I was making the point that in proposing that some action of the kind recommended in the Bill be taken by the Minister, I was not proposing anything that was strange or unusual. Already in our legislation we have many precedents for taking action, sometimes action the public might dislike but action which is taken for reasons of health, public security or a better ordering of the society generally.
I need hardly dwell on that but a point made by the Minister earlier on and taken up by a number of people in correspondence was that I appeared to get a certain delight out of restricting individual freedoms. As an individualist myself, nothing could be further from the truth. Anybody who knows me will realise that I should not like to interfere with individual freedom.
Take the licensing laws, for example. Clearly, there are people who would like to drink all night but they are not allowed to do so. This House exists for the passing of laws of one kind or another which restrict a freedom of one kind or another. Cigarettes can be called a drug to some extent. We have restriction on the sale of cocaine, hashish, marijuana, opium: I suppose a certain comparison can reasonably be drawn between the two. They are all restricted by law. No matter how much the public might think they enjoy using these drugs, or how much value they might get out of using these drugs, we do not permit them to use them. We believe that that is in their interests.
To his embarrassment, I praised the Minister for introducing the 1947 Health Act, which contains a section which is relevant at this time. In section 65, the Minister has power to prohibit the advertisement of preparations to which certain regulations refer. The section then goes on to require the printing on the outside of packets or containers in which the preparations are to be sold of the composition of such preparations and the prohibition on the sale of any preparation in a packet or container which has not printed on the outside thereof the preparation. There are other paragraphs dealing in much the same way with undesirable substances or substances which it is desirable that the public should know they are taking in a drug, or in a medicine, or in a toilet preparation or in any other preparation that the Minister decides to lay down as being a preparation that requires this condition that it shall not be advertised without his authority and, if it is advertised, the preparation contained in the packet will be stated on the outside. Therefore, the Minister must accept the completely unexceptional nature of the proposals contained in my Bill now before the House. In fact, the wording is very close to the wording of his own legislation.
The summary conviction for breaking the Minister's law is £500, a fairly stiff fine, if the preparation contains a substance which he is of opinion involves a risk of serious injury to health or body. I think I can show that the free sale and advertisement of cigarettes as at present—the wide promotion of cigarette sales as at present —implies the selling of a substance which involves a serious risk of injury to health or body.
The fact has been noticed in most other countries, believed to be associated to some extent with the improvement in the standard of living, that there has been a widespread increase in cigarette consumption. In our own case, cigarette consumption has gone from 3,400 thousand lbs. in 1926 to 11,000 thousand lbs. in 1963. With it, again noticed in most countries in which the matter has been looked into, have gone deaths from lung cancer. In 1925, the death rate was 56 and by 1962, it had risen to 697, quite a spectacular rise.
Excessive cigarette smoking is a factor attributed to the other disease I mentioned—death from coronary heart disease. The figures are: Deaths from coronary heart disease in 1950, 2,900; in 1962, 4,500—a very spectacular increase in the death rate.
I do not wish to mislead the House by the lung cancer figures. They are dramatic—a rise of from 56 to 697 deaths over 40 years. The better diagnostic services available have made it easier now to diagnose lung cancer than it was at the time the earlier figures were available. Therefore, to some extent, the great increase we now note is due to the much better facilities for diagnosing lung cancer. There is, at the same time, the fact that there has been a proportionate dramatic increase in the number of lung cancers diagnosed compared with a number of other cancers diagnosed. All forms of cancer appear to have increased in their incidence but the rate of lung cancer is disproportionately high. Therefore, to that extent, I think the apparent increase due to better diagnostic facilities can be said to be ruled out.
The real problem, I think, which is facing the Minister is the problem of revenue and that is a problem every country is facing in this matter. I am giving these figures because it was in 1957 that the cancer scare first started, and I think it important that we should deal with these two figures. I would imagine the revenue for 22 years would be astronomical if it were given. That would be unfair because we are only concerned with the change in revenue since the public became aware of the danger of cancer from cigarette smoking. The two figures I have are 1957, £22 million; 1962, £30 million. It is quite an increase, if you take into consideration other factors such as a falling population during a number of these years. It is a considerable increase and even the lowest figure, £22 million, must weigh very heavily with the Minister for Health and his colleague, the Minister for Finance, when they are attempting to deal with this problem. There must be a certain amount of ambivalence in their attitude in bringing about a significant reduction in the incidence of cigarette smoking in the country.
It is important to notice that, in spite of the fact that the Minister for Finance put it forward as his reason for increasing taxation on at least one occasion, it really had no effect at all on the reduction in consumption. The State is very much dependent on the continued existence at a high level of cigarette smoking. The figure usually given is three out of four. Apparently 75 per cent of the people smoke cigarettes so that the incidence is very high indeed and it is unfortunate that the State has a vested interest in the continued existence of this very high rate.
Consideration was first given to this problem following a clever piece of work by two general practitioners. They carried out what is called a retrospective examination of certain death rates in a number of people who died from lung cancer and they found a very definite relationship. It was a crude experiment in its own way but was sufficiently important to worry the British Royal College of Physicians. From the information the two doctors, Doll and Hill, got from their small survey, they became worried and felt there was a reasonable case and believed there might be some association between cigarette smoking and lung cancer. The College of Physicians then established an inquiry into the whole matter. They set up a committee to report on the question of smoking and atmospheric pollution in respect of cancer of the lung and other diseases.
The first time I referred to the matter in the House was in 1958 when I put down a question to the Minister, and he was worried at that stage. His general attitude was that he had drawn the attention of the public to the relationship between cigarette smoking and lung cancer. At that time it was very speculative and certainly not established with any great scientific certitude. I would concede that. Therefore 1956/57 was the beginning and then a series of surveys was carried out by the Americans, Canadians and some of the European countries. In fact, 23 different investigations, in nine countries, were carried out.
I think everybody will agree that the diversity of the inquiries carried out by all these necessarily independent authorities is one of the most striking factors in the minds of the sceptic, should he have any doubt at all as to the reliability of the conclusions arrived at. The conclusions were practically universal in agreement on the dangers to health associated with cigarette smoking. Various scientific tests were carried out which do not concern us here. The simplest one was the fact that they were able to grow skin cancer in laboratory animals from the products of cigarette smoke. That in itself was not absolutely final evidence but it was supporting evidence to all the other statistical inquiries carried out in the most meticulous way by trained scientists with no vested interests whatever except in finding out the truth.
A number of these inquiries carried out in the United States, Britain, the Netherlands and Canada were submitted to various independent authorities in order that they could assess the facts as ascertained by the various scientific tests. The British Medical Research Council, the British Ministry for Health, the National Institute for Health, Canada, the Ministry of Social Affairs and Public Health, Netherlands, the United States study Group, the United States Public Health Services and the World Health Organisation are all absolutely above reproach when it comes to the question of the assessment of facts.
The other compelling factor was the retrospective studies of how a person died from lung cancer, going back through their life and finding out what their cigarette smoking habits were, and, in that way, finding out whether lung cancer resulted from cigarette smoking. The retrospective studies were borne out by prospective studies carried out on people who were asked what their smoking habits were. These people were followed up for a number of years and when they died the prospective studies bore out the findings in the retrospective studies, that those who were heavy smokers increased the likelihood of lung cancer.
Heavy smoking showed the highest rate, moderate smoking the next rate and the non-smoker represented the lowest rate in death from lung cancer. In the non-smoker the chance of dying before the age of 65 was one in six. In the heavy smoker, the chance of dying before the age of 65 was one in three.
There is another way of putting it. If one has a series of cards and one card is marked in a group of cards, a person aged 35 who is a heavy smoker, there is one card in 23, that is one chance in 23 of his dying from lung cancer within the next ten years. In a person aged 35 who is a non-smoker, the chances are one in 90— one marked card in 90 in one case and in the case of the heavy smoker the chance is one in 23—a very considerable increase in the risks of his getting lung cancer. The average male cigarette smoker has nine to ten times the risk of developing lung cancer, and the heavy smoker 20 times the risk of getting lung cancer.
In regard to coronary heart disease, the chief condition which causes excess deaths in cigarette smokers over non-smokers is coronary heart failure. Second place is given to lung cancer. There are other conditions, of course. One of them I mentioned last night, chronic bronchitis, which is also associated with cigarette smoking, is a very disabling disease which costs the State great sums of money. Anybody in medical or hospital practice finds that a very considerable part of one's work, certainly as a physician, is in relation to persons disabled because of bronchitis of one kind or another.
From observation, everybody is satisfied, scientific investigations have proved, that the rate of lung cancer in cigarette smokers is becoming a very serious question. Also, there is the other point that there is a very high incidence of coronary heart failure in relatively young people associated with cigarette smoking. These are disagreeable truths for people who have the cigarette habit, who find it difficult to stop cigarette smoking, but these are all scientifically established truths. It does not rest with the individual person as to whether he will smoke or not: in view of the evidence, it appears that every possible assistance should be given to those who wish to stop smoking. The State should help them to get rid of what I know myself to be a particularly difficult habit to give up, once started.
I am sorry to have to give so many figures. They tend to weary, but they tend also to impress the more intelligent. In regard to cigarette smoking habits in Ireland, Dr. Flynn in County Westmeath carried out investigations and found some interesting facts about the habit. He showed that 24 per cent of boys and 12 per cent of girls started smoking where there were non-smoking parents in the family. The rate for boys and girls where both parents smoked was 44 per cent and 18 per cent respectively—practically double the percentage where the parents both smoked. That is of interest to us later on, when we are dealing with the question of who should be educated and who should be, if possible, prevented from smoking.
It has relevance in so far as cigarette smoking is a social habit, one which young people take up largely for imitative reasons, because they want to feel grown up—the Minister himself concedes that in his little booklet— particularly if the adult is an admired and respected person like the parent should be. The likelihood of young people's smoking is very much greater if the parents in the home tend to smoke.
Dr. Flynn's findings were supported by Dr. Corridan of the Cork Health Authority who found that in his area the rate of smoking was the same as in County Westmeath. He had one interesting figure which, I think, illustrates the cumulative effect of smoking —the way it grows. Incidentally, both doctors found that children started to smoke at the age of seven. At the age of 11, apparently, they are well on their way to becoming habitues. At 11, the rate is 22.3 per cent in Cork, the same as Westmeath. At 12 the percentage is 23, at 13 it is 40 and at 14, 48 per cent—one in every two nearly.
That was a survey of children in 27 schools between the ages of 11 and 14. Another disturbing fact, which is the Minister's worry, is that 78 per cent of the boys and 72 per cent of the girls were aware of the connection between smoking and lung cancer and did not deter them even at that stage. The habit was fairly well established. Both doctors made the same point about trying to do something about the problem. The kernel is parental propaganda because no propaganda aimed at the child will avail against contrary example by the parents. I would extend that to contrary example from adults: so long as adults continue to smoke, I have no doubt we will continue to see children smoking in their turn in this progressive way—20 per cent to 40 or 50 per cent, according to Dr. Corridan.
He says that anti-smoking propaganda must take account of parents no less than children. Again emphasising the danger of smoking, a paper by Dr. Risteárd Mulcahy in 1962 showed that heart failure is five times greater among cigarette smokers than among non-smokers between the ages of 40 and 49 years, a very young age. He points out that the policy of the American Heart Association is to discourage cigarette smoking. That is in respect of one form of heart failure. Another, coronary heart disease, is the subject of a paper based on a survey of 500 patients.
The paper says that a significant number of male patients with heart disease are cigarette smokers, 90 per per cent of them being heavier smokers than are to be found in the average population. It is the same in relation to females. It does not say it is causative but does assert that there is no other reasonable alternative. It adds: "We believe it is a most significant influence in Ireland in causing coronary disease in persons under 60 years", and concludes: "It is likely that without cigarette smoking, disease and the death rate from premature heart disease would decline significantly".
All of these facts are confirmed by all the literature on this subject. The paper I have been citing refers to peripheral heart failure, a disease causing gangrene of the legs and pain, which are never found in non-smokers. I am sorry to delay the House with those figures but this is the first stage in a campaign which, I presume, will go on for a number of years until eventually we succeed in making ashtrays as rare as snuffboxes in this country. It is important to emphasise the case for taking this action. The proposition is serious for the community, for the Minister and for the Government. I have gone to some pains to emphasise that there is a serious need for more comprehensive action than the Minister has already taken. I believe it is wrong that only one side of the case is put continuously to the public.
I have found it difficult to get figures of the amount spent on advertising cigarettes. In Britain it went up from £3.7 million in 1955 to £11 million in 1960 and I would not be surprised if there was a proportionate increase in Ireland. In 1958 the tobacco industry's aggregate expenditure on cigarette advertising in this country was £295,000 and in 1959 it was £323,000. That is five years ago and I am sure that there has been a significant increase since then. The amount spent on television advertising in 1963 was £107,456 and in 1964 it was £150,100. That is on television alone and I suppose that is only a small proportion of the amount expended. That represents, as everybody who reads the papers or looks at television knows, an enormous expenditure on misleading and dishonest advertising. I say "dishonest" because they are suppressing the truth. It is positively amoral that they should continue to sell these things without making any serious attempt to draw public attention to the dangers involved.
I know that the tobacco companies have a huge financial stake in this matter but down through history financial stakes have had to be superseded in the general interest. There was a huge financial stake involved in the anti-slave trade campaign and the opium trade caused wars in its time. Various other limitations have had to be placed on the ambitions of people to make money in the interests of the public.
A case can be made here in this matter of cigarette advertising. We have the continual distortion of the truth, the implication that cigarette smoking is harmless, and that is the only implications one can draw from advertisements such as "Players Please" and all the other stuff they put out, all designed to suppress the truth and cloak the facts. These people know that there is in the public mind a slight and lingering belief that cigarette smoking is allied to ill health and therefore, they do all they can to create the impression that cigarette smoking is healthy, that it is allied to walking through mountains, walking down mountain roads, sailing on the open sea. All such advertisements are designed to damp down the reality working in some minds that cigarette smoking leads to lung cancer.
Most people who smoke have the slightly guilty feeling that they are wrong and so this highly emotive anodyne continues to be administered through the mass media of television and the newspapers. It is unfair to the unfortunate person who is doing his best to give up the habit when all the time he is being told that cigarette smoking is all right. He is confronted with the colossal figure of a man sucking at his cigarette which gives the impression that this man is one of the strongest men in the world and the unfortunate person who is trying to give up smoking is inclined to get the same feeling. The cancer hospital bed and the dreadful operations carried out in the cancer hospitals, which are generally without avail, are never brought to the public attention at all.
Instead this highly intelligent advertising material is poured out by very highly skilled technicians. Probably the finest intellects in the world are absorbed in propagating two of the most sordid habits, in propagandising the beer drinking industry and the tobacco industry. These men bring all their skills and talents into helping to sell cigarettes thereby increasing the incidence of lung cancer amongst members of the public who cannot stop smoking.
I suppose the Minister in time has been one of the best of our propagandists and politicans, one of our most skilled politicians in the various controversies in which he has been involved from time to time. I am certain that he would consider that if a point of view was stated which one believes to be wrong then one must establish what one believes to be the proper point of view. The Minister has always been very careful to say: "No, you are wrong there. This is the truth." The necessity of establishing what he believed to be the right point of view has always been put forward by him and he must know that that is a form of propaganda for such an idea. He knows the necessity of stating one point of view as against another if we are to arrive at the truth.
The Minister made the point in reply to questions of mine: "If it appeared to me that such advertising media could fruitfully be used, I would make use of them". I do not believe that the Minister believes that the effort which has been made to counter cigarette advertising propaganda is a serious effort or that he seriously believes that he has played the part that he would play if he were seriously concerned with this problem. If he is fighting this as a struggle for the establishment of a point of view, then he must know quite well he has made no significant attempt to establish a contrary point of view and that he has allowed the case for the cigarette companies to go virtually by default.
The educational propaganda put out by the Minister's Department is completely light-weight, completely unimpressive and grossly inadequate. I wonder how many Deputies have seen it? They may have seen it in their literature. These two little booklets were put out by the Minister's Department. One is entitled Summary of Surveys of Evidence. It is factual; it does not misrepresent the position. But this little two-page leaflet—not desperately inspiring; indeed the contrary—is meant to counter the £2 million or £3 million constant barrage of propaganda for cigarette smoking which the youngsters have to face all through their days in our society. The Minister cannot seriously suggest that that is the answer to the cigarette manufacturers' case for smoking.
Recently, a correspondent in one of the papers was very critical of the decision by Mr. Callaghan in Britain to stop cigarette advertising on television there. It will be interesting to see what they do, because Mr. Wilson is on record before the election as saying he was in favour of restricting advertising. If what I read is true, it appears they are going to restrict cigarette advertising on television in Great Britain. But it was suggested that this was a typical socialist idea of interfering with the right of adults to make up their own minds. There is no question of that at all. The barrage of the tobacco companies, costing £30 million in England, is directed at the adults, forcing them to make up their minds in a particular direction.
All we suggest is either stop them advertising or counter it with an equally clever barrage in the opposite direction. There is no socialist idea in that. It is merely common-sense. As I said, the Minister would be the first to accept that it was a reasonable proposition for anyone attempting to establish a point of view in the face of the propaganda used by the cigarette manufacturers. The fact that the British have taken this action at a difficult time financially for them should be some encouragement to the Minister, in his own worries, that it is morally justified.
The other spectacular decision was by the United States Surgeon-General, who hopes to implement the suggestion that the cigarette packets will carry a couple of sentences saying these cigarettes may cause cancer of the lung. I made that suggestion to the Minister many years ago. I must say I did not make it seriously. It was a magnificant suggestion, but I did not think it would ever be carried out by anybody. We look forward with great interest to see whether the American Surgeon-General is able to overcome the resistance of the cigarette manufacturers to his suggestion. It is interesting to notice that, while the Minister has got agreement on the joint proposals put forward by his Department and the cigarette manufacturers here, the American Surgeon-General, apparently, is faced with the likelihood of having to go to the Supreme Court on the constitutional rectitude of his decision to insist on the tobacco companies carrying out his propaganda.
It would be very silly of the Minister to spend millions fighting these people. Both sides would be wasting a tremendous amount of money. The simplest thing to do would be to insist that they discontinue their advertisements altogether or carry on the packets this simple truth, that these cigarettes may cause cancer of the lung, and then leave it to the adult, in the light of that information, to decide whether he will smoke or not. Many of them will continue to smoke no matter what is put on the packet, but I think a number of them will be influenced.
That must be the influence that changed the smoking habits of so many members of the medical profession. We are no different at all to anybody else in our liking for cigarettes or any other form of addiction. But it is striking that there has been a continual reduction in the number of doctors who have discontinued smoking. Apparently, the incidence of coronary heart disease among doctors has also begun to decline concomitantly with, apparently, the decline in cigarette smoking.
This is the Minister's little leaflet. I just wish to draw his attention to a couple of matters. It says:
Why do you want to start smoking? Isn't it because smoking seems to be a grown-up thing to do?
That is a perfectly true, intelligent remark. But it does make nonsense of the Minister's proposal to direct his propaganda at the children. As I understand it, his general proposal is to see that children do not start smoking. Clearly, if this is true—I believe it is and the Minister believes it to be true—then the person who has to be stopped smoking is the grown-up, because, according to the Minister's propaganda, as long as it is a grown-up thing to do, the child will smoke. As long as the Minister allows the grown-ups to continue to smoke then, clearly, he will not have any significant influence in stopping youngsters smoking.
The Minister then goes on to talk about the first cigarettes giving them a choking cough and so on. He goes on:
All right; you may say, then why do so many grown-ups smoke? If you ask them, 90 per cent of them will admit that they thought it was the grown-up thing to do.
Continually in his propaganda, the Minister reiterates the point that the child has already established for himself that it is the grown-up thing to do to smoke. He continues to remind the child. I suspect that this leaflet must have been written by persons who were themselves heavy smokers and more anxious to convert people to smoking than to convert them to being against smoking. Certainly, there is this continual reminder to the child that it is grown-up to smoke. That is one of the truths which it would be better to try to counteract rather than remind the child about it.
The leaflet then, incidentally, goes on to call it a drug habit:
They will tell you, too, that once the first nasty effects are overcome (and it takes quite an effort to overcome them) smoking, like any other drug habit, becomes very hard to give up.
That is extraordinary stuff to tell the child. If he has any worries about the unpleasantness of smoking, he is reassured by the Department of Health that if he persists, everything will be all right, because, after a while, it is like any other drug habit: it becomes very hard to give up. So, naturally, the child will persist in acquiring this habit which is very hard to give up.
The Department plods its weary way and talks about the "unpleasant and exhausting cough". That should be frightening but it does not seem to frighten the children because, as we have found out from two separate counties, they start smoking at the age of seven and are fairly well on their way at the age of 11 and one in two is smoking by the age of 14.
The leaflet goes on to say:
If you want to be good at games, for instance, you'll find that most really good athletes don't smoke at all. Then there's the question of cost.
The leaflet goes on to point out that if you start smoking, you will probably find yourself, in a very few years, with a craving that only 40 cigarettes a day will satisfy. That is true but the Department of Health emphasises the seriousness of this cigarette-smoking habit by saying that it does create a craving that only 40 cigarettes a day will satisfy.
I do not see how you can expect to influence children merely by directing propaganda at them and letting the adult addict carry on in his ordinary way of continuing to smoke. I do not know how any self-respecting adult could go, with a cigarette hanging from his lower lip, to a child and tell him: "You had better stop smoking because if you continue to smoke you will get lung cancer, coronary thrombosis, coronary infarct, bronchitis and various other diseases," and go through this list of diseases which the child will get if he smokes. The obvious thing the intelligent child will do is to turn to the adult, to the teacher, the clergyman, the doctor, the politician or the parent and say: "Why not do it yourself? Why do you not give it up yourself? Why did you ever take it up? Is it not a very stupid thing to have done?"
We adults set ourselves up as the final arbiters in everything that is good and desirable: "What shall I eat? What shall I wear? Where shall I go to school? What shall I study for? —the child all the time turning to the adult and the adult expecting this near-idolatry. Having established that kind of conditioned reflex, the acceptance by the child of the parent's point of view on practically every subject under the sun, the parent suddenly comes along and says: "Do not smoke", and then, completely unreasonably, continues to smoke himself. It seems to me it is like expecting some sort of drooling alcoholic to go along to a Father Mathew meeting and expecting him to impress the Pioneers there with the necessity to give up alcohol.
