THURSDAY 9 DECEMBER 1999

PROFESSOR JOHN BRITTON, DR JENNY MINDELL, SIR ALEXANDER MACARA and DR BILL O'NEILL

  340. We were in the United States last week and we met up with a company called Star Scientific who have got this patent to take it out of cigarettes. Do you think though that if it were to be shown that that is infinitely less dangerous, then it should be made compulsory on the basis that you are not going to get everyone to give up smoking, so you may as well have a product that is the least dangerous one as possible on the market?
  (Professor Britton) Well, I think that cigarettes need to be regulated, as I said earlier, like any other drug-delivery device, but you are starting from a situation where instead of a new drug being introduced into the market and having to demonstrate its safety, you have an established product in the market whose market share we want to reduce, whose coverage we want to reduce, and it is important that tobacco manufacturers are made to do as much as they reasonably can to ensure the minimum danger of their product in a background of regulation which has the target of a smoke-free society in a reasonable period of time.
  (Sir Alexander Macara) You probably know that the Council of Ministers in the EU, which was attended by Gisela Stuart of the UK, in its meeting on the 18th November supported the proposal from David Byrne, the Commissioner for Health, that there should be EU-wide limits on the tar, carbon monoxide and nicotine content of cigarettes, so there is at least a start there within the EU.

  341. But picking up on that point, do you think that consumers have been misled in the recent past by the emphasis on lowering nominal tar use?
  (Sir Alexander Macara) I do not think there is any doubt that they have been misled by receiving part of the truth and not the whole truth. It is sometimes more damaging to have part of the truth because you do not realise what you do not know, and I think it would be fair to say that in recent times the industry has begun to admit not its complicity in concealing facts for so long, but to admit that there is a link between smoking and-ill-health. They are still trying to deny the nature of addiction, so at least perhaps they still deny that tobacco is addictive, but they seem, I think, to be more concerned to fend off the possibility of litigation than to be honest in freely informing their consumers about the risks.

  342. Am I right in thinking, and I just have this in the back of my mind from some people we were talking to in America, that with regard to lower-tar cigarettes, the light cigarettes, the medical evidence is now showing that although people believe that by smoking lights, they are in fact enhancing their health prospects, but in fact the illnesses have shifted or different strands have developed, particularly with heart disease, because it is a different product, so in fact it is not safer and it is a myth that if you buy lights, you are actually going to be improving your health prospects? That is correct, is it not?
  (Sir Alexander Macara) That is absolutely correct and it reinforces the point made earlier about the importance of language; that to suggest that something is light means it is not heavy and, therefore, it is not dangerous, and we do have to be aware of this.
  (Dr O'Neill) There are two things here because not only has it not lowered the burden of disease, but it has also changed the distribution of disease, which is the point Professor Britton made a few moments ago.

  343. So do you think that you can take a logical conclusion from that, that all the publicity about the safer cigarette, whether it be by taking out certain elements in cigarettes or by having lights or lower-tar ones, is in fact leading to encouraging some people to smoke or to continue to smoke who would not otherwise have started smoking or who would have tried to stop smoking with the painful withdrawal symptoms that that entails rather than going on to what they believe is a safer cigarette?
  (Sir Alexander Macara) Yes.

  344. So if the answer is yes, do you think then that we should do anything to stop that sort of marketing of cigarettes that creates the impression that they are safer or better for you?
  (Sir Alexander Macara) Yes. In fact we believe that you should stop all advertising and sponsorship and, as part of that, misleading statements. Marketing equates with advertising and sponsorship and we think that it should all be stopped. After all, we do not allow heroin, for example, to be advertised and freely available to the public. There is nothing much we can do to stop cigarettes being available in a free society, and perhaps if we had known what we know about them now when Walter Raleigh brought tobacco across that "damn ditch", as Perry Worsthorne once described it, we would have prohibited its consumption a very long time ago, but we did not.

  345. James I tried.
  (Sir Alexander Macara) Yes, James I did try, but then he was a Scot in England!

  346. It was James VI, I think.
  (Sir Alexander Macara) It was James VI and I.

  Chairman: We are going slightly off beam now.

  347. I just wanted to take us slightly off beam as well because something has just occurred to me, arising out of something you said earlier. Forgive me for asking, but when did you leave the BMA?
  (Sir Alexander Macara) I was Chairman for five years.

  348. When did that finish?
  (Sir Alexander Macara) Seventeen months ago in July 1998.

  349. Do you think, given your experience in that role and your liaison and dealings with the Department of Health, that it is surprising to you that the independent Chief Medical Officer would not have given the Government of the day his advice on, say, for example, making exceptions to Formula One sponsorship?
  (Sir Alexander Macara) One would be speculating of course—

  350. Indeed.
  (Sir Alexander Macara)—but I would be surprised if Sir Kenneth Calman had ever withheld any good advice—

  351. I was thinking more of the current Chief Medical Officer.
  (Sir Alexander Macara) I would again not speculate, except that he was my student.

  352. So you do not know how he operates, his modus operandi?
  (Sir Alexander Macara) Yes. He was a good student and I would expect him to have demonstrated that. The Chief Medical Officers, as I keep emphasising, there are of course four in our devolved kingdom, I would be very surprised if they have not given good advice whether solicited and welcome or not.

  353. Even if they had only been in place for two weeks?
  (Sir Alexander Macara) Or perhaps particularly because they have to establish their position, and their credibility depends upon being seen to give the best advice without any political consideration.

  354. Of course. That is fascinating. Would it then come as a surprise to you that he told me that because he had only been in post for two weeks, he had never given any advice to the Government on Formula One and sponsorship?
  (Sir Alexander Macara) No, it would not surprise me if he had not been given the opportunity or if he had judged perhaps that ministers at that particular time had a great deal more on their minds, and I assume that what I said at the proper opportunity would have been—

  355. I am sorry, but I thought you said a minute or two ago that knowing the man, regardless of whether he was asked or not, he might have given a view.
  (Sir Alexander Macara) Yes, but a CMO, no more than any other civil servant, they are civil servants, cannot very well bully ministers and force them to—

  356. No, but they can give advice surely in that capacity without bullying by carrying on if the advice is not taken.
  (Sir Alexander Macara) I was assuming there would be the appropriate opportunity for them to give advice—

  357. So would I.
  (Sir Alexander Macara)—whether welcome or not.

  358. Chairman, can I help SirAlexander. Would it not be true to say that the Minister that the Chief Medical Officer would have been talking to, the Public Health Minister, was not actually involved in making the decision on Formula One?
  (Sir Alexander Macara) I imagine that so far as Formula One is concerned we all have something of a problem because I think we could all have handled the matter better and the political sensitivities, I think we all understand the political sensitivities, and it is highly unfortunate, but I would take the view that we should go on from that experience to learn that we cannot make exceptions in terms of essential public policy.

  359. I think you will be aware of the comments of this Committee on the Formula One issue, Sir Alexander.
  (Sir Alexander Macara) I can imagine, Chairman.