machine is being used by children? In my submission this really will not do.
There is only one answer here, and noble Lords have expressed this already: that slot machines in places to which children have access must go. I suppose at this stage I ought to say, as the lady says over the loudspeaker at Waterloo station, that I am sorry for the inconvenience that is going to be caused hereby to many members of the general public. But I am not. In my submission, it is perfectly easy; if grown up people forget to buy their cigarettes over the counter during shopping hours, and if they are so unfortunate that they cannot buy them in the evenings over the counter from cafés, or from theatres, restaurants or public houses, then, in the interests of keeping children away from cigarette slot machines, those people must wait until the next morning. It is very inconvenient if you run out of bread after shopping hours. If you run out of bread on Saturday evening you perhaps have to wait until Monday morning; but people survive this experience. In my submission, there is no question about it here: cigarette slot machines in places to which children have access must go.
There is only one other subsection that I propose to mention and that is the next one, subsection (3), under which if a policeman or a park keeper in uniform sees a child apparently under the age of 16 smoking in a street or other 717 public place it is his duty to confiscate the cigarettes or the tobacco in whatever form it is. I do not know to what extent this is acted upon by the police—I suspect very little. No doubt the police, again understaffed and overworked, have up to now considered that this was not one of the more important of their duties. I should like to see chief constables instructing their forces that this is from to-day one of the important parts of their duty. I believe that if police officers were seen to be dealing severely with children found smoking in public, the whole of the public would be encouraged to deal severely likewise. When I sit in a tube train and see a boy of 10 sit down opposite to me, look me straight in the eye and light a cigarette, I feel that this is a piece of effrontery. I feel there is nothing I can do about it. But if the police were to make a determined effort to stamp out smoking in public by the under-sixteens I believe the whole of the adult population would be encouraged to take part in that campaign.
That is all I have to say. There is one sentence in this Report which has already been quoted once by the noble Baroness, Lady Summerskill. It was some time ago when she had the opportunity of quoting it, and I think it is so good that it bears repetition. It is at the end of paragraph 103:At present both social custom and commercial pressure outbid the voice of caution, and the balance must be redressed ".
§ 7.45 p.m.
§ LORD AUCKLAND
My Lords, two schools of thought must necessarily pervade this debate which has been so admirably introduced by my noble friend Lord Arran. One is that the Report of the Royal College of Physicians is another example of the whittling away of the liberty of the individual, and the second is that it is a sensible, workmanlike and easily readable document. I incline to the latter view. As a non-smoker I, of course, lay myself open to charges of prejudice when I criticise smoking habits. But I am the last person to criticise smoking in itself: it is all a question of degree.
One can argue, as my noble friend Lord Conesford did most admirably, that the eating of sweets by children can do harm. And I must confess a partiality for confectionery myself, pro- 718 bably due to the fact that I do not smoke. As regards children and sweet-eating, the answer must, at least to a large extent, lie in the hands of the parents. My own eldest daughter is now six. Like any other normal child she enjoys sweets. When she goes to the dentist, which is fortunately rarely, he gives her a little lecture on the care of the teeth and also on the importance of not eating either too many sweets or sweets of poor quality, and I must say that she is very co-operative. So I think that rather "heavy weather" is sometimes made of the harm that sweets can do to children's teeth. Harm it certainly can do; but, as I say, the remedy is in the hands of parents, and if necessary the teachers, and should be rigorously applied.
Excess of smoking can, of course, do tremendous, and probably fatal, damage; and it does not need even an admirable Report of this kind to convince one of the common sense of abstention. Excess of alcohol can cause cirrhosis of the liver, excess of sweet-eating or other foodstuffs can cause tooth decay and stomach upsets. But this Report, whether it is a good Report or not, has, one hopes, achieved one thing: it has got into the minds of the public. And I notice particularly to-day how much discussion there is of the virtues or otherwise of smoking. I believe that for that reason alone the publication of this Report is extremely worth while.
The question of smoking in public places is something on which I feel very strongly, and I hope that the very sensible recommendations of the London County Council and the Manchester City Council will be applied without delay. There is absolutely no reason why anyone cannot sit through an act of a play or of an opera without smoking. After all, people do not, one hopes, produce a bar of chocolate and start munching it.
§ LORD AUCKLAND
So why should they light up a cigarette? For one thing, it is bad manners, so far as the per. formers are concerned, and it is certainly most inconvenient for any singers, operatic or otherwise, because invariably the smoke drifts towards the stage. It is argued by some that actors on the 719 stage smoke in order to give atmosphere to the drama of a play. To my mind that is a completely irrelevant argument. I hope that the Government will take into serious consideration what the London County Council and, one hopes, other county councils and city councils will in future legislate for.
The Daily Express has been sensitive about the criticism which it has incurred on another matter; but this paper is really asking for criticism when, in its comment column to-day, there appears this deader:It cannot be a serious suggestion that cigarette smoke can harm anyone except the smoker.This leader refers to smoking in cinemas, theatres and public places. I submit that it does harm. If there are 2,000 people in a theatre, 600 of whom are smoking, whether it be cigarettes, cigars or pipes, the atmosphere becomes fouler and fouler; and I think that it is not a denial of liberty that legislation should be brought in to ban this habit. After all, it is done on the Continent and in other parts of the world; in fact, it is already done in a good many theatres here. I do not think that bookings would decrease; in fact I am not sure that they would not increase.
Turning to restaurants, and particularly restaurant kitchens, I think that public health authorities should use greater influence to make sure that smoking is forbidden in these places. It is by no means unknown for one to be served with a plate of fish and chips, or something like that, with a film of cigarette ash around it. It is quite obvious how it got there. As for railway compartments, I see that a Question was asked yesterday in another place regarding the provision of more "non-smoking " carriages. I hope the Government will take note of that point, and will provide more of these carriages because they add to the comfort of one's journey. I do not say that out of prejudice, because I believe that even fairly heavy smokers like to travel free from cigarette smoke.
I was interested in to-day's Daily Herald, which has a column of opinion concerning those under 25. The question to-day concerned the banning of smoking. Of six youngsters who were 720 asked about their views, only one said categorically that smoking in public places should be allowed; at least two of the other five said categorically that it should be forbidden, and the remainder had qualifications as to how it could be carried out. Surely that proves that young people are not all for the burning of the infernal weed.
With regard to television advertising, those of us who watch I.T.V. know that it has good programmes, but often one has to sit through tedious advertisements for various types of cigarettes. I have in mind what I might call a particularly seductive advertisement for a cigarette known as "Strand". Whether or not it is worth the man's waiting for his girl friend who is late, and whether or not this particular brand of cigarette gives him comfort and soothes his temper, I do not know, but I should greatly doubt it. It seems to me that these advertisements are just plain stupid. Whether or not they help to sell the product, I do not know. What irritates me and a number of other people about these particular advertisements is that in the course of one evening something like six brands of cigarettes are advertised. If they concentrated on perhaps two per evening, that would be reasonable. But why must viewers be subjected to five or six?
Now how do you cure youngsters of smoking? I was twelve when I smoked my one and only cigarette. I had about two puffs; I was violently sick, and I have never touched one since. So perhaps it is not a bad thing for youngsters to have the initial puff. It may well put them off for life—although certainly I think that school children should be rigorously banned from smoking. I was most interested in the remark made by the Minister of Education at a teachers' dinner at Letchworth the other evening, when he said that the deflating of the ego was the answer. If the girl friend were to say to her boy friend, "With all the money you spend on cigarettes over a period of four weeks I might have bought a new dress", he may think twice about continuing smoking. Perhaps he will not. It is worth trying, and I commend it to young people.
This has been a useful debate. Those who criticise this House, whether in Time and Tide or elsewhere, might take 721 note that all sections of the community, the doctors and the tobacco "barons", are not as bad as they are painted; they are honest men. After all, one might argue that television tycoons or whisky distillers also sell products which might be potentially harmful; so I think it is not entirely right to single out the tobacco magnates. But, in all seriousness, I hope that the Government will pay great heed to this well-worded document which the Royal College of Physicians have produced.
§ 8.0 p.m.
§ LORD COLWYN
My Lords, I am positively terrified after all the brilliant speeches made by the "dottori" and "dottorina", and my contribution is going to be very short, as we are running rather late. I know it is very fashionable to-day to attribute lung cancer to cigarette smoking. I would not seek to dispute the integrity of the Report of the Royal College of Physicians, nor do I claim that there is no connection. I would ask your Lordships to consider, however, that there are other prime aggravants, not to say causes, of respiratory cancer. I speak particularly of diesel emission. In my capacity as Chairman of the Diesel Exhaust Fume Abatement Society I have statistics which are frankly, to me, terrifying. The increase in male deaths from respiratory cancer between 1937 and 1960 was 350 per cent. During the same period deaths from respiratory tuberculosis in males fell from 680 per million in 1937 to 106 per million in 1960. It can be assumed that the conquest of T.B. over this period has led to the survival of constitutionally weak-chested men who are more liable than average to chest diseases, including lung cancer.
Taking this into consideration, I think some new fact must have caused such a tremendous increase. A clue here is that respiratory cancer is more prevalent in town dwellers than in countrymen. My good friend, Mr. Arthur Dickson Wright, has said that in his experience the townsman's lungs are black, the countryman's pink. I do not know whether your Lordships read in the Daily Telegraph on Wednesday, March 14, the letter from Lady Fergusson Hannay—Doris Leslie, the authoress—whose late husband was my Society's doctor consultant on diesel fumes. The article was headed "Tobacco 722 or Diesel?" Sir Walter died from cancer of the lung and had not smoked for 25 years. My noble friend Lord Amulree earlier in this debate mentioned a mouse. Sir Walter Fergiusson Hannay used to stand in Blackwall Tunnel with a mouse in one pocket trying to smell diesel fumes, and in the other pocket he had a mouse that he was trying to affect by cigarette smoke. A similar case was raised in another place on March 14 by the !honourable Member for Falmouth and Camborine. This involved an Admiralty employee who, though a nonsmoker, died of cancer of the lung. He had been working among diesels for a considerable time.
The emission of factory smoke is waning in the cities as smokeless zones are introduced; yet respiratory cancer is not waning in those areas. Petrol engines were with us for many years before the cancer increases of the last three decades, but diesel engines were not. Since the introduction of the diesel, lung cancer has increased. I appeal to you, therefore, my Lords, to use all your influence to prevent the public from blaming smoking entirely for causing this disease for which it cannot be entirely to blame.
§ 8.4 p.m.
§ LORD AMPTHILL
My Lords, I am sure we are all very grateful to the noble Earl for initiating this debate. In the past we have been fascinated by his account of drinking large quantities of whisky in order to test his reactions to motor-car driving. We have also been interested to read his account of how for a time he donned the guise of a "Ban the Bomb" gentleman. Now he comes to us as a "Ban the Smoking" enthusiast. In common with all of you, I admire his enterprise and am grateful to him, speaking as a tobacco manufacturer, for giving us this opportunity of ventilating this subject so thoroughly to-day. Nevertheless, though the noble Earl opened the debate with great moderation, I must just record it as my personal opinion that I think it is a great pity he saw fit to introduce into this debate the choice of our Gracious Majesty the Queen in this matter.
THE EARL OF ARRAN
My Lords, may I interrupt the noble Lord? If Her Majesty has set a fine example, I think it only right that it should be recorded.
§ LORD AMPTHILL
I rise to intervene in this debate for reasons which will appear in declaring my interest, which I must do. I am a director of a company manufacturing cigarettes, tobacco, snuff and cigars. I have worked for this company for 27 years; I have been a director for 25 years. I am not a tycoon or a "baron". Until two years ago I was a hard-worked factory director, working my shoe leather pretty hard in walking round seven or eight factories every week. I have a further interest to declare in that I have smoked both cigarettes and a pipe since I was 18 or thereabouts, and I will always smoke a cigar when anyone is kind enough to give me one. My father before me smoked cigarettes, cigars and a pipe, and in his day it was possible to obtain in your Lordships' refreshment room very decent cigars at a very reasonable price. This is not possible to-day, thanks to successive, if not invariably successful, Chancellors of the Exchequer.
I may add that, when turning over some old papers quite recently, I found that my grandfather, who had a not undistinguished diplomatic career in the 1870s or thereabouts, invariably rolled his own cigarettes. He is on record as saying that a cigarette helped him considerably in his diplomatic duties, particularly when dealing with difficult customers such as Bismarck. However, despite this smoking background I can fairly claim to be a reasonably moderate smoker. I must say that I smoke more than the noble Lord who sits in front of me, who, I think, said he smoked one in three days. On the other hand, I am not a 25-a-day smoker.
Before I proceed with the few remarks I wish to make, I should like to mention that—I fear, like all too many of your Lordships—I have had some very sad personal experiences with cancer. Several friends and relatives, including one lady particularly near and dear to me, have been carried off in the prime of life with little or no warning. I mention these personal experiences briefly to show that I am conscious of the dangers and horrors of cancer. I can truthfully say that in none of these cases with which I came into personal contact was the victim anything but a very light smoker, 724 if he or she smoked at all, and in any case the disease had not attacked the lungs—though in one case, the saddest of all, it spread to the lungs towards the end. In all these cases the doctors and surgeons told me, or all the immediate relatives concerned, that they did not know what caused cancer, and that there was nothing they could do except possibly to arrest the spread of the disease by operation and/or deep ray therapy. I believe that to be the position to-day. No one has the faintest idea of what causes cancer, with the result that no one knows how to cure it. This Report by the Committee of the Royal College of Physicians bases its findings almost entirely on statistical evidence and not on proven scientific facts.
My noble friend, Lord Sinclair of Cleeve has dealt with the tobacco manufacturers' attitude to the scientific and medical aspects of this Report, and it would be both presumptuous and unnecessary for me to attempt to add anything to his very able and comprehensive review. At any rate, I could not attempt to emulate the way in which he dealt with this subject. I can only echo his words, that the real lesson of this Report is the need for more and more research, and not only into tobacco smoke.
I think my duty to-night is to try to examine some of the conclusions and recommendations in the Royal College of Physicians' Report, which bear upon commercial rather than medical and scientific matters. The Committee say thatmost smokers suffer no serious impairment of health or shortening of life as the result of their habit".And a little later in their Report they go on to say:There can … be no question of prohibiting a habit which most smokers enjoy without injury to their health".Having made these very reasonable comments, they go on to recommend a number of courses of action to the Government, which are expressly designed to discourage smoking by all who wish to smoke, whether or not they are among the minority who may be susceptible to diseases rightly or wrongly attributed to smoking. In fact, in paragraph 96 the 725 Committee describe their recommendations aspreventive measures of general application".But although in paragraph 100 the Report states, too, thatwe cannot identify the substances in tobacco smoke that may be injurious to health ",nevertheless they recommend that the smoke analysis should be printed on the packet. Most proprietary medicines have a note of their constituent parts printed on the label. How many people read these or, if they do, understand them? If the medicine or the tablet gives relief, they take it; if it does not, they do not. People smoke cigarettes, tobacco or cigars which give them pleasure, and I do not honestly think that they would pay any attention to some formula marked on the packet.
There are other considerations which, in my view, do not make this a very practicable proposition. Surely, it would make sense only if the figures stamped on the packet enabled a smoker or his medical adviser to decide which cigarette brands were the safest. In this context the figures would be meaningless, simply because it is not known at the present time what substances in cigarette smoke, if any, are harmful. The Committee themselves say:it is not known what part nicotine plays in the hazards of cigarette smoking ".What purpose would be served by stamping the nicotine content on the packet?
The Royal College of Physicians' Committee also recommend that packets of tipped cigarettes should carry an indication of the efficiency of the filter. My Lords, the company for which I have the honour to work introduced the very first filter-tipped brand into this country; and my first job with the company was setting up a manufacturing department, so I do know a little about filter tips. But the Committee suggest that we should put an indication of the efficiency of the filter, so thatthe purchaser could distinguish a more from a less efficient filter".Cigarette smoke consists of a cloud of fine droplets suspended in gas, and the only practical effect of a filter tip is to retain a proportion of the droplets. The harmful substances, if any, might be in the gas; they might be in the droplets. If there are any in the gas, the filter 726 would not trap them. Thus, any statement on the efficiency of a filter tip would be both meaningless and misleading.
In paragraph 118 of their Report the Committee say—in my view quite rightly:No claim should be made that any particular brand of cigarette was safer than any other.Since nobody knows what, if anything, is dangerous in tobacco smoke, it is indeed impossible to claim that one brand is safer than another. Therefore, with all respect, I suggest that the Committee are being inconsistent in recommending a course of action which could only lead to unjustifiable and misleading comparisons being made. For these reasons, as a manufacturer, I am very strongly opposed to the recommendation. Even if it were known beyond doubt that tar and nicotine yields meant anything in the health context, there are really serious practical difficulties in implementing the Committee's recommendation.
As your Lordships know, tobacco is a natural product. It is subject to very wide variation in composition from time to time. Rainfall and sun, to which the crop is exposed during its growth to maturity, both have their effect. You can buy tobacco from field "X" this year and from field "X" next year, but the character of the 'tobacco and the composition will be quite different owing to these varying conditions. Moreover, manufacturers in their buying and subsequent blending operations go to immense trouble to maintain the consistency and character of their brand. This is done for obvious commercial reasons. Nevertheless, it would be well-nigh impossible, certainly very difficult, for any manufacturer to maintain the so-called tar and nicotine yields within the rigid limits implied by the recommendations. There is one other practical point on this recommendation which I think I should bring to your Lordships' notice. It is that it would be very unfair to quote these yields, if they were to be given, as "per gram of cigarette". They would have to be on a "per cigarette" basis, because cigarettes are bought and sold as units and not by weight.
I should now like to turn, if I may, for a very short time, to the Committee's recommendations in respect of adver- 727 tising. They recommend that the Government should conduct an expensive publicity campaign to educate the public, adults and more particularly children, in the hazards of smoking. They also recommend, on the ground that such a campaign would be frustrated by the industry's own advertising, that the Government should prevent or restrict the latter by legislation. Other noble Lords have spoken a lot of sound sense on this subject of advertising, and I propose to cut my remarks rather shorter than I had otherwise intended to do. In the first place, I do not think that the public are short of information on the dangers of smoking. The Chief Medical Officer said in his last Annual Report that the public does not lack information. There have been public announcements in another place, and wide publicity on sound and television broadcasting. I will not waste your Lordships' time by going over the details, though I have them here.
The tobacco companies' commercial advertising has in no way affected what is, in my submission, the considerable volume of information reaching the public, through one means or another, on the strength of its news value. On commercial advertising itself, the Report says:Much of this increased expenditure has been devoted to establishing loyalty to particular brands of cigarettes and no advertisements have specifically encouraged heavier smoking.That statement is perfectly true, but the datum year shown for the increase referred to is 1955, and I should just like to put this to your Lordships: 1955 was the year in which our industry emerged from a long period of shortage of supplies. Tobacco was on quota, cigarettes were on quota and so on; and so, very naturally, advertising was restricted to the minimum. At that particular time I had shortly come back from the war, and before going into the factory chair I was at that moment sitting in the sales chair, so I can speak from personal knowledge that it was not possible to advertise then.
At any rate, in 1955 free competition was restored, and since the industry is a highly competitive one (as the Monopolies Commission found) expenditure on what is called brand promotion in- 728 evitably increased. Then came the advent of commercial television, and the total advertising expenditure in the tobacco industry went up, just as it did in nearly every other industry selling consumer goods. Nevertheless, my Lords, the tobacco industry's total advertising expenditure in the Press and on television is only about one-half of the national average. In 1960, for example, it represented 1½d. in the pound of retail sales, compared with 3d. in the pound for all consumer goods and services. I think that this fact shows beyond dispute that the tobacco industry's expenditure on advertising is not excessive in relation to its actual sales. In any case, the Report itself says:It cannot be assumed that the increase in advertising is the only or even the main reason for rising tobacco consumption".The noble Lord, Lord Coleraine (I think it was), said that he was not at all sure that advertising had so much to do with rising consumption as some people thought. That is a doubt I have sometimes shared, I must say. But in the same paragraph of the R.C.P. Report it records that in Czechoslovakia, where there is no direct advertising of tobacco, cigarette consumption per adult rose by 14 per cent. between 1953 and 1958, which was exactly the same rise as in this country—and that I find rather interesting, my Lords
In fact, of course, no manufacturer can afford an excessive expenditure on advertising. Like all costs in a highly competitive industry, there is every reason to keep it as low as possible. For example, take advertising the nationalised industries. I do not think there is a great point in it, but the nationalised industries find advertising necessary. What should we think if somebody came along in the future and forbade the Air Corporations from advertising in order to boost the sale of railway tickets? But should the Government decide to accept the Committee's recommendation to restrict, or prevent, advertising of tobacco goods, I think they would find it very difficult to find any halfway house to total restriction—a restriction which I think the citizens at large might resent.
I agree with the noble Lord (I think it was the noble Lord, Lord Brain) who asked: if you put on a total restriction, where will it end? If you put on a 729 partial restriction, as has been mentioned by other noble Lords, having regard to, say, matters of taste (my noble friend Lord Auckland talked about seductive goods, and so on; I forget all the other epithets which were used about advertising: I do not know whether he was referring to my company's advertising, or to my noble friend's company's advertising), I think that there would he a great difficulty. What body would decide whether an advertisement for "X" brand was in good taste or bad taste, or was right or not right? Personally, think that it would be much better for all concerned—I expect that all manufacturers will read this debate—that the manufacturers should he trusted to do the right thing. I also think that it is right that all manufacturers, whatever they manufacture, should be forced to come right out in the open and say what they have to sell and why they are trying to sell it. I have tried to imagine what conditions must be like in Czechoslovakia, where direct advertising of tobacco goods is apparently forbidden or restricted. Suppose it happened here. One can imagine the sort of whispering campaign that would go on—"Try X-brand", "So-and-so recommends Y-brand"; and so on. I really think it is better to bring the whole thing out in the open.
Still on the subject of advertising, the Report itself says:The tobacco manufacturers have never encouraged smoking by school children and have never in the slightest degree aimed advertising at them".It says:No attempt has ever been made to secure advertising space for tobacco goods in boys' and girls' papers or to advertise cigarettes in the breaks on children's television programmes".I can assure noble Lords that, though I have not been in the industry as long as my noble friend, I have never heard any suggestion that anything like that should be done. The tobacco manufacturers are well aware of the law which prohibits the sale of tobacco to children under sixteen, whether for their own or for another's consumption, and I am very grateful to the noble Lord, Lord Airedale, for reminding us of the details of that law. I found his speech particularly interesting. The manufacturers will be glad, naturally, to assist in any measures to make the law more widely 730 known, because, regrettably, we all know of cases where it has been broken.
Then there is the very difficult question of the slot machines, which has been raised by more than one noble Lord and by the noble Baroness, Lady Summerskill. The manufacturers find this, and always have done, for more than one reason, a very difficult problem. The slot machines have been put in more as a convenience to the consumer, and even more as a convenience to the shopkeeper who does not want to keep his shop open or who has not opened his shop. Nevertheless, I freely admit that slot machines are a difficult problem.
But in the main, my Lords, surely, the question of children is a matter for parental discipline. It is a matter for both fathers and mothers, even more than for schoolmasters. There was a little boy on television the other night who said that he smoked. He said his mum knew but his dad did not. He added that if his dad did know he would get a tanning. Of course, the answer is that his mum ought to have given him a tanning, too. Then, again, I think that many parents—and I find this in all walks of life—give their children far too much pocket money. I am thought to be very mean because of the amount I give my children. My son aged eleven gets lld. a week—ld. for each year of his life—and my little girl of nine gets 9d. a week: but I know that other children get far more than that.
There are shopkeepers, of course, who sell single cigarettes to children under sixteen. Of course they are breaking the law; but they would have less incentive to do it if the parents exercised more control, and also kept their children a hit short of pocket money. My father forbade us to smoke until we were eighteen. I went to sea at 161, and the Navy forbade smoking until one was eighteen. I admit that this rule was broken on guest nights, when the junior midshipmen were allowed to smoke after the Royal toast, but if one was caught at other times, the "sub." of the mess took the necessary action on one's posterior, which of course is what one should do with children who smoke before they are 16. By and large, my brothers and sisters observed our parents' wishes and instructions. Now three of us smoke in 731 moderation; two do not smoke at all, and never have. In my young days the fashionable theory was that if you smoked it stunted your growth. I forget how often I was told that. All I can say is that all my brothers, whether they smoked or not, are the same size as I am.
Another main recommendation of the Committee is that there should be an increase in the tax on cigarettes, with perhaps adjustments of tax on pipe and cigar tobacco. At present the basic duty on tobacco is 64s. 6d. a lb. With the 10 per cent. surcharge, if my arithmetic is correct, the total duty now is 70s. 11½d. per lb. This represents 3s. 4d. tax on a packet of cigarettes sold at 4s. 6d., and is the highest rate in the world. The Royal College of Physicians' Committee is doubtful whether increasing the duty would have any long-term effect on cigarette smoking, and I must say that I share their doubts, unless the tax were put up to an absolutely ridiculously penal figure. What is certain, though, is that it would penalise the many millions of smokers who do derive pleasure and solace from smoking, and who, as the Report so clearly shows, do not develop the diseases in question. I do not think that this is a course which it would profit the Government to take, even if they were prepared to face a further increase in the retail price index.
But actually there are practical difficulties in the way of a differential tax on tobacco used for cigarettes as opposed to that used for pipe tobacco. Some types of flue-cured tobacco are used in both cigarettes and pipe blends. Then what about the tobacco blend for people who roll their own cigarettes? To those who are not familiar with the tobacco industry, I may say that all tobacco is stored in bond, and every day at 4 o'clock in the afternoon you give a cheque to the collector of customs for the tobacco you draw the next morning to bring to your factory. Great difficulties would be created if you were drawing out certain flue-cured tobaccos; you would have postively to identify them as one thing or another.
Finally I must put on record my personal opinion, which is that excessive smoking, like excessive drinking and ex- 732 cessive sweet eating (I could not agree more with what has been said about that), is bad for one. Excess in any of the pleasures of life, among which I personally count tobacco, frequently attacks the weak points of an individual's constitution, and disease of one sort or another will follow. My Lords, I do not believe—if I did I would not be standing here to-night—that moderate smoking, whether it be of cigarette, pipe, or cigar, causes any harm. I have spoken of moderation, so I think I should apologise to your Lordships for the immoderate length at which I have spoken at this very late hour. But as I have already told your Lordships, until recently I was a factory director responsible for a group of factories employing several thousand people among the many thousands, about 40,000, employed in this industry, and I felt that I owed it to these loyal and decent folk, many of whom I have known intimately by their own Christian names for 25 years or more, to come and speak up for this clean, healthy and efficient industry, temporarily, I hope, under a cloud—in my submission, an utterly false cloud, certainly not of its own making. All of us in the tobacco industry are proud of it and its record of service to the community, more particularly in the two great wars of the century.
§ 8.36 p.m.
§ LORD GLADWYN
My Lords, at this very late hour I do not want to detain you for more than a few moments. I did offer to scratch, but the noble Earl who moved this Motion to-day told me that he thought the two points that I proposed to make had not been made, and therefore, with your Lordships' permission, I will inflict them upon the House.
I gather that it is almost obligatory in this debate to start off with what I might describe as a short case history. May I say, therefore, that in my own case I did indulge in the habit at school. Once or twice I was, in the immortal words of Lord James of Rusholme, "drastically discouraged"; I remember the incident very well, my Lords! After I left school I indulged in this practice for a certain number of years until the war. Then I began smoking much too much, and in the middle of the war I had the 'flu, As your Lordships know, immediately after 'flu one does not particularly want 733 to smoke, so I decided to renounce it; and I cured myself of ever reverting to the habit of cigarette smoking by smoking cigars. It was not possible to get many cigars during the war, but one could get very long things called "Trichinopoli cheroots "—I do not know whether your Lordships have seen them. I was in the habit of smoking those things occasionally when I went out, but, of course, not inhaling. I managed to smoke no more cigarettes, and to this day I have never smoked more cigarettes, though I do have the occasional cigar, which I like.
I believe that one thing emerges from the Report, and indeed from this debate; and that is that, on balance, and in the average, cigarette smoking shortens one's expectation of life. Not all lives are shortened, of course, by cigarette smoking. Some people, I think, live to the age of 90 or so while smoking up to, say, 40 cigarettes a day. That is possible. But I do not think there are many such people. Possibly a few would die if they gave up cigarette smoking—I think was a point made by the noble Lord, Lord Coleraine—but again, I do not think there would be many. The plain fact, I think, is that a considerable number of inveterate cigarette smokers do undoubtedly die of cancer of the lung, bronchitis, heart trouble, and so on. There are certainly more deaths in the ranks of inveterate cigarette smokers than outside them. Therefore, if you want to live for a long time, it is obvious that, among other things, you should stop smoking cigarettes, if you can. It seems to me that this particular point has now been established beyond reasonable doubt.
The real question before us, it seems to me, is: Should the Government take any action in order to reduce the consumption of cigarettes, and thus undoubtedly improve the health of the nation, or should they not? Here, a major question of principle arises. Is it in order for the Government to prevent people from doing something which gives them undoubted pleasure, and which causes no harm to people other than themselves? I do not refer to the practice of smoking in public. I think there is a case for preventing smoking in most public places. But irrespective of that, is it in order for the Government to deprive people of a pleasure which 734 does not, broadly speaking, do any harm to anybody else? If, knowing the risk, many people want to continue the pleasure, have they not a right, to put it bluntly, if they want to, actually to shorten their own lives? Maybe quite a number of cigarette smokers really do not want, consciously or unconsciously, to live till 80 or 90 years of age. If so, must they be forced to do so? To penalise such people would seem, on the face of it, to be an attack on the essential liberty of the individual.
As against this, there is no doubt at all that nicotine is a habit-forming drug and that once the practice of cigarette smoking has been adopted it is very difficult to get rid of it. So no doubt we have large sections of people who do not want to shorten their lives, either consciously or unconsciously, and therefore would gladly give up cigarette smoking if they could, but who simply cannot. This is the point I want to make. It is arguable that such people should be helped to drop the habit and should be told what are the means of doing so. I think that I am right in saying that there is some counter-drug which helps people to do this. If so, could not Government-sponsored advertisements of such facilities be of real help to people who want to be rid of the habit and do not know how to do it? The resultant loss of revenue, if that is considered to be an inhibiting factor, might be compensated by a possible rise in productivity.
There remains the question of children. Obviously, it would be better if children did not smoke at all. They are, of course, not supposed to smoke at school—that is to say, up to fifteen, at any rate. At public and secondary schools this rule applies presumably up to seventeen or eighteen. But there is nothing in law to prevent them from smoking outside school, unless it is the influence of parents. As it is only cigarettes which are alleged to be harmful, it might be argued that from the earliest age it would be the duty of somebody, presumably the parents, to impress this fact on young people, This might be rather difficult in practice. Would young Tommy be beaten if a packet of Gold Flake were found in his drawer but in no way punished if it were full of pipes or cigars? How- 735 ever, in principle, I think that every effort should be made to impress on young people that there are definite dangers in cigarette smoking. Parents and school teachers, even if smokers themselves, should be urged to spread propaganda. Teachers might be circularised about the right arguments to be used in support of their charges against the use of tobacco.
What is the general moral to be drawn? Obviously, adults cannot and should not be forbidden to smoke cigarettes. On the other hand, they might be warned of the effects of so doing. I think that the noble Lord, Lord James of Rusholme, made that point. How could this best be done? It could, of course, be laid down by law, that every package containing cigarettes—the individual sale of which in slot machines or otherwise should be expressly forbidden—should bear a label with the words, "Cigarette smoking may result in less expectation of life", or the same thought more epigramatically expressed. More drastically, cigarettes might he rationed, as they were during the war; or, less drastically, there could be a tax on cigarettes or, alternatively, a tax on advertisements.
All these things could be thought of, but I do not believe that, in practice, anything like this will happen, even if we think it would be desirable—which I do not. I do not think that any positive restriction can be, or indeed should be, imposed. Excessive drinking is as bad as, and no doubt much worse than, excessive smoking. But look what happened in American when they tried to curb that. I myself should prefer that any action taken by the Government should be limited to the two means to which I have referred—namely, officially sponsored advertisements on how to rid oneself of the habit of cigarette smoking and officially inspired propaganda among children to prevent their taking up the habit at all.
§ 8.44 p.m.
My Lords, I will not keep your Lordships very long. In the first place, I am very hungry and, in the second place, I want to hear my noble friend Lord Taylor. Some years ago in the General Assembly of 736 the Church of Scotland, Principal Storey, reputed to be the most eloquent man in the country, got excited about something and made a long speech. He was followed by Principal Pirie, of Aberdeen, a stocky little man, who did not agree with him. He said, "Mr. Moderator and brethren, you have listened to a vara eloquent oration and noo I'll gie ye the facs". We have listened to many Principal Storeys this afternoon and I hope that your Lordships will accept me as a Principal Pirie. I will try to give your Lordships a few facts.
I have started and left off smoking at least five times in my life and I have made certain observations upon this. I started when tobacco was 7s. 10d. a lb., including postage, and I smoked 5 oz. a week. The first thing that happened after I formed the habit was that I went down to my old school and played a very warm game of football. I found myself knocked about by somebody only half my height. I came back and took a very hot bath and then I realised what condition I was in. To my surprise and dislike, the perspiration on my knees and the extremities of all my limbs simply stank of nicotine, as badly as a third-class smoking carriage. I realised from that that when you are a heavy smoker the effect of it permeates the whole of your body. Ever since that time, it has always distressed me to see a woman nursing a baby with a cigarette in her lips. I may be making a mistake, but I cannot find anything that touches on that subject at all in this Report. I think that it ought to be considered because it is very important. The Report wonders what are the inducements to children to smoke cigarettes, and I think that this may have something to do with it.
Leaving the medical details to my noble friend Lord Taylor, I go on with my observations about smoking. From starting smoking and leaving off many times. I have come to the conclusion that it is definitely a drug. If I wanted to start smoking again, that would not deter me. I found that one of the effects of smoking is that it engenders a certain slight melancholia. for which afterwards it becomes the anodyne, the cure. Therefore. it tends to make you persist in smoking. Again. I noticed the tendency always to wish to make recruits. A third tendency I have 737 noticed all my life is that smokers, especially heavy smokers, love smoking in a fresh uncontaminated place, and the drug effect I think is one of the reasons why people are so irritable and often rude if you point out that they are smoking, for example, in a non-smoking railway carriage. I honestly think that people who do not smoke deserve far more protection than they get from the servants of British Transport and others, when they find people smoking in places where smoking is forbidden.
I never smoke cigarettes. Cigarette smoke hurts my eyes frightfully and I dislike it in other ways. I sometimes wonder whether being subjected to cigarette smoke for a long time may not have something to do with inducing cataract. Again, I have always felt, when travelling in a plane, that it is a little unfair that nobody is allowed a pipe or a cigar, while cigarettes are allowed. Sometimes in an aeroplane it is difficult to avoid the effect of cigarette smoke in your eyes.
There are some observations I have to make on the general effects of smoking. In my smoking periods, I find that I do very little work and not such good work. There is a certain irritation that idleness induces in a normally active person and, if you are not smoking, you start in and work on something in which you are interested, but if you have the habit of smoking you sit down and smoke a pipe and that takes the place of work. In that connection, it has always struck me very much that in the Arts, Dante, Cervantes, Shakespeare and Rembrandt, and the very greatest names, with the one exception of music, all occurred before the impact of tobacco on Europe 'was very strong. If your Lordships go behind the Palace of Peace at the Hague you will find there a white marble plinth, and on the top of it is a female figure tracing with a gold style the words:Countrymen of Rembrandt, your country awaits ".And the country is still waiting, unless you look on Jan Steen and Vermeer as the equals of Rembrandt.
Another thing for which I have to be grateful to tobacco, and which I put in, is that my first really good lesson in physics came from tobacco. If you go into a railway carriage and watch a 738 man light a pipe, you see the flame draw down to touch the top of the pipe, and you smell What tobacco he is smoking before the flame touches the pipe. That shows the rapidity and the distance the molecules of the objects around us fly through the air. I am grateful to tobacco for that; but I wish that we could get people to refrain from smoking in places where it ought not to occur and where it offends other people.
§ 8.52 p.m.
§ LORD TAYLOR
My Lords, the noble Lord, Lord Ampthill, said that nobody knows what causes cancer. He is quite wrong. We know what causes quite a number of cancers. We do not know all about it, but we do know several things which cause cancer. One of them is aniline dyes, and in aniline dye works many, unfortunately, still die of cancer of the bladder. We know that cancer of the skin occurred in certain operatives working an old-fashioned type of loom in Lancashire; but, thank goodness! that is no longer used. We know that cancer of the skin also occurs in gas workers, due to contamination with tar. And when I was a young medical student we knew perfectly well that cancer of the lip was caused by smoking with a clay pipe. We had no elaborate statistics to prove this; it was common-sense observation, and we all saw this happening. We saw these old men corning up who had been smoking a clay pipe for twenty or thirty years, with an awful cancer of the lip. But when the clay pipe went out, cancer of the lip disappeared. I see my noble friend Lord Cohen of Birkenhead nodding his head. That is, of course, true. There was no wickedness on the part of the manufacturers of clay pipes. It was just jolly bad luck. We think it was due to the heat, and not to the nicotine; because the pipe got very hot. Certainly the modern pipe does not cause cancer of the lip.
I am sure we are all grateful to the noble Earl, Lord Arran, for introducing this debate in a very reasoned and reasonable way. I was pleased to hear him say that it is not the fault of the people who are involved in this industry; it is jolly bad luck, again, on everybody associated with the tobacco industry that this strange thing should have been discovered. When I was a medical student there was another 739 student called Richard Doll; we were students together. Twelve years ago Dr. Richard Doll, with Professor Bradford Hill, published the first paper showing the relationship between cancer of the lung and smoking. It was not a popular paper in medical circles; in fact, it was treated with contempt and suspicion by consultants and others who did not want to give up smoking. This is not a sort of medical lobby, The noble Viscount, Lord Stuart of Findhorn, looked upon us as a kind of gang of doctors. We are not. We do not want smoking to cause cancer of the lung. It is a horrible discovery, so far as we are concerned, and certainly so far as I personally am concerned.
This paper was ill-received, but I should like to pay tribute to Dr. Doll and Professor Bradford Hill who did the first work leading to the present result. And I would add my tribute to that of my noble friend Lady Summer-skill to the Royal College of Physicians for this excellent Report. Whether it is right or wrong, it is extremely clear and readable and one can understand every word in it. The President, and particularly Dr. C. M. Fletcher, the Secretary, who did the drafting, are to be congratulated. It is indeed a very good job of work.
I want to speak as simply as I can. I am certainly not going to apportion blame here, becausethe fault, dear Brutus, is not in our stars,But in ourselves",when it comes to smoking—and that applies to all of us. We get exactly what we deserve. So far as cancer of the lung is concerned, I have the feeling that the noble Lord, Lord Gladwyn, has not known many cases or he would not feel it was such an easy thing to which to condemn oneself. It is a horrible disease, and it is, unfortunately, an extremely inoperable one. The noble Lord, Lord Airedale, now sitting on the Woolsack, said that there were two ordeals. I would say that there are three. There is often the ordeal of the surgery, and then there is the subsequent ordeal when the disease recurs. Again, when I was a medical student thirty years ago, it was a very rare disease, and I can remember only one case. I do not know why it was so 740 rare then. We were not failing to diagnose it, because all the cases that die in a voluntary hospital are all postmortemed—they are autopsied. We were not missing cancer of the lung; it just was not occuring, or it was occuring very rarely then. Now it is forty times more common.
It is a staggering occurrence, absolutely unheard of in public health, for a disease of this dreadful severity, and hopelessness, as a rule, suddenly to appear in a matter of a very few years. Each year it is killing five times as many people as are killed on the roads, and most of these are not old people, but people under 65, still with working lives and happy lives before them if it did not occur. Each year a thousand more of us die of it than in the previous year. And this will go on, so far as I can see, if we go on smoking as we are. Each year now 12,000 of us die before we are 65.
Each year we spend millions on trying to find the cause of cancer; and yet we know the commonest cause of cancer, but do not do much about it. Most people who smoke, as has been made clear, do not die of smoking; most people are all right. We have been given the figures. It is 1 in 8, if you are a heavy smoker, and 1 in 12 or 15 if you are a light smoker. That, in a way, is part of the trouble, because most people know the facts about this and they think they will take the risk. They say: "I will go on smoking, because it is a 1 in 8 chance or a 1 in 12 or 15 chance. I like smoking, and it is not worth bothering about." That makes the whole problem of propaganda very difficult.
I am not going to speak of air pollution, because my noble friends Lord Cohen of Birkenhead and Lord Brain really disposed of that quite convincingly. It is important, but it is only marginally important; and this smoking business is doing fearful harm in places where there is no air pollution. We all want to get rid of air pollution, but it does not let us out: as regards the actual situation, cigarettes are the worst danger: that is absolutely clear. Filter tips, so far as I can see, do not do any good, or very little good; and if you get a really effective filter tip, you cannot draw through it. It does help a bit if you smoke half a cigarette and throw the stub away, because you have trapped 741 something or other—nobody knows what it is, but that seems to help a bit. Pipes are not safe. Pipe-smokers get three or four times as much lung cancer as nonsmokers, whereas cigarette smokers get twelve to thirteen times as much. In America, cigars seem to be safe. We have no figures for Britain because there are not enough cigar smokers. That, very briefly, is the story.
Now what on earth are we to do about it? I like smoking. I really enjoy smoking. I like my pipe. I do not smoke cigarettes, but undoubtedly I smoke too much for my own health and safety, and I do it knowingly. I know the risks I take and the awful nature of the disease and death it may cause, and, like millions of us throughout the country, I want to be helped to behave more sensibly. This sounds quite ridiculous, but this, I think, is the true situation. Most of the British public know the facts. When a lady was staying with us one of my little boys, aged twelve, noticed that she was coughing. He said, "By the way, does she suffer from cancer?" We said, "No. What made you say that". He replied, "I noticed that she was coughing a bit, and I thought she had lung cancer." They know all about lung cancer; they cannot help knowing about lung cancer. I know about it. Yet I go on smoking.
Propaganda is the easy answer, but that does not mean that it is wrong. I must tell your Lordships a few facts about it. I am not very optimistic about propaganda. Doctors have known all about the risks for twelve years now, but you will have noticed that 50 per cent. of them still smoke, in spite of knowing all the risks, and in spite of seeing the people die. That just shows the power of tobacco as against a horrible death. So far as we are able to find out, propaganda works best among the mare educated people. We might do something among the more intelligent in all social classes. When it comes to the line of propaganda, I think that my noble friend Lady Summerskill was on the right lines. Up to now, conventional propaganda has been shown to have virtually no effect: people know all about lung cancer, but they like smoking enough to stop them doing anything about it. They face the risk and still go on smoking.
Same colleagues of mine tried some first-class propaganda material in two secondary modern schools. There were 742 posters, pamphlets, lectures and a film which included an, operation for lung cancer—a perfectly horrible affair. At the end of it, the number of boys smoking was 35 per cent. and the number of girls was 10 per cent., exactly the same as at the beginning. There was one further fact. After the propaganda more girls said they intended to smoke when they were grown up than before the propaganda. The girls were perfectly sensible. They had made a perfectly logical deduction: because the propaganda material showed much higher rates for lung cancer in men than in women, the girls thought they were safe.
§ LORD TAYLOR
It was a half-truth. It was the sort of misfire which so often occurs with propaganda.
THE EARL OF ARRAN
My Lords, I hope, in all seriousness, that the noble Lord is not suggesting that propaganda of this kind would be useless in all cases.
§ LORD TAYLOR
I am saying that, unfortunately, it was not very useful on this occasion. I believe that it was tried out for a year in a secondary modern school in Edinburgh, and with precisely the same result—no effect whatsoever. I have been round a number of tobacconists and they all tell exactly the same story. When all this mass of propaganda comes out, as it came out with this Report, with a great volume of propaganda—with most of the media, the B.B.C., I.T.V., and the newspapers really "doing their stuff"; and now we in this House are having a good debate on it—what is the impact? For two days tobacco sales go down, and then the tobacconists all say the same thing: that;It is back to normal, we are pleased to say."
I must say that it is an extremely difficult job to try to do anything by propaganda. But that is not to say we should not try. I am not going to abuse the noble Lord, Lord Sinclair of Cleeve, for advertising his product, even though I think it does harm. So long as he is allowed to make it, why should he not advertise it? Any other view would seem to be quite illogical. I think all the people who smoke throughout the 743 country would say, "Why should we pick on cigarettes and allow them to be made and sold, but not advertised"? My noble friend Lord Cohen of Birkenhead, mentioned various advertising matter which is prohibited; but, of course, in the cases he mentioned the sale of the goods is also prohibited. One is not allowed to sell remedies for tuberculosis or venereal disease. Of course, that is perfectly logical and sensible. When one stops the sale, one of course stops the advertising. I personally find it very hard to accept the view that we are right to attack tobacco advertising, though we may attack the form and its direction at young people, and I would certainly ask the tobacco folk to do something about that.
When children who smoke were asked why they started, 40 per cent. said it was because their friends smoked. It is a sort of chain reaction, and it is a chain that has to be broken. I agree entirely with my noble friend Lady Summerskill, that the way to break it is to make it the wrong thing to do, instead of the right thing to do. Again, 20 per cent. of the children said they did it for fun, curiosity or experience; and 10 per cent. said it was because they felt they wanted to be big. All these figures, as your Lordships know, are far higher in secondary modern schools than in grammar schools, and higher in grammar schools than in public schools. It is the secondary modern children who smoke 20, 30 or 40 a week. When asked why they go on, 40 per cent. of them say they like it. That is just the reason why they all go on—because they like it. Then 20 per cent. said that they went on smoking because their friends smoked, while another 20 per cent. said that it was habit. The rest gave a variety of reasons.
There is no need for advertising to keep people smoking. It is an addiction—and a pleasant one at that; and if you have the money, tragedy, years ahead, can look after itself. That is the ordinary people's attitude to it. But that does not say that the Government should not go on "plugging" the propaganda. I think they have done, and I hope they will use the Social Survey, and every other means they have, to make the propaganda effective. But they have to decide what they are trying to do with 744 this propaganda, and that is a very difficult decision.
The hardest thing of all to do is to try to think straight. To stop these awful deaths we must cut tobacco consumption, and that is the thing that is going to hurt. I reckon we must cut the present tobacco consumption by half if we are to stop these deaths, and that is something quite frightful. The implication of this, in terms of the noble Lord, Lord Sinclair of Cleeve and the noble Lord, Lord Ampthill, and their industries, is a complete revolution. It is like getting rid of the clay pipes. But I do not see much happening unless we do cut consumption to this sort of level. There has been a steady increase of tobacco consumption over the years. It is growing each year, and here is an industry which might reasonably expect to go on growing. But the trend must be the other way to stop this lung cancer. We may not feel like it now, but deaths are going to get worse and worse if we do not. That is all one can say.
My Lords, would not precisely the same effect be achieved if a major portion of the population turned over from inhaling to either non-inhaling cigarettes or pipe smoking?
§ LORD TAYLOR
There is nothing in this inhaling. You cannot avoid smoking without inhaling. One breathes partly through one's mouth and partly through one's nose. They intercommunicate, and what is inside goes down. So there is nothing in inhaling. We all do it; we cannot avoid it.
§ LORD TAYLOR
We do not know, but probably it is because there is a trap in the pipe and a collection of dottle at the bottom of the pipe (this is guessing), and also, perhaps, because it is different tobacco. I think that if I were a noble Lord in the tobacco industry the thing I should be looking at would be the comparison between the composition of tobacco before the war and its composition now. I do not know what has caused this extraordinary increase associated with tobacco smoking, and that is the thing I should be puzzling Over.
My Lords, may I ask the noble Lord whether paper has something to do with the reason why cigarettes are so poisonous?
§ LORD TAYLOR
I do not know whether it is the paper. It looks much more, I am afraid, that it is tobacco, because if you smoke half a cigarette and use the lower half as a sort of filter and collector of muck it reduces the incidence of lung cancer.
I think we have to cut smoking in half. It is going to hurt all of us like billy-ho to do this. Rationing, I should have thought, is useless; and prohibition is also useless; we just cannot do it. I do not think we are going to stop this lung cancer at the moment by propaganda, for propaganda to succeed must cut tobacco consumption. That is the only object of the exercise. I think there is only one way to do it, and that is by increasing the price so that tobacco becomes a luxury instead of a necessity. I can see no other way to do it. I do not for one moment, however, expect the Government to do this at the moment. I would hope that one day we shall do it when the deaths get to a point which we think cannot be faced any more. It means drastic increases in price if it is going to be effective. We had to do this with gin many years ago when the country was gin-riddled and gin-sodden and it got rid of alcoholism.
§ LORD TAYLOR
The noble Viscount says it did not, but virtually it did. Alcoholism is no problem in this country. In. France it is a terrific problem. Lung cancer, unfortunately, is a tremendous problem, and we must change our whole smoking habits so that we smoke only very occasionally—perhaps not as seldom as the noble Lord, Lord Conesford, but as an occasional pleasure and as an occasional treat. We must get out of this continuous smoking if we are not going to die in increasing numbers from lung cancer.
§ LORD COHEN OF BIRKENHEAD
My Lords, may I interrupt the noble Lord for a moment? He is in fact advocating what the Observer advocated: that there should be a swingeing duty on tobacco. Coming from his side 746 of the House, that is a curious doctrine: it is one law for the poor and one fox the rich. Does it not mean that the rich man will be able to indulge his habits as he wishes and the poor man not? Is it not true also that the Government will control cigarette smoking for the poor but have no influence whatsoever on the rich?
§ LORD TAYLOR
There wil come the point when we shall all cut our smoking drastically, and I think that is What we must do. After all, we do in fact ration spirits by their price, and that is, in my opinion, the only way to ration tobacco—by its price.
§ LORD CONESFORD
My Lords, may I interrupt the noble Lord at this point? I am very ignorant. Is not tobacco in the cost-of-living index? The only effect would be a claim for more wages to meet the increased cost of tobacco.
§ LORD TAYLOR
Of course it would be quite ridiculous to keep it in the cost-of-living index. If one's object is to cut the consumption of tobacco as a socio-medico exercise, the whole thing must come out of the cost-of-living index. I am putting this as a pretty brutal sort of measure in order to achieve the desired result. I do not suppose for one moment that we shall get it. Instead, we are going to get more lung cancer. Let us try to get rid of lung cancer by the cutting of tobacco consumption. Unless we face that fact, and unless we face that fact bravely, I see no point in the exercise at all. I know that is unpleasant for all of us, but I can see nothing else that we can do.
§ 9.16 p.m.
§ VISCOUNT HAILSHAM
My Lords, I think I must at this somewhat late hour apologise to the House for inflicting a speech on behalf of the Government. I rise myself rather than my noble friend who ordinarily speaks for the Ministry of Health because I anticipated, and I think rightly, that the most important thing that I could do at the end of this debate was to try to discuss what the facts are. I respectfully agree with what my noble friend Lord Salter said, that after the Government's immediate statement and immediate action, and before they have considered what further action is desirable, it is not possible really to announce a great series of measures. But 747 I think we must get our facts right in order to decide on any measures; and I felt very much that, as this is a matter very closely allied to the field of medical research for which I have been responsible now for 4½ years, it was perhaps appropriate that I should say what, at any rate in my judgment, the facts are.
I agree with the noble Baroness who spoke first from the Front Bench opposite that we owe a great debt to the Royal College of Physicians for this document. I think it will have a bigger effect, and is already having a bigger effect, than many other statements about the subject which have been made. Why this is so I am not quite sure, but, unless I am mistaken, the penny is beginning to drop; and if the penny is beginning to drop, we ignore the facts at our peril, whether we use cigarettes or, with respect, we try to sell them. It is not much good ignoring facts once people begin to learn what they are.
I think this House plays a great part in the formation of public opinion. In this world we live in, a world very largely of emotionalism, in these great matters of life and death it is often very difficult not to introduce an element of subjectiveness and emotionalism in these discussions. I share with my noble friend, Lord Sinclair of Cleeve, the desire that this subject should be discussed objectively. Whether he was, in fact, objective is a question which I shall ask when I come to consider the facts and the evidence. But I certainly would not go the whole way with the noble Baroness, Lady Summerskill, who described the manufacturers of tobacco as guilty men. I would agree, on the whole, with those noble Lords who said that, whatever we want to do, if we want to do anything we must get behind us the great mass of articulate and well-informed public opinion to do anything at all.
As we have all described our smoking habits, perhaps I had better confess mine, because I am going to say some rather rough things about this subject. I had better confess that I am not a smoker myself; I have not chosen to pay this form of taxation for many years. Like the most reverend and noble Lord, Lord Fisher of Lambeth, I decided one day that I was not going to do it 748 any more, and I never did, having been a fairly heavy smoker before that. But I do not think that I have ever had a "down" on smoking. I do not think that until this particular question arose for discussion it ever crossed my mind that it was any concern of the Government whether I smoked or not. Certainly I think that until this question arose it had appeared to many millions through a long time a harmless and, for some, even a beneficial habit. This is a view with which I do not myself happen to agree, but hitherto it had never occurred to me to interfere.
I think it has been emphasised by more speakers than one that smoking is very largely a question of social attitudes. I think it is worth saying, because it has a direct bearing on what we are discussing, that during the lifetime of most of us there has been a great change in the social attitude towards smoking. In my grandfather's day it was almost proscribed; certainly it was wholly proscribed in public places, in theatres and restaurants, in some—I think most—railway carriages; and in private houses where it was permitted at all it was reserved to a room called the smoking room or even banished to the shrubbery. A few foolhardy men furtively indulging in smoking up the chimney courted discovery and disgrace. Among women it was rejected almost entirely. The cigarette itself was frowned on as foreign or dandyish or even associated in guilt with dangerous immorality.
Since those days, it may be thanks to the noble Lord, Lord Sinclair of Cleeve, or same other reason, the whole social attitude towards smoking has altered; whether for the better or not is a matter which we must discuss. What is, however, important, I think, is to notice that what has changed in social habit in one direction might quite easily be caused to change in the other direction in a similar period of time, over a period of years, perhaps in a shorter period.
It has been emphasised by speakers on all sides of the House that, of course, in the course of this social revolution a great industry has arisen. I think it is fair to say that it is an industry with high standards of staff relations, as my noble friend Lord Ampthill emphasised, and, apart from the present question 749 which we shall have to examine a little more closely, an industry with irreproachable business ethics. The Chancellor of the Exchequer himself, as has been pointed out by my noble friend Lord Conesford, makes very nearly £850 million a year out of tobacco duties. If the manufacturers are guilty men we are all guilty men. Our public revenue is very largely sustained by smoking. It has therefore become a part of our lives. Now it transpires, so it is said in this Report—and this I shall examine—that this habit which is so deeply built into our social and economic system is dangerous, in many cases lethal, in the form of cigarettes, possibly more dangerous than alcohol. And the question we are discussing is: is this so, and, if so, what are we to do about it?
I do not think this is an easy problem. If we admit the facts we cannot wholly shrug off responsibility, as the most reverend and noble Lord, Lord Fisher of Lambeth, said. On the other hand, my noble friend Lord Stuart of Findhorn said it is not the business of the Government to be a governess. We live in a free country and the question of what we do in such circumstances does, whether we like it or not, raise the whole question of paternalism. If tobacco is to be interfered with, why not alcohol, why not betting? My noble friend Lord Conesford says: Why not sweets?—which are alleged to rot the teeth of the young and, I think, to render middle-aged gentlemen like me prone to coronary thrombosis. The noble Lord, Lord Brain, from the Cross Benches asked: where are you to draw the line? Where indeed? And, if you draw it anywhere, what kind of line are you to draw and how far are you to lead, how far are you to precede and how far are you to be guided by public opinion? To what extent are adults to be allowed to go to hell, and by their example to encourage others to go to hell, their own way? Not, apparently, by heroin. But if not by heroin, then why by tobacco?
These are not, I venture to think, easy questions. Those who regard them as easy, I think tend to be a little superficial in their political judgments and I certainly do not propose to answer them tonight. In the meantime, however, the noble Baroness is entitled to say lung cancer rates continue to mount, families are being deprived of their 750 fathers and harmless men are coughing themselves to death. There is one thing I do want to say tonight. I think it is something of supreme importance in this matter, and it is that we cannot afford to trifle with the truth. We cannot afford to yield to the interests of the Revenue. We cannot afford to fear economic consequences to business interests. Men who go into business for profit must be prepared, if necessary, to bear loss. This is one of the advantages of the private enterprise system.
There is one thing I would say to my noble friends. My noble friend Lord Sinclair of Cleeve said that there was growing pharmacological evidence of the beneficial effects of tobacco. This may be true, but I must tell him that if my noble friend Lord Auckland and I had his money to advertise the effects of not smoking there would be growing evidence of the benefits of not smoking.
§ LORD SINCLAIR OF CLEEVE
My Lords, will the noble Viscount allow me to speak? I do not think I said there was growing pharmacological evidence of the benefits of smoking. I said that the observations of Professor Burn at Oxford (I am speaking from memory; I hope this is right) formed a basis for the opinion that much more research on the pharmacological benefits was desirable.
§ VISCOUNT HAILSHAM
I certainly did not mean to misrepresent my noble friend. I only say that with half his money I could get a great deal of evidence about the beneficial results of twenty years of not smoking. We have voted with our feet.
I want now to turn to the facts. As we have heard to-day, both from my noble friend Lord Sinclair of Cleeve and from my noble friend Lard Ampthilil, and as we already knew, the official attitude of the tobacco industry to this Report at the present moment is one of agnosticism bolstered by scientific doubt. They have sent me, as I have no doubt they have sent others of your Lordships, a rival document to that of the Royal College, more expensively got up, scientifically argued and amply documented, the evident intention of which was to create in the mind of the reader, who if he smokes at all does not wish to be 751 convinced that he is going to die or may have to die from this disease, at least a doubt as to whether cigarette smoking is a cause of lung cancer after all. In addition, they have given many of us a short and more popular statement to the same effect.
I do not think I am misrepresenting my noble friend or either of the documents if I say—and indeed my noble friend has declared it as his sincere belief—that the intention of the document is certainly to create a belief in the mind of the reader that the evidence is too doubtful to be acted upon. That is the intention of the thing; indeed, my noble friend has declared it as his own belief. My duty I think compels me to scrutinise the wisdom of this aittitude and the validity of the arguments upon which this attitude of agnosticism is based. Clearly the case is too doubtful we can do nothing. But are we really being wise to treat the case as unproven? That is the question to which I want to address myself, for, whatever conclusion we arrive at about policy, we surely cannot afford to deceive ourselves about the facts. I have one duty which seems to me to transcend all others, as a man, as a parent and as a member of the Cabinet. It is a duty to the truth as I see it, as the Government sees it, and, I am bound to say, in common with the noble Lord, Lord Cohen of Birkenhead, as the overwhelming body of scientific opinion sees it.
Whatever our policy may be, our duty is to the facts—that we should not be deceived about them. I wish to say to the House, with all the emphasis at my command, that it is my serious conviction that this case is proved, that beyond any reasonable doubt whatever cigarette smoking—that is to say, the smoking of cigarettes as they now are made, and especially heavy smoking of cigarettes—is, in popular lanauage, a cause of lung cancer. I reached this conclusion myself ten years ago, on evidence. The whole of my professional life, although not scientific, has been based upon the assessment of evidence, which has nothing at all to do with my membership of the Government or my reliance, as I shall proceed to show that I do rely, upon the advice of my scientific advisers in my present office.
752 It is no good saying, as the representative of the Tobacco Manufacturers' Standing Committee is reported as saying a day or two ago, that this approach is unconstructive. It is no good saying it is unconstructive if it is in fact true. Of course it can be said with absolute truth that not all the people who smoke get lung cancer. Even amongst those who smoke cigarettes heavily no more than one in 8 die of lung cancer. But this is all discussed and allowed for at length in the Royal College's Report. But one chance in 8 of dying of lung cancer is, I must tell my noble friends, a bigger risk than I should myself be prepared to run, if I knew it, or be prepared to allow anybody I loved to take. Of course, it is true, too, as noble Lords have said, that many people who do not smoke at all get lung cancer—about one in 300, I think, is the figure mentioned by the noble Lord, Lord Cohen of Birkenhead. But the difference between one in 8 and one in 300 is one which is surely worth grasping with both hands. Those are the facts.
More than 23 investigations and some prospective investigations in about nine different countries have established a causal connection between cigarette smoking and lung cancer, without, to my mind, any doubt at all. I myself do not know of any impartial organisation whatever which has studied the matter, which has not accepted in general the position adopted in the present Report by the Royal College.
At all events, as the noble Earl who moved the Motion said, the following have accepted the position: our own Departments of Health for Scotland and for England and Wales; our own Medical Research Council; the National Cancer Research Institute of Canada; the Netherlands Ministry of Social Affairs and Public Health; the United States Study Group on Smoking and Health, 1957; the United States Public Health Service; and the World Health Organisation. But as my noble friend has pointed out, there is, of course, much that we still need to know. We do not know the exact mechanism by which cancer is caused in this case. We can only guess, as several noble Lords have pointed out, at the type of constituent in the tobacco smoke which acts as the agent. 753 I thought that my noble friend Lord Ampthill made a valid point when he cast doubt upon the argument of the noble Baroness, Lady Summerskill, and, indeed, on the recommendation of the Report, that it might not be a fair test to place on the outside of the packet an analysis of the two particular constituents which are under suspicion, because they are, I concede, no more than that. We do not know whether the constituent acts alone or whether it requires other, and if so what, co-factors. We do not know whether the offending factor can be eliminated, or whether the attempt to eliminate it is as futile as to try to eliminate alcohol from whisky.
No doubt all these matters, as my noble friends Lord Sinclair of Cleeve, Lord Ampthill and Lord Coleraine, have pointed out, are all matters deserving of research. I do not want to say anything against research. I wish to acknowledge the generosity of the manufacturers in placing at the disposal of the Medical Research Council large and munificent sums for the purpose of research. By all means let us research on all these questions. But do not let us delude ourselves that research will buy us out of action now, or out of a belief in the conclusion which has now been established; because that would be wholly contrary to research, and research then would be a curse and not a blessing.
We know, so far as any human being is concerned, that cigarette smoking, as it is now practised, is a cause of lung cancer in the countries and places where they are smoked. Whatever we do or do not do, we ought to act in this belief, and we cannot buy ourselves out of that fact by research; otherwise we deceive ourselves, and endanger others. We cannot afford to delude ourselves with alternative explanations which have been eliminated, nor with other hypotheses which, though possibly true, are not inconsistent with what I have said.
Of course we cannot acquit atmospheric pollution; but the possible implication, indeed, the probable implication, of atmospheric pollution to which the noble Lord, Lord Cohen of Birkenhead, has referred, and which is referred to frankly in the Report, does not diminish the responsibility of cigarette smoking. 754 Nor are the figures, quoted in several quarters, for the unpolluted parts of the world, which show that lung cancer is less frequent there, of any real assistance to anybody. Because, side by side with those figures, is the fact that the ratio between lung cancer in those areas of the smoker of cigarettes and the nonsmoker is the same as the ratio between them in the much higher figures which exist in the polluted areas.
My Lords, it is not possible any longer rationally to believe, as some have tried to do, that smoking simply determines the site of the cancer; or that the cancer is due to some inherited tendency which independently excites the desire to smoke, or even (as I think the noble Lord, Lord Cohen of Birkenhead. said), excites the inability to get rid of the desire to smoke at a later stage; or that cancer is caused by drinking, or that the exhausts of vehicles, or even our climate, are responsible for the significant increase in the figure. I am not going to discuss all these at length because the extent and validity of these various escapist formulas are all adequately exposed and discussed in the Report of the Royal College itself.
It is for this reason that I regret the present professed agnosticism on the part of the tobacco trade. It is not that I condemn them. It is not that I criticise them in any way, save this one. On the contrary, I realise that it must be a hard and bitter thing to persuade oneself that an honourable business, decently built up, is in fact purveying a substance capable of implanting mortal disease without any fault on the part of the purveyor. But the facts of life are often hard things to face, and the impression the tobacco manufacturers now make on public opinion—this I must tell them plainly—will largely depend on the extent to which they prove themselves able to recognise as facts propositions which are accepted by impartial scientists everywhere but which they find unpalatable.
Probably they will not relish what I am saying, but I believe it is to their interests to recognise the truth before, and not after, they are compelled to do so; and to drop the escapist propaganda which at the present time they are putting out, which personally, I am bound to say, I find both distasteful and lacking 755 in scientific courage and integrity. My Lords, otherwise the money they are spending on first-class brains and organisation will be wasted. The first-class man is a man who recognises and accepts compelling evidence, not one that fights against it.
I believe, with absolute conviction, that this evidence is compelling, and that not to accept it is not so much to sin against the light as to disregard one's own long-term interests. I am quite sure myself that it would in the end be more to their credit and less to their disadvantage if they got together in their boardrooms and frankly recognised that the merchandise they are now selling, in its present form, is dangerous and, taken to any degree of excess, potentially lethal. If they would do that they could begin to plan the consequences, which it is absolutely vital for them to plan, and if they do not plan now in advance of the recognition of the facts they will find it very much to their disadvantage.
It may be that they can, by research, establish that it is safe to switch to filter tips; it may be they can experiment with other tobacco cures; it may be they will think it wise to switch to other products, to switch their advertisements to pipes or snuff or cigars—possibly even to consider other things altogether. But they cannot do any of that so long as they cling to their illusions. The longer they cling to them, to an untenable position on the facts, the worse their dilemma when it comes, and the more people, incidentally, will die and the less they will themselves command the respect they will need if they want to prevent public opinion demanding more draconian expedients.
In parenthesis, may I say that it is fatuous to say that cigars are too expensive. In France, Holland and Scandinavia they are smoked by all classes. In this country, cigarettes cost as much as the best cigars used to cost, and I have no doubt that if they decided to sell cigars to the mass market the manufacturers would find considerable means of cheapening production. I frankly believe that tobacco companies would do far better to plan their future policy in the sober recognition of the true facts, realising that they cannot buy themselves out of the facts with propaganda, or blind themselves out of them with 756 science, and that research, although essential, will not be accepted as a substitute for action.
Cigarette smoking is the most important cause of the increase in lung cancer. I will quote the words of the scientific advice I have received. Lest it be thought I was expressing a purely personal opinion—although the personal opinion that I have been expressing is one I believe—I asked the Medical Research Council for their own comments on the Royal College's Report. The Secretary replied, "I cannot see how anyone can now deny the closeness of the association between smoking and lung cancer. With regard to the association of other diseases, such as bronchitis and coronary diseases, the evidence is less overwhelming, but if the subject were non-controversial it would be regarded as sufficiently strong as a basis for action."
My Lords, I must dissent, with respect, from the closing words of my noble friend who seems to think that until you can establish when or how or why the mechanism operated to cause this disease you must withhold your judgment and stay your hand. Human life is made up of moral certainties and moral probabilities. We have to base our judgment on evidence which is less than that which is absolutely cogent, but I cannot conceive of evidence in any matter in which one could give dispassionate advice and which, if it were presented in this form, would not be regarded as cogent in any other matter.
My Lords, so much for the tobacco manufacturers. Now, how about the public? Can we afford to go on as we are? Can we afford to bury our heads in the sand? If we have children, can we afford to leave this to the schools? We warn them about drink, and gambling and, if we have got any sense, about venereal diseases. Can we afford not to warn them about cigarettes? If we leave it to the schools, can we afford to be seen smoking in front of our children? What is the good of asking the Government to take action unless we are prepared to take action ourselves? In our homes, we are the Government. Can we afford to let our children know that we smoke?
How about the doctors? The Report is fairly clear about them. In their own lives 757 they have already begun to see the red light. According to the Report:The contrast between the smoking habits of doctors and the general public is notable in this matter. Doctors are in a position not only to read and appreciate the scientific evidence on the hazards of cigarette smoking, but also in their daily practice they witness the tragic consequences of the habit.Clearly the G.P. cannot shirk his duty to his patient.
How about the life assurance companies? Clearly, they must act on statistical evidence in such matters. How about publicising the fact, emphasised by the Report, that it is never too late to change your smoking habits? Even at an advanced age, to give up cigarette smoking improves your chances of life. How about the good people who subscribe immense sums to persuade their neighbours of the evils of gambling or beer? I thank they would be wise to change some of their targets in the light of contemporary knowledge. How about public places—railway carriages, theatres, cinemas? Are we going to pollute the atmosphere for other people there? My Lords, I do not answer these questions—yet I do ask them. We cannot, as individuals, afford to continue to act as if the facts stated in the Report were uncertain or incorrect.
If the facts are conceded to be established, what can the Government do about it? The Report itself contained a number of suggestions. Of one thing there appears to be no doubt. Whatever may be our duty towards the adult population, we cannot shirk our responsibility to children and young people. True, if the parents will not co-operate as I have suggested, much of our effort will be wasted on them. All the same, we must make the effort. We must continue to try, by all means of education in our power, to stop the habit from being formed. In the long run this is by far the most valuable thing we can do. I myself would not desire to say anything, despite the noble Lords who have expressed a contrasting opinion, to minimise the value of education in this respect. The Report itself says that an experiment it describessuggests that appropriate education can dissuade a significant proportion of children from starting to smoke.So education on the hazards of smoking 758 has been, and will continue to be, the the policy of the Government.
My Lords, the House will remember that in the publication of the Report of the Medical Research Council on Cancer and Smoking in June, 1956, the Minister of Health announced the Government's intention that the link between heavy smoking and lung cancer should be brought effectively to the notice of the public, so that everyone could make up his own mind whether—and how much—to smoke. This has been done through teachers, local education authorities and local health authorities. There is evidence that these efforts were successful in making the facts known to the public and that before the publication of this Report most people were aware of the possible association between smoking and lung cancer, but there was little sign of people's giving up smoking.
One result which I expect to emerge from the publication of this Report is that the number of those who accept the evidence of the link between smoking and cancer will increase. As I informed the House last week, the Government have already taken action in the recommendation of the Report that there should be more education of the public and particularly of schoolchildren. My right honourable friends the Minister of Health, Minister of Education, and Secretary of State for Scotland have again sent circulars to all local health and education authorities requesting them to take immediate and positive action. The officers of the Ministry of Education have written personally to chief education officers and principal school medical officers asking them to take a personal interest in discouraging schoolchildren from smoking. The Health and Education Ministers are devising publicity material for issue to local authorities; in particular the pamphlet for teachers and trainee teachers on Health Education is being revised to
incorporate material from the Physicians Report. All this will, of course, be issued free of charge.
Now about the adult population. The question here is how far we ought to go to help those who will not help themselves. This does not, of course, apply to those who want to get rid of tobacco addiction and cannot. The Report suggests clinics and injections. My right honourable friend the Minister of 759 Health has announced that he has in mind experiments with anti-smoking clinics.
The Report suggests differential taxation. This obviously is a matter for the Budget. I do not wish to indicate one way or the other what my right honourable friend will do or not do, but I would make one or two observations of my own. Differential taxation aimed at cigarette smoking could not, of course, be based on the present tobacco duty, which is based on the leaf before it is made up. The scale of the present tobacco duty on most other things would, I should have thought, have been considered crippling; yet it does not seem to have deterred for any length of time. My noble friend Lord Salter said that he did not want the Chancellor of the Exchequer to have a bigger vested interest in ill-health. This, again, is a matter which will have to be considered, and so is the suggestion in the Report.
Should we ban, control or tax advertising? The debate this afternoon has shown that there are plenty of people who would like to see us do so. Advertising as such has its enemies, of course, but I personally am not among them. Previous efforts to regulate advertising of a product, not in itself illegal, have, I should have said, despite the noble Lord, Lord Cohen of Birkenhead, really been limited to unethical advertising methods, such as claims to cure cancer or venereal disease. Ought we to embark on an effort to regulate the advertising of a perfectly lawful habit? Here I must say that I wish the tobacco companies would themselves make suggestions. Children's television broadcasts are already insulated from tobacco television advertisements.
I wonder whether the companies would not gain in respect and prestige if they had an even further look at this. They claim now—I think with reason—not to slant their advertising towards the young. The Report challenges this. Could they not look again at it and consider, too, their products, as I have suggested before? Obviously our own attitude as a Government must depend in part on public opinion, and this in turn will depend on the kind of figure which the companies themselves are prepared to cut.
760 My Lords, I have endeavoured to put before the House the social and political issues inherent in this problem, and implicit in the recommendations of the Report. I have told your Lordships in some detail of the action so far taken in education on the hazards of smoking. We are, as I told my noble friend Lord Salter, studying the other measures on which the Report recommended action. Some of these recommendations, those on restrictions on the sale of tobacco, and on the places where smoking is allowed, relate to matters already covered by legislation, the enforcement of which depends to a great extent upon the co-operation of the public. Other recommendations, such as those proposed restrictions on advertising, increasing the tax and informing purchasers of the tar and nicotine content of cigarette smoke, must clearly be considered in relation to their likely effectiveness in reducing the hazards to health and in discouraging children from starting smoking.
My Lords, I cannot give answers to these problems to-day. I will only say this in conclusion: that I think this debate has done a very great deal to assist the public to form its own conclusion. My own impression, for what it is worth—and I am bound to say that one's subjective impressions are not necessarily worth a great deal—is that this time, at last, the public has begun to take an interest in this important matter; and that, for some reason which can only guess at, this Report may have succeeded where others equally emphatic have failed. If that is so, it is something which all of us will have to ponder upon, and conduct our own private lives and our public lives accordingly.
§ 9.56 p.m.
§ LORD SINCLAIR OF CLEEVE
My Lords, this may be somewhat unprecedented, but the noble Viscount, the Leader of the House, has seen fit to impugn the motives of manufacturers and in particular, I think, myself.
§ VISCOUNT HAILSHAM
No, my Lords. I do not want to interrupt my noble friend, but I really must emphatically say that I was particularly careful to say that no motives at all were impugned. What I did impugn was manufacturers' wisdom in olinging to a belief about facts which I thought could no longer be sustained.
§ LORD SINCLAIR OF CLEEVE
May I say this, my Lords? When I informed the House earlier this afternoon that I did honestly and sincerely believe that the case is not proven, I meant that that is my belief, and I must ask the House to accept it. I would also ask the House to accept the fact that the manufacturers' attitude to this is as I have described it. They have never said that heavy cigarette smoking cannot in certain circumstances cause this disease. But they do say that the fact that smoking causes lung cancer is not proved.
§ VISCOUNT HAILSHAM
My Lords, I hope I may be allowed just to say that I absolutely accept my noble friend's complete sincerity in everything he said, and if I gave any other impression I did not intend to do so. I am certainly delighted to correct it, because I know my noble friend sufficiently well to know that he would never tell this House anything which he did not sincerely believe himself.
§ 9.57 p.m.
THE EARL of ARRAN
My Lords, we have had a long and tense debate, the length and tenseness of which shows the interest taken in these affairs, and the seriousness with which they are regarded; and that is an excellent thing. In a way the debate has been the first expression of public opinion since the publication of the Report, for I like to think that this is a democratic Assembly and that, despite our curious composition, we represent public opinion. This debate has also produced some very clear results. After the views expressed, I hope it will be clear to the interested persons and parties that it is not just the doctors and the Government who believe in this Report. Rightly or wrongly, and despite the Daily Express, most people believe in it.
That being settled, I hope that we can now once and for all approach the 762 major problem of what to do next without any looking back over our shoulders. It has been a comfort to hear the reassuring, indeed, strong, words of the noble Leader. As I said earlier, what we really want to be sure of is that this time the Government really mean business. The impression I get is that they do and I can assure them that, if they do not, we shall be after them. Perhaps to-day we may have saved a few lives, my Lords, and that is a pleasing and a comforting thought on which to go to bed. With your Lordships' permission, I beg leave to withdraw my Motion.
§ Motion for Papers, by leave, withdrawn.