Thank you for your letter of 14 January 2000, which crossed with my letter to you of the same date. The issues that underlie your request have already been addressed in Gallaher's Submission to the Health Committee dated 23 September 1999 and/or the evidence that Mr Peter Wilson provided to the Health Committee on 13 January 2000. Adopting the order in your letter of 14 January, Gallaher's reponse to your additional information request is as follows:

  Research. Gallaher's current budget for its research and development division is approximately £6.1m. That figure represents by reference to Gallaher's 1998 published accounts, approximately 0.65 per cent of Gallaher's total turnover of £938 million, excluding duty. As is apparent from our submission (see paragraphs 4.13 to 4.48), a key characteristic of Gallaher's response to the smoking and health issue has been to find ways of achieving overall reductions in the smoke yields of the cigarettes Gallaher manufactures. That remains a cornerstone of Gallaher's current approach to the deployment of its research and development resources. Against this background, Gallaher does not differentiate between research and product modifications that result from such research. In general terms, we consider in the region of half to two thirds of the current budget to be directly or indirectly focused upon issues surrounding the health risks associated with smoking, such as continual enhancement of our understanding of our products, experimental product innovations and on-going efforts to produce lower tar cigarettes that are acceptable to smokers. The remaining proportion of the budget is applied in technical support to other divisions of Gallaher, and is needed to deal with, amongst other matters, quality control, manufacturing support and environmental issues.

  SCOTH. Gallaher is a party to the judical review proceedings. As I confirmed by my letter of 14 January 2000, I have asked Lovells, the lawyers responsible for that litigation, to provide the explanatory note requested.

  Addiction. In your letter you ask whether Gallaher believes that smoking is "addictive" by reference to two criteria: the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, IV Edition, which is commonly known as "DSM-IV" and which was published in May 1994; and the 1992 ICD-10 International Statistical Classification of Diseases and Related Health problems. Neither of those classifications uses the word "addictive" in a tobacco context, but rather focus upon providing guidlines as to what amounts to a "substance dependence". Furthermore, the categorisations that are used in DSM-IV and ICD-10 are primarily designed to assist medical and psychiatric practitioners assess whether, on an individual basis, patients have a substance dependence by reference to subjective and objective analyses of their own particular situations. Ultimately this is a question of assessment and judgment in each individual case. Addressing each classification in turn:

(a)  DSM-IV. DSM-IV is not rigid in its definition of "substance dependence". DSM-IV, in addition, cautions against categorical use of the term "dependence" noting, for example, that "The diagnosis of Substance Dependence requires obtaining a detailed history from the individual and, whenever possible, from additional sources of information (eg Medical records; a spouse, relative, or close friend). In addition, physical examination findings and laboratory test results can be helpful." (DSM-IV at page 185). The diagnostic criteria for substance dependence in DSM-IV, which do not "take into account such issues as individual responsibility" (see introductory passage xxxvii) and which do not require a finding of either tolerance or intoxication (at page 177-181) may be applied with respect to certain individuals to support a finding of nicotine dependence. The individual nature of dependence diagnosis is highlighted by DSM-IV's admonition that "It is important that DSM-IV not be applied mechanically by untrained individuals. The specific diagnostic criteria included in DSM-IV are meant to serve as guidelines to be informed by clinical judgment and are not meant to be used in a cookbook fashion" (see introductory passage xxiii). As such, smoking may or may not be assessed as supporting a finding of nicotine dependence in an individual applying these criteria.

(b)  ICD-10. ICD-10 focuses upon mental and behavioural characteristics in connection with use of psychoactive substances and acknowledges that determinations of whether an individual has a mental or behavioural disorder should be based on as many sources of information as possible. It states (at page 320) that "These include self-report data, analysis of blood and other body fluids, characteristic physical and psychological symptoms, clinical signs and behaviour, and other evidence such as the drug being in the patient's possession or reports from informed third parties".

Against this background, ICD-10 categorises the use of both caffeine and tobacco, amongst other substances, as capable of leading to unspecified mental and behavioural disorders determined by reference to one or more of the following subdivisions: acute intoxication; harmful use; dependence syndrome; withdrawal state; withdrawal state with delirium; psychotic disorder; amnesic syndrome; residual and late-onset psychotic disorder; and other mental and behaviour disorders. Again, as such, smoking may or may not be assessed as supporting a finding of nicotine dependence in an individual applying these criteria.

  It may be helpful if I remind you of what Gallaher's position is. As Gallaher confirmed in its Submission, Gallaher accepts that the meaning of addiction has been given such a wide interpretation in today's society that it can be taken to apply to smoking. From Gallaher's perspective, no matter how smoking is termed—addiction or habit—the key question is whether or not people can give up smoking. As the evidence that Gallaher has already provided to the Committee illustrates, whilst for some smoking can be a very strong habit, millions of people have given up smoking in the UK and elsewhere. People give up smoking at different times in their lives with different motivations. People can choose to smoke; they can chose to stop, even if some people find it much more difficult than others to do so. As Mr. Wilson also indicated to the Health Committee, Gallaher believes that, in terms of any message that public health authorities may wish to give to smokers, it could be unhelpful to those who want to stop smoking to categorise smoking as an addiction.

  Let me now turn to the six specific questions asked by you. Using your numbering:

1.  Lung Cancer. As set out in Gallaher's Submission (see paragraph 4.84) the strength of the statistical evidence is sufficient to conclude that it is substantially more probable than not that smoking can and does cause lung cancer in some smokers. Accordingly, it is clearly likely that as a result of smoking there are more lung cancer deaths than there would otherwise be—other things being equal.

3.  Heart and Circulation Disease. As is again set out in Gallaher's Submission (See paragraph 4.85) Gallaher accepts that the statistical evidence shows that smoking is a risk factor for some heart and circulation diseases. There are, however, many other risk factors associated with these diseases such as alcohol consumption, cholesterol levels, lack of exercise, obesity and stress. Nevertheless, Gallaher does accept that the statistical evidence relating to smoking and these diseases is sufficiently strong to conclude that smoking can and does cause or contribute to the incidence of these diseases and that it is clearly likely that, as a result of smoking, there are more deaths from these diseases than there would otherwise be—other things being equal.

5.  Respiratory Illnesses. Yet again, Gallaher recognises that the statistical evidence shows smoking to be a risk factor for respiratory diseases such as emphysema and that smoking can and does cause, or contribute to, the incidence of such diseases. As such, it is clearly likely that as a result of smoking there are more respiratory illness-related deaths than there would otherwise be—other things being equal.

2/4/6.  It is generally accepted that smoking is neither a necessary (non-smokers get the same diseases as smokers) nor a sufficient (mean smokers do not get diseases associated with smoking) cause of disease and that causal conclusions in this regard are a matter of judgment in each individual case. As such, it would as yet be going too far to say that causation has been proved beyond all reasonable doubt.

  I should stress that none of the above detracts from the assessment that so many have made, including Gallaher, that smoking does cause disease in some smokers and we would not want anything that is said in this letter to be viewed as in any way undermining the clear message, which Gallaher endorses, that there are health risks associated with smoking. It is our strong belief that we, Government, the Public Health Community and other interested parties should work constructively together based upon the conclusion that smoking does cause disease.

  If I can be of further assistance, please do not hestiate to contact me.

20 January 2000