THE TOBACCO INDUSTRY AND THE
HEALTH RISKS OF SMOKING http://www.parliament.the-stationery-office.co.uk/pa/cm199900/cmselect/cmhealth/27/2709.htm#n54
Nicotine addiction
28. The Royal College of Physicians 1962 and 1971 reports
on smoking recognized that smokers might be addicted to
nicotine.[54] In
Britain more specific research which traced the effects of
nicotine was, according to the RCP, conducted at two locations.
One was the Institute of Psychiatry, where the development of
the blood nicotine assay "helped to establish the role of
nicotine as the major controlling factor in smokers'
regulation of smoke intake".[55]
The second location where such research was being conducted
was within the tobacco industry itself. According to the RCP
the industry was "establishing a sophisticated
understanding of the role of nicotine in smoking behavior".[56]
29. It has taken some time for the implications of the role
of nicotine addiction in smoking to be reflected in public
health policies. The 1980s saw a number of studies analyzing nicotine addictiveness using animal self-administration
studies, as well as neurochemical studies, and analyses of
absorption and dependence and craving and withdrawal. A major
influence on the climate of policy was the publication in 1988
of the US Surgeon General's Report, The health consequences
of smoking, nicotine addiction. The analysis that nicotine
addiction underlay smoking behaviour led to the US Food and
Drug Administration attempting in 1996 to assert jurisdiction
over tobacco products.
30. Normally the FDA regulated drugs which manufacturers
wanted to put on the market, that is to say manufacturers
themselves sought regulation. The cigarette companies, however,
strenuously resisted regulation and mounted a legal challenge
to the FDA. Provision existed in statute to allow the FDA to
take into account the intent of the manufacturer (so
that the FDA merely needed to prove that the cigarette
companies intended to deliver a "pharmacologic effect"
for it to claim jurisdiction over tobacco products).[57]
The FDA felt that this evidence was not clear in 1994 so they
mounted a lengthy investigation into the use of nicotine in
tobacco products. Following this investigation the FDA
concluded that cigarettes "were delivery devices for the
drug nicotine".[58]
31. During their investigations the FDA learnt precisely
how the US cigarette companies had blended tobacco products.
One company's handbook on leaf blending was anonymously
submitted and from that the agency "learned that tobacco
companies used chemical additives to affect the delivery of
nicotine".[59]
The actual blending allowed the companies to achieve fine
tuning over the levels of the nicotine delivered. The former
director of applied research at Philip Morris told the agency
that "product developers and blend and leaf specialists
at Philip Morris were responsible for manipulating and
controlling the design and production of cigarettes in order
to satisfy the customer's need for nicotine".[60]
32. The Supreme Court rejected the FDA's case on 21 March
2000. It determined that the statute setting up the FDA, the
Food Drugs and Cosmetic Act, excluded tobacco which Congress
had sought to control by means of other measures.[61]
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:
Summary of Diagnostic and Statistical Manual of Mental
Disorders, DSM-IV and International Classification of Diseases
ICD-10 criteria for substance dependence.[62]
|
DSM-IV |
ICD-10 |
|
At least 3 of: |
A cluster of behavioural cognitive and
physiological phenomena that develop after repeated
substance use and that typically include: |
|
Substance often taken in larger amounts
or over a longer period than intended |
A strong desire to take the drug |
Persistent desire or unsuccessful
efforts to cut down or control use |
Difficulty controlling use |
A great deal of time spent in
activities necessary to obtain the substance, use the
substance or recover from its effects |
|
Important social, occupational or
recreational activities given up or reduced because of
substance abuse |
A higher priority given to drug use
than to other activities and obligations |
Continued substance use despite
knowledge or having a persistent or recurrent social,
psychological or physical problem that is caused or
exacerbated by the use of the substance |
Persisting in use despite harmful
consequences |
Tolerance: need for markedly increased
amounts of the substance to achieve intoxication or
desired effect or markedly diminished effect with
continued use of the same amount |
Increased tolerance |
Withdrawal: the characteristic
withdrawal syndrome or the same (or a closely related)
substance is taken to relieve or avoid withdrawal
symptoms |
Sometimes, a physical withdrawal state |
|
The RCP concluded that smoking particularly met the
criteria for "difficulty in controlling use" "continued
use despite harmful consequences" "tolerance"
and "withdrawal".[63]
Overall, the 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."[64]
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.
The response of the tobacco companies to
evidence of the health risks of smoking
34. Evidence from internal company memoranda, many of which
have come to light as a result of the Minnesota litigation,
suggests that tobacco companies have been aware of the dangers
of smoking for decades. Mr Martyn Day, a solicitor in the firm
of Leigh, Day and Co., which represented hundreds of claimants
in unsuccessful actions against the tobacco companies between
1992-98 and had access to "hundreds of thousands of pages"[ 65]
of internal tobacco company documents under the discovery
process, suggested "in 1958 Dr Bentley, a leading
research scientist for Imperial, accompanied two other British
tobacco experts on a trip to meet a number of scientists from
the US tobacco industry and other independent experts. In
their report of the meeting to Imperial they said: 'with one
exception ... the individuals whom we met believed that
smoking causes lung cancer'."[66]
The joint memorandum from ASH and the RCN quoted a number of
other examples:
- "the sum total of scientific evidence establishes
beyond reasonable doubt that cigarette smoke is a causal
factor in the rapidly increasing incidence of human epidermoid
cancer of the lung....[this is] a view with which we concur"
(Paul Kotin, a pathologist at the Tobacco Industry Research
Committee, 1957).[67]
- "the results of the research would appear to us to
remove the controversy regarding the causation of the majority
of human lung cancer.... to sum up we are of the opinion that
the Auerbach work proves beyond reasonable doubt the causation
of lung cancer by smoke." (The Research Manager, Gallaher,
1970. In 1998, Gallaher stated that this memorandum was an
initial reaction and that its views were later discounted.).[68]
Reviewing the Minnesota evidence, the World Health
Organization concluded that for decades tobacco companies,
including those in the UK, have "denied or minimized the
overwhelming scientific evidence of the dangerous effects of
tobacco".[69]
35. Little of the evidence we received from the tobacco
companies dwelt on the public statements they had made in the
past as to the health risks of smoking. Mr Martyn Day's
memorandum, however, listed a number of public pronouncements
on this subject made by senior representatives of tobacco
companies since the 1950s:
- "The Tobacco Manufacturers Standing
Committee stated yesterday, after considering the statements
by the Minister of Health and the Medical Research Council,
that it had not been established with any certainty and to
what extent there might be a causal connection between
smoking and cancer of the lung." (The Times, 28 June
1957)[70]
- Dr Wakeham, Vice-President of Philip Morris said:
"You must be trying to get me to admit that smoking
is harmful. Anything can be considered harmful. Apple sauce
is harmful if you get too much of it.
Q I don't think many people are dying from apple sauce.
Dr Wakeham: They're not eating that much. I think that if
the company as a whole believed cigarettes were really
harmful, we would be out of business. We're a very
moralistic company." ("Death in the West",
Thames TV, 1976)[71]
- "letter by Richard Duncan from BAT subsidiary
saying "The company does not believe that cigarette
smoking is harmful to health." (The Sunday Times, 3
May 1990).[72]
36. We sought to establish as accurately as we could the
position of the major companies operating in the UK on the
dangers of active and passive smoking and on the degree and
nature of nicotine's addictiveness as delivered via cigarettes.
The companies' stance was generally to 'recognize' the
evidence, without tending to comment on it. For example,
"Gallaher recognises that starting... in the 1950s, the
quantity and quality of the statistical evidence reporting the
association between cigarette smoking and lung cancer have
increased. For many years, Gallaher has proceeded on the
assumption that cigarette smokers are more likely to contract
lung cancer and other diseases such as chronic bronchitis,
heart disease and other vascular diseases than non-smokers".[73]
In oral evidence, Mr Peter Wilson, Executive Chairman of
Gallaher, said "we understand and accept that there is a
general agreement amongst most people today, particularly the
medical and scientific community, that smoking can be
dangerous and can cause a number of diseases. I am not going
to begin to argue with that ...".[74]
Similarly Philip Morris in its memorandum said that it "
recognizes, for example, that epidemiological studies have
concluded that the incidence of lung cancer among smokers is
many times greater than among non-smokers".[75]
37. Following the oral evidence session we submitted a
number of detailed written questions to the companies to
establish for the record their current public position on the
health risks of smoking and the addictiveness of nicotine. The
responses of the companies are summarized in the table below:
(a) Does smoking cause
lung cancer - "cause"meaning that smoking is
an activity that results in there being more lung
cancer deaths than there would otherwise be - other
things being equal? |
BAT |
"Yes" |
Gallaher |
"the strength of the statistical
evidence is sufficient to conclude that it is
substantially more probable than not" and it is
"likely that as a result of smoking there are
more ... deaths than there would otherwise be" |
Imperial |
"Smoking may be a cause of lung
cancer, cardiovascular disease and respiratory disease"
and "Imperial does not know whether or not there
would be fewer deaths from these diseases in the
absence of cigarette smoking" |
RJ Reynolds |
"Yes, based on the interpretation
of the evidence by the public health authorities.
Other factors ... may also be required to develop
these diseases" |
Philip Morris |
"There is an overwhelming medical
and scientific consensus that cigarette causes lung
cancer, heart disease, emphysema and other serious
diseases in smokers ... smokers are far more likely to
develop serious diseases, like lung cancer, than
non-smokers" |
(b) Do you agree that
smoking causes lung cancer beyond all reasonable doubt? |
BAT |
"In populations, yes" |
Gallaher |
"It is generally accepted that
smoking is neither a necessary ... nor a sufficient
... cause of disease and that causal conclusions in
this regard are a matter of judgement... As such, it
would as yet be going too far to say that causation
has been proved beyond all reasonable doubt" |
Imperial |
"We do not agree that smoking
causes [these] ... diseases beyond all reasonable
doubt" |
RJ Reynolds |
"No - nobody knows what causes
these diseases beyond all reasonable doubt" |
Philip Morris |
"There is an overwhelming medical
and scientific consensus that cigarette causes lung
cancer, heart disease, emphysema and other serious
diseases in smokers ... smokers are far more likely to
develop serious diseases, like lung cancer, than
non-smokers" |
(c) Does smoking cause
heart and circulation disease - "cause" meaning
that smoking is an activity that results in there
being more heart and circulation disease related
deaths than there would otherwise be - other things
being equal? |
BAT |
"Yes" |
Gallaher |
"the statistical evidence shows
that smoking is a risk factor for some heart and
circulation diseases ... the statistical evidence
relating to smoking and these diseases is sufficiently
strong to conclude that smoking can and does cause or
contribute to the incidence of these diseases and that
it is clearly likely that, as a result of smoking
there are more deaths from these diseases than there
would otherwise be..." |
Imperial |
"Smoking may be a cause of lung
cancer, cardiovascular disease and respiratory disease"
and "Imperial does not know whether or not there
would be fewer deaths from these diseases in the
absence of cigarette smoking" |
RJ Reynolds |
"Yes, based on the interpretation
of the evidence by the public health authorities.
Other factors ... may also be required to develop
these diseases" |
Philip Morris |
"There is an overwhelming medical
and scientific consensus that cigarette causes lung
cancer, heart disease, emphysema and other serious
diseases in smokers ... smokers are far more likely to
develop serious diseases, like lung cancer, than
non-smokers" |
(d) Do you agree that
smoking causes heart and circulation disease beyond
all reasonable doubt? |
BAT |
"[Notwithstanding
certain complexities] in populations, yes" |
Gallaher |
"It is generally accepted that
smoking is neither a necessary ... nor a sufficient
... cause of disease and that causal conclusions in
this regard are a matter of judgment ... As such, it
would as yet be going too far to say that causation
has been proved beyond all reasonable doubt" |
Imperial |
"We do not agree that smoking
causes [these] ... diseases beyond all reasonable
doubt" |
RJ Reynolds |
"No - nobody knows what causes
these diseases beyond all reasonable doubt" |
Philip Morris |
"There is an overwhelming medical
and scientific consensus that cigarette causes lung
cancer, heart disease, emphysema and other serious
diseases in smokers ... smokers are far more likely to
develop serious diseases, like lung cancer, than
non-smokers" |
(e) Does smoking cause
respiratory illnesses such as emphysema -
"cause" meaning that smoking is an activity
that results in there being more respiratory illness
deaths than there would otherwise be - other things
being equal? |
BAT |
"Yes" |
Gallaher |
"the statistical evidence shows
smoking to be a risk factor for respiratory diseases
... it is clearly likely that, as a result of smoking
there are more respiratory illness-related deaths than
there would otherwise be ..." |
Imperial |
"Smoking may be a cause of lung
cancer, cardiovascular disease and respiratory disease"
and "Imperial does not know whether or not there
would be fewer deaths from these diseases in the
absence of cigarette smoking" |
RJ Reynolds |
"Yes, based on the interpretation
of the evidence by the public health authorities.
Other factors ... may also be required to develop
these diseases" |
Philip Morris |
"There is an overwhelming medical
and scientific consensus that cigarette causes lung
cancer, heart disease, emphysema and other serious
diseases in smokers ... smokers are far more likely to
develop serious diseases, like lung cancer, than
non-smokers" |
(f) Do you agree that
smoking causes respiratory illnesses beyond all
reasonable doubt? |
BAT |
"In populations, yes" |
Gallaher |
"It is generally accepted that
smoking is neither a necessary ... nor a sufficient
... cause of disease and that causal conclusions in
this regard are a matter of judgement. ... As such, it
would as yet be going too far to say that causation
has been proved beyond all reasonable doubt" |
Imperial |
"We do not agree that smoking
causes [these] ... diseases beyond all reasonable
doubt" |
RJ Reynolds |
"No - nobody knows what causes
these diseases beyond all reasonable doubt" |
Philip Morris |
"There is an overwhelming medical
and scientific consensus that cigarette causes lung
cancer, heart disease, emphysema and other serious
diseases in smokers ... smokers are far more likely to
develop serious diseases, like lung cancer, than
non-smokers" |
(g) Does your company
believe that nicotine is addictive by reference to
each of these criteria: DSM-IV and ICD 10? |
BAT |
"The question seems to
misunderstand the purpose of DSM-IV and the manner by
which criteria are set out in DSM-IV. This manual does
not set out to define criteria for judging whether a
particular substance is addictive (or more accurately
capable of producing dependence). Rather it provides
standardised diagnostic criteria to assist clinicians
in determining whether a person has a particular
disorder ... We think that it is reasonable that,
under these criteria, some smokers would be classified
as being dependent on nicotine" |
Gallaher |
"DSM-IV is not rigid in its
definition of 'substance dependence' ... [it] cautions
against categorical use of the term 'dependence'
noting, for example, that 'the diagnosis of Substance
Dependence requires obtaining a detailed history from
the individual' ... the diagnostic criteria for
substance dependence in DSM-IV ... may be applied to
certain individuals to support a finding of nicotine
dependence ... The specific diagnostic criteria ...
are not meant to be used in a cook book fashion ... as
such smoking may or may not be assessed as supporting
a finding of nicotine dependence ... ICD-10
categorises the use of both caffeine and tobacco,
amongst other substances, as capable of leading to
unspecified mental and behavioural disorders ... as
such smoking may or may not be assessed as supporting
a finding of nicotine dependence..." |
Imperial |
"We agree that nicotine could be
regarded as addictive by reference to DSM-IV and ICD
10 but this does not mean that smokers are unable to
stop smoking if they choose to do so" |
RJ Reynolds |
"Yes- nicotine can be
seen as 'addictive' if what is meant by this is that
it is capable of creating some of the dependence and
withdrawal symptoms that are described in DSM IV and
ICD 10" |
Philip Morris |
"We believe that it is important
that smokers and non-smokers ... hear a single
consistent message on the issue of smoking and
addiction and we will not engage in a debate over the
message provided by the public health authorities on
this issue ... we will not debate the application of
the criteria ... to smoking. As we stated in our
submission ...cigarette smoking is addictive as that
term is most commonly used today."[76] |
38. The responses to our questions accurately reflected the
positions taken during the evidence session. Gallaher, Philip
Morris, BAT and R J Reynolds all either directly acknowledged
that smoking caused serious diseases, or acknowledged that
there was a consensus amongst public health bodies that this
was the case.[77] In
stark contrast, Mr Gareth Davis of Imperial refused to accept
directly any of the evidence, nor did he appear to think it
was his role to evaluate this evidence. He told us: "I do
not think that we can say that it [smoking] is safe or unsafe
... we do not know whether it is safe or unsafe".[78]
He added that "we do not agree that smoking has been
shown to be a cause [of certain diseases]".[79]
We discuss below our response to Imperial's position.
39. In its memorandum Imperial told us that, together with
the Tobacco Manufacturers Study Committee / Tobacco Research
Council, it "consulted and took advice from leading
scientists on the direction of research carried out and the
interpretation of the results of the research".[80]
A list of distinguished scientists was supplied: Sir Charles
Dodds, President of the RCP Committee of Air Pollution, Sir
Ronald Fisher, Professor of Genetics at Cambridge University,
Sir John Richardson, President of the Royal Society of
Medicine, Lord Todd, Professor of Organic Chemistry at
Cambridge University, Professors Sir Alexander Haddow, R D
Passey and E Boyland of the Chester Beatty Institute of Cancer
Research at the Royal Cancer Hospital London, Professors Sir
Ernest Kennaway and J W S Blacklock of St Bartholomew's
Hospital, Dr C M Fletcher, co-author of the 1962 RCP report on
Smoking and Health, and Dr J W Cook of the MRC Carcinogenic
Substances Research Unit, University of Exeter.
40. We asked Imperial to supply us with the written
interchanges between the company and these scientists.[81]
We felt that the implication of Imperial drawing our attention
to the advice they received from eminent medical authorities
was that this advice had governed their conduct in assessing
the health risks of smoking. The resulting dossier they
submitted was extremely unconvincing. In the case of several
scientists there was either no correspondence at all (Sir
Ronald Fisher; Lord Todd; Sir Ernest Kennaway; J W Blacklock)
or nothing which touched on matters of substance ((Dr W
Carruthers and Dr J W Cook). From Sir Charles Dodd there were
a mere three pages covering the period 1952-72. The bulk of
the material comprised exchanges between Charles Fletcher and
Geoffrey Todd of the Tobacco Research Council and related to
research the TRC was funding in Professor Fletcher's
laboratory. There is nothing here to suggest that Imperial was
seriously seeking his views and advice; instead the
correspondence generally deals merely with the administration
of grants for research. In many cases the evidence is
incomplete with only one side of the correspondence surviving.
There are occasional indications that, if more of the
correspondence survived, more would be known of the companies'
actual understanding of the health risks of smoking. For
example, Charles Fletcher describes a discussion with Geoffrey
Todd thus: "The evidence you told me about certainly
suggests that nicotine is the basis of cigarette addiction".
In 1964 E Boyland suggested "greater efforts should be
made to detect ... nitrosamines in cigarette smoke". Yet
only recently have processes to remove nitrosamines been
developed. Overall, however, the package of materials supplied
is patchy and fails to give documentary support to the idea
that these scientists were a source of valued advice on
matters relating to the company's stance on smoking and health.
Some of the deficiencies may be attributable to the passage of
time, but the general lack of material in which Imperial
either seeks or receives advice suggests that this may never
have been a high priority.
41. We also sought the views of the five companies on the
health risks of environmental tobacco smoke. Mr Wilson of
Gallaher rejected the findings of SCOTH that, amongst other
things, ETS caused lung cancer and heart disease.[82]
In written evidence BAT told us that they believed that
"the claim that ETS presents a health hazard is not
supported by the science".[83]
They argued that most studies of ETS have not shown any
statistically significant increase in risk. In respect of
dangers to children they noted "a number of reports of
statistically significant increased risk of respiratory
disorders in pre-school children exposed to ETS".[84]
Here they contended that the increased risks may be due to
other factors statistically more common in households with
smokers such as diet and housing conditions. They went on to
suggest that the pattern of increased risk is "not
consistently replicated" in children of school age
indicating that any real effects are short-lived. They
concluded "it is right that parents and other adults be
particularly sensitive to the needs of young children,
especially infants, for a clean, comfortable environment. It
makes sense not to smoke around infants, especially in poorly
ventilated environments and not to smoke around young children
for long periods".[85]
42. We found BAT's analysis of the epidemiology of
environmental tobacco smoke largely unpersuasive. If they
believe that no increased risk arises from passive smoking it
is unclear why they thought it "makes sense" not to
smoke around children for long periods. The word they - and Mr
Wilson of Gallaher and Simon Clark of FOREST - used to
describe the effect of ETS on non-smokers was "annoying".[86]
We asked Mr Wilson whether he would define an asthmatic attack,
which the SCOTH report considered could be triggered by ETS,
as merely "annoying".[87]
He replied that he accepted that ETS was "annoying, can
cause this kind of unpleasantness but not lung cancer, heart
disease etc." Bearing in mind that asthma causes 1,400
death per year,[88]
we do not regard asthma attacks as merely unpleasant and
believe that policy goals related to ETS must take account of
the real health risks it poses.
43. We also questioned Mr David Davies of Philip Morris
about the activities of his company in respect of the debate
on ETS. We specifically asked him to explain the function of
Operation Whitecoat and to indicate the role of the late
Professor Roger Perry of Imperial College in his capacity as
an advisor to the Environment Committee on its 1991 inquiry
into indoor air quality, which included a substantial section
on environmental tobacco smoke. Mr David Davies told us that
Operation Whitecoat was "the name given to activities in
which we engaged in the late eighties and early nineties which
were designed to solicit the support of those who shared our
views in relation to environmental tobacco smoke and indoor
air quality". Mr Davies revealed that Professor Perry was
associated with the tobacco industry from the late 1980s and
"subsequently became affiliated directly with Philip
Morris". Mr Davies assured us that Professor Perry's
affiliation with the industry and with Philip Morris was
"very well known".[89]
44. We wrote to Mr David Davies requesting further evidence
that Professor Perry's contract with Philip Morris had been
notified to the Environment Committee. In response they
submitted a newspaper cutting from 1988 which noted that
Professor Perry had conducted research on indoor air quality
funded initially by the Tobacco Advisory Council and later by
Philip Morris and a New Scientist article which, based on
documents released as a result of the Minnesota litigation,
suggested that Philip Morris "secretly recruited
influential people to help allay fears about the health risks
from passive smoking". This article also cited the former
Clerk to the Environment Committee as acknowledging that the
Committee members "knew Perry had done research for the
tobacco industry"; according to the article, the Clerk
went on to add "he cannot recall Perry mentioning that he
had any deeper relationship with Philip Morris".[90]
We went back to the then Clerk of the Environment Committee
who confirmed that, as far as he was aware, the Committee had
known that Professor Perry had conducted research in the past
for the tobacco industry but had not been told of his other
contracts with Philip Morris, although he acknowledged that
Professor Perry "may have mentioned the fact that he had
a general retainer from Philip Morris to the then Chairman,
Sir Hugh Rossi MP".[91]
45. The issue of ETS is crucially important for the tobacco
companies. The central strand of their defence of their
activities is that smoking is a matter of free and informed
adult choice. If dangers are found to attach to other people's
smoke, and if non-smokers such as young children in a smoker's
house are unable to avoid that smoke, those non-smokers are
not exercising free choice at all. The extent of nicotine's
addictiveness is similarly crucial. Mr Martyn Day told us that,
in law, "if you get an individual case ... there is a big
debate about whether someone voluntarily accepts the risk that
they are pursuing - it is a legal argument called volente
- part of the legal case would be that you cannot voluntarily
accept a risk if you are addicted to the substance you have
been using".[92]
Similarly, ASH/RCN noted: "To recognize publicly the
evidence for pharmacological nicotine addiction would ...
undermine the assertion that smokers choose to do so as a
matter of 'free will'. Without the 'free will' argument, a key
part of the industry's defences in product liability
litigation would be destroyed".[93]
They draw attention to the startling image of seven Chief
Executive Officers of US tobacco companies each testifying on
oath during the 1994 US Congressional Hearings before the
sub-committee on Health and the Environment of the Committee
on Energy and Commerce that, in their view, nicotine was not
addictive.[94]
46. In evidence in July 1999 before the Irish Joint
Committee on Health and Children, Mr Ian Birks, Head of
Corporate Affairs at Gallaher, told members:
"The confusion in the debate is when we get to the use
of the word addiction because it is an emotive word. It is a
word which tends to get used in many different ways. A
couple of weeks ago I was driving to work and I heard on the
radio that 10 million Americans are addicted to the
internet. We know of people who are addicted to soap operas,
tea, coffee, cream cakes, chips etc. The difficulty is that
when the word is used broadly to describe all kinds of
behavioural habits, then clearly smoking is a habit. It can
be a strong habit for some people, but we reject the fact
that people are addicted to smoking and cannot stop smoking
because they can and do."[95]
47. In written evidence Gallaher drew attention to the fact
that, whereas the US Surgeon General's report of 1964
characterised smoking as "an habituation rather than an
addiction", in 1988 he concluded that cigarettes and
other forms of tobacco were addicting.[96]
The conclusion that Gallaher came to was that "the
meaning of addiction has been given such a wide interpretation
in today's society that it can encompass almost any type of
behaviour, including smoking".[97]
Mr Broughton of BAT similarly referred to the two definitions
produced by the US Surgeon General. He contended that efforts
by manufacturers to alter the nicotine:tar ratio so that
smokers got more nicotine with reduced tar had not satisfied
their consumers.[98]
Nicotine he described as having a "mild"
pharmacological effect "on a par with caffeine".[99]
In its written memorandum BAT argued that "people say
they are addicted to particular foods, using the internet,
taking exercise, watching certain television programmes, or
even to working".[100]
48. We asked Mr Broughton to expand on why his company had
included such comparisons. He told us that "What the
memorandum is trying to do is to say that we can get bogged
down in semantics. There is a real danger that the current
popular definition of addiction can be used for all sorts of
things and not differentiate sufficiently between them. It
does cover things like the internet. I think it is quite wrong
to cover that ...".[101]
But in his opening remarks to us, Mr Broughton demonstrated
exactly why precision is essential in discriminating between
habits and pharmacological addiction: "Let us just accept
for the sake of moving forward that the popular understanding
today is that smoking is addictive. Nevertheless our customers
are not fools nor helpless addicts ...".[102]
In our view, Mr Broughton's statement here shows just how
dangerous and misleading the semantic vagueness which he
purportedly decries can be: having indicated his unhappiness
with the vagueness of the term "addiction" he then
glibly exploits it. His confident assertion that his customers
are not "helpless addicts" only makes sense if the
addictiveness of smoking "in the popular understanding,"
which he apparently accepts, excludes pharmacological
dependence.
54 Nicotine
Addiction in Britain, 2000, p.90. Back
55 ibid.,
p.90. Back
56 ibid.,
p.91. Back
57 David A Kessler et
al., "The Food and Drug Administration's Regulation
of Tobacco Products", The New England Journal of
Medicine, 1996:335, p.988. Back
58 ibid.,
p.991. Back
59 ibid.,
p.990. Back
60 ibid.,
p.990. Back
61 The Times,
22.3.00. The text of the judgment can be found at
www.cornell.edu/supct. Back
62 Nicotine
Addiction in Britain, p.85. Back
63 Nicotine
Addiction in Britain, pp.86-87. Back
64 Nicotine
Addiction in Britain, p.183. Back
65 Ev., p.80. Back
66 Ev., p.90. Back
67 Ev., p.61. Back
68 Ev., pp.61-62. Back
69 Ev., p.97. Back
70 Ev., p.89. Back
71 Ev., p.90. Back
72 Ev., p.90. Back
73 Ev., p.170. Back
74 Q391. Back
75 Ev., p.228. Back
76 Information in
the tables is sourced from Ev., pp.340-41, 356-57, 358, 359,
360. Back
77 See QQ388-435
and QQ462-69 passim. Back
78 QQ397-98. Back
79 Q418. Back
80 Ev., p.207. Back
81 TB13F (not
published). Back
82 Q581. Back
83 Ev., p.159. Back
84 Ev., p.160. Back
85 Ev., p.160. Back
86 Ev., p.159;
Q614. Back
87 Report of the
Scientific Committee on Tobacco and Health, 1998,
pp.31-32. Back
88 ONS Mortality
Statistics 1998. Figures are for England and Wales. Back
89 Q1067. Back
90 New Scientist,
16.5.98, p.4 (cited Ev., p.634). Back
91 Ev., p.630. Back
92 Q1198. Back
93 Ev., p.62. Back
94 Ev., p.62. Back
95 The Houses of
the Oireachtas Joint Committee on Health and Children, Minutes
of Evidence relating to Smoking and Health, November 1999,
p.35. Back
96 Ev., p.184. Back
97 Ev., p.184. Back
98 Q550. Back
99 Q573. In its
written evidence BAT described the pharmacological effects of
nicotine as "milder than ... coffee". See Ev.,
p.153. Back
100 Ev., p.153. Back
101 Q575. Back
102 Q388. Back
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