I move: "That the Bill be now read a Second Time."
I am moving this Bill for the second time. The previous occasion was in 1964. It is the same Bill. May I first say that I should like to express my gratitude to the Deputies who have supported the Bill. I do not believe this is a political issue and for that reason I was anxious that the Bill should preferably be sponsored by Deputies from the three parties because there is a difference of opinion in all three parties, a difference among Deputies about the desirability of introducing a Bill of this kind. However, the difference cuts across party lines. I had hoped to get some of the Fianna Fáil Deputies to support this Bill. For their own reasons, however, which they explained to me, they could not do so although those reasons do not seem as valid now as they were then. Two Fine Gael Deputies, Deputies Cooney and Harte, very kindly agreed to try to give the Bill a non-party character and so far as my own party are concerned I was permitted, rather the same as in the case of the Bill last week, to introduce this Bill on the understanding that it is not a piece of Labour Party legislation. Deputy O'Connell and I have put forward the Bill on our own accord and the Labour Party Deputies will be free to vote on it as they wish.
Some time ago the Minister assured us that steps were being undertaken to deal with the problems of the sale of tobacco. The main purpose of the Bill as set out in (a), (b) and (c) of section 2 is simply to ask that the Minister shall ensure that the manufacturers of cigarettes carry on the labels of containers and in their advertising material a notice to the effect that cigarettes contain substances likely to cause injury to health, and then to specify the deleterious nature and the origin of the substances. In spite of the undertaking given by the Minister it is worthwhile discussing this Bill again because whatever doubts there may have been in 1964 regarding the dangers of the cigarette smoking habit, from the scientific point of view, such doubts have been eliminated completely. I asked a question about this matter first in 1958. The problem was noted first in 1954 when two brilliant London GPs carried out a retrospective study of the deaths of people from lung cancer and, consequently, became interested in the possibility that there might be some link between lung cancer and cigarette smoking. Consequently the interest extended to countries all over the world. Various countries have carried out their own investigations and each confirmed satisfactorily the findings of the others. In nine different countries, 23 different investigations have been carried out and there is no doubt now in anybody's mind as to the serious problems of lung cancer and other diseases that are associated with cigarette smoking.
I wish to make it clear that neither of us who sponsor this Bill is putting forward these proposals lightly or with any intention of gaining satisfaction from depriving people of this simple pleasure and, God knows, there are few enough pleasures available to humanity. The reason for putting forward the proposals is that these people need help. First, they need help in finding out about the seriousness of the cigarette smoking habit and, secondly, the Department of Health must become involved in re-education in order to make it possible for people to give up the habit of smoking. I know this is a difficult task and I understand the Minister's difficulty in relation to revenue. There is a conflict between the revenue from tobacco sales on the one hand and, on the other, the Government's responsibility to inform the public of the dangers of cigarette smoking. Also, from the point of view of the community, cigarette smoking is very costly in the amount of disability and in the number of avoidable deaths that it causes. The Bill distinguishes between cigarette smoking and the smoking of cheroots, cigars, pipe tobacco and snuff because so far as is known these other forms of smoking are not dangerous. It is important that this distinction be emphasised because it may be of help to many people who have found themselves addicted to nicotine and its products to know that they can smoke cheroots, cigars, pipe tobacco or take snuff without subjecting themselves to the dangers associated with cigarette smoking. As one who gave up cigarette smoking some years ago I know how difficult it is for people to do this. Therefore, every possible help should be given to people who are endeavouring to discontinue the habit.
My approach to this whole question is rather different from that of the Minister's. On the whole, I find his approach rather punitive although he is tending to be rather more sympathetic to the problem than was the case in the early days of the drug scare. Whether they are users of heroin, hashish, morphia, cocaine or nicotine who are involved, I do not think we should indulge in any kind of moral judgments in relation to these people. One hears of various punitive proposals, including long terms in prison, and many angry speeches are made by Deputies in all parts of the House about people who are drug dependent—these are the drugs other than nicotine.
I should prefer that our approach should be that these are individuals with emotional problems of varying degrees of severity, and this includes the cigarette smoker. Most people smoke a cigarette when they are in a state of anxiety or emotional stress. They do so because of some defect in their personality for which they are not responsible, and they should not be blamed or punished for this. For instance, the idea of locking up a cigarette smoker for two years or a tobacco manufacturer for 15 years for pushing cigarettes would be an irrational act. I am not going to digress into what one should do in relation to drug control because this is a special and separate problem, but in the general approach to this difficulty that people have in their need for support, whether it be hard drugs, pot, alcohol or cigarettes, society should have sympathy for them and should try to help them rather than have this tendency to hunt and punish them.
During the years a powerful and expensive campaign has been conducted in the Press, on radio and television, in magazines and papers by the cigarette companies. Equally, it has cost an enormous amount of money through the repercussions of people who have become ill as a result of cigarette smoking. Knowing what we know now about the dangers of cigarette smoking, how can society continue to tolerate any kind of incentive to smoke? It would be quite unthinkable to propose the suppression of all cigarette smoking—it just would not work. It did not work when we were at school and now the problem is too big to be dealt with in that kind of authoritarian manner. People have to be persuaded, to be informed and educated into taking the difficult decision themselves.
One of the most interesting things about the effectiveness of this kind of approach is demonstrated in the smoking pattern among doctors. Doctors are not more noble, more independent-minded or mature in their personalities than anyone else; they are exactly the same as the rest of society. It is interesting to note that there has been a dramatic drop in the use of cigarettes by doctors. This has nothing to do with any special qualities the medical profession might have but we have access to the very frightening reality of the individuals who get the diseases which are now widely, and indeed nearly universally, associated with cigarette smoking.
I suppose the main and most horrible and frightening disease is lung cancer. Anyone who has ever seen lung cancer in its terminal stage would find it very difficult to smoke another cigarette. Then, there are the coronary diseases, arteriosclerosis, various blood vessel diseases, now agreed to be associated with cigarette smoking. Dr. Risteárd Mulcahy produced interesting information on this matter in the Irish Medical Association Journal some years ago. There is also the disease of bronchitis which is crippling; it causes difficulty in breathing and acute attacks of respiratory distress during the winter months. Associated with this is the horrible complication of emphysema, which is the destruction of lung tissue; this leaves the person with no facilities with which to breathe. A person with an acute case of emphysema would find it very difficult to walk for any distance without gasping for breath. Those are the three main problems associated with cigarette smoking. The disability and distress which is caused is inestiminable. There is no way of knowing the amount of suffering which results from the continued use of cigarettes.
The Government have a grave moral responsibility in this matter. They cannot ignore the fact that the findings of successive, very distinguished scientific bodies are quite incontrovertible. To me the odd thing is the near hysteria involved in the anti-drug programme at the moment. The Minister is very active in this regard. He disallowed Deputy Byrne's Bill last week because he himself wanted to bring in various stringent proposals, apparently, in relation to the control of drugs, that is, drugs like pot, morphia, cannabis, LSD, or any of the other drugs that he feels are beginning to be used here widely. I agree with the Minister's attempts to control these drugs. Although I do not share his approach to the problem, I know something must be done about it, but how can he impose all these restrictions, prohibitions and all these various penalties in regard to a relatively minor problem like drug addiction and not deal adequately with the enormous universal habit of cigarette smoking which exists among a very high proportion of people? All he appears to be proposing to do is to put a notice on the packet and publish advertisements. I was not very impressed by what the Minister said, but I would hope he would take an opportunity of telling us precisely what would be the content of the notice to be put on the packet and in the advertisement warning people about the cigarette habit.
The Department must be faulted very seriously for its completely dilatory approach to this whole problem. Take a country like the United States which has a very big stake in this industry. In 1964, when the American surgeon general's first report was published, they began to take the matter seriously and I think they were the first, but certainly they were among the first, to insist on the packet containing the notice which the Minister is now thinking of introducing. I was quite astonished at the behaviour of the United States Government at that time. I thought it was particularly enlightened of them to do that in view of the fact that they had a very big financial involvement in the whole tobacco industry. They did it at any rate. Various other countries followed, and then Britain did it recently.
I should like the Minister to tell us whether he has been able to resolve this conflict between his moral responsibility as Minister for Health in a Government which have a financial commitment to the continued popularisation of a very dangerous habit, cigarette smoking, by media other than television. What does he intend to do about it? These unfortunate people who find it very hard to give up cigarette smoking have to combat the wonderfully clever ways in which the advertising industry are able to put across the safeness of the habit. The usual thing is its association with heathy outdoor sports; nothing will happen to you if people like this smoke, so it is all right. Will the Minister allow this to go on? Will there be any further restriction in relation to advertising? Again I refer to the American surgeon general's report. I must ask the forgiveness of the House for dealing with this subject in such detail, but its results to many thousands of people are serious. One of the major conclusions of the report is:
Cigarette smokers tend to die at earlier ages and experience more days of disability than do comparable non-smokers.
This is just non-smokers, not heavy smokers. One of the things that fascinates me about my colleagues, and friends, people whom I do not bother to proselytise about cigarette smoking, is the individual's capacity to rationalise his decision not to give up smoking because he cannot. The obvious one is: "I will die from something or other; people die of lung cancer who do not smoke at all." Another rationalisation is: "I am not a heavy smoker and therefore it does not include me." There are various escape hatches which people use in their attempts to justify their continuation of what they know to be a dangerous and, in fact, a lethal habit. The second conclusion is that:
If it were not for cigarette smoking practically none of the earlier deaths from lung cancer would have occurred.
The third conclusion is:
If it were not for cigarette smoking excessive disability from chronic respiratory and cardio-vascular diseases would be reduced.
That is, angina, coronary, bronchitis and emphysema. The fourth conclusion is that by quitting or significantly reducing their smoking people could delay or avert a substantial portion of deaths which occur from lung cancer and the other diseases.
Part of the conclusions were based on facts they got from a series of deaths which they investigated. The analysis of these figures showed that among smokers 1,329 persons per 100,000 population died from general illnesses of one kind or another; and the death rate for non-smokers was 70 per 100,000 population. The deaths from lung cancer alone were 87 per 100,000 for smokers and 11 for non-smokers. This epidemiological information was confirmed by various animal experiments which I will not bother to go into. They showed that it is possible by painting the products of smoke on to various animals to develop skin cancer of various kinds.
Tobacco smoke contains at least seven known cancer-producing substances. As well as known cancer-producing substances in nicotine and in cigarette smoke there are also other cancer-promoting substances. This is the kind of information which makes it very difficult for anyone who knows about it to continue smoking. The risk of death is 70 per cent higher for men who smoke cigarettes than for men who do not. The risk of death from chronic bronchitis and emphysema is three to 20 times higher. The risk of death from coronary artery disease is 70 per cent higher for smokers than for non-smokers.
We have not got very good figures, I am afraid, in Ireland and I have to use United States figures. I think they can be accepted as being applicable here. An attempt was made to suggest that in some way or another we were different—but I do not think it has ever been substantiated to the satisfaction of anyone—in our reaction to cigarette smoking. It was estimated in the United States that the number of working days lost from cigarette smoking was 77,000,000 each year, that 88,000,000 man-days were spent in bed and that there were 306,000,000 man-days of restricted activity because of the cigarette smoking habit.
There is no doubt that the incidence of lung cancer could be greatly reduced if the general population tried to reduce the smoking habit or eliminate it altogether. Cancer deaths in the United States went from 3,000 in 1930 to 59,000 in 1969. Quite obviously they had a very serious problem and we have much the same problem here. All of these facts were confirmed later on in autopsy findings.
The American report was then supported by the Royal College of Physicians in London. In 1959 they were asked to investigate the problem and in 1962 they reported and confirmed the United States findings. There is very little information here in Ireland, I regret to say, but in 1963 the Journal of the Irish Medical Association, mainly because of the interest of Dr. Risteárd Mulcahy, produced figures. The Minister will probably bring the findings up to date or correct them if they are wrong. The findings I have for lung cancer were: 1925, 56; 1950, 298; 1960, 648; 1962, 697; 1965, 716; 1970, 961. From 298 in 1950 to 961 in 1970. In order to be quite fair one must remember that the diagnostic process since 1951 is reasonably comparable because there has been ready access to X-rays, and so on Before 1956 probably many people who died from lung cancer were not recorded because it was not diagnosed. It is fair to take the 1950 and 1970 figures and show that, in spite of a considerable drop in population, the figure has gone from roughly 300 to 961. Dr. Mulcahy said that the coronary incidence was five times higher in smokers than in non-smokers.
Eventually the Government started to take action. I should be glad to know what detailed action is being taken. The Minister replied to a question by me in May 1970, in regard to the recommendations by the Director General of the World Health Organisation in a report entitled "Limitations on Smoking" submitted to the 23rd World Health Assembly in May, 1970. A number of recommendations were made about health workers giving an example by not smoking, discouraging young people from starting to smoke, demonstrating the ill-effects of smoking, urging action against smoking forming part of all medical and all health care programmes, discouraging cigarette-smoking in hospitals, in clinics, out-patient departments, establishing anti-smoking counselling services in hospitals, encouraging all health workers to refrain from smoking, discouraging smoking in public places and conveyances and giving the maximum publicity to health hazards. It was recommended that the health authorities should collaborate with the education authorities in schools, teacher-training institutions, universities and other educational establishments, that research should be intensified and that consideration should be given to the establishment of statutory upper limits for various constituents of cigarettes.
I wonder what has the Minister done in detail about this. Has he taken any action? The simplistic approach is simply to say to everybody to stop smoking and then prohibit the importation of tobacco. That simply would not work. It could not be thought about seriously. I am not suggesting that at all. The wiser approach is to keep on trying to convey to the people whatever information people like ourselves in the medical profession appear to have obtained from our own experience and from what we have ready or what we have seen, and to try to convey to the people the extreme urgency of the need to take some action.
For a long time the Department adopted the extraordinary policy of telling us it was useless to advertise. When one thinks of the enormously costly, and predominantly wasteful advertising superstructure in our economy, or in any capitalist economy, it seems extraordinarily irrational for a Government Department to say there is no point in advertising, that it has no effect, that it does not reduce the incidence of smoking, and so on. This runs against the experience of all of us in relation to advertising. In relation to most of the propaganda for which I was responsible when in the Department, for things like diphtheria and TB it quite obviously is particularly valuable. Therefore, I could never understand the rationale of that kind of approach to the use of advertisements. The Department, having deserted that position, in recent times have adopted a rather more effective programme. I remember complaining to the Minister that I had not seen any of the new advertisements. I now want to congratulate him on the recent advertisements of various athletes who have been persuaded to go on television to say that they relate their fitness to the fact that they do not smoke cigarettes. The advertisement featuring Tom Kiernan—this is a very important basic point: example is the best way of persuading young people not to smoke— is a very good one. For many years I found this very hard to get across.
The whole process of a child assimilating attitudes, values and standards is by watching the two most admired people in his life—his mother and father. Most lifestyles of a young person growing up are an agglomerate of the mother and the father or the teachers in the school—any person whom a young person admires. We will have to try very hard persuading parents that it is no good telling the child to stop smoking if they smoke. Therefore, the emphasis must be on the obvious. The Department are sending leaflets to schools; they are concentrating on the children. I believe one has to concentrate on the parents because to the child smoking is an adult habit, it is a component of growing up, it is a sign of being like the father, the mother, the people the child admires. It is very important that the Department's advertising be directed to adults to persuade them that they are the most important advertisement a child sees for smoking. If the people smoke, who the child knows do nothing but good, honourable things, then it must be all right to smoke. We feel that children will imitate their parents and we should try to persuade the parents in our advertising campaign that they should give up smoking.
Dr. Flynn of Westmeath produced very interesting figures on this when he showed that 24 per cent of boys and 12 per cent of girls smoked where there were non-smoking parents and 44 per cent of boys and 18 per cent of girls smoked when both parents smoked. His figures of a survey of a school were particularly disturbing and showed that 22 per cent smoked at the age of 11, 23 per cent smoked at 12, 40 per cent at 13 and 48 per cent at 14 years of age. This was a very enterprising investigation carried out by Dr. Flynn which showed the age at which youngsters start smoking.
The Department have at last decided to do something about this advertising. More money is spent on advertising today than ever before. I cannot see why we should spend public money in a counter-advertising programme. Why is the whole process of advertising not eliminated? I am glad to see that the Minister has put an end to it on television, but why not stop the whole advertising process or make them carry the facts about cigarette smoking? I will be interested to hear what the Minister says on this. The Minister's statement that cigarette smoking may constitute a danger to health is a rather anaemic one. Why do we permit any cigarette advertising at all? If we allow it, why do we not insist that the facts should be stated clearly and unequivocally by the advertiser?
Unfortunately, the Bill does not go as far as I would like it to go. I should like to know to what extent the Minister is prepared to put a notice into the advertisements or on to the cartons which would be so convincing that in fact people would not smoke. That is what I would do if I were in the Minister's place. It would, therefore, not be worth the tobacco companies while advertising at all. From what we have seen here and in other countries we can have no doubt whatever that serious remedial action should be taken in regard to this very serious health hazard which affects tens of thousands of our people.
I do not see why we can on the one hand become positively hysterical about the relatively small drug problem in the community and at the same time continue to tolerate this very much more dangerous—certainly as dangerous—and from the point of view of trying to get rid of it as difficult a habit. As long as our people can see advertisements telling them it is all right to smoke, minimising the dangers involved, glossing over the great hazards to health which are inseparable from continued cigarette smoking, the Minister is betraying his trust to the people. His difficulty probably is in relation to revenue, but surely one should offset that against the enormous cost that must be involved to our society if we would only consider the American investigation into man working days lost, disability, reduced activity, death rate and the cost this involves to the community.
We have on the one hand the Minister continuing to get his revenue from taxation on tobacco and on the other a very considerable amount of it spent on dealing with the results on people who smoke cigarettes and who suffer from these terrible, crippling, disabling diseases. From the point of view of the tobacco companies, anything they have done they appear to have done simply because the Minister has insisted they should do something about the problem.
I wish the Minister would try to make up now for the failure of the Department of Health to act in a responsible way since 1964. In this as in nearly everything else we are behind everywhere else in the world and I should like the Minister now to make the sacrifice. There is a sacrifice involved but it is in a good cause.
People who smoke cigarettes tend to ridicule the practice, to underestimate its seriousness, to minimise the appalling consequences which many of them suffer out in isolation in their hospital beds long after anything can be done to help them because by the time they get lung cancer nothing can be done about it. I am glad to see the things the Minister has done, and I welcome them, but a lot more remains to do.
