HL Deb 17 March 1971 vol 316 cc476-552

4.18 p.m.

Debate resumed.


My Lords, it had not been my intention to venture to speak in your Lordships' House until I was better versed in its great traditions. I cannot, however, remain silent on the subject of cigarette smoking, which offers us to-day the most challenging opportunity for real preventive medicine. I am well aware that it would be entirely wrong for me to embark upon any topic that was controversial, but there surely can no longer be any controversy about the widespread and appalling harm that results from smoking cigarettes.

My noble friend Lord Platt has outlined the contents of the second Report from the Royal College of Physicians, and has depicted the holocaust that results from smoking, and I would fully endorse his remarks. He was, of course, President of the Royal College in 1962, at the time of the first Report, and this Report was followed by an immediate decline in the smoking of cigarettes—a decline which was, unfortunately, ill-maintained. The present Report not only confirms the damage that is done by cigarette smoking, but carries a clear message of the benefits to health which follow from giving up this pernicious habit. My noble friend Lord Platt has given the figures of the results of the giving up of cigarettes by my own profession and the saving of life that has resulted from that.

In addition to the report from the World Health Organisation to which my noble friend Lord Aberdare referred, there has been a similar report from the United States Public Health Commission which again supports evidence of the dangers which result from cigarette smoking. At the World Health Organisation Assembly in May, 1970, their report, with its far-reaching recommendations, was considered, and the Assembly resolved: That the Director General be requested to call the attention of all members and associate members to the report on the limitation of smoking and to suggest that the advantage of applying the recommendations made in this report should be considered in all countries. My Lords, it is essential that every effort should be made to stop this widespread addiction and to control the present epidemics—and I was delighted to hear my noble friend Lord Aberdare use this term—of cancer of the lung, of chronic bronchitis and of coronary artery disease. I welcomed the statement made by Lord Aberdare, and I am delighted that the Government have taken the first steps towards the promotion of public health in this field. I hope that many further steps will follow. I was delighted to hear the noble Baroness, Lady Serota, suggest that smoking should be forbidden in public places rather than that certain areas should be set aside. How fine it would be if the atmosphere in cinemas were to become as pure, clean and unpolluted as the air in your Lordships' House!

We are, I believe, observing a slow change in social habits. This change must be encouraged and accelerated. It is now rare to see cigarette smokers in gatherings of doctors. Doctors have not only received the message but those who do smoke often look self-conscious, and, I suspect, feel guilty. This message must be spread far a field. The Health Education Council, under the chairmanship of Lady Birk, has been doing excellent work and the posters of that Council have been steadily improving in their impact. I am delighted to hear that a further grant is being made to the Health Education Council; but I would draw attention to the fact that 13 times as much is being spent on public education in road safety, although each year lung cancer kills four times as many people as do road accidents. While the Health Education Council is spending £100,000, millions of pounds are spent on promotion, on advertising and on coupon schemes.

If social attitudes are to change, a campaign must be launched and waged. The Royal College of Physicians, having published their Report, have sponsored a new organisation, Action on Smoking and Health—ASH—and it hopes to unite the many voluntary and other bodies and individuals who are fighting against cigarette smoking. The aims of this organisation are simple: to provide information, to stimulate and promote research, to consult with other bodies concerned with smoking problems and to strengthen and harmonise their efforts; to influence public opinion-forming bodies, at present uninformed and unconcerned, and in fact to act as an authoritative voice to try to weld all these bodies into one mass movement to get a change in our habits.

Doctors are clearly setting a good example, but far too many still smoke cigarettes and far too few seize the opportunity to talk to and to persuade their patients when they meet them in consultation or in hospital. There is much room, I must admit, for further instruction of medical students, and also of other students and schoolchildren. Teachers and parents must be taught to set an example to the young; while business executives could well spend some time examining how much time is lost from work through ill-health, let alone the time taken on smoking cigarettes while on duty.

Much research is in progress in the search for a safer cigarette. This is clearly to be welcomed, and I trust that this research will prove successful. In the meantime, operational research is needed into why people should smoke and how they can be helped to stop. Such research, in my opinion, may lead to far greater saving of life than results from the more glamorous, more exciting and far more expensive laboratory research into the causes of cancer. We must no longer tolerate the unnecessary misery and years of ill-health that result from chronic bronchitis, the high toll of coronary diseases and preventable deaths from cancer of the lung. My Lords, we know how to slop these tragedies. The time has come to act.

4.27 p.m.


My Lords, before I begin my speech, may I exercise the privilege that by tradition is accorded to someone who next follows a noble Lord who is speaking in this House for the first time? The privilege in this case is to express to the noble Lord, Lord Rosenheim, our warm congratulations on his maiden speech for, if I may say so, its clarity and comparative brevity; and to express, as I am sure I can on behalf of all Members of your Lordships' House, our hope that we may have the pleasure of listening to him speak on many subjects in the future.

I must at the outset of what I have to say on the subject of this Motion declare an interest, in as much as I have had a long connection with the tobacco industry although not any active connection for the last 12 years. I am prompted by some of the opening remarks of the noble Lord, Lord Platt, to feel that in all honesty I must also declare a personal bias, because I have been a consistently heavy smoker all my life—at least from the age of 19; that is, for about 58 years. If I add to that the fact that to the best of my knowledge my health has not suffered there from, I should like to make it clear that I do not do so in order to suggest that I am one of the exceptions that prove the rule or that I am to be classed among those whom I think the noble Lord, Lord Platt, described as having a congenital ignorance of mathematics. Nor, on the other hand, would I claim for a moment that I am qualified to contest a medical opinion.

My purpose in addressing your Lordships to-day is not to state my personal convictions but rather to say something about the position of the manufacturers, so far as I know it, in regard to a question which for the last quarter of a century, ever since the first Doll and Hill Reports on the statistical association between smoking and lung cancer has caused them as well as—if not indeed more than—the general public very real concern, a concern that has by no means been confined to the actual or potential effect upon their trade.

Although, as I have indicated, I am not qualified to comment upon the medical conclusions contained in the recent Report of the Royal College of Physicians, I felt that because of my long experience in the industry, I had some obligation to speak to-day and, with that in view, to obtain as far as I could the facts about the manufacturers' attitude to the problem. To avoid any possible misunderstanding I ought to add that my intervention to-day is not made at the suggestion of the manufacturers or of any one of them. But I hope that what I say, in the light of the information that I have been able to get, may contribute something to that part of the background, and the appreciation of that part of the background, to the problem.

From the outset—that is, as soon as the problem became known—manufacturers felt that the key to its solution must lie in scientific research to find whether there was, in tobacco or tobacco smoke, some identifiable agent which made smoking directly one of the causes, or a contributory cause, of lung cancer. If this could be found, they felt that it must be possible to deal with it; if not to eliminate it immediately, then progressively to render it innocuous.

With the co-operation of all the leading manufacturers in the country, the Tobacco Research Council was set up in 1956. I cannot say precisely what each individual manufacturer did, but I am, of course, familiar with what Imperial did. I can assure your Lordships that nothing that they could do has been left undone, and no expense has been spared. Directly, and indirectly, through the Tobacco Research Council, the manufacturers have kept in touch with research on this subject throughout the world; and from time to time they have supported financially not only work by the Medical Research Council on lung cancer but also particular research projects by many independent investigators which seemed promising and which were held up for lack of funds. The Tobacco Research Council set up in Harrogate, and staffed, a large research laboratory working solely on problems related to smoking and health. In addition, Imperial and its fellow manufacturers in the United Kingdom each carry out substantial health-related research on their own private account.

As time went on, my Lords, the results of the research undertaken or sponsored by individual manufacturers have been pooled for the common good, and the authorities have been kept informed of all that has been done. The manufacturers have welcomed, and would continue to welcome, any suggestions from medical scientists for further research. Apart from the scientific and medical conclusions of the new Report of the Royal College of Physicians, there are various recommendations which, I think, fall naturally into three groups. First, there are those designed to increase the knowledge of members of the public and smokers generally on the subject; to develop safer smoking products and to enable those smokers who choose to continue to smoke to take into account all relevant information as to choice of product and as to what might in the generality of cases be safer smoking habits. Secondly, those designed to restrict the freedom of manufacturers to engage in cigarette brand advertising and sales promotion; and thirdly, fiscal measures, in particular differential taxation to discourage particular forms of smoking. There are some practical difficulties in the last, but in any event that recommendation, like some of the recommendations regarding schools, et cetera, falls, I think, strictly within the sphere of Government action.

The others, my Lords, are recommendations on which, to some degree, action by the industry is called for in the Report, and they have been the subject of detailed discussion between the manufacturers and the Department of Health and Social Security. I read this morning the Statement in answer to Questions, to which reference has been made to-day, which was made by the Secretary of State for Social Services in another place, and which the noble Lord, Lord Aberdare, repeated in your Lordships' House last evening. As has already been said, that Statement refers to the responsible and helpful way in which manufacturers have approached these discussions with the Government, defining the area of agreement which has been reached at this point, and including, most importantly as I see it, the establishment of a Standing Scientific Liaison Committee.

The Statement does not, however, deal with advertising, save in the context that advertising can be used for the promulgation of a warning on health risks. Yet, as the extent of advertising is commented on in the Report, and as it is a not unimportant part of the background, I felt that I ought to obtain some information on the subject; and the facts, as I understand them, are these. There has not been for many years any advertising designed to induce people to smoke, to induce smokers to smoke more or to appeal especially to young people. This policy has been operated under a voluntary code of practice agreed by the industry and policed by the independent Code of Advertising Practice Committee.

The advertising, my Lords, is strictly grand advertising. Considerable sums are spent on advertising, but then the industry is a large one and highly competitive. I believe that currently the total cost of advertising is approximately one-fifth of a new penny per packet of 20. The Report states in paragraph 9.27: Banning cigarette advertisements from television was not followed by any general reduction in smoking but it was accompanied by a great increase in gift coupon schemes that could have nullified any effect of the ban. It goes on to say: Increased expenditure on sales promotion has not been associated with any great increase in cigarette consumption. My Lords, I have no wish to over elaborate this point, but I think it only fair to say, first, that there is no direct connection between the cessation of television advertising and the growth in popularity of coupon brands. The growth of coupon brands began in the late 1950s and was accelerated by the 1961 duty increase. In July, 1965, when television advertising of cigarettes ceased, coupon brands had already obtained 22 per cent. of the total market. Secondly, that the circumstance chiefly responsible for the growth of coupon brands at the expense of non-coupon brands has been the general rise in prices and reduction in disposable incomes; and thirdly, that in the last 10 years, as I think was referred to by the noble Lord, Lord Aberdare—though he did not give specific figures—the total consumption of tobacco in cigarettes in this country has in fact decreased by some 12½ per cent.

I think that there can be no question that the reason for this decrease is a combination of higher duty, with other costs rising and with less money available; and a consequent change to smaller cigarettes, and from plain cigarettes to fitler-tipped cigarettes against the general background of an increasing awareness of health risks. Manufacturers have given the Government their reasons for believing that banning or restricting advertising would seriously reduce the effectiveness of inter-brand competition without affecting the total consumption of cigarettes.

As to the remaining recommendations in the new Report, I can say, in the first place, that manufacturers cannot, and do not, have any quarrel whatsoever with action by the Government or educational agencies to ensure the widest possible dissemination of the facts relating to smoking and health; always provided that any such educational programmes are conducted with due regard to the need for the information given to be factual. As has already been referred to, they have discussed constructively with the Government ways and means by which, without infringement of the accepted canons of advertising, they themselves could convey on advertising material and on packings a warning which the Government considered appropriate.

I understand that the accumulated research results now indicate with increasing certainty that the constituents of cigarette smoke which cause lung cancer in laboratory animals are to be found in the fraction which is called tar, and not in any other fraction of the total smoke. Incidentally, my Lords, I think it only right to say that the most significant contribution to research in this area has come from the tobacco industry; notably the work conducted by the Tobacco Research Council at the Harrogate research laboratories. In this connection there is a reference in the Report to the evidence now becoming available in the United States that lung cancer mortality risk is reduced for those smokers who, in a relatively short space of time change from plain cigarettes with higher than average tar yield to filter cigarettes with lower than average tar yield. And it is significant that surveys in the United States have indicated little tendency for smokers who change to cigarettes with reduced tar and nicotine delivery to smoke more of them, to smoke more of each cigarette, or to inhale more.

Having regard to the prevalence of the habit, and to the satisfaction tobacco smoking brings to some, at least, this latest evidence could be very important. Manufacturers have already taken effective action towards reducing tar content in the smoke delivery of their brands and, in conjunction with medical scientists, will seek to effect further reductions. I am informed that the average tar yield of cigarette brands manufactured in the United Kingdom has in fact declined by about 30 per cent. over the last six years, and this is largely the result of steps which have been taken substantially to reduce the tar yield of filter cigarette brands.

These facts are clearly relevant to the recommendation of the new Report of the Royal College of Physicians that the tar and nicotine yield of cigarette brands should be published for the information of smokers. As I have said, the manufacturers are ready, if this is the wish of the Secretary of State, when all the facts have been appraised by Government, to collaborate in regard to the publication by the authorities of cigarette brand tar and nicotine yield data, provided only that these data are presented by the authorities in a way that clearly delimits their significance in relation to the health of smokers. The Report of the Royal College of Physicians suggests that any statements regarding the possibility of reduction of risk through reduction in cigarette brand tar and nicotine yield should be accompanied by an authoritative medical statement that the only sure way to avoid risk is not to smoke. It would seem, my Lords, in the present state of knowledge, that concentration on this tar problem might well prove to be of cardinal importance.

May I say, in conclusion, that I believe it to be true of the general body of manufacturers, as it is certainly true of Imperial, that they do not presume (because they are not qualified) to contest medical judgment on the interpretation of factual statistical data relating to smoking and health; nor do they make specific or implied health claims for any of their products. While they would naturally feel that their freedom to make and sell a product which can be legally acquired by the public should not be restricted beyond an extent which can be shown objectively and impartially to be necessary to protect the public health, they themselves would spare no expense, or relax in any way their efforts, to pursue and help others to pursue research into the reduction and eventual elimination of any elements in their products which are found to be harmful. And they welcome most warmly the announcement of the Secretary of State to appoint the new Standing Scientific Liaison Committee, comprising scientists from the industry and scientists and doctors appointed by the Department of Health and Social Security.

4.44 p.m.


My Lords, I am tempted to challenge many of the statements made by the noble Lord, but I am anxious to devote the time at my disposal to something more constructive. There is, however, one point on which I really must comment. I was astonished to hear the noble Lord say that the tobacco industry did not use advertisements designed to encourage young people to smoke. I would direct the noble Lord's attention to a full page coloured advertisement in the Daily Express last week, depicting a lovely young girl, wearing a huge luxury hat and against a luxurious background. Protruding from her mouth was a long cigarette, with a filter tip, of course, because that is deliberately designed to give the reader confidence. I ask the noble Lord to examine some of these advertisements, and I am sure that when he next comes to address the House on this subject he will not be quite so frivolous.

I want to thank my noble friend Lord Platt for his excellent exposition of this Report. The only item that he omitted—and after the last speech I am sorry he did—was his own personal description of manufacturers of cigarettes and tobacco. He refrained, he said, because he might be tempted to use language that the House might object to. Next time I hope he will not be so sensitive. I want to thank also the noble Lord, Lord Rosenheim. Here we have the hero of the hour, because the noble Lord, as the President of the Royal College of Physicians, was the Chairman of the Committee which was responsible for this Report. He and I met many years ago when I was at the Ministry of Food, and I was grateful for his help and advice. I learned then that he was a man of integrity who had at heart the public weal. Perhaps I may voice just one criticism. I feel that the Royal College of Physicians has at its command the finest brains in medicine. They are only too anxious to help on this subject of cigarette smoking and others. But I feel that their public relations department is not sufficiently strong, and I am glad to hear that the noble Lord is going to strengthen it. After all the time, energy and money spent, I want not only the people in this country but the people of the whole world to know the findings of his Committee.

In parenthesis (the noble Lord will forgive me for mentioning this, but it is an excellent opportunity) I should like to remind him of another committee which was very similar to this one, because it was to inquire into the effects of boxing on health. Seven years have been taken over that subject, and I understand that it was only when he became President that he expedited the matter. The noble and learned Viscount on the Woolsack and I took part in a debate on a Bill to prohibit boxing, which I tried to pilot through the House, and it was then decided that the Royal College of Physicians should examine the matter. The noble Lord, Lord Rosenheim, has told the House (and I am very pleased about it) that he is setting up a committee—ASH—for action on smoking and health. May I ask him to set up one also for A.B.H.—for action on boxing and health? Who knows but that if his public relations committee had been a little bigger and stronger Henry Cooper might have been persuaded not to go into the ring last night. There are these other questions which need publicising, and I am sure that if the nobl3 Lord needs any help in any direction many of us would be only too glad to assist him with ideas about public relations.

I propose to make some suggestions—and I was pleased to hear this afternoon that one of my suggestions has already been acted upon on television. Some of us are old enough to recall the vigour with which Governments years ago tackled tuberculosis, which had reached epidemic proportions. As dried sputum was known to transmit the disease, notices were put in all public places. Perhaps some of your Lordships remember the notices in buses.




I am sure my noble friend is too young to remember them. But I see the noble Earl, Lord Arran, assenting, and I am sure he is old enough. The notices read: "Fine for spitting, £5." As I sat in buses and looked at those notices I said to myself: "This is an excellent idea. For hours and hours on buses people look at this notice." The interesting thing is that as a result of that notice, spitting, except perhaps among nasty people, is no longer a habit in this country. This derives from the fact that we conditioned the people of the day—they did not know anything about dried sputum transmitting T.B.—into behaving in such a way. What I suggest to-day is that we should condition people with regard to smoking. Why have the Government and their predecessors failed to prohibit smoking in public places? We have heard to-day that it is going to be done in parts of public places. Is it going to be suggested that in the cinema there will be a notice in the circle, "No smoking up here", but that smoking will be permitted downstairs, and the smoke will go up in the air and be breathed by people in the circle? Is is very difficult to localise smoke and therefore I listened to the Minister with a little doubt in my mind when he said that in certain areas we should not allow smoking.

If we believe so sincerely in this, why do we not to-day say that we will set an example by prohibiting smoking in the Committee Rooms of your Lordships' House? To be absolutely radical I am leaving out the Library; I am even leaving out the Dining Room. But why should we not start in our Committee Rooms? No noble Lord says here that we must smoke: we seem to be debating quite effectively without having to smoke. Let us start, and tell the country that we have started. At the moment it is a little embarrassing. The silent majority have to endure the discredited practices of the few, and the few now have become a little embarrassed about it. But they are such addicts that it is difficult to control them unless you say, "Thou shalt not smoke here", and I hope the Minister will consider that.

Recently we were considering aspects of drug addiction and quite rightly—I think Lord Rosenheim said this—we must regard the cigarette addict as equally in need of our help. As I look round here I know one or two noble Lords who smoke, and I feel that I ought to be looking at the ceiling. Most smokers are nervous individuals, anxious to present to the world a calm, confident front which they do not possess. The result is that the very act of smoking becomes a symptom of the disease. A man will say, "It is not the smoke I want, but I must have something to fiddle with in my fingers." Those of us who have been to the Middle East have seen them using "worry beads". A good Muslim is not allowed to smoke. He feels nervous; he does not feel confident, and his Government, or his religion, very cleverly provided him with something; and he sits there with his little "worry beads". I know a man who has given up smoking, and he always has coins in his pocket which he twiddles; and it helps him.

Those of us who are anxious to prohibit smoking are not unaware of the difficulties of the smoker but, having said that, I must add that I believe we are wasting our time a little on older people. I feel that they are beyond our help, because habits are very difficult to change. For instance, as I came into this Chamber to-day one noble Lord said to me, "Why will you try to deny me my method of euthanasia?". My Lords, what can one say to that? I long to take him into a cancer ward and let him see cancer of the lung. But that was his approach. Nothing we say here to-day, I believe, will make any difference to the smoking habits of the noble Lords who listen to us. We must concentrate on youth.

I was impressed with regard to the methods of advertising. I am going to talk about what I think should be the approach by referring to a dinner that I went to some years ago. It was arranged by an international organisation; I was in the chair, and an American senator sat on my right. He lit cigarettes between the courses and after coffee I toasted the Queen, and I then said, "Ladies and Gentlemen, you may now smoke". The senator was covered with confusion. He apologised, and asked me that when I visited the United States the following month not to mention the incident to his wife. Now, my Lords, his confusion was due to the fact that he realised he had committed a social gaffe, not to the fact that I and his neighbour had to inhale with our dinner his stale exhaled smoke which completely ruined our meal. No apology was forthcoming for that, only because he had made a mistake regarding social convention.

Here, I believe, lies the key to effective advertising which those men and women in the advertising world who are employed to prostitute their talents to increase smoking understand full well. I described the picture of the lovely girl with a luxurious background with a long slim cigarette on her lower lip. These massive advertisements, with glamorous girls and unisex boys, always display luxurious backgrounds, indicating that social standing and sexual attraction are associated with smoking. We have to tackle it in the same way. Why do the Government not embark on an equally massive advertising campaign to disprove this false image and present the true picture? I must confess that I do not think there are any reliable statistics which prove that smoking reduces sexual potency, so we cannot go as far as that. But I want the Government to be bold, to make it clear to the young that the first loving approaches to one of the opposite sex cannot be highly successful if one of the couples smells of stale tobacco.

I welcome Lord Platt. I listened to every word when he said to noble Lords, "I cannot tell any difference between those of you who smoke and those who do not, except that you smell." I was going to say it, but I thought to myself, "Dare I?". When Lord Platt said it I thought, "That is all right; I can emphasise it". The olfactory sense is the sense that soon becomes fatigued and the result is that the smoker cannot smell himself. I am sorry, smokers, these are absolute facts, and the chain-smoker exhales smoke with his breath and exudes it through his skin; and doctors know the chain-smoker. When the chain-smoker who has done a hard job of work all day takes off his shirt, it smells of tainted sweat. Here is the real picture of the smoker. His teeth become discoloured; his conjunctæ become yellow, and his fingers are stained; his moist cough accompanies his unattractive lovemaking. Well, my Lords, this is what you have to do to counter this pernicious advertising of the manufacturers across the road.

To-day, I agree, the girl is smoking more—I am not apologising for my sex: she is smoking more. There are other factors. She meets the boy friend who is doing pretty well. He is a heavy smoker, and she learns after a time that he likes the person with him to smoke, because if the person with him does not smoke it accentuates the fact that he is doing something which he has been told is dangerous. I think that we have to relate some of the increase in smoking among girls to this. In some cases the girl recognises the addict, and she joins him with a cigarette out of sympathy. As regards the luxurious background, I want the Ministry not only to have this picture of the individual, as the real smoker is, but also to have the picture that the home smells of the heavy smoker; that signs of ash on the carpet, the signs of ash in the ashtray, are really not attractive. I agree with the noble Lord, Lord Platt. I do not know what the young mothers will do when they fully appreciate that smoking during pregnancy not only retards the growth of the fԓtus—and tremendous publicity should be given to this—but leads to a greater risk of an abortion.

My Lords, I see one welcome change at this debate: non-smokers have become less tolerant of smokers, and smokers are on the defensive and showing signs of self-criticism. That is why the Government can step in with excellent advertising. What they find difficult to accept—and I was very surprised when my noble friend Lady Serota talked about the smugness of people getting up and speaking on this subject—is that those trying to solve this problem are not killjoys; on the contrary, they are simply trying to promote the general wellbeing.

I just want to say this, to add my experience of what good advertising might be. On my first visit to the Soviet Union, many years ago, I brought home a propaganda poster on this subject. It showed the family in a small room, with father puffing away, and the children doing their homework in a cloud of smoke. I am quite certain that that did not do any good because the true addict, I am sorry to say, is not concerned with the welfare of his family. If he were, he would avoid smoking, which would result in his premature death with consequent disastrous results on his dependent family.

Although we have heard to-day from two noble Lords, Lord Platt and Lord Rosenheim, emphasising cancer of the lung, chronic bronchitis and coronary thrombosis, I think we should repeat time after time that smoking has a causative link with chronic bronchitis, emphysema, coronary thrombosis, angina pectoris, cancers of the lung, mouth, pharynx, larynx, ԓsophagus and bladder, and also with pulmonary tuberculosis. This should be repeated time after time, otherwise there are those fatalists who say, "Cancer of the lung; after all, I have to die of something." Tell them the lot in an advertisement. Let them realise that they are vulnerable to half a dozen diseases; that any of these can occur in middle life, and that a smoker's premature death can condemn a wife and dependent children to a lower standard of living. I believe that powerful propaganda, which disproves the seductive statements of the tobacco advertisers, is the most effective approach to the problem.

My last words, my Lords, are on money. All this needs money. I would invite people to look at The Times to-day to see what I call dangerous advertisements put in by the wealthy drug manufacturers. These are now called Fison's. Fison's were not making sufficient profit out of the insecticides, and so on; so now they turn to drugs. If one wants to see the wicked effect of advertising on the reader, look at The Times to-day. We should be told, on the subject of money, whether the failure to provide adequate funds is due to the Government's fear of antagonising the electorate or to the Treasury's fear of losing revenue. Whatever it is, we should recognise that the price which we shall have to pay by the 1980s, if Governments continue to evade their duty, will be 80,000 premature deaths a year from the effects of smoking.

5.4 p.m.


My Lords, may I first of all explain that I live in one of those outlandish parts of the country where there is the inevitable early last train home? If, therefore, I am not in my place at the end of the debate, I hope I shall be absolved from any discourtesy. When my contemporaries and I were at school there was one stock sentence which we had to translate, or try to translate, into Latin. It went in the form of a question: "Is he a knave or a fool?" I think, having heard what I am going to say, your Lordships will probably unanimously say of me, "Both". I will tell you the reason why. The noble Lord, Lord Platt, has risen to the very heights of his profession—a profession which we all revere and admire, and to which most of us have at one time or another had reason to be grateful. Yet, having read the Report (my copy is well thumbed), frankly I do not think the case is completely and utterly proved.

The other day the noble Lord, Lord Platt, addressed your Lordships and referred to atheism. I am not going quite so far as that, but I must confess that I am still at this moment an agnostic. I do not want my words this evening to be in any way carping criticism. I read this Report very carefully; in fact my copy is so well thumbed that probably I shall not be able to find the places that I want to refer to in a minute. There are certain statements and certain figures which I think need querying, and there are certain answers which I think need to be given before it is possible to get this across to the man in the street, of whom I am a simple example.

First of all, at page 48 you find a statement to the effect that cancer of the lung is almost entirely due to cigarette smoking. Nine Committees or Commissions have said "Yes" to this proposition. There are a number of individuals, referred to as a "small number" (there are 10 of them, including the redoubtable Professor Eysenck), who say, "No". I should like that question to be cleared up. It can probably be said that there are nine Committees or Commissions and 10 individuals; that there are probably three persons to each Committee or Commission, and that nine Commissions are far better than 10 individuals. But the 10 individuals include famous people—I have mentioned the name of one—who could give the man in the street a little cause for doubt.

I turn to bronchitis and perhaps your Lordships will allow me to read a small part of this Report. At page 75, it says this: Deaths attributed to bronchitis are more frequent in the British Isles than anywhere else in the world, even in countries with equally high consumption of cigarettes. Over the page, a few lines down it says: The Report on Air Pollution by the Royal College of Physicians concluded that life-long exposure to air heavily polluted by coal smoke in particular contributes to the special liability of British cigarette smokers to develop severe bronchitis. Note those words, my Lords: "life-long exposure to air heavily polluted by coal smoke". I should like to have an up-to-date comment on that point, because to-day, with our smokeless areas, less coal is being burnt. I think there might be second thoughts on this matter.

Then on the same page there is another matter which needs to be cleared up, It says: Deaths from bronchitis in unskilled labourers and their wives (social class V) are five times more frequent than in professional men and their wives (social class I) … The reason for this … remains obscure. I would urge that more research be devoted to this aspect to find out exactly why.

Then we come on to this great question as to whether, and if so why, pipes and cigars are less harmful than cigarettes. There is a statement about this on page 54. Reports in this country, and in the U.S.A. and Canada, say that pipes and cigars are better for us than cigarettes. On the other hand, reports in Germany and Switzerland say that pipes and cigars are worse than cigarettes. Again, where does one go from here? Incidentally, at page 61, the Report says that further study is needed in this respect.

There is another matter to which it would be helpful to have an answer. I have said that I am a fool; I am very ignorant about these matters, and I am merely asking questions. But at page 40 the Report says something which I did not know; that is, that pipe and cigar smoke are alkaline, whereas cigarette smoke is acid. Why? Having been in the paper trade for over forty years, I wonder whether it has anything to do with the paper. If so, cannot something be done about the paper? I was not concerned with manufacturing cigarette paper—a very different kind of paper was made by my firm—but I knew someone who for twenty years was manager of a factory which manufactured cigarette paper and he used to tell me of all the stringent tests and specifications which had to apply to the paper he manufactured.

In passing, he mentioned one point some years ago which I do not see referred to in this Report. In his belief, pipe smoking was healthier than cigarette smoking, and he thought that that was partly due to temperature. According to him, when one draws on a cigarette, a pipe or a cigar, the temperature at the lighted end is the extraordinary figure of 1500°C. Of course, the smoke very soon cools off to a much lower temperature than that, but if it has to go through a pipe or a thick cigar there is a much better chance of smoke becoming cool before it enters the mouth compared with an ordinary cigarette.

Next I would raise the question of experiments. Many of them have been carried out on rats and mice. My wife and I live in a pretty old house which we share with a lot of rats and a lot of mice, but we do not allow them to smoke so we have had no chance of experimenting for ourselves. But the question I should like to put seriously is this. Are the appropriate organs in rats and mice similar to human organs? Does the effect of nicotine and the other substances in tobacco on rats and mice correspond to the effect in human beings? In this connection, let me point out the position regarding the famous poison Warfarin, which, except for a small immune colony on the Welsh Marshes, is fatal to rats and mice. I am informed (although, again, I have not tried it) that a human being can eat bucketfuls of Warfarin without being harmed. Here is the point. Are rats and mice the appropriate animals on which to try out experiments so that they give the same results as would be obtained from those carried out on human beings?

On the question of drugs, on pages 113 and 114 of the Report it is stated: There appears to be no risk of addiction to other drugs in those who stop smoking. I have said twice that I am a fool, but I am not such a fool as to believe everything I read or see published. But this statement in the Report is quite contrary to what we have been led to believe from public statements and other statements in pint. Anybody who saw B.B.C. television News last Monday will have been horrified by what is happening in New York in this connection—if that report is true, which it may not be.

I now make one more reference to something which could possibly improve cigarette smoking. On page 38 of the Report reference is made to filters, and on pages 53 and 54 to filter-tipped cigarettes. They appear to be regarded favourably, but no definite conclusions have been reached. It is important that an attempt should be made to reach a conclusion in this connection. I have in my hand a small apparatus. I smoke filter-tip cigarettes through the holder I have in my hand. In this holder is a crystal filter—I am keeping my thumb firmly over the white dot, otherwise I might be accused of advertising. What I want to know is whether it is safer to smoke a filter-tipped cigarette through a holder containing a filter than to smoke a non-tipped cigarette without a holder.

Finally, my Lords, I wish to make two suggestions. Before your Lordships comment on the first I hope that you will hear me out as I want to explain a difficulty. On page 134 of the Report reference is made to cigarette brands with a low content of tar and of nicotine. I had no idea there were different contents of tar and nicotine. However, a question which I wrote down in your Lordships' Library a week ago is this: Could not brands with low contents of these substances be publicised and even, if I may be hopeful, be relieved of some taxation? I was rather pleased with that suggestion, but in the last 24 hours my noble friend Lord Aberdare came out with the statement that the question of tar and nicotine content was going to be looked into and that the amount of tar and nicotine in various brands was going to be publicised. If he will be kind enough to believe that I wrote this idea down a week ago, I certainly will not accuse him of cribbing it over my shoulder in the Library. My second suggestion is that there should be—I have asked for it already—more research into filters and filter-tipped cigarettes. To that, my Lords, I would only add that I have no interest, financial or otherwise, in the manufacture, distribution or sale of cigarettes or any type of tobacco.

5.17 p.m.


My Lords, I should like to add my expression of gratitude to the noble Lord, Lord Platt, and the noble Lord, Lord Rosenheim, who is presently President of the Royal College of Physicians, for putting us so greatly in their debt. It is very encouraging that it is the medical profession themselves who have indicated in two successive and extremely well documented Reports their concern over this problem, and that it is they who are putting pressure upon the Government and the public to pay heed to, and to follow, their recommendations. I hope very much that the noble Lord, Lord Brock, or the noble Lord, Lord Platt, in speaking again, may be able to answer some of the questions put by the noble Viscount, Lord Monck. But I would entirely support Lord Monck in his plea that greater efforts should be carried out in research, and that we should try to obtain even more authoritative answers to some of the detailed points which the noble Viscount has out before us.

However, I should have thought that on the main question there really is no doubt whatsoever. I say this because I have to declare an interest which, so far at least, no one in this debate has declared. I nursed my husband who died of lung cancer. I know what is entailed in human terms. Needless to say, when I was informed of the condition of his health I had long talks with the consultant surgeon at the great London teaching hospital where he was examined before he came home. From what I was told, I have no doubt whatever that the medical profession themselves are absolutely convinced of the causal connection between cigarette smoking over a period and the onset of lung cancer. One of the particularly distressing factors in lung cancer is that frequently one does not have the diagnosis until it is too late to do anything about it. Therefore, since that time, for both personal and public reasons, I have done as much as a lay person can do to try to inform myself of the position, and do anything I can to help.

It seems to me that there are certain more optimistic facets of this question than perhaps my noble friend Lady Summerskill suggested. She suggested that no one beyond a particular age, which she did not specify, could hope for redemption. But one of the most helpful comments in this Report is the suggestion that those who give up cigarette smoking over a period of five years or so (the period obviously varying for individuals) provided that no malignancy has already started, can very largely hope to overcome the effects of their earlier addiction. Therefore there is hope, and, as I understand it, it is sensible, even at a relatively advanced age, to give up. It is interesting that in the United States of America a quite significant proportion of smokers seem to have changed their habits. This is something about which we should all rejoice.

I should now like to say one or two words about a group to whom the noble Lord, Lord Platt, particularly referred, that is women smokers, because they are on the increase. It appears from such investigations as have taken place so far that if a woman becomes an habitual smoker—statistically at any rate—it is more difficult for her to give up later on than it is for a man. I do not understand the reason for this, but perhaps we may be enlightened later in the debate. If one looks at the investigations which have been made on a wide scale in the United States of America into younger women smoking, one finds that women aged between 24 and 35, if they tried to stop and in fact did stop for a short time, were more apt than others to revert. This is distressing, and I would so warmly endorse what the noble Lord, Lord Platt, and my noble friend Lady Summerskill said about the advertising which is now being carried on by the tobacco companies. To my mind, there is no doubt whatever that the nobler Lord, Lord Platt, is perfectly correct in his assumption that they have realised that this group is a possible growing market for tobacco products and therefore this is the market to which their advertising is currently being aimed.

Concerned as one is with smoking among women, my far greater concern is with young people and with children—and I mean children; I do not mean even adolescents. Yesterday I was able to speak to Professor Holland, who is in charge of the research now being undertaken by St. Thomas's Hospital with, I am happy to say, some financial support from the Department of Health and Social Security. As some of your Lord ships will know, this unit is about to undertake further investigations among schoolchildren in the Midlands, following the large scale investigation which they undertook a couple of years ago in Kent, where more than 10,000 schoolchildren were examined and were questioned concerning their smoking habits. As a result of these investigations the conclusion was reached that among children of 11 years of age somewhere between 10 and 15 per cent. of the boys and about 5 per cent. of the girls were already smoking regularly, and that the respiratory condition of some of these children gave evidence of that fact. I asked Professor Holland "Where did you start? Did you start investigating smoking habits?" He said "Oh no! I started on respiratory disease, and it was as a result of my investigations that I came to the conclusion that what was needed was an investigation into the smoking habits of children".

Taking a slightly older age group, of between 11 and 16, the investigators came to the conclusion that by the time children reach the age of 16 some 30 to 40 per cent. of the boys and some 25 per cent. of the girls are already smoking. This surely must cause us the very gravest disquiet. Something which is equally disturbing is that the investigations which have been made into the effect of propaganda on children of this age show that it is virtually negligible. It is water off a duck's back. It makes no impression at all. Apparently we have not yet found the way to understand the motivation of young children sufficiently to be able to devise satisfactory counter-propaganda with children of this age. The fact that they might die at the age of 50 instead of 60 has no meaning whatsoever at that age. The fact that their future wives and children may be left penniless again obviously has no effect whatsoever on a child of that age. Therefore, clearly one must have quite a different approach.

I hope very much that the Health Education Council, of which my noble friend Lady Birk is such a distinguished chairman, will be given far greater resources than it has enjoyed hitherto. We have not been given any order of magnitude of the help which the Government are making available, but I hope that the noble Lord, Lord Aberdare, recognises that there is a tremendous job in research, education and advertising to be undertaken if we are to tackle this matter seriously.

I was quite startled when I began to study this problem, to find that at this very early age there is already a direct correlation between smoking and respiratory symptoms, and that the influence of cigarette smoking is already significant and independent of other social and environmental factors which one could isolate. It is also recognised that the smoking habits of children are almost unaffected by current propaganda, and one must ask oneself how else can one hope to deal with this problem here and now before more elaborate research is done.

I would suggest, my Lords, that example is really the most potent weapon that we have. I have had a good deal of correspondence and various conversations with people since I made a broadcast to which a certain amount of attention was drawn, and I have been astonished at parents of children—mostly teenage children—who have said to me "Well, of course we have told them everything, but they still smoke". I have asked "Have you stopped smoking?" All too often the answer is "No". But the parents hope that the children will believe them, when I am certain that the reaction of the children (whether or not they say this in so many words) will be "Surely they must be hypocrites, because if they really believed all that they are telling us they would not smoke themselves". This seems to me to be a most important matter, and one of the directions in which our propaganda should be pointed. A man or a woman may not stop for their own sake, but they may for their children's sakes, and I think this is better than merely trying to horrify people by the results of lung cancer or other physical consequences.

The other group of people who are in a position to influence children are, of course, the teachers. One of the interesting things in the investigation into the smoking habits of schoolchildren was that so far as one could judge schools with comparable social structures and environmental positions nevertheless varied enormously in the incidence of children who were smoking. Therefore there really must be something in the influence of the staff and the general atmosphere in those schools. If the school is a happy school, in which the children are thoroughly interested and excited by what they are doing, then I suppose smoking is much less likely to be prevalent than in schools where possibly the atmosphere or the teaching situation is not so satisfactory.

I think it is in this area that possibly our greatest efforts should lie, and I hope very much indeed that the very small steps which the Government have so far taken are only the first. I realise that it is the first step which counts, and I welcome that: but I hope very much that the Government will not now weary in well doing, having once taken up this cause. One television crash programme, excellent as it may be, is just not enough, because the effect wears off. This must be a continuous process—changing the techniques, changing the approach from time to time, but a continuous process.

I also hope very much that the Government will take much more seriously some of the other suggestions made in the Report: for example, as I have been speaking more especially about the effect on children, the banning in public places of vending machines, because this is, after all, where most children get cigarettes. It seems to me that if we are serious about this problem something of this sort must surely be done.

I come to my final point, because I know that other noble Lords with greater authority than I wish to speak. I fail to understand the Government's attitude towards legislation. The noble Lord used the words "threat of legislation hanging over the head of the industry". If the industry is really proposing to do what we hope it will do, I do not see what it has to fear from legislation which just sets out this requirement in an orderly way and makes sure that there is universal compliance. I myself have no fears of proper legislation, and I was disturbed to be informed just a few hours ago that the Minister representing the Government on the Committee on the Bill now before another Place declared his absolute neutrality and said in effect, that he had no interest in helping the Bill. Quite frankly to me this seems regrettable.

I hope that the Government will not turn their back on legislation in other fields where it is required, and if nobody else does it, I will myself attempt to enlist your Lordships' support on this matter of vending machines in public places. I think this is a social responsibility that we should take seriously. This does not need research; this is common sense and social concern. I hope, therefore, that the noble Lord, Lord Aberdare, when, by leave, he replies to the debate, can perhaps give a little more positive assurance on some of these matters.

5.34 p.m.


My Lords, there is little left for me to say, but as I introduced the debate on the first Report of the Royal College of Physicians I think I should say something. I feel very strongly about these things. Your Lordships may remember that I introduced the debate on the first Report eight years ago, and I have been waiting and waiting desperately for some results from the wise things, the warnings, indeed the diatribes which we had in the House on that day. But perhaps I should first declare an interest. I am the beneficiary of a trust which owns tobacco shares. I have pleaded with my trustees to rid me of this incubus, but from their point of view, no doubt correctly, they retain my small shareholding. In other words, and I speak factually and not emotionally, I regard myself as an unwitting accessory to manslaughter, as indeed should all those who own tobacco stocks and still more the directors of the companies who control these slaughterhouses. Carmen did much more harm in her tobacco factory than she ever did in the bullring. Your Lordships will note that I naturally absolve those who work in these abbatoirs. They know not what they do, and, after all, it is a job like any other job, and jobs matter these days, matter indeed perhaps more than they have for the past forty years.

I am going on the basis that it is now generally accepted by the House, and by almost everybody I can think of, that cigarette smoking kills people. I defy any noble Lord to get up and say that this is not so. I am perfectly certain no one will. And I am happy that we have not had our attention diverted by the likelihood, beloved by the tobacco manufacturers, that diesel fumes also kill. It may well be so, but that has nothing whatever to do with the business we are discussing this afternoon. It is an entirely separate issue.

My Lords, 31,000 premature deaths associable with smoking is a lot of deaths. I am always amazed by the fuss justifiably made over deaths on the road, in the Press and in Parliament, which, as I am never tired of telling your Lordships, was last year for the first time higher than in 1934 when there were ten times fewer motor cars on the roads. My Lords, 7,000 deaths is a lot of deaths; 31,000 is a lot more, four and a half times as many indeed, as the noble Lord, Lord Rosenheim, pointed out. And yet I am afraid we still do virtually nothing.

After the "pasting" given by the noble and learned Lord, Lord Hailsham, then Leader of the House, to the tobacco industry last time, one might have thought that some consciences at least might have been stirred. And, indeed, in the very fear that consciences would be stirred, the value of tobacco stocks dropped some £30 million more or less overnight. But the death wish which is evident at the moment in other spheres of human activity proved stronger than the wish to survive, and the shares quickly picked up again. With even more contempt, incidentally, have the latest Government proposals been regarded by investors, so that shares have hardly been affected by the new regulations so much as by one new penny, and that in an upward direction. Clearly they are relieved; clearly they are laughing at the Government.

Do your Lordships really believe that the fact that a packet will henceforth carry a small warning, a mild warning, will make the slightest difference? Do your Lordships look at the cigarette packet or the chocolate box when you open it? We light up our cigarettes and we shall go on lighting them. Is this really a step forward? Who shall our immediate target be? It has been made abundantly clear—but I believe in the Goebbels technique of saying a thing over and over again—as the noble Lord, Lord Aberdare, said, that it is far harder to give up smoking than never to start. That is almost platitudinous. I ask your Lordships to consider this, as the noble Baroness, Lady White, asked us to do. At this moment there are boys and girls of 13 and 14 and less who, through sheer incredulity (or could it be stupidity?) are bringing on themselves the torments of thirty or forty years ahead. How can we expect these young people to know what they are laying in store for themselves? And how on earth shall we possibly sway them? It may even be indeed that they are right; it may well be that by the time they reach the cancer age—I speak loosely; all ages are cancer ages—that a cure or a preventative will have been found so that these follies of their youth will count for nothing.

I pray God that this may be so, but I must remind your Lordships that, even though some progress has been made, we have been hearing talk of cancer cures just around the corner for the past fifty or sixty years and still have not got the complete answer. Meanwhile, these young people must take their chance. And who is to prevail on them? Who can persuade them that the sunshine of a bright spring morning will one day turn into the bitterness of a withered autumn? Parental influence? But is that all?

My Lords, I am impressed by this second Report of the Royal College, but I think perhaps they have tended to overstate a case which is in fact proved beyond any measure of doubt. They have introduced irrelevant side effects of doubtful validity. The picture is horrific enough; why make it more horrific still? I do not at all object to the word "holocaust". Like the Royal College, I do not regard that as an overstatement; but to bring in ancillary bad effects such as the claim that smokers tend to be impulsive, arousal seeking, danger-loving,"— not necessarily a bad thing— risk-takers, belligerent towards authority is special pleading of the most unscientific kind. Non-smokers also tend to be "impulsive, arousal-seeking, danger-loving, risk-takers, belligerent towards authority". Among them I number myself, and I hardly smoke at all. Furthermore, the fact that smokers drink more tea, coffee, and alcohol, and are more prone to car accidents, divorce and changing of jobs, is just a lot of nonsense. It migh just as well be said that they tend to be blond. I think it is rather silly of the Royal College to spoil a perfectly good case by these vapid generalisations. There is no cause to pile on the agony.

I repeat, how are we going to stop young people? So far as adults are concerned—and adulthood now begins at IS. most foolishly, to my way of thinking—I will defend to the death, as an individualist, the inalienable right of a person to go his or her own way to hell. But the young people are a different matter. They are not responsible for themselves; we are. The trouble is—and I think the noble Baroness, Lady Summerskill, made it very clear—that boys and girls tend to associate the habit of smoking with growing up. When one is young one wants to "show off" a little to prove oneself and to give oneself confidence. In this age of comparative affluence, the easiest way of showing off is to smoke a cigarette, particularly in front of one's girl friend. In Portugal, children cannot afford cigarettes—or could not in my day—and so they spit. They make the most disgusting noises and thereby hope to emulate the grownups. My Lords, I do not like spitting, and the noble Baroness, Lady Summer-skill, has reminded me of the dangers of spitting, but, all the same, from the general point of view of health and survival I prefer it to cigarette smoking.

The question is, how do we remove the smartness, if I may use that word, of cigarette smoking as a symbol of adulthood? In my day at Eton we were birched for smoking, and although there was no valid reason for doing this so far as we knew at that time, it somehow entered the dim recesses of the pedagogic mind that there was something wrong with smoking, if only because it was fun. For once the schoolmaster was right, though by a sheer fluke. In fact, by punishing us it made us all the keener to smoke. Therefore, I do not recommend that. I am all for propaganda, but I am somewhat sceptical as to the far-reaching effects which sonic people claim for it. Education of the young, both at home and at school, must be a primary weapon in our armoury. But propaganda is not enough; we must take more positive action still to get the results we want. I am in favour of the Government's proposals, wishy-washy as they are, but I would add others, far more drastic, to them, some of which have I already been mentioned.

My Lords, I would suggest that all cigarette advertising in all the mass media, including commercial radio—and I would ask the Government particularly to remember commercial radio, which is about to burst upon us—should be statutorily forbidden. I am sure that this would have an immediate and effective result. Then again, I would statutorily forbid the placing of cigarette machines in any public place—as has been said by six different speakers. Clubs might be an exception to this. The truth is that the harder you make it to get something you want, the less likely you are to get it. Lastly, it is, I believe, illegal for a tobacconist or a publican to sell cigarettes to a person under 16 for his or her own use, but of course it is easy enough for the young person to say that he is buying them for his father or his family. I would interpret this law literally. There would be difficulties, naturally, for the publican or tobacconist to decide whether or not the child concerned was under or over 16; but the law works, on the whole, pretty well with regard to the sale of alcoholic drinks. Fearing himself in danger of breaking the law, the vendor will be on the safe side. He does not wish to lose his licence.

These are practical proposals which could be implemented forthwith, and I think they would be very effective indeed—even more effective than circulars to teachers, though I do not underrate the importance of them, too. If these measures are successful, and they could only be gradually successful, then we must take into consideration the workers in the tobacco industry. But the rundown in manufacture being gradual, so too would be the number of employees who could be gradually phased out. Prohibition, which the American experiment has put me against, would immediately put tens of thousands of people out of work; but by the run-down process, which would be the result of what I am suggesting, the tobacco industry would slowly, and only slowly, wither.

Last of all I come to the question of revenue. And here I am honestly less concerned. A large sum of money is of course involved, but I do not think it is one which should influence us in taking this vital action. As the noble and learned Lord, Lord Hailsham of St. Marylebone, said in our previous debate: … we cannot afford to trifle with the truth. We cannot afford to yield to the interest of the Revenue. We cannot afford to fear economic consequence to business interests. Men who go into business for profit must be prepared, if necessary, to hear loss."—[OFFICIAL REPORT, 22/3/62; col. 750.] My Lords, I found that, and I find it to-day, a very courageous statement. The revenue from cigarettes is tainted money. However excellent the use which may be made of it, it still comes under the heading of immoral earnings. If we must find the money, then we must find it some other way. It is not for me to suggest how. One thing is certain, my Lords: we simply cannot go on like this. The price of cigarettes in terms of pain and death is too great.

5.47 p.m.


My Lords, may I first thank my noble friend Lord Platt for initiating this very important debate, and also congratulate the noble Lord, Lord Rosenheim, on a really magnificent maiden speech on a subject on which he is such an expert. In addition, may I tell him how encouraging it will be to my colleagues on the Health Education Council when they read the kind words that he used about some of our campaigns.

Naturally we welcome this Report. We welcome it not only because it has given a very much-needed boost to the whole anti-smoking movement and campaign, but because it is written clearly, it is easily understandable, and it is not hard going. It has aroused the public, alerted the politicians; and the health professions have been more stirred than they probably have been before. A simplified version of the Report is at this moment being prepared by the Health Education Council for sale to the general public—not, let me hasten to say, because we have any criticism of the literary prose of the original Report, but because we feel that we need a rather shorter and more popular form if it is going to be read generally. We hope that this will be published at the end of April. In case any of your Lordships feel we are rather slow off the mark, I may explain that there is a three months' embargo on publishing another version.

One of the difficulties which affects some people is the widely differing figures on mortality that are circulating and are put out by different authoritative bodies. I think this leads to confusion in the mass media and in the minds of the public about the degree of risk they are running. This is the way some people feel about it. Frankly, as I rather abhor statistics and never use them unless I absolutely have to, that does not cut much ice with me, because I think that, regardless of whether a particular statistic is agreed by the Chief Medical Officer of Health or by the members of the Royal College of Physicians, what is agreed—as practically every speaker here this afternoon has said—is that smoking is harmful to health.

Although the physicians have told the nation the stark facts, many of the public do not like what they are told. About half of the public are committed to this very hazardous but enjoyable habit, and since human beings are emotional, irrational and under tremendous pressures it is not so easy to discard it and to bring about changes in behaviour. The difficulty of changing personal behaviour is one of the fundamental problems facing modern preventive medicine, and the creation of a desire for change is the first essential.

I am very sorry that my noble friend Lady Summerskill is not in the Chamber at the moment because, quite by chance, I found among my papers (I will not vouch for its scientific authenticity) a paragraph from a new journal called Europa, which states that 200 volunteers of different ages in France have been systematically questioned over the past ten years as to their sexual habits and proclivities. The findings were that sexual activity diminished more rapidly after the age of 25 among those who smoked than among those who did not. If fear is what is wanted, where sex is concerned nothing succeeds like failure. I do not know whether that will cheer up my noble friend. If that is completely unscientific and outside the bounds, I hope noble Lords on the Cross-Benches will forgive me. I mentioned it because it seemed so very relevant.

The difficulty of trying to change behaviour is highlighted in matrimony. Husbands and wives who are bent not only on changing one another but even, very often, on changing themselves, find that it is a very difficult and often impossible process. So, since everyone is certainly not going to stop smoking, we must at least encourage people to cut down and turn towards the least lethal forms of smoking. Although there is a certain amount of disagreement about pipes and cigars, they are still considered safer than cigarettes. And in view of the increase in smoking among younger women, should we not encourage them to think that the cigar is chic and the pipe is trendy?

The Health Education Council has welcomed the move towards warning notices on cigarette packets, indicating that cigarette smoking is dangerous to health. I must be quite frank and say that I do not believe that this is going to have a very long-lasting impact, but it is important because it is the first time we have had a notice giving a warning from the Government that smoking has harmful effects. I know that the wording of the notice has now been agreed, and that it may not be possible to change it, but one of the difficulties is that although everybody understands and accepts what is said about the ill-effects of smoking, people always believe that they are going to apply to somebody else and not to themselves. Therefore I wonder whether the tobacco manufacturers could be asked to agree that the word "your" in the warning should be brought up in a bolder type, or underlined. It is a very small typographical point, but it might make the message a little more emphatic and personal, which is what we are hoping to achieve.

I hope that we shall not wait for a great deal more research before the tar and nicotine content is shown on the packet. As the noble Lord, Lord Sinclair of Cleeve, said, the tobacco manufacturers have a point when they say they are prepared to put the content on the packet, but that the Government must then interpret what it means. Obviously, there are many areas where much more research is required, and that will continue to be so; but we cannot wait indefinitely. Enough is already known, and in the laboratories, which are mainly financed by the tobacco manufacturers, there is apparatus that can measure not only the content of tar and nicotine but also its effect on being drawn into the lungs. I suggest that the Government do not wait for further research, and that they should talk to the tobacco people about using these laboratory facilities. Perhaps they should have one or two of these machines of their own or, if they are working in conjunction with the tobacco manufacturers, have an observer in the laboratories so that the measurements are agreed.

The information could then be put on the packets so that the people who still insist on smoking, but who are sensible enough to want to find the least lethal way, can smoke the cigarettes which are least harmful to them. As I understand it from several visits to the United States, this is something that made an impact. The tobacco manufacturers were in competition with one another to see who could produce the mildest cigarette. That would at least be one step forward. The Consumers' Association, which is very interested in this field, should be right in the middle, because it is as important to know which are the least harmful cigarettes as to know which is the best value washing machine.

I should like to reinforce what the Secretary of State has said about the need to increase the number of places where smoking is not allowed, and I also support what my noble friend Lady Serota said about putting a great many more places out of bounds for smoking. Many smokers would accept such a restriction with great gratitude, because it would mean that for certain periods of time they would be forced not to smoke, like some of your Lordships who are sitting in this Chamber. I agree with my noble friend Lady Summerskill that the restriction should apply to Committee rooms here and in the other place, and there should certainly be a non-smoking room in the Library. This is something about which this House could decide by itself.

As regards what has been said about hospitals and public transport, I think there should be very much more positive action. It is only a few months ago that I had a letter from a woman who attended the out-patients' department of a hospital, and she complained bitterly not only about smoking going on where she was waiting, but about doctors walking around with cigarettes in their mouths. Much stronger action could certainly be taken on public transport, and in theatres and cinemas. The fire risk is taken more seriously in America, and the Government might discuss with insurance companies the idea of using no-smoking as a condition of insurance. Although the majority of theatres in London have, "No Smoking" signs up, there are many other theatres all over the country where smoking is allowed. The people who run those theatres would be delighted if they were able to impose restrictions against smoking, because of the risk of fire, the dirt and the untidiness.

The question of individual behaviour and freedom of choice has been mentioned by my noble friend Lady Serota, as well as by the noble Lord, Lord Aberdare. This is a rather tricky tightrope, I agree. A short time ago I wrote a letter to The Times saying that increasing the places where people were not allowed to smoke would not only help the non-smoker but be healthy for the addicted smoker; and I had a letter back, which quite astonished me, telling me that this was the most intolerant point of view the writer had read since Enoch Powell. This is really something which I think has to be grasped at some point.

At the moment, the Health Education Council's Medical Research Division is engaged in an investigation into morbidity—that is to say, the cost to the community of illness, as opposed to mortality—and hitherto there has been very little direct work done on this. I think it can be fairly argued that this is a social and economic cost to the country, and therefore this must to some extent balance the individual's choice. Then, again, there are the points that have been made by other noble Lords about the effect on the family, the effect on relatives, when somebody is ill; or as in the tragic case of the death of the husband of my noble friend Baroness White.

I am delighted to see that the Secretary of State has already been in touch with the Chairmen of the B.B.C. and I.T.A., to both of whom I have spoken about the question of smoking on television itself. I am happy to say that they have both shown considerable cooperation on this particular point. I also hope that the Secretary of State will be successful in trying to get public service time on both the B.B.C. and I.T.V., because I am very happy that we are being given some extra money to use on television, and we shall be using it for commercials. But it seems to me that, in addition, the I.T.A., like the B.B.C., has a public responsibility and, in addition to what we are spending (which I might say is a decimal drop in the ocean compared with what is being spent outside television by the tobacco manufacturers), public service time should be asked for and pressed for.

Talking about the money that is spent, I must say that my heart was touched by the reference of the noble Lord, Lord Sinclair of Cleeve, to the concern of the industry about the implications of smoking and health on the community. If I may, I should like to touch his pocket—or, through him, the pockets of the manufacturers—and say that one concrete way in which they could show this concern, if they do not feel like making a contribution to the Government, would be by making a financial contribution to the Health Education Council. I would ask the noble Lord to consider this, and I say this quite seriously. In view of that, I should not like to comment on some of the other remarks he made because I would rather charm him into giving me some money.

Next September, the second World Conference on Smoking, which is sponsored by the Health Education Council, will be held in London, and the discussion at this conference will be largely concerned with the changing of people's behaviour. One of the things that fascinates me is that we are all aware of the study among doctors and the fact that so many doctors have themselves given up smoking. I do not want to "knock" the doctors too hard about this, but how is it that those who have benefited so much have been unable to persuade their patients to do likewise? Because I think it is agreed—I think the noble Lord, Lord Roseheim, mentioned this—that they had not done so.

The Report rightly says that doctors should set an example to all their patients by not smoking in their presence, and should take every appropriate opportunity to inquire into the smoking habits of patients and try to put over the benefits of their stopping, particularly when they see them with children. Even when a mother with her child comes to see the doctor, he should try to press this point home. The Chief Medical Officer of Health is writing to all G.P.s emphasizing this, and the Health Education Council is backing it up with some teaching aids on, Why Never to Start Smoking and How to Stop Smoking. These are going to be distributed to G.Ps. through the local health authorities.

When the Report rightly suggests that medical students should be made aware of the dangers of smoking, and says that they are not at present being urged to avoid smoking or being trained to play any part in the education of their patients in this matter, I feel that here one comes to a rather different point. It is not just a question of the people who are teaching the students being, as many of them are, distinguished experts in their subjects, but that teaching in itself is a special skill. There are a few fortunate people who combine a tremendous knowledge and ability in their own subject with an innate capacity to teach; but the majority of people do not, and they need to be taught to teach. This, I think, is something which is very important for the medical profession itself to do. In addition, I think there are wider subjects than that. The whole question of psychology, human relationships and social behaviour in the basic curriculum of the medical student and, so far as possible, of the nurse and other health staff—in fact, anybody who comes into contact with the public in this field—is absolutely essential, because one must not restrict this question when one is talking about behaviour and motivation.

The Health Education Council is also considering this question of training. Everybody has been extremely kind about our efforts, but I must keep on stressing that they really are on a very small scale. We are considering how we can help in the training of doctors, dentists and nurses, and have already been discussing the problem with the professions, universities and hospitals. But I think the real impetus for this—I hope my noble friends on the Cross-Benches will agree—must come from the doctors themselves.

In their Report the Royal College also recommend other methods of public education, including the use of the mass media. One of the concerns of the Health Education Council since it was set up in 1968 under the chairmanship of my noble friend Baroness Serota has been the effective use of the mass media, and, to ensure that it is effective, to base it on adequate research data. I must say how grateful I am to Baroness Serota for having emphasised this and for having set this very important pattern when she was the distinguished chairman of the Council.

I hope the House will forgive me for spending a couple of moments on this matter, because it is public money that we are spending; but it means that a considerable amount of research has to be carried out before an anti-smoking campaign or any other campaign is launched. In the campaigns which are going on at the moment, attitudes to smoking were first examined to identify areas, then the themes suggested by this research were examined and then, from these, poster "roughs" were prepared. Then, reactions to these were tested and examined again. This was a whole process of examination carried out over a period of six months. I was hoping to have the results to-day, but unfortunately we are awaiting the processing of the data from the original interviews. I understand that this will be ready next week. Once the evaluation of interviews had been completed, we then continued the campaign; and it was then, for the first time in this country, that the antismoking advertisements were inserted in the national Press. We were also at the same time producing posters to distribute to the local authorities for commercial and underground poster sites.

Incidentally, I may say that the designs of some of our posters have won wide acclaim in the publicity world and in the commercial field. Two of the advertisements we used—those which explained the consequences of smoking in the most direct language—were researched among a sample of readers to find out how acceptable they were likely to be, and whether they would produce any immediate change. The reaction was that people noticed them and talked about them. But as to whether they will change their smoking behaviour, I must be quite honest and say that we will know only by the figures showing decreased tobacco consumption. But we know that the fact that they are talked about—some people think they are good, some do not like them, some think they are too frightening, others that they are not frightening enough—means that they are being discussed. This at least is the first stage in awareness. One of the young designers working on the posters himself gave up smoking as a result of the work he was doing. So we know that we have had a small amount of success.

For the future, may I say that I believe that our educational work must be selective. We have made the general approach, given what I call the "horror story". Now we should be aiming at emphasising the positive benefits which other noble Lords have mentioned, the financial and cosmetic benefits, of giving up or reducing cigarette smoking. I like the idea of my noble friend Lady Serota about non-smoking gift coupons; but I see the difficulties of operating something like that unless we can find a way of ensuring that people do not cheat—get the prizes and also smoke. I thought that the Scottish Health Education Unit was enterprising in inserting some advertisements explaining how people could get free holidays by working out what they would save by giving up smoking for a year. There were a thousand inquiries as a result of these advertisements. Naturally, a very much smaller number of people will have stopped smoking; nevertheless this, again, is the beginning of awareness.

I think that our outstanding priority in any future campaign is to aim at the young. Everybody who has spoken so far has agreed that prevention at an early age is the most important factor. In a piece of research done by Mr. J. M. Bynner for the Government Official Survey in 1968, 5,601 boys aged between 11 and 15 from 60 secondary schools were examined in relation to smoking. The conclusions were extremely interesting. It is not simply a matter of telling parents to tell their children not to smoke, or even of educating the teachers. Both these approaches are important; but we really need to know much more about the motivation of children who smoke at an early age and of those who do not.

In the survey the number of variables to smoking experience was narrowed down first to 21, and then finally to four as having the most impact. These were: (1) the number of friends who smoked; (2) anticipation of adulthood, wanting to grow up; (3) parents' permissiveness; and (4) knowing of the danger of lung cancer. This last came as a very low fourth. The interesting thing about the survey was that it was discovered that smoking was associated with educational failure; that those who smoked and were not making a "go" of school work were, nevertheless, anxious to be successful educationally. If this is so, there is at least one line of approach that now we know something about; but this also means a very much wider and deeper look than just from the point of view of smoking, into the attitudes of children at school. It was found that 80 per cent. of parents who were regular smokers but hoped their children would not smoke, gave them the odd cigarette or the odd packet of cigarettes. Also it was found that, until it was pointed, the parents were not aware of the fact that their attitude to their older children rubbed off easily and quickly on to the younger children. It is important to get the parent/child double-pronged attack on this subject. This is important, it seems to me, because although it is true that the parents should stop smoking to set an example. I believe that parents who now smoke, if they had known some years ago the facts now presented and if this knowledge had been as widespread then as it is now, for the sake of their children would not have become the addicts that they are today. We should get children to look at the other side of the coin: that they should not emulate their parents. They know their parents are hooked; that it is a bad thing: and it is important that they should not be hooked in their turn. We can educate the children more easily in the areas where young people meet. I am sure that the noble Viscount, Lord St. Davids, will be mentioning Youth Clubs.

Finally—and I am sorry to have kept your Lordships for so long, but this is a subject of particular importance to my Council—one of the priorities when we have the personnel (and, even more so, some extra money) of the Health Education Council is to try to aim educational propaganda at the pregnant woman. My noble friend Lady Summerskill mentioned this. Young pregnant women have an extra and tremendous incentive: they are not just thinking of their own health but that of another human being. The influence can spread wider. The young pregnant wife who gives up smoking can ask her husband to do the same. She may even say, "I shall not give up smoking unless you do, too". She can become a very important influence in that way. Furthermore, with pregnant women, we have the only evidence, as I am advised, established on a statistically valid sample of part of the whole population of the United Kingdom where there is a "cause and effect" shown.

Finally, we welcome the setting up of ASH which was mentioned by the noble Lord, Lord Rosenheim. We should have a very good chance of co-ordinating successfully with it since the Chairman of ASH, Dr. Charles Fletcher, is also the Vice-Chairman of the Health Education Council. It is important that there should be co-ordination so that everybody does not go around "doing his own thing". Although legislation may be appropriate for dealing with some aspects of smoking and health, it seems to me that we should have long-term, short-term and medium-term plans. We need to put as big an investment into education and into research into behaviour (as was mentioned by the noble Lord, Lord Rosenheim) as into pure medical or physical research. We also need to know a great deal more about and to delve deeper into the pressures and structure of our society which throw up these problems. I do not believe that in the long-term one can deal with smoking in isolation.

6.20 p.m.


My Lords, I wish first to join in the expressions of gratitude to the Royal College of Physicians for their Report and also for the debate which has taken place to-day. I do not intend to keep your Lordships for very long. There are only three things that I want to say. The first and obvious one which must be recognised on all sides is that this Report leaves no shadow of doubt about the effects of cigarette smoking. One of the biggest problems of which we are conscious is the way in which we are to get this across to the community as a whole. That this has to be something which is not merely a Governmental activity, not merely left on the plate of the doctors, but one in which every section of the community must be engaged, is absolutely clear. Equally clear is it that this is not a once for all campaign, if that is the right word, but something which must be a continuing part of our social set-up.

The first of the three things I want to do is to welcome very warmly the statement by the Secretary of State of the Government's intentions. In the Report there is a hint of a slur on the Government for failing to take action on previous Reports and what we have now been told is certainly a consolation. I would agree with those who hope that the action which the Government are intending might be even more drastic than we have been led to suppose. Certainly I would hope that the notice on cigarette packets might be more positive than has been suggested; certainly I would hope that the areas in which smoking is allowed should be very much more confined than they are at the moment; and I would support the plea of the noble Baroness, Lady Serota, that it should be the smoker who is, as it were, confined, rather than the non-smoker.

Secondly, I would say that the statistics in the Report make impressive and interesting reading. I think that two things stand out from them, especially for me. The first is the extent to which the average cigarette smoker is at risk, even compared with the heavy smoker. I think it true to say that most people have recognised for a while now that heavy cigarette smoking is a serious danger to health. What I do not believe has been as fully recognised—and the evidence is provided in these statistics—is that even medium cigarette smokers are equally at hazard. How many people have said to me, "I am no longer a heavy cigarette smoker, I have cut down. I have only 10 a day now, and therefore I am all right." The evidence in this Report shows clearly that in fact the person who smokes a small number of cigarettes is at risk as well as the heavy smoker. In a sense, I think this puts tobacco in a different class from alcohol. The Royal College of Physicians is pleading for total abstinence from smoking on the grounds that, however modestly it may be indulged in, it is bad for health.

The second thing which, for me, comes out of the statistics is something which I had not realised before; that is, that the age group on which the effects of cigarette smoking have been most disastrous, the group between the ages of 35 and 64, is the group of the breadwinners. Just at the time when politicians and sociologists alike are worried about the growing proportion of dependants in our community—children and those who are of retiring age et cetera—there is a suggestion that smoking is a habit which is socially irresponsible. Up to now the cigarette smoker has justified himself by saving, "Well, I do not hurt anybody else." It seems to me that one thing that this Report shows is that he does hurt someone else; and is, as it were, unloading on to society responsibilities which are really his and which he is sidestepping.

The third thing I wanted to do was to make a plea for even further investigation into the causes of smoking, if that is the right way to describe it. I think that somehow there is a lack of any true effort to find out the causes of habitual smoking. Very little is known at present about the unconscious motives and satisfaction on the pharmacological or biochemical basis of addiction. It is true that in the past the Government have instigated surveys. One into smoking among young medical students resulted in the report in 1969 and there was one into smoking among schoolboys. Neither of these projects threw much light on the psychological and physiological causes of a need for nicotine.

I wonder whether it might not be fair to ask the physicians whether the causes of smoking, which on the whole they seemed to suggest are reasonable ones—that it induces social ease, gives relief from tension and an arousal for work and for play—might not be gone into more fully; and possible alternatives to smoking provided to meet the needs of individuals. The Report as a whole is one which we cannot but welcome warmly, and our gratitude is extended to those who produced it. Quite clearly, this is an operation in which the whole of the community must be engaged, and not only one section, if the ravages caused by cigarette smoking are to be stopped.

6.28 p.m.


My Lords, we have all been pleased to read the current Report of the Royal College of Physicians which follows and endorses the findings of their first Report, Smoking and Health, published in 1962 and arising from the presidency of the noble Lord, Lord Platt. I think that both he and the noble Lord, Lord Rosenheim, deserve our warmest congratulations, which, of course, they have had freely this afternoon. I join with others in congratulating my friend and colleague the noble Lord, Lord Rosenheim, on his interesting, valuable and distinguished maiden speech. I strongly support their findings that warn so clearly of the grave dangers to health that follow from cigarette smoking. At this late stage in the debate it seems almost superfluous to state this.

The only point that I feel I cannot fully endorse is the concentration on the dangers of cigarette smoking and the playing down of the dangers of pipe and cigar smoking. Those dangers are far less than those of cigarette smoking, but my own observations tell me that the pipe smoker is not safe from the grave danger of contracting cancer of the lung. It would, however, appear to be reasonable to encourage those who cannot give up smoking to change from cigarettes to cigars. My Lords, I realise that the pipe is very popular and is associated with contentment and relaxation, but it is desirable to sound this note of warning, even though it will doubtless be ignored. I should also make clear that my reservations about the safety of pipe smoking arise from my own experience and observations and are not based on comments that have lately appeared in the national newspapers.

Of course I fully support the findings of the Committee in regard to cancer of the lung. This is a condition of which I have had considerable experience, dating back some 40 years, during 35 of which I have been specially concerned with its surgical treatment. From this long experience I wish to make some comments which I think are relevant to our discussion. I am embarrassed that so much of what I have to say has already been said in some ways this evening, but I hope that my rather late remarks will be acceptable. First of all, I turn to the direct relation between cancer of the lung and cigarette smoking. I take as completely proven the case put forward of this direct relationship. I emphasise this because one still hears expressions of doubt—in fact, we have heard them this afternoon in this House—about cigarette smoking being the chief cause of cancer of the lung. The grim figures of deaths resulting have already been given. As yet, men are more often affected than women, but as their smoking habits increase, as has been brought out clearly this afternoon, women are being more and more attacked. The disease, in my experience, is more serious in women than in men. I think that is a point that is worth emphasising.

The second point I wish to make is the difficulty or inability to accept that disaster may happen to the individual, or the feeling that its occurrence may be such a long time ahead that it is largely irrelevant and can be ignored. This attitude is summed up in the renderings, "It won't happen to me", or, "We have got to die some time, and as I am only 20", or 30 or 40, "it will be some event comfortably a long way in the future". In this we have the most difficult aspect of the problem: it is just not realistic to expect human nature to change much in this connection, and certainly not in the young or very young. How can one expect a boy or girl in the teens to be able to appreciate the full significance? The noble Baroness, Lady White, has already spoken aptly of this aspect and has indicated the need for special efforts in the case of children. One can only hope that as they get older there may come a time when they will decide to try to stop the habit, or at any rate moderate it, perhaps influenced by propaganda and public concern.

To return to the blind and common acceptance of the thought, "It won't happen to me". When I look back over my experience with this disease I am impressed with the futility of this attitude and the lives that are lost because of it. I cannot mention all the young fathers in the forties or fifties whom one has seen wrenched from their families, often after a painful illness, much earlier than than need have been, and resulting in a family problem and loneliness that might have been avoided. This has already been aptly mentioned this afternoon and it was stressed again by the right reverend Prelate the Bishop of Portsmouth just now. One has seen this even with doctors, who can just as often he attacked by this disease; although the great lessening of cigarette smoking among the profession, and consequently the lessened incidence of lung cancer and other conditions, is noted in the Report of the Royal College of Physicians. It is one of the hopeful observations that emerges from the Report, and may encourage others to do the same.

But it is not only the young or the middle-aged who may be attacked. Many people, after a life of hard work, when they are nearing retirement or have recently retired, fall to this terrible disease and are deprived of the quiet and comfortable years that they have justly looked forward to. The widow may not only be deprived of the company and comfort of a life partner but may find that she faces penury if the pension ceases or is greatly lessened with the husband's death.

I mention these things, my Lords, because I have so often seen them happen and have deplored their occurrence when they could have been prevented. I believe that it is the duty of those of us who see these personal and family tragedies to emphasise that they do occur; and occur to actual individuals, and not just to figures in a statistical return: that they can happen to the person who has comforted himself with the thought that they cannot happen to him.

I have two additional comments, one of which provides a small degree of comfort or encouragement. Although lung cancer is a terrible disease, with a short-life expectancy, some sufferers are fortunate in that they may be cured by treatment, especially by operation, in favourable circumstances. It is good that this hope exists. But—and this I must emphasise—only a small percentage of all cases are suitable for operation. The main mass of patients are not sent to a surgeon, because their disease is too advanced when it is diagnosed.

The Royal College of Physicians have issued their Report essentially because they have a duty and a responsibility to the nation and to the Government to make everyone fully aware of the medical facts of smoking and ill-health. As a part of this it is proper for them to make certain observations on how this danger, this menace, can be lessened. For example, the Report draws attention to the fact that if smoking is given up the risks of cancer et cetera lessen, and after, say, ten years have receded substantially. Smoking in public places is not only objectionable to non-smokers, but can be positively harmful to a sufferer from chronic bronchitis and emphysema, and especially to sufferers from asthma. These persons need, and may properly expect, protection from smoking in a public place or vehicle.

There are also certain simple things in the technique of smoking that are helpful and are legitimate medical advice. But beyond these matters of technique, cigarette smoking is a social problem, and has many facets that are not, and should not be, the concern of the medical profession once they have drawn the problem to the attention and to the conscience of the nation and made some initial constructive suggestions. The Report contains an important chapter on the prevention of diseases due to smoking and recommendations on achieving this.

There are many aspects relating to limitation of the smoking habit the implementation of which should be the concern of the Government. It is wrong for doctors to become too active in antismoking propaganda. They may of course do so as Members of Parliament, or as part of independent social activities, but they should be careful not to mix their medical advice with what are largely socio-political affairs. I am pleased to note that, apart from giving its strictly medical advice and its conclusion, the Royal College of Physicians is not active in this way. It is associated with an independent body that seeks to warn people against the perils of smoking and to help to avert the habit, but it does this only because of its social conscience. ASH was erroneously described by one noble Lord as a Committee of the College. I think that is not strictly correct. I strongly approve of the action of the College, because I think that medical men fulfil their responsibilities and obligations when they have pointed out the medical dangers and hazards of smoking. Thereafter it should be a matter for the social conscience of the nation as a whole. I do not support the plea of the noble Baroness, Lady Summerskill, to increase the public relationships of the College.

It gave great satisfaction to hear yesterday that the Government intend to take some first steps in this matter. It is a very difficult problem, because man seems essentially wayward in this and will certainly not abandon smoking as a result of sweet argument alone. Neither can he be forced to abandon smoking. The Government, or some social organisation or organisations, must strive to lessen the habit and to recognise those things that encourage it. The present interest shown by the Government gives real hope for improvement.

6.38 p.m.


My Lords, I hesitate at this late hour to join in this debate. We have had excellent speeches from the noble Lord, Lord Platt, and from the noble Lord, Lord Rosenheim. I can speak only from my personal experience. In the course of 83 years I have smoked a lot. I gave it up, and then smoked a little. Then, eleven years ago, I gave up smoking completely. I think it is quite easy to do so, and I feel all the better for it. There used to be a wonderful quip of the music hall: A little of what you fancy does you good. I am a great believer in that. I believe that all people are entitled to enjoy themselves. Every man has his own peculiar idiosyncracies, his weaknesses and his failures, but I do not see why he should not enjoy them. What we want in this world is moderation. At New College years ago, before my time, there was a well-known professor of history who used to have undergraduates up before him when they came in late to college. He used to say to the young men: "I cannot have you coming in at these late hours. I don't know what you may have been doing. You may be drinking, you may be gambling, you may even be smoking." He was fond of his bottle of port every night, and I believe that people should be allowed to enjoy themselves. In this connection, I thoroughly agree with all this cutting down of smoking; but what ought also to be taken in hand is drinking and gambling. I should like to see the three taken together and reduced.

Many years ago, on stations, in railway carriages, in buses and on the seats in the park one used to see notices saying, "Please do not spit". I remember this as a very common habit. I believe that people used to chew tobacco and to spit, and in view of consumption it was considered horribly dangerous. Cancer in those days was not thought of very much. I do not know whether the Englishman has lost the power of expectoration or has become a cleaner man. The latter I very much doubt, when you see the state of some of our ditches and fences and rubbish heaps all over the country. Anyhow, spitting has completely disappeared in this country.

I do not believe that the way to stop smoking is by legislation. You will never do it by legislation; you have to do it very gradually. I believe a great deal can be done by advertisements in the paper, on the railways and in the underground. Nowadays, on the new escalators on the Victoria line you see lovely pictures of so-called ladies in their briefs and their bras and sometimes a great deal less—personally I think they are the most terrible and the most suggestive things that can be imagined. I should like to see all those wiped out and replaced by some decent advertisements designed to stop smoking and gambling and drinking. I believe this would do a great deal of good.

One other aspect of smoking which has not been mentioned is the question of fire. I believe that more fires are started in this country through cigarettes and lighting matches than by anything else. Many a time I have known people burned to death when reading a paper. People sit, in a hotel perhaps, smoking a cigarette, and they go to sleep. They awake and stub out their cigarette, or think they have, and they go to bed. The next thing that happens is that the whole building goes up in flames and nobody knows the reason why. At the inquest it is said to have been caused by a faulty electric light wire or a short circuit in the television. I believe that in nine cases out of ten it was caused by a cigarette.

I was very surprised in the debate on safety driving the other day that there was no mention of the danger of smoking cigarettes when driving a car. It is an extraordinarily dangerous thing to do. I once did it and dropped the stub of my cigarette in the bottom of the car, and I nearly had an accident. Then there is the horrible habit of stubbing out a cigarette and chucking it out of the window. It falls in the middle of the road where it is safe; but it has not been put out, and the next car blows it a little to the right and the next car blows it on to the grass, and acres and acres of countryside are burned.

My Lords, this is a very acute question. It has been said to be a difficult question. I do not know that it is. I believe that it can be summed up completely in one word—self-control. We all know what self-control is. We have all known self-control from our earliest days. We knew it in our adolescence, and we know it in our old age. The solution of the problem is as simple as that.

6.45 p.m.


My Lords, may I add my thanks to the noble Lord, Lord Platt, for introducing the Report of the Royal College of Physicians, and my congratulations to the noble Lord, Lord Rosenheim, upon his most conspicuous maiden speech. May I also add the thanks of the various anti-smoking associations of one kind and another, not least those sponsored by the Christian Churches, and the much healthier basis that this document has provided for an attack on smoking which in many cases, as the document says, has had an undue amount of prejudice about it.

I, indeed, was reared on the proposition that smoking was an affront to the Almighty and that had the Creator intended us to smoke He would have provided us with an in-built chimney; that smoking was in fact near to sinful. The evidence which is before your Lordships to-day is not necessarily utterly distinct from that, but it is in my judgment of a very different and much more coercive kind. I should like briefly to make my comments about this particular document, which I have read with care. To begin with, it is a devastatingly important document and I do not share any of the half-reservations that have been voiced to-day in your Lordships' House. It seems to me, as, I hope, a fair-minded observer of facts, many of which I am not expert enough to understand, except in general terms, that an overwhelming case has been made out, and that that overwhelming case constitutes a challenge which is unavoidable and demands action which we should indeed be fugitive if we denied.

I remember talking the other day to an extrovert, robust smoker of many cigarettes a day who had given up smok ing. When I asked what was the prime cause of his giving up smoking, he said, somewhat naïvely, that when doctors were frightened it was time for him to be terrified. He had indeed been terrified by evidence which is exemplarily set forth in Smoking and Health Now. Perhaps the most impressive fact about this document is that it indicates the way doctors who know what it is about have taken the appropriate steps to do what they think was necessary in the light of the evidence which they could not ignore. This provides something of an answer to my noble friend Lady Summerskill, who remarked that those of mature age are not likely to change their habits. Professionally I would not agree with that, and in this case there is plenty of evidence that what has happened in the reading and in the various erudition and other qualities that belong to this Report is that such an overwhelming case has been made out to those who are best equipped to appreciate it that they themselves have taken the appropriate action and stopped smoking. I find that very impressive.

I find it equally impressive that those who have set forth the indications and facts about this malaise have not hesitated to propound a number of quite practical and precise objectives and programmes for its alleviation, and indeed for its final abolition. I wonder if it would be impertinent for me to make two somewhat critical comments—not critical in the sense that I do not believe that the writers of this particular document have been insensible to the facts, but perhaps in addition. I have some little knowledge of drug addiction and of how to treat it, and it is a statistical fact that there is a close relationship between the smoking of cigarettes and the smoking of marijuana and "pot" To establish a causal relationship would, I think, be improper—there is not enough evidence—but it would seem to me to be fairly reasonable to suggest that if there were a very rigorous diminution in the intake of ordinary smoking cigarettes there would be less likelihood of young people, having tasted cigarettes and enjoyed them, going on to the next stage of taking marijuana, however comparatively bad that particular habit is. I should like to know what the evidence is, if any, that there is a correlation not only statistical but perhaps causal, particularly among young people, between the smoking of cigarettes and the next stage in drug addiction, even to what are erroneously called the "softer" drugs.

A much more serious criticism can be levelled against the evidence that is set forth, and the deductions which are made, in the field of cigar and pipe smoking. I could wish that the noble Lord, Lord Brock, were in the Chamber, for I heartily agree with him. If you consult Chapter 2.2 of the Report, you will find it more or less blandly asserted that there is much less risk in tobacco addiction from cigars and from pipes, and that the level of expectation of mortality among the pipe smokers is only a little higher than that of the non-smoker.

In Chapter 4.23, the statement is made that it is difficult to understand why this situation should have occurred. Indeed it is difficult to understand it, because the situation has not occurred. If you read Chapter 4.13 carefully, you will find that there is ample evidence from the Swiss and German investigations that there may be a heavier mortality and a greater incidence of lung cancer for those who smoke cigars compared with those who smoke cigarettes. In Chapter 9.23, which is part of the recommendations at the end of the Report, once again the assumption is made that the smoking of cigars and pipes is much less lethal, and much less dangerous, although previously it is said that much more research has to be undertaken on this point. I think it would be very unfortunate if people, looking for gleams of comfort in this Report, were to assume that the assertions made as to the relative innocuity of tobacco smoked from the pipe and the cigar should encourage them, because the evidence is contradictory in the Report itself. I hope that my medical friends will not assume that it is impertinent for me to make that point; I have looked at it carefully and have given your Lordships the appropriate references.

As to the prognosis, what is to be done? I regard the Government as having given us very puny encouragement. I hope that they will go much further. I believe that the answer has to be found in the most excellent examination given in the Report of the relationship of the social environment, and the particular application of plea, or of resolution, in the private sector. I entirely agree with the Report that what is needed is the provision of an ever-enlarging smokeless zone, for it is within the general framework of the smokeless zone that the most likely results are to be found. This is manifestly true in the question of public places, and it seems to me that the evidence for the provision of occasional places where people can smoke in public is a much more reasonable proposition than the allocation of certain places in public areas where they can be free from smoking. Surely, it is beyond doubt that the inconvenience and, maybe, the predisposition to illness, caused in public places by the fumes of tobacco is a sufficient argument for the alteration in the whole principle of what should be the norm. The norm should be non-smoking, not smoking.

I have little use for the tag on the packet. If it is sufficiently severe—not in the conditional subjunctive tense, rather like the way in which we sometimes pray that the Lord might do something for us, instead of saying, as we ought, that he will do something for us, and the assumption is that it may be dangerous, then a great many people will ignore it—if it is put much more rigorously as a real and great danger, will it not increase the sense of cynicism among a great many decent people? They will ask the question: "Why, if this is such a serious business, are we being invited to purchase the packet of tobacco?". I do not want to be unduly provocative, but would it not be another instance of the cynicism of the capitalist system in the minds of many young people, who are not without perception in these matters, and will regard a very severe indication on a packet that it is dangerous alongside the incentive to purchase that packet as a piece of rabid cynicism? I do not think this will do much good; and in any case, after a while people will take no notice of it.

I am perfectly satisfied, furthermore, that there is overwhelming evidence for the abolition of the vending machine, particularly in public places. This is a monstrosity of injustice. If it is wrong for youngsters to be able to buy cigarettes over the counter, then it is an encouragement to the evasion of that law that they may stand outside the shop and get those cigarettes by the insertion of a coin. This is nonsense, and anybody with a sense of justice will recognise that it is nonsense.

I have come, inevitably, to the position that all advertisements of cigarettes ought to be abolished. I can see the simpliste naïvete of those who assume that there are other reasons for advertising cigarettes than promoting the sale of them. I should have thought that it was inevitable that if you advertise a cigarette what you are advertising is your prognosis of a purchase and your anticipation of profit. What else are you advertising for? I should have thought that the advertising that now takes place is—as has been indicated already to your Lordships amply enough without further comment on my part—in the light of this document, another instance of the cynicism of a community which is not prepared to take its public responsibilities seriously enough.

Although this may sound an altogether outrageous comment, the more I have listened to what has been said to-day, and the more I have endeavoured to make my own mind up as to what is the sufficient action, the more am I satisfied that voluntary associations and methods will not do. Every year for many years I have been to Cornwall for my holidays. I have sat on many a beach, and bathed from many a beach, from which intrepid and dangerous bathers have gone out and not come back. How often have they gone out when the red flag has been up, when they have been warned by everybody that it was dangerous! I do not believe that ultimately we are going to make any sufficiently serious impact upon the attractiveness of smoking cigarettes until the manufacture and sale of those cigarettes is prohibited by law. I believe that we shall come to that sooner or later, and the sooner the better.

If this sounds rigorous and a reduction of human liberty then, after all, liberty is only ordered restraint. I believe that the stage has been reached in which one man's selfishness can impair the welfare, not only of his family, but of a great many other people, and depreciate the general wealth and condition of the community. I believe that that stage has been reached with regard to tobacco smoking in cigarettes. Therefore, although it sounds a too rigorous and extravagant a claim, the more I have listened to what has been said the more I am committed to believe that whatever happens in the realm of the cigar and the pipe, sooner or later—and may it he sooner—we shall abolish the sale of the cigarette.

6.58 p.m.


My Lords, this is a debate I particularly do not like taking part in, for the simple reason that I must declare an interest. It is an interest almost diametrically opposite to that of the noble Lord, Lord Sinclair of Cleeve, in that I am an almost lifelong non-smoker. I say "almost" for the reason which was given by the noble Earl, Lord Arran, that as it was against the rules, I smoked when I was at Eton. I may add—and one always laughs, but it happens to be true—that I gave it up when I left, and have not smoked since. Because I studied the matter, I decided that this was a habit which, on the whole, I should be better without, and I stopped. No doubt I stopped early enough not to have acquired a permanent need for the habit. By so doing, I found myself among the non-smokers. Therefore I started to notice things, particularly the smell of various people and of places where I found myself. It is for this reason that I dislike taking part in this debate: that if smoking is very much reduced I myself shall be extremely pleased; life will be much simpler and more pleasant for me; and I greatly dislike speaking about something which will restrict other people but will not affect me adversely. It is a matter of conscience for myself, but it hurts me to take part in this debate. Nevertheless, I think I must.

As I said, I shall be happier if smoking is reduced. Among other things, I always secretly in my mind label people who smoke as "smellies"—I hope my friends who smoke will not mind too much, but that is how I regard them. I may also say, for the noble Lords on the Front Bench before me, some of whom are Whips, that I often do not go to Party meetings in the Committee Rooms for the reason that my noble friend Lady Summerskill referred to: I cannot stand the smoke. All these are reasons why I shall be much happier. But the time has come when we must put a stop to smoking, not for my reasons, but for the reasons of the community.

What can we do? There is legislation. I personally would support almost everything that has been said in the House about subjects for legislation to diminish smoking. I am not sure that I would go so far as to ban the sale of cigarettes, but I would go almost any other distance. But that is a matter for the future. The Government could do various other things, apart from legislation. In this country Governments are notorious for doing things too little and too late, and, if I may say so, the Government of noble Lords opposite seem particularly bad at doing things very much too little and very much too late. The recent pronouncement on smoking seems to me to be so feeble as hardly to touch the subject at all.

I am afraid I consider that the tobacco manufacturers are behaving, it is true, in a manner which one could approve of, but for much the same reason that a gentleman sweetly and kindly hands over his cash when faced by a thief who shoves a revolver in his stomach. I must say that it has struck me as peculiar, as I am sure it has struck many noble Lords, that this announcement should come out at the same time as a Bill on the subject was appearing in another place—a measure which would be received with considerable approval if it came here. I have considerable doubts whether any such announcement would have been made if such a Bill had not been put on the Table elsewhere.

Apart from Government action of one kind or another, there is something else we can do and that is to act ourselves. I do not like saying this, because, as I say, it does not affect me, but there are a great many of us who are leaders of one kind or another, particularly of the young in this country. That is a point very much to my own heart and, as we have heard to-day, very much to the heart of other noble Lords in this House. Doctors, teachers, youth leaders like myself, all have a duty first of all to stop smoking themselves. If it is a habit which we just cannot get rid of, I believe it is our duty at least to go through the motions of not doing it and to restrict it to a private habit. School teachers should not let children see them smoke. This should be true of doctors, youth leaders and every kind of person who has any sort of claim to be a leader in this country. This is one of the reasons why I personally have believed it to be right that such leaders of the young as "pop" singers, and so on, should be more heavily dealt with than ordinary people if they go in for drugs—because they are leaders and people will follow them. It is first of all the duty of the leaders to get themselves right.

All my years I have very much taken to heart a quotation which I found in Chaucer but which I do not normally see quoted outside its context. In the Prologue to The Canterbury Tales the merchant is particularly assiduous about his business, because he says: When Golde rust, what shall Yrone do? The day the boss starts slacking, what sort of slacking will go on beneath him, among the workers? I do not know why this is not quoted so much. It may be because it is more anti-boss than anti-worker; that may be the reason why it does not appear very much in public print. Nevertheless, it is an extremely important fact. It is the business of leaders to give the lead, and if they do not they can expect worse to be done by others. I repeat, "When Golde rust, what shall Yrone do?" Let that be the principle that everybody who leads in this country takes, right the way from Her Majesty down to—I will not name the lower levels, but everybody who leads.

To me, that is the most important point I should like to get home everywhere. It is our first duty to put ourselves right. When we can do that, then we can go on to preach at others, but they certainly will not believe it otherwise. One of the reasons why too many children are smoking in school and elsewhere is that too many parents, schoolmasters and others are smoking. How can children believe our words when we do not act ourselves? That seems to me to be quite basic.

There are some people I believe we shall not save, because they are not liable to be persuaded. The noble Earl, Lord Arran, read out a long list of people who were more apt to smoke, and he thought the doctors had been rather charmingly humorous in producing that list. He did not believe it. I personally believe it most strongly. Smoking is in many ways a relief, and those who are weak, uncertain, deprived, and so on, are apt to be delinquents, heavy smokers, heavy drinkers, and accident-prone. I believe that all these things belong in one basket, and that if you produce statistics about one you will find yourselves producing statistics about the others. It cannot be said that these conditions are caused by smoking. Smoking is one of the group of things which belong in this basket, and if you are to cure smoking among these people you will have to go after effects which lie far outside this debate—matters which I should love to go into, and indeed have gone into at other times, but cannot go into now. This is something quite different. But with the others I am convinced that it is a matter of example, and it is example that we should now go in for. My Lords, let us—I cannot really include myself because this I have already done—ask the leaders to cure themselves, and then we shall have gone a long way towards putting this problem right.

7.10 p.m.


My Lords, my only excuse for intervening at this late hour is that I intend to be extremely brief. I think there is no doubt in the minds of all of us, as is borne out by the Report of the Royal College of Physicians, that consumption of tobacco is on the increase despite all the efforts which have been made to draw the attention of the public to the dangers of lung cancer. It is appalling to hear now, perhaps more than ever before, the request at public dinners that the Loyal Toast should be proposed early in the proceedings, long before the serving of the dessert, just to enable people to give way to their craving to smoke—a craving that seems to be more insistent and more prevalent to-day than ever before. I wish the example could be more widely followed of one toastmaster who, after the Loyal Toast, instead of the usual words, "Gentleman, now you may smoke", remarked, "Gentlemen, those of you who are fully aware of the risks you run of developing lung cancer—now you may smoke".

The right honourable gentleman stated yesterday in another place: Perhaps the most important aspect is to dissuade the young from starting to smoke."—[OFFICIAL REPORT, Commons; 16/3/71, col. 1191.] The emphasis was on "starting to smoke". In my view, to print on each packet a warning notice to the effect that smoking can damage your health is almost useless. Why the emphasis on "your health"—purely from the selfish point of view? The noble Lord, Lord Brock, has already pointed out, speaking with unique authority, that smoking also constitutes a severe danger to others around the smoker especially those who may happen to be sufferers from emphysema or chronic bronchitis. But what is the point of merely putting on the packet, "Smoking can damage your health"? The packet is thrown away as soon as the cigarettes are smoked; or even sooner if they are transferred at once to a cigarette case. One can imagine that prolonged negotiations must have taken place between the Department of Health and Social Security and the representatives of the cigarette manufacturers to wring out from the latter even this concession of agreeing to print these words on each packet of cigarettes. Once the packet is thrown away the warning may pass unheeded.

What is really needed is something that will act as a constant reminder, and especially for the young. Here I should like to suggest that we ought to take advantage of young people's fondness for collecting. Children love collecting things, whether it be coins or pictures of World Cup footballers, pioneers of motoring or of aviation. Many of us vividly recall those cigarette cards of earlier days. They went out of issue long before the war with the advent of stiff cartons for cigarettes. Now they have become valuable collectors' pieces. Why should not the Department of Health and Social Security, in addition to increasing its subvention of more than £100,000 to the Health Education Council, also sponsor the issue of a new series of 20 or 25 different cigarette cards and approach the cigarette manufacturers to insert one into every packet of cigarettes, as was done in the good old days?

I am glad that the noble Lord, Lord Sinclair of Cleeve, is present in the Chamber, and I would pass on the suggestion to him for really serious consideration. Instead of depicting inventors or explorers, these cards, drawn up with imagination and ingenuity by experts in the Department of Health and Social Security or the Council for Health Education, would depict cases of cancer of the lung or cancer of the larynx and similar diseases, and on the back of the card there would be a brief case history of the patients, drawn up imaginatively with some appeal to the children who collect these cards, and generally designed to drive home the ill-effects of the smoking habit.

The scope for such a series of cards could be almost unlimited. Other sets could be issued on the history of smoking, with particular reference to the strictures of his noble Majesty King James I on that "noxious weed", dating back as far as the year 1615, or a series of cards on cancer and recent advances in medicine. These cards would have a definite educative value. I think they would be immediately collected by school children, and competition would be stimulated among them to possess a full set of cards. Even a special album could be issued, free of charge, perhaps by the Council of Health Education or even by the Department of Health and Social Security, or by the cigarette manufacturers themselves, to encourage schoolchildren to complete their sets.

Of course, the issuing of such a set might result in a slight increase in the sale of packets of cigarettes, but surely no more than the issue of cigarette coupons or Green Shield stamps does at the present time. This is an idea that I think cigarette manufacturers themselves voluntarily ought seriously to consider. Certainly it is a risk worth taking, as the dangers of cigarette smoking will constantly be brought home to the young collectors of these cards and will remain with them as a permanent record.

Is there not something in this idea which is worth considering? I throw it out to the Department of Health and Social Security or the Council of Health Education, or even to the manufacturers themselves, with the suggestion that they look into it quite seriously, simply because I believe that every possible step that can conceivably be taken to reduce the incidence of lung cancer ought to be taken, and that our warnings especially should go out to young people, to acquaint them with the very grave dangers of starting—and particularly of starting—this pernicious anti-social habit.

7.20 p.m.


My Lords, there is little that I wish to add to the debate at this time, but I should like to say just one or two things. First, I should like to say how pleased I am to have been present when my old friend Lord Rosenheim made his maiden speech, and how much I enjoyed what he said and how I trust that he will speak to us a great many more times.

I am very pleased indeed that the noble Lord, Lord Platt, put down this Motion for debate. There is little one can do positively at the present time, apart from what has already been suggested. I am pleased that the Government have decided to increase the grant to the Council for Health Education, because I am sure the noble Baroness, Lady Birk, will do her best to see that the money is properly spent, and that seems to me to be one of the best ways of getting the point across. It is very difficult to deal with the young, because the dangers seem to them such a very long way away. They cannot see themselves dying in 50 years' time of cancer of the lung, even though they may be told that cancer of the lung is a very unpleasant thing to die of; it does not seem a very likely thing to happen to them.

But there is one thing that might be thought of (I do not think it will do enormous good), following what has been said by quite a number of speakers, to discourage people smoking in public places. Would it not be possible for the Government to encourage the local authorities when they license cinemas, theatres, and so on, not to allow people to smoke in them? I cannot help feeling that we are not so very different from other European countries, and there are quite a number of countries where people may not smoke in the theatre or cinema—Austria, Belgium, Finland, France, Germany, Norway, Spain, and I think some of the Scandinavian countries. I have mentioned this point to your Lordships before, and I am told that it is quite unnecessary here; that these countries do not prohibit smoking from a health point of view, but merely to ensure that the building will not catch fire and burn down.

I do not mind what the reason is. But if in those countries I have enumerated there is a reasonable, normal population who can go to the theatre and not smoke, I do not see why English people cannot do the same. I agree with the noble Viscount, Lord St. Davids, that it would certainly make life far more pleasant to be in an atmosphere which is not full of smoke, though I am bound to say that I do occasionally smoke myself.

I am not at all sure that putting a little notice on the packet of cigarettes will do any good, except that it shows goodness of heart somewhere; it shows good will. As I say, I do not think it will have much effect, but it is better to do that than nothing at all. Finally, I would say that I entirely agree with everything the Report of the Royal College of Physicians says. It can be summed up that smoking is a beastly, dirty habit, and it would be far better if everybody could give it up.

7.24 p.m.


My Lords, I must start by again telling the noble Lord, Lord Platt, how deeply grateful we are to him for initiating the debate. I always think that he rather nestles under a mantle of modesty which does not succeed in hiding his extremely sharp perception and very deep knowledge, and I think the debate to-day has been one of the most important we have had, even if not one of the most dramatic. It has also been remarkable for a very large number of mercifully brief speeches, for which we must all return thanks. But, of course, it has really been remarkable for the maiden speech of the noble Lord, Lord Rosenheim. Having listened to him today, if I may say so with respect, one understands why he is always described as the doctors' doctor. He showed a distillation, if I can put it that way, of wisdom and originality which will be invaluable in the debates in your Lordships' House. We very much look forward to hearing him again.

This is, of course, an extremely important question and a very, very difficult one. European man has been smoking now for 3½ centuries, and almost ever since he began, efforts have been made to make him stop. It is perhaps rather ironical, as we have had so many dis tinguished physicians speaking to-day, that it was probably a physician called Francesco Hernandes, who introduced the smoking habit in the fifteenth century; instantly everybody tried to put a stop to this pernicious habit, and quite rightly. The Czars would deport you to Siberia. The sort of things which were done in Switzerland one would hardly believe. I think it was Pope Urban the Eighth who actually introduced a Bull threatening excommunication for smokers; and James I, as my noble friend Lord Segal mentioned, had a marvellous campaign called "Counterblast to Tobacco". I recommend the title to the noble Lord, Lord Aberdare. In that campaign he took the view of my noble friend Lady Birk rather than my noble friend Lady Summerskill about people's sexual prowess on tobacco, because this was the frontispiece of this counterblast: Tobacco, that outlandish weed It spends the brain and spoils the seed. It dulls the sprite, it dims the sight, It robs a woman of her right. But to no avail; everybody went on smoking. They imperilled their bodies and souls by doing so. This is still the great problem.

With this magnificent Report, in spite of some of the criticism which the noble Lord, Lord Soper made, we know what the problem is. There is no doubt about the physical evidence. But what are we to do about it? One of the remarkable things about the debate to-night has been how much everybody has agreed about the action that we ought to take. Everyone agrees that we ought to have a sustained campaign on television and so on, not merely an instantaneous one but one that must go on. I think almost everybody agrees that cigarette vending machines ought to be stopped, especially when we think about the children.

The most important thing that we all agree on is that there should be, as my noble friend Lord Soper said, an enlargement of the smokeless zone. If people want to smoke, then they should have to go to a great deal of trouble to do so. For instance, most compartments on a train should be non-smoking compartments and smokers should have to scurry up and down the platform looking for what might be a smoking compartment. This is the way to tackle this problem. I think there is no question about our agreeing on that.

I do not want to go into the details, which have been so very well expressed by most speakers, about youth. Of course, it is absolutely vital that young people should in some way be convinced that the thing to do is not to start smoking. It is absolutely true that if you can stop before you are 20 you are rarely going to start again. I myself, like my noble friend Lord St. Davids and the noble Earl, Lord Arran, smoked at school because I was not allowed to, but from the moment I left school I have never smoked. So our propaganda directed at the young people must not be self-righteous or preaching. In some way we must show them that smoking is the dirty habit we know it to be.

I particularly welcomed what the noble Lord, Lord Aberdare, said about the talks with the broadcasting authorities: that people should not smoke while they are actually appearing on television. Of course, if it is in the situation of a play, that is one thing; but speakers should not actually be seen smoking, because television people are the great heroes of to-day. Those are the persons the young people look to, and that is the kind of climate we have to think about. I very much agreed with my noble friend Lady Summerskill in what she said: that we must get across the complete unattractiveness of the habit. Young people are not going to be afraid of dying of cancer at 40—they think you might as well be dead at 40 anyway. But show them that smoking is rather disgusting, the coughing and wheezing, and the smell; that is the thing to get across to them. Show them that it is not fashionable and glamorous to be smoking, but the disgusting thing it really is.

That is where the advertising comes in. If I may say so, we very much appreciated the way that the noble Lord, Lord Sinclair of Cleeve spoke; it must have been a rather difficult debate for him. I thought he explained extremely well what his view about it all was. But it really is rather astonishing, when you think of those bronzed young men and those delectable young women in the advertisements. Of course this appeals to the young; and I could not follow his argument about advertising not being meant to sell the cigarettes, only to sell the brand. I cannot make out why the tobacco companies spend millions of pounds a year if they are not going to sell the cigarettes. If I may say so, it reveals an astonishing view of capitalist economics. If this is the way industry is run, it is no wonder that we are in some difficulty now. I believe that we have to tackle this advertising question from the beginning, if I can put it that way.

I do not want to speak for too long; there are many things we could all say. I should just like to turn to one or two matters that the noble Lord, Lord Aberdare, spoke about, and put one or two questions to him. I very much support what the noble Lord, Lord Rosenheim, said about research into the question of why people smoke. I have read a fascinating article by Dr. Charles Fletcher, who said he was worried that in the anti-smoking clinics all smokers were treated in the same way, whereas the reasons for people smoking are extremely varied and very complex. Surely we need more research into this. I hope the noble Lord will tell us that the Medical Research Council and his advisers are in a position to research into the causes of smoking, just as much as into the disasters which happen when you do.

The statistics which the noble Lord gave to us seemed to me horrific, and I must say that, of the forms of warning on the cigarette packets that he mentioned, the one he discarded was my favourite. I think that if he had said, "Fags are fatal", it would have an extremely good effect. In general, it seems to me, all of us agree that "Smoking may be dangerous" is not enough. May I also say to the noble Lord that I do not think he was quite right when he said that this is the most serious warning that any Government has put in. As my noble friend Lady Serota said, in the United States, though they began rather gently, they now say, "The Surgeon General has determined that smoking is dangerous to your health." That seems to me to go much further, and to be far more effective than what the Government are now proposing.

I should like to take up one point which I think has not so far been mentioned. The noble Lord referred to an inter-departmental committee. In the Report at the end of Appendix A the Royal College called for an official inquiry into the economic consequences of a decrease in cigarette smoking, and asked that a full and public account of the balance of benefit and loss should be published. Last year, we lost 6.8 million working days through strikes—a horrifying figure, about which we are very worried. However, in the same period we lost 36.8 million working days through bronchitis. The situation is extremely serious, and I do not think that an inter-departmental committee such as the noble Lord mentioned fully answers the point put by the Royal College. Therefore, I should like him, if he can, to reconsider this.

Then I should like a little more information about the tar and nicotine content of cigarettes. The noble Lord said he could give us the information. But will it be put on the cigarette packets? Will it be put in some kind of pamphlet? We should like to know a little more about that, if he can tell us. We all want to know much more about whether there is a real possibility of a safer cigarette. For myself, I am rather doubtful, and I should not like him to hold off legislation simply because he was waiting for that.

My Lords, I come to my last point. The noble Lord and the Government have to face up to the legislative position. We know that there is in the other House Sir Gerald Nabarro's Bill, and if he gives it up (which does not look likely, as he is not that kind of person) there is another Bill waiting from Mr. Laurie Pavitt. So I do not think the Government can say, in that bland way, "Well, if we go for legislation the cigarette manufacturers will stop doing what they have promised to do." I do not think they would want to; I do not think public opinion would allow them to. I should like to ask the noble Lord to reassure the House that, as well as welcoming this Report, as he has already done, the Government will implement it with a little more vigour?

7.36 p.m.


My Lords, may I speak again and try to cover some of the points that have been put to me. Many of your Lordships have declared interests in the course of the debate. May I say straight away that I am a nonsmoker, and the fact that I produced a packet from my pocket was merely to illustrate the warning on it and not as part of my usual equipment.

May I say, like the noble Baroness, Lady Llewelyn-Davies of Hastoe, what a pleasurable debate this has been, particularly having regard to the fact that all the speeches have been to the point and reasonably short, and only, if I may say so, interrupted by an agricultural diversion. I have already expressed my thanks to the noble Lord, Lord Platt, for giving us an opportunity to debate this matter. I think now we have another reason to be grateful to him, because evidently it was because he put this Motion down that the noble Lord, Lord Rosenheim, decided to make his maiden speech as early as he did. I certainly think that all of your Lordships will feel, as I do, that this was an excellent thing, and we all hope that he will join us on many more occasions and speak to us. His speech was certainly right on the target, brief, and extremely pleasant to listen to.

The noble Lord told us, much to my pleasure, something of the objectives of ASH, and the Government have most warmly welcomed the formation of this body. I feel sure that it has much to contribute to the solution. He also had some very wise words to say on the need to do more to instruct young doctors in training, and also on the very desirable objective of persuading both the general practitioners and the hospital doctors to show, themselves, how conscious they are of these dangers by using their influence to persuade their patients to give up smoking. I am sure that this is a most profitable line to pursue. After all, this is a health hazard, and most of us are rather more liable to pay attention to our family doctor than we are to the Government.

He also stressed the need for research into the reasons why people smoke. This was another point that the noble Baroness, Lady Llewelyn-Davies, brought up. Certainly there is research going on. There is research going on in the United States, and also at the Maudesley Institute for the Study of Addiction. Further research into why people smoke could give us greater insight into how to help them relinquish the habit. An outstanding and comprehensive piece of research has been commissioned and published by my Department into why young people smoke. The reasons are almost exclusively due to social conditions. Therefore, in a different social climate the onset of smoking might never need to occur. The young have been found to associate smoking with adulthood, and this is a pattern which is laid down for them by the fact that adults are so prone to smoke themselves.

The noble Lord, Lord Sinclair of Cleeve, spoke from his great knowledge and experience of the problems of the industry. I was particularly pleased to hear him speak of the research work that has been done by the Tobacco Research Council, and I freely acknowledge that it has done some useful research. I would say that the Government are aware of the co-operation that the industry has given in reaching this voluntary agreement, which we think has real advantages over legislation. It was appropriate that the noble Baroness, Lady Summerskill, was after the noble Lord, Lord Sinclair, in the batting list and she was well placed to attack some of his speech. She certainly put the case against smoking with great force and in very human terms that went home very deeply to many of us. I particularly agree with her view that it is best, first, to tackle the problem with the young people. I am sure that some of her ideas will be of value to the Health Education Council when they are considering their advertising campaigns.

I think the noble Baroness was the first to raise the question of smoking in public places and, as I said earlier, my right honourable friend is going to ask those responsible for public transport, cinemas and the like to set aside more accommodation for non-smokers. Some progress is this direction has already been made, but there is room for more. Perhaps we should even go so far as to bring the space for smokers and non-smokers into broad correspondence with their respective proportions. But in all these matters it has to be remembered that the Report of the Royal College of Physicians was published little more than two months ago, and we feel that we have gone as far as we can immediately go. But we are committed to trying to enlist the cooperation of those concerned with public places.


My Lords, the noble Lord said that he wishes to bring the spaces for smokers and nonsmokers into broad correspondence. Would it not be very much more appropriate if he brought into correspondence the spaces for what he hopes will be the smokers and non-smokers?


My Lords, I think one has to take into account facts as they are, rather than try to wield the big stick over people in this country. My noble friend Lord Monck asked some very technical questions about the Report, which I felt it was rather beyond me to answer. I was sorry that the noble Lord, Lord Rosenheim, had already spoken as he might have been in a better position to reply. My noble friend mentioned the question of pipes and cigars, as well as filter tipped cigarettes.

There are papers from Europe which have recently been referred to, suggesting that the incidence of lung cancer is as great in pipe and cigar smokers as in cigarette smokers. But the experimental method used in these papers makes their interpretation exceedingly doubtful and unreliable. American and Canadian studies, as well as the Report of the Royal College of Physicians, indicate that pipe and cigar tobacco is relatively less harmful. The new scientific committee which is to be set up will be asked to consider whether further research is needed, but on present evidence people who cannot stop smoking would be well advised to switch to pipes or cigars. As regards filter tip cigarettes, it is too early to assess whether the increase in their production has had any effect on the incidence of lung cancer. A number of studies are taking place on this subject and we are still awaiting their results. There is some evidence from research in the United States that, in general, filter tip cigarettes are safer than similar cigarettes without filters.

The noble Baroness, Lady White, started her speech by declaring an interest in the subject which deeply moved all of your Lordships who heard it. We listened with very great attention to what she had to say, and I found myself in considerable agreement with almost all she said at the beginning of her speech. I am quite sure that, if we can, we must first tackle this problem among the young. But, above all, there is a need to understand the motivation of young people before we can bring much influence to bear on them. I agree with her about the potential influence of parents and teachers in helping with this problem. She did not quite understand why the manufacturers were apprehensive about having legislation hanging over their heads, and could not see why they could not go ahead anyway with the voluntary agreement. But I think the position is rather difficult, because in order to fulfil the voluntary agreement they have had to go to a great deal of trouble to put notices on the packets and on their advertisements. It clearly would not be in their interest to go ahead with any of these preparations if they thought that there was going to be legislation following up which might change the whole requirements to which they had already agreed.


My Lords, I think the Government possibly underestimate the manufacturers' public spirit. I think they want to do this not only in their own interests but in the interests of everybody else as well. My view is that they would seek to do it.


But, my Lords, the time factor is surely a very short one. We have waited many years for this action. The Bill is already in Committee in another place and I am sure that we can pass it through all its stages fairly rapidly when it reaches this House. It would be a matter of not more than a few weeks one way or the other.


My Lords, the noble Baroness knows the other place better than I do, but I do not think that it would be so easy as that. But whatever their motives may be, I do not think you can really expect people to honour a voluntary agreement if they are then going to be told forcefully to do something which might prove to be different.

The noble Baroness was followed by many other speakers on the subject of the prohibition of public vending machines. I can only say that I have taken note of the feelings of the House on this subject. As I said earlier, to ban them would involve legislation, and we have no plans for this at present. But certainly this is one of the recommendations in the Report that will be carefully examined, and if we decide that it is a useful suggestion we shall go ahead with legislation. But I cannot anticipate what the result will be on that.

The noble Earl, Lord Arran, designated himself a proud individualist, and as he spoke from the Liberal Benches that was entirely appropriate. But his Liberal views did not seem to extend to the young. He felt that they should be controlled in a more autocratic way, as I understood it. But he realised that the solution lies in influencing young people's social attitudes. His constructive suggestions for positive action included the prohibition of advertising and of public vending machines. He also suggested that we should tighten up on the sale of cigarettes to people under the age of 16. At first sight, I see some difficulty in distinguishing the age in this matter—who is above the age, and who is below it? This difficulty would of course apply at whatever age the prohibition was applied. The noble Earl drew an analogy with the prohibition on the sale of alcoholic drinks, but this is rather different, because in the case of alcohol there are a very much smaller number of sale points, which makes enforcement very much easier, quite apart from the effect of the sanction of the loss of licence.

The noble Baroness, Lady Birk, had a great many useful points to make. I took particular note of her feeling that the word "your", in the warning that smoking can endanger your health, should be marked in some way as the important word in the sentence. I shall certainly see that that suggestion is considered. She also said that some parts of your Lordships' House, such as the Committee Rooms, might show a better example in the matter of smoking. I do not think it is up to me, but the Chairman of Committees will have noted her point. Perhaps she is aware that there is a notice in the main room of the Library which reads: The two north rooms in the Library are available for smoking. That is one of the most polite "No smoking" notices in the world, and one of the least observed.

I agree with the noble Baroness on how important it is to persuade broadcasting organisations to help in this matter, because it is not much good advertising in television if, at the same time, in the programmes the tough guy is always lighting up a cigarette. That merely encourages young people to think that that is the way to live tough. My right honourable friend is going to have conversations with both broadcasting organisations, and I hope that something may come of those.


My Lords, before the noble Lord goes on (I think he has finished with me at this point) I wonder whether he is going to say anything more about the tar and nicotine content—


Yes, my Lords.


—because I understood from the speech of the noble Lord, Lord Sinclair of Cleeve, that the tobacco manufacturers are willing; and if they are willing I hope the Government are going to say, "Yes".


Yes, my Lords; I was coming to that: I had not finished with the noble Baroness.

It is a matter of great satisfaction that the manufacturers have agreed to the publication of figures for tar and nicotine. These figures, it is intended, will be published in a sort of league table, so that people who smoke will be able to compare the amount of tar and nicotine in any particular brand of cigarettes with that in others. But at the moment there is a certain amount of difficulty. It cannot be done quite as easily as it sounds, for the reason that what has to be measured, in the case of the tar, is the tar content of the smoke. It is the yield of tar from the cigarette as it burns; and there are something like 1,200 different constituent compounds that have been found in this tar. So it is important to know not only the amount of tar but also the danger of the particular compound that is in the particular tar, and I think that there are very great difficulties from this point of view. It is not only the amount of tar, it is also the type of tar, the specific carcinogenic activity, that is highly significant. It would be quite wrong to lead people to think they were smoking a safe cigarette because they were inhaling less tar when in fact the less tar was of a more dangerous type. That is the difficulty at the present time. But, as I say, this committee is going into it.

My Lords, we listened with interest to the right reverend Prelate the Bishop of Portsmouth. He also mentioned the importance of research into the causes of smoking, to which I have already, I hope, given some answer. I listened also with interest to the noble Lord, Lord Brock, and especially to his reference to sufferers from asthma, because only last week I was opening the Asthma Research Council's Pharmacological Research Unit at the Brompton Hospital, and I very much sympathise with those sufferers. I sympathise with the idea that there should be more non-smoking areas in public places.

The noble Lord, Lord Poltimore, has had rather more years' experience than I have, but I, like him, am a bigot because I, like him, gave up smoking some ten years ago; so I have a great deal of sympathy with what he had to say. I found myself in less sympathy with what the noble Lord, Lord Soper, said. He went rather farther than I should be prepared to go, in saying that the liberty of the individual should be overridden, and that in the end we should have to abolish cigarettes. On the other hand, I took his point about public vending machines.

So far as the noble Viscount, Lord St. Davids, is concerned, he said we did things too little and too late. I do not agree. He can hardly say we are doing things too late because the Royal College of Physicians' Report has come out only in the last few months, and we are already putting forward some proposals,. The noble Lord, Lord Segal, I thought, put up an excellent idea for the toastmaster. I think that all toastmasters should in future adopt his suggestion. But I was not quite so happy about his cigarette cards suggestion. Of course we will look at it, and I am sure the cigarette manufacturers will, but I have a suspicion that it might increase the sales of cigarettes. I also collected these cards, and I doubt whether I should have been very sympathetic to collecting a set of this sort. I am also sure that I never read what was on the back of them; but I appreciate his idea. I am grateful to the noble Lord, Lord Amulree. We will take into account his suggestion about the licensing of cinemas.

Finally, the noble Baroness, Lady Llewelyn-Davies of Hastoe, at the end of her remarks, asked me one or two quick questions. I think I may already have answered some of her questions in the course of what I have said. On the subject of advertising and the banning of advertising, the only thing I can say (which is quite interesting, I think) is that in two countries, at any rate, Russia and Italy, where the sale of cigarettes is a State monopoly, there is no advertising at all; but still the numbers of those who smoke are rising. But that is not a very significant answer. For the moment, we are going ahead with voluntary agreement, and we feel that for the time being this is the best way of proceeding.

I think I have answered the question put by the noble Baroness about the tar and nicotine content. I hope that this information will be published in the form of a league table. I cannot go any further about the inter-departmental committee—or, rather, discussions. I explained in my original speech that these inter-departmental discussions are actively in progress, and that is as far as I can go at present. As to whether our notice on the cigarette packet is likely to be more effective than anybody else's notice, I think opinions might differ in comparing the actual wording with that used in America. But certainly our notice is more conspicuous, and we also have the additional notice appearing on all Press advertisements and hoardings.

My Lords, I hope that I have answered most of the questions that were put to me. I do not wish to detain your Lordships any further. I will only say that we cannot stop people smoking overnight. Public opinion has to be changed, and it can be changed only slowly. But we believe that in the light of the Report we have at least taken the first steps. We have taken them fairly quickly, and we shall hope to see some results from them.

8.0 p.m.


My Lords, I shall not detain you very long at this late hour. We have already had a splendid summing up from the noble Lord the Minister of State, but I take it that I have your Lordships' permission to make a few comments on what has been said during the debate, because I think that some of the remarks made are of some importance. Almost the last thing that the Minister said was that we shall not stop smoking overnight. That is very important from a point of view which has not been mentioned but which I am not going to bring up now; it is the financial one. The Government are in danger of thinking: "We cannot afford to lose"—what is it?—"£1,000 million or so in revenue". That is absurd. The best that we could hope for and expect from the non-smoking point of view is that there will be a very gradual drop in smoking. No Government will lose its revenue overnight.

I must start by thanking all—and I say "all", without exception; and your Lordships will see why in a few minutes—who have spoken in this debate and, of course, in particular my noble friend and colleague Lord Rosenheim. I would say to the noble Lord, Lord Aberdare, that I may have been less than generous in welcoming what his Department is already setting cut to do in this matter. If I was less than generous in my welcome—I shall see in Hansard tomorrow—it was because of my very considerable disquiet about the bargain which we now know has been made between the Government and the cigarette manufacturers. I know that the noble Lord, Lord Aberdare, and the Secretary of State for Health and Social Security are dedicated to the cause of non-smoking. I also know that there is a close connection between the C.B.I. and the Imperial Tobacco Company, and I wonder whether certain decisions may not have been made at a level perhaps even above that of the Department of Health.

However, I am greatly heartened by the speech of the noble Lord, Lord Sinclair of Cleeve, because, having heard him, I think the Government may never again be able to take the statements of the cigarette manufacturers as having any particular claim to reality. I do not wish in any way to accuse the noble Lord of any kind of hypocrisy; I am sure that he believes everything he says. But I believe that he does not know what is going on in the world around him, even in his own industry, and that he is blind—especially colour blind. He has not seen any of the display advertisements directed obviously at trying to encourage young ladies to smoke, at this time in history of all times.

Before my voice finally fails, I should like to take one or two other things that the noble Lord said, for, as I have said, he did not stick to reality too closely. In the first place, he brought tears to our eyes at the concern of the cigarette manufacturers on this issue. I only wish that they had acted in the way they felt. He said—and this is near enough to his actual words—that the cigarette manufacturers and especially the Imperial Tobacco Company do not presume to contest medical judgment. Does he remember what happened when the College Report was issued in 1962 and a very prominent member of the Imperial Tobacco Company appeared with me on television in "Panorama" and tried to discredit the whole of the evidence of the Royal College of Physicians? Has he forgotten that? I have not; and I do not think that that gentleman has forgotten it either.

The noble Lord talked about advertising. Advertising has increased enormously in the last twenty years—it is up now to £52 million a year. The biggest increase of all was in the year immediately after the College Report. He spoke about coupon advertising not having increased when television advertising was banned. It did increase. He has not read page 18 of the latest Report of the College. He spoke about advertising not being directed to induce people to smoke and so forth. He may remember that in 1962 the British tobacco manufacturers voluntarily adopted a code that excluded any cigarette advertising which over-emphasised the pleasures of smoking, featured conventional heroes of the young, appealed to manliness, romance or social success, or implied the greater safety of any brand. Can we say that the cigarette manufacturers have kept to this voluntary agreement? Certainly not—as we see if we look around us or open almost any newspaper which has special coloured pages for these display advertisements which appeal to young people. My Lords, I felt that I had to say those things. I am very sorry to have had to do so. I do not want to blacken the reputation of the cigarette manufac turers; I think that they have done it for themselves.

There are one or two other points of a general nature, but the only one I need allude to is the quest for the safe cigarette, the mild cigarette. Personally, I do not agree with this. I do not mind if people think that they can eventually produce a safe cigarette. I believe that the quest for it is roughly the same as that for producing whisky without alcohol. I believe that you will find that if research is done to get a milder cigarette with less nicotine and less tar, your real addictive smokers will simply smoke more of them and nearer to the butt-end. Those are my personal thoughts not based yet on scientific investigation and proof.

Finally, your Lordships will not be surprised if I welcome the idea that far more public places, and especially dining rooms, and so on, should be places where people do not smoke. I do not wish to be known in this House, to the embarrassment of all my friends who enjoy their cigarettes, as a man who does not believe in smoking. Nevertheless, if you did not smoke actually during my luncheon I should be very pleased. With those final words, my Lords, I beg leave to withdraw my Motion for Papers.

Motion for Papers, by leave, withdrawn.