THURSDAY 18 NOVEMBER 1999

PROFESSOR LIAM DONALDSON, DR DAWN MILNER, MR TIM BAXTER AND MR PAUL LINCOLN

  1. Colleagues, can I welcome you to this first session of our new inquiry and particularly welcome our witnesses and place on record the Committee's gratitude to both of the organisations represented, the Department of Health and the HEA, for the written evidence we have received which is extremely helpful. We do appreciate the effort you have put into that evidence. Could I ask, first of all, each of our witnesses to introduce themselves to the Committee. Mr Lincoln, would you like to begin?

  (Mr Lincoln) Paul Lincoln, a Director of the Health Education Authority.
  (Professor Donaldson) Professor Liam Donaldson, the Government's Chief Medical Officer.
  (Dr Milner) Dr Dawn Milner, Senior Medical Officer in the Tobacco Policy Unit.
  (Mr Baxter) Tim Baxter, Team Leader in the Tobacco Policy Unit.

  2. Thank you very much. Can I begin by asking a very general question. Looking at the evidence that we have received for this inquiry from a range of agencies, including the Government's memorandum, the concern that I have got is looking at the known health effects of the use of tobacco. The Government's White Paper, which we have all obviously looked at, notes that smoking cuts people's life expectancy more than any other factor. Over 120,000 people are killed a year because they smoke. We have also received evidence from the World Health Organisation who say that tobacco kills one in ten adults worldwide, at least four million human lives last June in 1998 and by 2030, perhaps a little sooner, they propose it will be one in six or ten million deaths per year more that any other single cause. We have received written evidence that there was clear knowledge of the links between smoking and illness as far back as 1950 in this country and certainly in the States. Since 1950, during the lifetime of most of us here, six million people have died in this country as a consequence of smoking. We have a public health problem of horrendous proportions. What I would like to ask you all as a starter is how on earth have we allowed this problem to continue for the last 50 years when we have known for a substantial part of those 50 years of the very serious health problems smoking causes?
  (Professor Donaldson) We very much welcome the Committee's interest in this subject. As a public health professional and as somebody who started off in clinical practice it has been a lifetime commitment of mine to draw attention to the dangers of cigarette smoking both for individual patients but also for the population as a whole and it has been a long uphill battle and it has taken us a long time to get to the position where we have got a Government policy which sweeps across the range of measures which start to address this problem in a comprehensive way. As to the reasons for why it has taken so long to get to this point, I think it is very difficult to put your finger on specific reasons, but undoubtedly in the early days there was dispute and no clear agreement about the scientific evidence. That was resolved more or less completely in the early 1960s when most scientific authorities recognised the dangers.

  3. It was clear we knew from the early 1960s. Why on earth has it taken so long for any serious measures—assuming we have got some serious measures now—to be brought in by the Government?
  (Professor Donaldson) Firstly, it was not 100 per cent clear what measures would be effective to achieve behaviour change. Secondly, there was not the tenacity to face up to the actions of the tobacco companies and to try and control particularly advertising and the promotion of tobacco which is the absolute key to successful action in this area.

  4. It is probably unfair to put this question to a civil servant, but looking back over previous governments and the history of this issue, do you feel that there is evidence that people previously in your position have pointed to the connection between smoking and ill health, drawn the attention of politicians to it at various times over a period of years since the 1960s and the politicians have been complacent on this issue as opposed to people in your position?
  (Professor Donaldson) I have not had an opportunity to review the advice which was given behind the scenes to Ministers of previous governments, but I have knowledge of all the previous Chief Medical Officers during my professional lifetime and I know that they were all very strongly committed to these sorts of goals and many would have given advice about the importance of action in this area. I have no knowledge of the opportunities they had to have those sorts of discussions directly with Ministers, how often they took place or how pointed the advice was.

  5. Would it be reasonable to assume that some of your predecessors were frustrated by the lack of political action on advice they may have given at a particular time during the past 30 or 40 years?
  (Professor Donaldson) I think you would have to ask them. All I can say is that if I had been in post at the time I would have been very frustrated.

  6. Do any of your colleagues wish to make any points on that general opening question?
  (Mr Baxter) Certainly by the time the evidence became very clear there were already a number of millions of smokers in this country addicted to smoking and that is even with a comprehensive tobacco control strategy in place. One comes back to the problem of how do you combat the fact that many millions of people are smoking. If we had had the evidence back before the First World War, say, when the government started giving cigarettes to troops then we may have been able to cut this off at that point.
  (Mr Lincoln) Could I just say from the point of view of the Health Education Authority and its predecessor body, the Health Education Council, that tobacco control, the cessation of smoking and smoking prevention have always been the priority for those organisations. As Professor Donaldson has said, it has always been the preeminent priority for public health professionals and they have been looking for the evidence for action and also consistently arguing through professional bodies and organisations like public health bodies like the Health Education Authority for governments to take a stronger stance on particularly tobacco control. I think it is worth reflecting on the effectiveness of the voluntary agreements. We do applaud the current Government's position in terms of its comprehensive tobacco strategy announced in the White Paper Smoking Kills which we know from colleagues, such as those in the World Health Organisation, is seen as the leading example of action of national governments.

  7. Would it be fair to say, picking up the comments from Professor Donaldson, that your organisation perhaps shares its frustration that the politicians have not been prepared to address this issue as seriously as you would have liked over the years?
  (Mr Lincoln) Yes, we would agree with that.

  8. Have you any idea why the politicians have not been prepared to be more serious about dealing with this matter?
  (Mr Lincoln) In all fairness I think that is a question to ask the previous administrations. We have made our view quite public through the years in all sorts of areas, such as on the strengthening of advertising regulations.

  Chairman: A member of the previous administration wants to ask a question at this point.

  9. I wanted to ask Mr Lincoln, because his frustration has been raised on a number of occasions, are you frustrated with what has happened to tobacco advertising and Formula One racing?
  (Mr Lincoln) Speaking as a public health professional, we are pleased to see the European Directive on Advertising Controls and Sponsorship Agreements coming into effect and on a pan-European basis. We are very pleased to see that, and the derogations accepted by the UK Government that have advanced and strengthened that Directive.

  Chairman: With respect, you have not answered the question. Actually I am interested in hearing your answer as well.

  10. He did preface his answer, Chairman, by saying "speaking as a civil servant", but then speaking as a civil servant a little previously he said how pleased he was by what the Government was doing. Can I repeat the question: as a civil servant, in the same capacity as you answered the previous questions, are you frustrated at what has happened on tobacco advertising and Formula One?
  (Mr Lincoln) I cannot speak as a civil servant because I am not a civil servant.

  11. It is you who raised that.
  (Mr Lincoln) I can speak as a public health professional. I think speaking for public health professionals many people in the public health professions would have liked to have seen a curtailment of Formula One at an earlier date. I think that is a fair comment.

  12. Can I just seek clarification. Am I right in thinking that in one of the earlier questions you answered "speaking as a civil servant"?
  (Mr Lincoln) No, I was not speaking as a civil servant. Technically speaking I am not a civil servant.

  13. Did you use that expression?
  (Mr Lincoln) No, I did not use that expression.

  14. I will come back to you in a minute, Simon, on other issues. Before we move on, can I explore the issue of how much knowledge there has been of the tobacco companies' own research? I wonder, Professor Donaldson or Dr Milner, whether you can advise us when the Department, or predecessor department concerned with health, first actually discussed the health effects of smoking with the tobacco companies? Have you any knowledge of this?
  (Professor Donaldson) Chairman, I have been in post for 14 months but Dr Milner has been in charge of this area and of policy for longer, so perhaps I can ask her to start.
  (Dr Milner) I think, Chairman, you are asking when dialogue commenced with the industry?

  15. Yes.
  (Dr Milner) Looking at historical records I would imagine it commenced at the time that we became aware of the dangers.

  16. So the 1960s basically?
  (Dr Milner) From the 1960s, maybe even earlier, there would have been dialogue once the health concerns became current.

  17. You are obviously aware that the tobacco companies from the 1950s were conducting their own research. Do you know what efforts successive governments made to look at the findings that tobacco companies themselves had obtained about the impact on health of smoking?
  (Dr Milner) I do not know what effort was made to discover the research that was carried out by the industry at that time, not in the 1960s. The history we have laid out for you in our memorandum of the scientific committees that were then initially co-operating with tobacco companies. The very first Standing Liaison Committee had tobacco company scientists on the committee, this was a committee in the early 1970s, that decided that there should be health warnings and there should be measurements of tar and nicotine and a league table of high, middle and low tar cigarettes. The subsequent committee which was set up, which I described in the memorandum, the Independent Scientific Committee on Smoking and Health, had a remit to work as appropriately, to inform as appropriately, the industry. There was close co-operation there over the production of the list of approved additives. Coming further up to date, in the 1980s we had considerable investment of money from the industry to support research via an independent body called the Tobacco Products Research Trust and I detailed that in my memorandum.

  18. Do you have any knowledge at all over the period that we are looking at, from the 1950s through to the present day, of specific requests by your department or its predecessor for access to information that you believed was in the hands of tobacco companies?
  (Dr Milner) I do not have any knowledge of that.

  19. Have you any reason to believe that the tobacco companies have concealed research evidence that they have of the harmful effects of smoking from the Government?
  (Dr Milner) To answer that I would have to consider the information that we now have because of the American litigation, information of internal industry documents which have been made available on the Internet which would appear in certain areas to suggest that the industry did have early knowledge of such things as, for example, compensatory smoking, the effectiveness of the product that perhaps the outside world was not party to. That information has been brought to our attention by other bodies, such as ASH, that have published that information and it is available on the Internet.