Published: 14/03/2002, Volume II2, No. 5796 Page 14
Forty years ago the landmark report Smoking and Health hit the press and cigarette sales fell. Five million premature deaths later - but with almost 2 million lives saved since 1962 - how much or little has been achieved? A commemorative booklet tells a tale of government failures and political complacency.
The original Royal College of Physicians document warning of the danger of tobacco-related deaths and disease came out on 7 March 1962. It drew on groundbreaking research by doctors Richard Doll (now Sir Richard) and Austin Bradford Hill. Last week Forty Fatal Years was launched by the college in a joint initiative with anti-tobacco pressure group Action on Smoking and Health.
It combines a fascinating historical overview with a depressing account of how few of the original report's seven recommendations - including a call for a restriction on tobacco advertising - ever saw the light. The updated booklet urges a far-reaching and committed approach to tobacco policy, contained in an open letter to the Treasury health trends team.
In the new report, RCP president Professor Sir George Alberti calls for a smoking-cessation service in every hospital and a longterm commitment to stabilise and expand existing services to meet up to four times the current target of 20,000 ex-smokers a year.
Sir George wants 'proper risk communication on packets' - which is reaping benefits in Canada, where new hard-hitting pictorial warnings cover half the front and back of the package - and continuing use of tax hikes.
In the March 2000 Budget, chancellor Gordon Brown announced that a 5 per cent hike in tobacco tax, worth£300m, would go into the NHS. While the tax revenue from tobacco amounts to over£9bn, Sir George says the 1998 tobacco white paper Smoking Kills voted£37m per year to tobacco policy - 'about 4p in every£10'.
This is not enough of a return to smokers as an investment in their wellbeing, Sir George says.
Forty Fatal Years re-emphasises the baffling reluctance of the government to give guaranteed Commons time to a private member's bill banning tobacco advertising, sponsorship and promotion.
Surely heels are not being dragged, given that a near complete ban on tobacco advertising was a Labour Party manifesto commitment in 1997 and 2001?
Tobacco advertising legislation was left out of the Queen's speech - which 'deeply and openly disappointed' the college.
Gathered on a panel to launch the booklet, ASH director Clive Bates recalled how the government capitulated to Formula One racing chief Bernie Ecclestone opposition to a proposed ban in 1997 and warned that 'we all have to be nervous that someone in Number 10 just doesn't want to deal with tobacco'.He said he thought health secretary Alan Milburn and public health minister Yvette Cooper were 'on side'.
'But there is something not quite right about the tobacco issue as a whole.'
The 'big test' is this month, with Liberal Democrat peer Lord Clement-Jones' private member's bill expected to clear the House of Lords tomorrow. The bill needs a swift move to the Commons if it is to make progress in this parliamentary session, Mr Bates believes. If not, it will indicate 'something quite terrible about the government'.
While there is no evidence of sinister forces at work, HSJ has established that the bill may fail to get a prompt Commons reading.
The official line is that the government supports its aims, 'but it is too early to say if it will have time to be debated'. The government is 'waiting to see what amendments it has when it comes out of the Lords and what pressures of other business are in the Commons'.
Have we experienced a catastrophe or a public health triumph since 1962? Mr Bates avoids conclusions but says the death toll 'continues to mount'. He balances the large fall in the numbers of smokers - 29 per cent of men and 25 per cent of women compared to post-war rates among men of 80 per cent - against the fact that 3 million people are still exposed to passive smoking at work.
He wants 2p in the pound spent on anti-tobacco programmes and believes there should be a hypothecated tax, and a tobacco regulatory authority as recommended by the health select committee in 2000.
HSJ's predecessor Hospital and Social Service Journal covered the parliamentary reaction to the report 40 years ago.Health minister of the time Enoch Powell called it 'an extremely valuable and powerful weapon. . . which the government would be actively supporting'. The minister said 'the government certainly accepted that the report demonstrated authoritatively and crushingly the connection between smoking and lung cancer'.
But as former director of ASH David Pollock shows in the new publication, the 'immediate fruits' of the 1962 report were confined to a£50,000 publicity campaign - about£650,000 in today's money - and the beginnings of cessation clinics. Little seems to have improved. Chair of the RCP's tobacco advisory group Professor John Britton says such clinics are 'still a specialist service available to a tiny minority and they need to move 'to the mainstream'.
Sir George says despite 'some successful legislative measures and government policy initiatives', most improvements have been as a result of the public taking on board public health messages and their own doctors' advice.
So how does Sir Richard Doll - now 89 - assess progress? 'One would have to say disappointing, but on the other hand the fact that so many people have given up smoking is very encouraging.'
His advice on reasons to stop include the intriguing promise that it will improve libido.
His other clear message is: 'It is never too late to give up. Enjoy life and enjoy it for longer - do not smoke.'
Forty Fatal Years www. ash. org. uk/html/policy/ rcp40threport. pdf www. rcplondon. ac. uk/pubs/ books/ash