2. Almost any report on the health risks of smoking begins with a mass of statistics because the statistics in themselves point to the profound impact of tobacco on public health. Some 120,000 people are killed by tobacco each year in Britain alone, according to official figures. The Royal College of Physicians describes cigarette smoking as "the single largest avoidable cause of premature death and disability in Britain" and "the greatest challenge and opportunity for all involved in improving the public health". In the European Union, 15% of all deaths are attributed to smoking, that figure rising to 24% in respect of deaths in middle age (35-69 years). The World Health Organization estimates that tobacco kills one in ten adults worldwide, costing at least four million lives in 1998. As the tobacco epidemic continues its progression from developed to less developed countries it estimates that this proportion will increase to one in six of all deaths, or ten million deaths each year by 2030. On present trends, of the children alive today in the world, 250 million will be killed by tobacco.

6. It was as long ago as 1954 that a health minister, Iain Macleod, disclosed in a written Answer to the House of Commons that it was "established that there is a relationship between smoking and cancer of the lung".

7. It seemed astonishing to us that, almost 50 years after Government recognized the dangers inherent in smoking, tobacco products remained on sale in a remarkably unregulated fashion. In July 1999 we announced our intention to conduct an inquiry into "The Tobacco Industry and the Health Risks of Smoking". Our terms of reference were as follows: "The Committee will examine what action the tobacco industry has taken, and is currently taking, in response to the scientific knowledge of the harmful effects of smoking and the addictive nature of nicotine. It will also assess the role of Government in providing consumer protection."

25. In 1983 the Independent Scientific Committee on Smoking and Health (ISCSH) referred to several reports relating to the health risks of environmental tobacco smoke (ETS). In particular they noted findings that children exposed to tobacco smoke from their parents had an increased risk of respiratory illness and that passive smoking exacerbated symptoms in adults already suffering from coronary and other arterial diseases.

26. The First Report of the Scientific Committee on Tobacco and Health (SCOTH), published in March 1998, offered the most comprehensive analysis to date. It concluded that "exposure to ETS is a cause of lung cancer, and in those with long term exposure, the increased risk is in the order of 20-30%. Exposure to ETS is a cause of ischaemic heart diseases.... Smoking in the presence of infants and children is a cause of serious respiratory illness and asthmatic attacks. Sudden infant death syndrome.... is associated with exposure to ETS. The association is judged to be one of cause and effect".

28. The Royal College of Physicians 1962 and 1971 reports on smoking recognized that smokers might be addicted to nicotine.

33. We believe that the publication of the recent RCP report Nicotine Addiction in Britain should have as much impact on the public health debate on smoking as the seminal studies relating to lung cancer and heart disease of the 1950s and early 1960s. The RCP reviewed an enormous amount of material. For example, they analysed whether nicotine use through smoking met standard diagnostic criteria for addiction, a point we pursued with the companies. They listed the two most widely recognized diagnostic criteria for substance dependence - the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders DSM-IV criteria and the World Health Organization International Classification of Diseases ICD-10 criteria.

[Regulation:]

159. The primary weapon of Government action to reduce smoking has for many years been price. In its memorandum the Department concluded: "it is generally recognized on all sides that the single most effective policy for reducing tobacco consumption is price. Successive governments have therefore regularly raised excise duty on tobacco products as a means of discouraging consumption."

162. Secondly, we believe that if the Government is to make price its main weapon against smoking there needs to be a more explicit recognition that the duty increase is a health-promotion tax. We were surprised that the Department's officials had conducted no systematic analysis of the costs of smoking to society as a whole in the UK. We asked the Department to estimate the social costs of smoking and they arrived at a figure of £2.32 - 2.35 billion per annum to cover fire damage to property, the costs of treating disease caused by passive smoking, the costs of treating smoking related diseases amongst current smokers and invalidity benefit relating to smoking related diseases. The Department admitted this analysis was "patchy".

165. In its memorandum the DoH pointed out to us that "successive governments have also invested in education campaigns warning consumers of the dangers of tobacco products".

191. Consequently we would envisage the creation of a TRA [Tobacco Regulatory Authority] with its own scientists, completely independent of the tobacco companies. When considering its function we should like to stress that we do not believe that the TRA could, for example, seek the elimination of nicotine from cigarettes. Its policies would have to recognize the realities of a global market for tobacco products, where any attempt to exclude nicotine - which would in our view be tantamount to prohibition of cigarettes, in that nicotine is, in the words of the RCP, the "unique selling point" of cigarettes - would be likely to be counter-productive.

194. In a research capacity, the TRA could examine, and offer definitive statements, on the current scientific consensus as to the dangers of smoking, and could examine the most effective ways of persuading people to quit or never to start.

195. Assuming there is a will on the part of Government to tackle nicotine addiction in the very fundamental way that we propose, the question remains where should a TRA be located? One possibility would be for the UK to have its own TRA, in a way analogous to the Food Standards Agency or Medicines Control Agency; another would be for a TRA to be located in Europe, the source of much of what currently passes for tobacco regulation.

198. Turning to the question of how the TRA should operate we think it vital that such a body should be very well resourced to deal with the huge scientific and legal resources of the tobacco companies. We think that a proportion of tobacco duty should be hypothecated to finance the regulatory authority. In oral evidence the DoH told us that, to analyse and understand the technical composition of cigarettes, it relied on a scientific adviser, Professor Frank Fairweather, who worked one day a week, another scientific advisor working two days a week, and Mr Tim Baxter who worked full time.

 

SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS

(a) We very much welcome the Government's firm commitment to action to combat smoking in its White Paper Smoking Kills. We do not, however, regard the targets they have set as sufficiently challenging to justify the Department of Health's rhetoric that it is for the first time tackling smoking seriously. The target trends for adult smoking are no more than would be expected extrapolating from the general trends since the 1970s. We believe that the DoH should set much tougher targets and take such measures as are open to it to achieve those targets (paragraph 19).

(b) The Royal College of Physcians (RCP) drew the following main conclusion: "Cigarette smoking should be understood as a manifestation of nicotine addiction ... the extent to which smokers are addicted to nicotine is comparable with addiction to 'hard' drugs such as heroin and cocaine." We endorse this conclusion, which underlies many of the recommendations in our report and is, we believe, of fundamental importance to policy makers in the UK and elsewhere (paragraph 33).

(f) The current regulation applying to tobacco products is entirely inadequate (paragraph 59). We take the view that if the Government fails to take the sort of direct regulatory action we recommend below as a consequence of its anxiety not to be seen to be 'nannying', it would be failing in its responsibilities (paragraph 61).

(g) We believe that the Department should urgently commission comprehensive research relating to the age at which children start smoking, the reasons they begin, continue and quit smoking, the relationship between pack size and consumption by children, and the sources from which children obtain cigarettes.

(j) We believe it is deplorable that so many local authorities have failed in their responsibilities to deter under age tobacco sales.

(l) The policy failure on youth access to tobacco results from both inadvertent and deliberate law breaking. This was recognized in the White Paper, which promised to draw up an enforcement protocol with local authorities to tackle both issues. We welcome this - the terms of the Children and Young Persons (Protection from Tobacco) Act need to be greatly strengthened - but we feel that the protocol will need to be strongly worded, and backed by both adequate resources and severe penalties for non-compliance, if it is to have any effect. We also note that, despite "lengthy discussions" having taken place, no such protocol has yet been agreed.

(n) One possible way to enhance deterrence, would be to introduce a system of 'negative licensing'. Rather than requiring all retailers to be licensed, this would simply forbid sale by those who have infringed the law. We believe that this would act as a potentially powerful deterrent. It would also be appealingly appropriate in that the punishment would fit the crime - "shopkeepers who sell to children can't be trusted to retail tobacco responsibly, therefore should not be permitted to do it at all". Alternatively, the Department might wish to assess the advantages of introducing a comprehensive licensing system for all retailers of tobacco, which would give consistency with the arrangements for the sale of alcohol (paragraph 76).

(p) The evidence we have reviewed from the advertising agencies leads us to conclude that, once more, voluntary agreements have served the industry well and the public badly. Regulations have been seen as hurdles to be overcome or side-stepped; legislation banning advertising as a challenge, a policy to be systematically undermined by whatever means possible. We recommend that any future regulation of marketing should be statutory, and overseen by an independent and powerful regulatory body which has the consumer's interest at heart, such as the Tobacco Regulatory Authority which we propose below at paragraph 189 (paragraph 88).

(r) Our review of the copious evidence from the advertising agencies, which includes substantial quantities of market research, leads us to conclude that the advertising agencies have connived in promoting tobacco consumption, have shamelessly exploited smoking as an aspirational pursuit in ways which inevitably make it attractive to children, and have attempted to use their creative talents to undermine Government policy and evade regulation.

(t) We share Mr Mosley's view that the EU's tobacco subsidy undermines its anti-tobacco health promotion strategy.

(y) In our view, voluntary agreement on passive smoking cannot yet be said to be really delivering smoke-free environments to all those who want them. The very real improvements of recent years probably owe more to market forces than to any action by Government. Indeed, we believe that market forces will continue to be a significant driver for change in this area. On balance, we accept that in the leisure sector, voluntary codes may offer the best way forward. We would hope, however, that these yield much more effective action on the part of the hospitality sector than has been the case to date.

(aa) We believe that a tobacco regulatory authority such as that we propose below in paragraph 189, with access to high quality scientific advice, would be the appropriate body to advise the Government on the evidence as to the health risks of passive smoking

(gg) We think that the position of the tobacco companies in withholding information on the additives their cigarettes contain is completely untenable. Consumers have a right to know what they are smoking, including the percentage of the product such additives form, and we believe that this information should be available on every packet. We believe the companies should immediately take steps to ensure this is done and that the Secretary of State should introduce measures to make such labelling a mandatory requirement for cigarettes sold or manufactured in the UK (paragraph 158).

(hh) We do not believe it would be appropriate for health policy to be shaped by the activities of criminal gangs. With this in mind we welcome the additional funding the Treasury is providing to boost Customs and Excise in their efforts to secure compliance with the law [in respect of smuggling of tobacco products into the UK] (paragraph 164).

(oo) We believe it is essential that the packet contains clear and effective labelling to the effect that tobacco products are drug-delivery devices creating addiction through nicotine (paragraph 174).

(tt) The final conclusion of the RCP in its Report Nicotine Addiction in Britain was that "an independent expert committee should be established to examine the institutional options for nicotine regulation, and to report to the Secretary of State for Health on the appropriate future regulation of nicotine products and the management and prevention of nicotine addiction in Britain". We concur. It seems to us entirely illogical that treatments for nicotine replacement therapy are subject to stringent regulation whereas the infinitely more deadly tobacco products they are designed to supersede escape any fundamental regulation. So we believe a Tobacco Regulatory Authority (TRA) should be introduced (paragraph 189).

(yy) We regard the current staff resources devoted to tobacco control, especially in the area of scientific knowledge and advice, to be pitifully weak. Irrespective of whether the Secretary of State accepts our recommendation that root and branch reform is needed in terms of a TRA, we would expect to see a major increase in resources, met out of the enormous income the tobacco companies pay in duties to the Treasury (paragraph 199).

(bbb) We welcome the fact that BAT's audit committee will look into this matter [allegations of BAT involvement in smuggling] and we will be calling for its findings when they are available. But this is not enough. The allegations need to be looked at independently and we therefore call on the DTI to investigate them. If they prove to be substantiated, the case for criminal proceedings against BAT should be considered

(ccc) We welcome the Framework Convention proposed by the World Health Organisation and the Government's support for it. However, any success will be dependent on a responsible approach being taken by the tobacco companies. Depressingly, there is little sign of that in the cheap jibes made at the WHO's expense by BAT. To call an organisation committed to improving global health 'zealots' and a 'super-nanny' because of its concern about the 10 million deaths which will be caused by tobacco each year by the late 2020s seems to us bizarre. We hope that the other companies - and, belatedly, BAT - will work constructively with the WHO.

 

Government reply:

the Government agrees with the Select Committee that tobacco products need to be regulated more effectively than at present and that the public should be entitled to more information from the tobacco industry.

(b) The Government supports the RCP’s view that nicotine is an addiction. It believes that the facts are clear: nicotine in tobacco is highly addictive.

(c) Hundreds of people die every year in the UK as a result of high levels of exposure to passive smoke.

(f) We believe that people should have a choice about whether or not to smoke but they should also be properly informed.

(h) The Government strongly supports the use of proof of age cards. It believes that it is ultimately for the producers of age-restricted goods to introduce such cards as it is in their interests to have a card that aids the legal sale of these products. However, as we have done in the past, we will encourage the industries concerned to introduce such cards.

(l) All local authorities should be enforcing the law and monitoring the problem of underage sales and we would encourage them to do so. Whether they are or not will become clear from the annual survey. Enforcement should be seen as a key part of local authorities fulfilling their duties under local Health Improvement Programmes.

(o) The Government does not believe that a system of negative licensing to target retailers who partake in underage sales is necessary.

(bb) The Government believes that there can never be a “safe” cigarette and therefore will continue to encourage smokers to give up the habit.

(gg) The Government agrees that consumers should have more information. Nevertheless, the Government believe there is no such thing as a safe cigarette and will continue to support smokers who want to give up and measures to deter young people from starting smoking. Where it is possible to produce a less toxic cigarette, for example by removing carcinogens, we believe this should be done but stress the need for great caution in claiming a specific product is safer without consensus that there is reliable scientific evidence to support such a claim.

(xx) The Government agrees with the Select Committee that tobacco products need to be regulated more effectively than at present. We believe that much of this regulation will be most effective if it is done at the European level.

(zz) The Government strongly disapproves of the [EU] CAP tobacco regime on health, expenditure and control grounds and continues to press for progressive disengagement from the regime. However, given that eight Member States are tobacco producers, achieving reform of the regime is extremely difficult.

(bbb) The Secretary of State for Trade and Industry has carefully considered the Committee’s call upon his Department to investigate the allegations that British American Tobacco plc (BAT) has been involved in smuggling; the Committee’s report and recommendations; the evidence given to the Committee and other representations made and the Committee’s aim that allegations of criminal activity should either be pursued or BAT vindicated. He has also considered the various powers available to him. The Secretary of State shares the Committee’s concern with regard to the allegations that offences may have been committed. He has therefore decided to conduct an investigation under Section 447 of the Companies Act 1985. Should this uncover material indicating that consideration should be given to the launching of a criminal investigation, the matter would then be referred to the appropriate prosecuting authority.