Sub-Committee on Health and Smoking

The sub-committee met at 9.30 a.m.

DEPUTY BATT O'KEEFFE IN THE CHAIR.

Chairman: Ladies and gentleman, the Sub-committee on Health and Smoking is now in public session. This sub-committee was established on 24 January this year by order of the Joint Committee on Health and Children to consider such matters as it may think fit arising from the report of the Joint Committee on Health and Children entitled "A National Anti-Smoking Strategy", a report on smoking and health. Specifically, this committee will inquire into the general health effects of smoking, including consideration of the level of knowledge within the Irish tobacco industry through research or otherwise of the safety of tobacco products and the health dangers posed by them to consumers or third parties, the issue of nicotine addiction and an assessment of the level of knowledge within the Irish tobacco industry through research or otherwise of the addictive qualities of nicotine, the steps being taken by the Department of Health and Children and the Irish tobacco industry to advise consumers and third parties of the dangers of smoking, the prevalence of smoking and smoking related illnesses among children and adults and the cost to the State and private health insurers of the treatment of smoking related illnesses. We'll also inquire into the problem of underage smoking, including consideration of the influence on underage smoking of the marketing and promotion activities of the Irish tobacco industry, the positive steps being taken by the Department of Health and Children and the Irish tobacco industry to eliminate underage smoking. We'll review oral evidence given by the Irish tobacco industry to the joint committee on previous occasions in the light of subsequent revelations in the course of litigation in the United States and we'll consider what future health policy legislation, initiatives and programmes which could be implemented by the Oireachtas and the Department of Health and Children in order to eliminate underage smoking, substantially reduce adult smoking and protect the public from environmental tobacco smoke.

Today's meeting is the first of four scheduled meetings when evidence will be heard from a cross-section of interested parties and while witnesses have agreed to appear voluntarily before this sub-committee evidence is being heard under oath under the provisions of the Oireachtas Witness Oaths Act, 1924. I'd like now to welcome Dr. Fenton Howell who's appearing before us in his capacity as Chairman of ASH Ireland. Dr. Howell, please stand and take an oath of affirmation.

Dr. Fenton Howell was sworn in by the Clerk to the sub-committee.

Chairman: Dr. Howell will make an opening statement which we hope will be about 15 minutes, which will be followed by questions from the Members present. Before we begin I'd like to advise the witness that while Members of this sub-committee enjoy absolute privilege, this will not apply to witnesses appearing before us. I'd also like to bring to the attention of the witness and Members the fact that under the provisions of section 10 of the Committee of the Houses of the Oireachtas (Compellability, Privilege and Immunities of Witnesses) Act, 1997, certain rights are granted to persons who are identified in the course of the committee's proceedings. These rights include the right to give evidence, the right to produce or send documents to the committee, the right to appear before the committee either in person or through a representative, the right to make a written or oral submission, the right to request the committee to direct the attendance of witnesses and the production of documents and the right to cross-examine witnesses. For the most part these rights may only be exercised with the consent of the committee. Persons being invited before the committee are made aware of these rights and any persons identified in the course of proceedings who are not present may have to be made aware of these rights and provided with a transcript of the relevant part of the committee's proceedings if the committee considers it appropriate in the interests of justice. So, notwithstanding this provision in the legislation, I should remind Members of the long standing parliamentary practice to the effect that Members should not comment on, criticise or make charges against a person outside the House or an official, either by name or in such a way as to make him or her identifiable. I now invite Dr. Howell to make his opening statement.

Dr. Howell: Thanks very much Chairman. I think I understand all that fairly well. I apologise in advance if I take a fit of coughing, it is not a smoker's cough. It's a nasty viral thing I've had for the last few days but it'll go away. By way of introduction my name is Dr. Fenton Howell and I'm the chairman of ASH Ireland and treasurer of the European Network on Smoking Prevention. In my day job I'm a specialist in public health medicine with the North Eastern Health Board, I hold a part-time lecture position in the Department of Community Health and General Practice in Trinity College and I also hold fellowships in the Faculty of Public Health Medicine and the Royal College of Physicians of Ireland.

I note from the documentation sent to me the various issues that the sub-committee hopes to cover and I hope that I'll touch most of these issues today. If we begin by looking at the general health effects of smoking I believe that the sub-committee itself is well versed from previous presentations to them and from their own readings as to the burden that tobacco places on society. It is well known that tobacco kills somewhere between 6,500 and 7,000 Irish adults every year and those calculations are very much on the conservative side. In addition citizens in this state suffer substantial sickness for quite a long period of time before they eventually succumb to the harm that is caused by tobacco products.

Overall smoking has a devastating effect on our health services and recent documents from the Department of Health and Children, such as the 1994 Health Strategy, the Report on Health Promotion, the Cancer Report, the Cardiovascular Report and the Chief Medical Officer's Report on the Health Status of the Population all point to the importance of tobacco to our low level of life expectancy in this country. The prevalence of smoking among the adult population is at approximately 31%. The latest figures available to us are from the SLAN survey which was carried out in 1998. Figures for children smoking were also established in 1998 and these show that between 35% and 40% of children are smoking by the time they reach their 18th birthday. Both reports show that there has been no significant perceptible shift in smoking prevalence over the past five to ten years.

It is unfortunate that there are not more up-to-date figures for the sub-committee to consider and indeed this is an issue that one might return to later, the collection of data on smoking prevalence so that we can adequately monitor the effects of various campaigns which seek to reduce smoking prevalence. The types of campaigns that have been developed by the Department of Health and Children are outlined in the report "Ireland, A Smoke-Free Zone" which was produced by the report of the Tobacco Free Policy Review Group in 2000, some months after your own committee's excellent report - "A National Anti-Smoking Strategy". That report outlined the various programmes that have been put in place over a period of time. The fact that we have seen no significant drop in the prevalence of smoking over the last number of years would suggest that on their own these initiatives are not having the desired effect. However, in the absence of these programmes perhaps we might have seen an even more significant rise in the figures and I think we need to keep that in mind.

Having dealt with the numbers who smoke and the consequences of that smoking I now want to turn to another important issue. Why do people smoke? Whilst there are many reasons individuals might start to smoke, key among them is the marketing of tobacco. We also need to bear in mind that most people begin to smoke before their 18th birthday. However, what is very clear and of much greater importance is why people continue to smoke. The evidence is now overwhelming that it is the addictive nature of nicotine that has people continually smoking. When one examines the evidence from the tobacco industry to the Oireachtas joint committee in the past it is clear that they are not in agreement that nicotine is addictive. In truth their position is untenable in this regard. Indeed, if the sub-committee wishes to examine the issue of nicotine addiction in some detail I commend to them a report "Nicotine Addiction in Britain - A Report of the Tobacco Advisory Group of the Royal College of Physicians" which was produced in the year 2000. That advisory group examined all issues relating to nicotine addiction and concluded the following: "Nicotine obtained from cigarettes meets all the standard criteria used to find a drug of dependence or addiction. Nicotine is highly addictive to a degree similar or in some respects exceeding addiction to hard drugs such as heroin or cocaine". This is an important point and one we should not lose sight of. Most smokers do no smoke as a choice but because they are addicted to nicotine. All of us who ever smoked or those of us who are lucky enough not to have been addicted but have friends who are addicted know the reality of that statement for our family and friends. Addiction to nicotine is established in most smokers during the teenage years, in many cases before reaching the age at which it is even legal to buy cigarettes. Teenagers who smoke one or more cigarettes per day demonstrate evidence of addiction similar to that seen in addicted adults but addiction can be evident at lower levels of smoking. Addiction to nicotine is usually established in young smokers within about a year of first experimenting with cigarettes. Only a small proportion of smokers, approximately 5%, do not appear to be addicted to nicotine. They are the lucky ones.

The trouble is that it is not possible to identify who they might be before it's too late. Once addicted most smokers are unable to give up even if they develop diseases caused by smoking and made worse by continuing smoking, and this was brought home to me in the starkest of manners when I was a junior hospital doctor in St. Vincent's Hospital here in Dublin. I will never forget walking into a ward as an intern where there were six male patients who had four legs between them. All of them had lost their other leg because of their smoking and yet every one of them was still smoking in that ward at 6 o'clock in the morning. It was quite remarkable. This is how strong the addiction can be. Only about 2% of smokers succeed in giving up in any one year despite the fact that at any time some 7% of them express a desire to quit in the next six months or so.

Given the addictive nature of nicotine and the harmfulness of the delivery systems, cigarettes, cigars, pipes, it is remarkable that we have allowed such products to go so unregulated in such a manner for so long. It is not beyond the bounds of possibility that we could all be called before a tribunal of inquiry in the future to account for our actions in this area. I think it is interesting to note that the tobacco industry in their previous submission to the Oireachtas joint committee sought to undermine the science on nicotine addiction by suggesting that in these days everything is addictive - the Internet, chocolate and coffee, they said. They also argue that nicotine could not be addictive since people successfully quit. Both these statements are nothing more than red herrings and must be seen to be so. They are a most feeble attempt to justify their actions. To equate the harm caused by tobacco to the Internet, chocolate and coffee is an insult to our intelligence. Without nicotine there is nothing to sustain smoking. That is what sustains people smoking.

Since I'm talking about the tobacco industry I also note that in their previous submission to the Oireachtas joint committee the industry indicated that they were always willing to work with Government and they regularly say this. I think that the behaviour of the tobacco industry when requested by the Minister for Health and Children to provide details of the constituents of tobacco products on a brand basis speaks for itself. They objected to providing this information at every step of the way and when they finally did provide this information to the Minister they had the audacity to tell him that it was confidential information and that he shouldn't give it to anybody else. That's co-operation for you.

A further indication of the industry's contempt for the law was the involvement of P. J. Carroll Ltd. in their sponsorship with the UCD Law Society Ball at which they were making available free cigarettes for distribution to students, which is against the law. One also needs to question the role of the tobacco industry or their agents in the refurbishment of practically every tobacco retail outlet in the country whereby cigarettes and cigarette advertisements are prominently displayed and indeed the question needs to be asked if they are in breach of section 18 of the 1991 Statutory Instrument which states that a person shall not give financial or other inducements in consideration of being allowed to advertise a tobacco product at a point of retail sale.

Further evidence of the tobacco industry's contempt for the position of the Minister for Health and Children in regulating tobacco products was their plea to the Minister for Finance in their last pre-budget submission for him to bring his influence to bear on the Minister for Health and Children in modifying proposed legislation on tobacco control. Indeed, it is also noteworthy in that submission that they have displayed not only their contempt for Government but also for their customers. In that pre- budget submission they argued very strongly that there should be a moratorium put on increases in the price of tobacco products because they felt that their customers had suffered disproportionately in the previous budget yet within a few months of the budget, which unfortunately saw no increase in the price of tobacco products, the tobacco industry themselves raised the price of cigarettes to cover increases, as they say, in manufacturing and distribution costs. I suppose one should not be surprised at their lack of concern for their customers given that they are quite happy to market such a lethal product to all and sundry.

As I understand it, a key issue for the sub-committee is a wish to come to grips with levels of knowledge within the tobacco industry concerning both the health effects of tobacco products and indeed their whole advertising strategy campaigns. I note that it is proposed to call in the principal office holders of the three Irish based tobacco companies. Might I suggest that the sub-committee consider extending greatly the list of individuals involved with the tobacco industry that they should question? It is very obvious from the last appearance of the tobacco industry's senior management to the Oireachtas joint committee that they were well versed in portraying a well-rehearsed tobacco industry line. Perhaps the sub-committee would consider calling not only the principal office holders but they should include the chairpersons of the various board of directors and directors themselves of the tobacco companies so as to understand from them how the tobacco industry operates in this country. Indeed it is a matter of concern that there is almost a secret veil thrown over those who actually benefit from the tobacco industry in Ireland. ASH Ireland believes that the public has a right to know who the boards of directors are and what their views are on tobacco related issues and indeed, that such a trawl should go back over a period of 20-30 years.

The sub-committee might also consider calling in tobacco industry lobbyists in order to ascertain their view and role in promoting the tobacco industry and their products. The sub-committee may remember that on my previous appearance before the Oireachtas joint committee under a different guise, I was able to bring forward information which showed the involvement of Mr. Flor O'Mahony with the Consultative Committee on Smoking in the Workplace. It is my opinion that Mr. O'Mahony, when he was called before the Oireachtas joint committee, was less than candid in his reply to the committee and perhaps now that evidence is being sought under oath he may be more forthcoming in his replies. Since then I am sure the sub-committee members will have noted that Ms Kathy Sheridan from The Irish Times wrote an extensive piece concerning the involvement of Mr. Brendan Halligan as a senior secret tobacco lobbyist, I think a copy is enclosed in what was given out. It is interesting to note that he has refused to comment about his role in lobbying for the tobacco industry.

ASH Ireland finds it quite disturbing that at a time when Mr. Halligan, who appears to have been a prominent tobacco lobbyist working against Government policy which is to reduce the prevalence of smoking in this country, at the same time and in another guise as Chairman of the Institute of European Affairs he was in receipt of substantial Government funds. Given his pre-eminent role as a tobacco lobbyist and his failure to disclose to journalists what that role was, perhaps he might be a bit more forthcoming to this sub-committee and more helpful in outlining how the tobacco industry operates.

ASH Ireland also notes that the committee is anxious to understand the role of the tobacco industry in marketing its product, particularly to children. This point was of particular concern to a similar health committee of the UK Government which also carried out an investigation of the tobacco industry there. Rather than rely on the tobacco industry's own interpretation of how they marketed tobacco products, the House of Commons Health Committee obtained access to the internal documents of the industry's advertising agencies. On receipt of these, they asked the Centre for Tobacco Control Research at the University of Strathclyde to analyse these documents and to prepare a report for the committee. What followed was the report "Keep Smiling -- No One is Going to Die", a copy of which I have made available to the sub-committee.

In the foreword, David Hinchliffe, MP stated that the report made shocking reading. It showed how powerful and cynical marketing campaigns have been used by the tobacco industry to encourage people to start and continue smoking. Every possible channel of communication is pressed to the cause, from conventional advertising and sports sponsorship to the Internet and innovative shop displays. Other aspects of marketing such as the pack, pricing and pack design are used at every opportunity to enhance the appeal of smoking. Vulnerable groups such as the young and the poor are favoured targets. He concluded that voluntary agreements and government health policy were treated with equal contempt. Given the ownership of the tobacco industry in Ireland, one would hardly expect anything different to emerge. ASH Ireland would urge the sub-committee to seek from the tobacco industry's marketing and promotional campaigns information which might help the committee. Indeed, ASH Ireland would also urge the sub-committee to investigate whether the tobacco industry or their agents, either directly or indirectly, have been involved in organisational promotional trips for media figures, especially to Formula One Grand Prix events. One would also suggest the need to investigate whether favourable terms are offered to RTÉ, either directly or indirectly, in their televising of Formula One Grand Prix - probably the most important advertising venture for the tobacco industry, both in Ireland and elsewhere.

I also include for the committee's information a report on the role of the tobacco industry and youth smoking, which was compiled by the Cancer Research Campaign in the UK and our sister organisation, ASH UK. It is called "Danger - PR in the Playground - Tobacco Industry's Initiatives on Youth Smoking. The report was compiled from previously confidential internal documents which the tobacco industry was forced to release as part of the litigation in the USA. The report shows how the industry is trying to buy respectability by supporting youth anti-smoking campaigns, stressing that smoking is for adults only. The report concludes, using evidence from the tobacco industry documents, that the tobacco companies have conceived and publicised youth prevention programmes to forestall serious regulation and garner better PR, rather than reduce sales and the number of potential customers.

The industry's focus on youth prevention programmes invariably strengthens the definition of tobacco use as an adult activity. Prohibitive measures, promoted by the industry, aimed at youth, enhance the image of cigarettes as a forbidden fruit and enhance smoking as a rebellious activity. A major motivation for teen smoking is the aspiration to adulthood - rebellion and rejection of parental values. The position of tobacco as adult and forbidden is, therefore, a thinly concealed pitch to aspirational and rebellious youth.

The published literature on youth prevention suggests that these measures are generally ineffective unless they are embedded in a comprehensive programme including advertising bans, taxation, adult cessation, restriction on smoking at work and in public places - all aimed at reducing overall smoking rates. The published literature on the types of youth prevention strategies favoured by the tobacco industry - age restriction, ID cards, age-rated warning, retailer schemes - suggest that they are always ineffective. This is especially so because the tobacco companies never advocate embedding their youth initiatives in comprehensive programmes.

Tobacco companies advocate the involvement of parents, teachers, health officials and other figures of adult authority in anti-smoking activity, but use heroic aspirational role models such as racing drivers, actors and rock stars in promoting tobacco. The measures that are known to be effective in reducing smoking - taxation, advertising bans, high-quality anti-tobacco advertising -- are either ignored or actively resisted by tobacco companies.

Evidence from internal documents of tobacco companies suggests that the youth market is essential for the long-term viability of their business and success with starters is highly valued in brand management. They have failed to establish any credible evidence base to support their programmes and have either paid no heed to the evidence of what actually works, or they have actually disputed it. Another important issue that was discussed by the Oireachtas joint committee was the issue of passive smoking and environmental tobacco smoke. In their submission to the Oireachtas joint committee the tobacco industry implied that there was no evidence to support the fact that passive smoking was a health hazard. One should not be too surprised that they would take this position given that they have denied the effects of direct smoking for many years despite having their own evidence to the contrary. Evidence of health impact of passive smoking has been building up over the past two decades. More recently further major reviews on passive smoking have been published. These include studies by the UK Government appointed Scientific Committee on Tobacco and Health, a World Health Organisation consultation report on Environmental Tobacco Smoke and Child Health and a report by the California Environmental Protection Agency which identified passive smoking as a risk factor for low birth rate, cot death, in children middle ear infection, asthma, bronchitis and pneumonia, for adults, heart disease, stroke, lung cancer and nasal cancer. I would also identify the link between passive smoking and spontaneous abortion, adverse impacts on learning and behavioural development in children, meningococcal infection in children, cancers and leukaemia in children, exacerbation of asthma, and cystic fibrosis and increased lung cancer, decreased lung function and cervical cancer.

It is abundantly clear that passive smoking is a significant health hazard and needs to be dealt with as a matter of urgency and that public health needs to be protected by way of legislation rather than by some loose voluntary arrangements which have failed to work in the past. A recent report from WHO Europe outlines in some detail the way forward in how the issue of passive smoking or environmental tobacco smoke needs to be dealt with. Some of their key recommendations include public health policy and action should aim at the elimination of environmental tobacco smoke pollution by creating smoke free environments for everyone. This goal should be achieved through a combined programme of legislation and education. Legislation is necessary to create smoke-free workplaces and public places, including restaurants, educational institutions, day care centres and hospitals. Educational and promotional campaigns should be implemented to facilitate compliance with legislation and also to encourage smoke free homes. Laws and regulations are essential to provide protection against involuntary smoking. Voluntary arrangements are not sufficient, for such legal instruments to be effective they should have viable means of enforcement, be supported through educational and promotional programmes and be equipped with appropriate sanctions for non-compliance. Since there is no evidence for a safe exposure level, legislation limited to ventilation design and standards cannot achieve smoke free workplaces and public places. The tobacco industry should be required to disclose the names of people and organisations to which it provides both direct and indirect funding and support. In the Irish context there is evidence the tobacco industry was actively involved with the Vintners' Federation of Ireland in promoting the concept of ventilation as a means of reducing exposure to environmental tobacco smoke to avoid the threat of legislation in the hospitality industry.

Legal action should be taken, using existing laws, to protect non-smokers and to require smoke free environments. This action should be encouraged, to use existing laws and legal systems to protect the rights of non-smokers most effectively. Employers, health professionals, teachers, occupational health and safety professionals, trade union leaders, policy makers, the media, the hospitality industry and other opinion formers should be informed of the benefits of the need for a smoke free environment. Legislators, policy makers and the public should be educated about misinformation campaigns by the industry.

At the end of the day environmental tobacco smoke is our number one indoor air pollutant. If I choose not to smoke, then I think I have the right to continue that policy wherever I am. Employers and Governments around the world should take note of the recent successful action by an employee in Australia which found the pub owner liable for the employee's cancer of the larynx attributed to the effects of passive smoke from customers. This is an international benchmark case with massive implications. No statement on tobacco related issues would be complete without the mention of the role of price and how important the public health tool price is in encouraging current smokers to quit, helping ex-smokers to stay smoke free and more importantly in preventing young people from becoming smokers in the first instance.

The previous Oireachtas joint committee recognised the important role of price and made recommendations about sustained price rises and the need to exclude tobacco products from the Consumer Price Index so that it would be possible to raise tobacco prices without contributing to inflation. Obviously the last budget was a major disappointment in that a public health opportunity was lost by not increasing the price of products as outlined in the committee's report, which was accepted by all parties in the Oireachtas. Given the pre-eminent position of price and tobacco control, ASH Ireland would urge the sub-committee to do all in its power to see that significant price rises occur in the next budget. Indeed the inclusion of tobacco products in the CPI is a matter of grave concern. Whilst one can accept the historical reasons as to why tobacco products were included in the CPI, given our current knowledge on the addictive nature of tobacco, it is perverse that tobacco products should be maintained within the CPI.

While a lot of emphasis is placed on the need to stop young people from becoming addicted to tobacco products, we must never forget that there are many thousands of addicted smokers who are trying to quit.

ASH Ireland is delighted that recommendation from many bodies, including the Oireachtas Joint Committee, were taken on board with respect to making smoking cessation products available, free of charge, to smokers who hold medical cards. But should we stop there? Should not all smokers who wish to quit be supported by the State, in an effort to become smoke-free? In addition, there is a need to ensure that non-prescription aids such as nicotine replacement products are as readily available as tobacco products and not limited to pharmacies.

Finally, there is a need to recognise that if we are to make any significant inroads to consider the problem of smoking in this country, we will need to develop campaigns that are comprehensive, well-funded, and are sustained over time. We also need to recognise that where there have been major successes in dealing with the tobacco problem, that success was achieved by properly resourcing the issue. In Massachusetts, where adult smoking prevalence is now well below 20%, they spend some $7 per person per annum, on their programme, of which 30% goes to well organising research media campaigns. In the Irish context that would mean that we would be resourcing tobacco control activities to the tune of about £25 million per annum, a tiny proportion of the amount of money that is collected from tobacco taxes.

In conclusion, I suggest that this committee take the following action in the course of its work: I think we should insist on the appearance before this committee of the tobacco industry principal officers, but more importantly the chairpersons and boards of directors, and the directors, their lobbyists and their marketing and advertisement companies, so that a truer picture might emerge as to the nature of the tobacco business in this country. In addition, I would advise this committee to make the following recommendations to the Oireachtas: that there is a need to bring forward without further delay the much awaited and promised comprehensive legislative package on tobacco control; that this legislation incorporate the previous recommendations of the Oireachtas Joint Committee and the recommendations from the Tobacco Free Policy Review Group; that such legislation recognises that vending machines which cannot be fully supervised be banned; that the age of which one can buy tobacco products be raised to 18 years; that the age at which one can sell tobacco products be not less than 18 years; that tobacco products be sold below the counter; and that all advertising, sponsorship, promotion and patronage, direct and indirect, by the tobacco industry cease; that strong legislative provision is made for banning smoking, in all work places and public places, especially in places of public entertainment - and that includes pubs and restaurants - so that exposure to ETS is avoided; that tobacco control and cessation programmes and research initiatives are adequately financed so that they have a chance of success; that consideration be given by Government to take legal action against the tobacco industry in order to recoup the high cost of treating tobacco related illnesses; that the Houses of the Oireachtas continue to support and lead the way in Europe on introducing tough tobacco control directives which can further protect public health in the region; that the Houses of the Oireachtas push for a strong and meaningful treaty from the World Health Organisation Framework Convention on Tobacco Control negotiations; that we use this opportunity to do something meaningful about tobacco control in this country, so that we can start to put an end to the misery that is inflicted upon our citizens from tobacco.

ASH Ireland wishes the sub-committee well in its deliberations and is happy to assist in whatever way it can. Thank you for your time and patience.

Chairman: Thank you very much, Dr. Howell, for a very forthright and incisive presentation, we now go on to questions. Are you suggesting that between the media and the tobacco industry, inducements are available to the industry, in order to co-operate with them in the promotion of their products?

Dr. Howell: I suggest that over the years, many senior people in the print media in particular, would have been brought on trips abroad to Formula One Grand Prix events, and we need to know who paid for those. Does the industry have a direct and indirect involvement in those? I wouldn't be at all surprised if they probably stopped since advertising is now no longer allowed but I suggest that there is certainly a need to look at how they influenced or whether they brought influence to bear, on the media. I would suggest, because I did carry out a survey some years ago where I looked at - it was quite an interesting study - the contents of five years of women's magazines produced in this country and I read five years of women's magazines. In those magazines there were several hundred tobacco ads and in not one of them - out of, I think it was 634 full page ads - and we all know the attribution at the bottom, whether smoking causes cancer or whatever. There are eight that you can choose from. One of them is: "Smoking when pregnant harms your baby". That never appeared in the 694 ads in women's magazines. Funnily enough, I don't believe that's a coincidence.

Chairman: Have you any evidence to back your suggestion that RTÉ is getting extremely favourable terms from the agents of the tobacco industry in terms of televising Formula One Grand Prix programmes?

Dr. Howell: RTÉ is a small company in many respects in the sports world yet we have incredible coverage of Formula One. It has to be incredibly expensive to send two or three reporters and full crews to every country in the world to report on Formula One on a fortnightly basis. There is an hour long programme before the actual race starts, never mind the race itself, and one would wonder what price they pay for that and is it on a par with other sporting events because I think for the industry it's most important, they use it as their most important international means of advertising and it's in their interests that it's beamed into all of our homes.

Chairman: Do you deny the right of individuals who hold positions such as those you mentioned to act as consultants for the tobacco industry? Do you think that they would be in a position to act in an independent way and still continue to serve the State in other areas?

Dr. Howell: I don't deny anybody the right to work for the tobacco industry but what I do expect is that we should know about it. I think what we have seen in the past is there is almost a secret veil about tobacco lobbying in the same ways that I will lobby against it - I do it up front and openly and everybody knows who I am, what I stand for and what I believe. I don't go behind doors and I don't try to use influence and stay secret about it. I think that in an issue like this if there is lobbying going on among Government or towards politicians or figures of authority the public have a right to know who those people are. I certainly don't deny their right to do it. I think people have a living to make and they chose how they might do that. I think lobbying, in fact, is a very honourable activity as long as it's up front and open, when it's not then it's worrying.

Deputy G. Mitchell: There are two points I wish to raise at the outset. As regards people who are taking the oath, they should take the Bible in their hand and take the oath unless they are not Christians or have an objection. I don't direct this at Dr. Howell but there will be other witnesses.

Chairman: There were particular reasons in relation to Dr. Howell. That was his choice.

Deputy G. Mitchell: We should ask people to take the oath unless they have a reason for not doing so in the normal way. We should confine contributions to 15 minutes otherwise people will make long speeches and we will not be able to ask questions. The lectern should be removed so that barristers will not come in here and make long speeches for them. We need to take that in hand.

Who comprise ASH? In relation to addiction, we saw the tobacco industry going before a committee of the US Congress taking the oath and saying that nicotine is not addictive. Clearly there is evidence to show that nicotine is addictive. Who knew that? Surely some research has been done by ASH and others to see if people who actually pushed these products knew them to be addictive? What can you say about that? As regards young people, what worked in Massachusetts in persuading people to stop? You mentioned the spend there but was there anything else? You mentioned the EU efforts at the World Health Organisation. Is there some disagreement in the European Union on a common position at the WHO? What do you know about that? I'd like you to expand on how legislation can deal with passive smoking. I object to going into a pub where other people are smoking but I don't know how to deal with it.

Lastly are there any benefits in smoking? Are there people who, if they didn't smoke, would die from other causes? Are there people who, if they didn't smoke would have very bad nervous problems, for example? What do you say? We must in our considerations and deliberations try to raise all the issues. Are there any benefits in smoking? If we abolish smoking altogether would some people's lives fall apart for example?

Dr. Howell: ASH is a voluntary organisation established jointly in 1991 by the Cancer Society and the Heart Foundation and it has a Board of Directors which include myself, Tom Hudson, a former Chief Executive of the Irish Cancer Society, the Chief Executives of both the Cancer Society and the Heart Foundation, Gladys Ruddoc who is a former school principal and there is a legal person as well whose name totally escapes me at the moment. It's a totally voluntary body and gets all its funding from the Heart Foundation and the Cancer Society. So they're our parent and we work for those. What worked for young people in Massachusetts? The elements of the campaign were its comprehensiveness, that's what worked. The fact that all elements were tackled together but in many respects their main protagonists would have said that they spend wisely. They spent 30% of the money on sustained media campaigns that get to children, that are market researched properly.

Now, if you look at Florida as well they have done things like the truth campaign where they use the media to try to show young people what the industry is actually about, that in fact they're fooling them, that they're setting up this whole imagery of tobacco being wonderful, cool, sexy when in fact it the complete reverse and they try to, I suppose, use that rebelliousness of youth and that environmental concern of youth to show that the industry is really major multinationals laughing all the way to the bank. It is also issues about supporting cessation, it's about supporting adults, it's about enforcing sales. In some parts of the States, as you probably know, here is just no way you would be sold alcohol and tobacco unless you have your own proper ID. It just doesn't happen. Recently President Bush's daughter was pulled up for buying alcohol below the legal age. Can you think of that happening in this country? You know, it's how people address issues. Another major issue is how they enforce non-smoking in public places. You try to reduce adult smoking and I think that is the big key for youth smoking. We have to recognise that youths smoke to be like adults so what we have to do is to reduce the prevalence of adult smoking if we're going to have a significant impact on youth smoking. And it's a long-term spend that they've put in a lot of money in all the comprehensive parts of the campaign. You know education is only one part of it.

I don't accept that there are any benefits from smoking. The only tension and stress that tobacco and nicotine relieves is the tension and stress caused by withdrawal from nicotine. That's what, you know people always say "oh I needed that fag". What they needed was to replace the nicotine levels that have fallen. That's what it relieves and anybody who is addicted will know that. There are no benefits to it. This society would be incredibly better off if we didn't have tobacco and indeed if tobacco products came on the market for the first time tomorrow or were suggested for the first time they wouldn't get past first base. There's been a lot of controversy among the EU member states about legislation. The initial directive that Padraic Flynn promoted on advertising was eventually passed by a qualified majority but it was strongly resisted by Germany in particular and Austria.

Deputy G. Mitchell: In relation to the World Heath Organisation is the redivision in the EU in relation to this?

Dr. Howell: Well the EU, this is on the Framework Convention Treaty. The EU has decided that they will speak with one voice so the Presidency and the Commission speak on behalf of the member states. So the divisions that have always existed still exist. Ireland strongly supports complete advertising bans. Germany and Austria don't. Luxembourg doesn't. So there are those tensions within the Council which need to be addressed and from that point of view they do exist. They must be overcome and one would find it regrettable if we had to sign a convention Treaty that we didn't actually fully believe in and felt it could be stronger. However, that's politics in many respects and it is up to ..... connotations in different countries to overcome those issues. Legislation on passive smoking is quite important because I think the problem is that we are still treating environmental tobacco smoke as something akin to a bit of a nuisance rather than a serious significant cause of ill health. We have absolutely no problem in introducing legislation that will ban asbestos in buildings. None at all. No one would think twice about it.

If somebody came in today and said that there was asbestos here we would be out the door as quickly as you would think about it. You wouldn't think twice about it. Yet environmental tobacco smoke is much more dangerous as an indoor air pollutant than asbestos. We need to address two issues. We certainly need to educate people in general that this isn't some little bit of a nuisance. The issue is about environmental protection and protecting the health of workers. We should not be exposed to tobacco smoking in pubs and restaurants although some people would say well you have a choice to go in or out. Well I don't really accept that but it's an argument you could make. However, it's an argument you can't make for people who work in those institutions. That case in Australia, is the first in the world where a woman, a non-smoker, worked in a pub and developed cancer of the larynx. It was attributed by a judge, having looked at all the evidence, to passive smoking, she was awarded damages for it and it has thrown the hospitality industry in Australia absolutely in a spin because what they see coming down the road is that more and more people are recognising that their health problems are caused by their working environment and that they are entitled to be protected from it. The evidence is now so strong that people can no longer use it as a defence and say they did not know that passive smoking is harmful.

We must take positive action to protect people from environmental tobacco smoke rather than allow the courts to foist that upon us. I know pubs in this town have put in incredibly expensive ventilation systems but they do not work because ventilation systems in general recirculate the air. They recirculate the actual harmful cause in products and to remove tobacco smoke entirely probably requires such a rate of air exchange that most of them won't turn it on because it sucks out all the heating and it then becomes incredibly expensive to heat buildings if you use ventilation systems which would have to be to outdoor air and without recirculation. It is a problem but I think we have to start tackling it and give leadership on it by not dodging it and by facing it up front and saying "look this is a reality". And let's be honest, we have legislation at the moment that was enacted by the Oireachtas which says that 50% of seats in restaurants are supposed to be smoke-free. Now I don't know what restaurants you go into but I know that in the ones I go into it's not very clear that that's happening. I have never seen anybody prosecuted for that so we also need to enforce legislation.

What's emerging from all the papers that have come out and that the industry was forced to bring out is that they knew about the nature of nicotine addiction way before anybody else. The ASHs of the world are people like me and a few others here, there and everywhere who have no money to carry out the science in this. In fact, there are very few laboratories worldwide that can actually deal with this issue in a serious manner.

In probably the last five to ten years, neurophysiologists have done a lot of work, -- often on shoestring budgets, on meagre research campaigns -- looking at the whole neurophysiological effect of nicotine addiction. The health side are now beginning to come to grips with it -- that report from the Health sub-committee in the UK certainly pulls together all that information very well. I would say that the health side have only begun to understand properly the addictive nature of tobacco in the last five or ten years but we are very much aware that the industry were light years ahead of us in their own laboratories. They would have said in 1968 that they were in the business of nicotine addiction. The cigarette is a delivery system for nicotine. They knew it and recognised it well in advance of anybody else, because they had the money to do it.

Deputy G. Mitchell: Could we get that sub-committee report, Chairman?

Deputy Kenneally: I too welcome Dr. Howell. Could I clarify something first, going back to something Deputy Mitchell said -- his opening remark? I presume we are under no time constraints here in that often with committee meeting there are other committees coming in afterwards and meetings have to be got through in a certain time.

Chairman: Not today.

Deputy Kenneally: It is not the case today, fair enough, but will it be the case on other days? The reason I ask the question is I have no problem with the length of a contribution anybody might make and I found Dr. Howell's contribution extremely interesting and informative. Now I accept some people can ramble on forever, but I am afraid that if we curtail this too much, some people would say they did not get a chance to put forward their case properly. I understand we don't have a problem today -- but I am afraid that on other days we will be told we must finish by a certain time in order that another committee can come in.

Chairman: We are being assigned this room for technical reasons, so that there can be television coverage of the committee. There will be no demand by other committees on this particular room.

Deputy G. Mitchell: A vote in the House, though...

Chairman: In the normal way, we would suspend for a vote in the House but there should be no constraints on our time.

Deputy Kenneally: That's fair enough, Chairman, thank you for clarifying that. Many of the questions that perhaps were prompted by your contribution this morning, I should ask of the tobacco companies when they come in here, and hopefully they will come in here. I don't think they have given an indication yet as to when they will come in, but I hope they will come in and be as forthcoming as you were in order that we can get a balanced view, and that's what we want, more than anything else.

Dr. Howell said it was well known that tobacco kills somewhere between 6,500 and 7,000 Irish adults every year. Where does that figure come from? Has any study been done to quantify exactly what the number is, or is this just an estimation of what it might be?

Do you have any view as to why the American tobacco companies, who for years and years denied that smoking caused death or health problems suddenly turned around last year, I think it was, and said, yes, smoking does damage your health? Now it was quite obvious why they were doing that, it was to prevent further litigation. Some of the companies here I understand are owned by some of these American companies -- do you have any view as to why they are doing and saying that in America but that Irish tobacco companies over here are still denying that there is any health risk?

On three different occasions Dr. Howell mentioned his disappointment that the tax had not been increased in the last budget on tobacco products. I just wonder is it price sensitive, because as you rightly said from all the evidence that you put forward anyway, nicotine is addictive. Heroin is addictive as well; heroin is not price sensitive. So I wonder is tobacco price sensitive either, and does it matter how much taxation we put on it? If people are addicted will they not smoke anyway? Nicotine in the product is the problem. When we were in Florida we saw the very imaginative efforts of the tobacco companies in trying to attract young people to smoke because they had to recruit a certain number of people every day to replace those who quit. I read reports recently that suggest sweets laced with nicotine will be produced.

Coming back to an Irish context, is that legal? Do we need to enact a law to make sure that something like that cannot happen in this country because it is pointless waiting until it has happened to close the door? Perhaps legally it cannot be done here but maybe you would comment on that. I agree with you about making cessation products free to everybody and not just those with medical cards. We tend to look at the cost now, and I have remarked on this in other areas as well, but not at the invisible costs that are down the road, in this case the massive health care costs. It would make more sense to try to get people off nicotine, cigarettes or whatever. It would save money down the line but because it cannot be quantified you cannot say to the Department of Finance and say this will be the saving. You mentioned Massachusetts and said if we spend £25 million here it would be comparative. That would be money extremely well spent because I believe it would save us a fortune in health care costs in the future but, again, it is very difficult to quantify.

Chairman: Thank you very much. There is a vote in the Dáil. I thought Deputy Mitchell and the Opposition would give us an opportunity to ------

Deputy G Mitchell: I assure you it is the Labour Party.

Chairman: We will suspend the sitting for ten minutes.

Sitting suspended at 10.40 a.m. and resumed at 11 a.m.

Chairman: Dr. Howell was about to respond to Deputy Kenneally.

Dr. Howell: Yes. He asked about the number of people who die, how that is calculated and whether the number is picked out of the sky. A few major studies have been done on this where they followed groups of people who smoked and groups that did not smoke. They looked at the proportion of them who died from different causes and they were able to attribute them. They use a very conservative estimate in their calculations so that they can attribute, let us say, 85% of lung cancer cases to direct smoking, that in about 90% of chronic obstructive ... disease death would be directly attributable to smoking. You look at the total number that died from that and you apply the apportioned percentage and arrive at that figure of directly attributable deaths. It is quite conservative and it is geared so that you say there is at least this number rather than this is the top end of the scale. It is the minimum. There has been a lot of that work done throughout the world.

You asked if tobacco products are price sensitive. The answer in a nutshell is yes. The World Bank economists carried out an assessment of various elements of tobacco control strategies and they advised Governments the world over in a report on curbing the epidemic that if there were one thing Governments should do to try to reduce smoking patterns it was to use the price mechanism. You are right that it is addictive so it does not follow the straight economic supply and demand, that as price goes up demand goes down, because of its addictive nature. In general, for adults, what you tend to see usually in all the economic studies is a 10% increase in price will probably see a 4% decrease in consumption but it is much stronger for young people who have less money. In general, parents do not give young people money to buy tobacco so what they buy they do so with their own money. They give them money to buy new trainers, new jerseys for their football team but parents do not give kids money to buy fags so they are much more price sensitive in many respects. That is why there is a lot of evidence to show that the ten pack, in Australia they are called kiddie packs - young people buy cigarettes in packets of ten because they are less expensive in that short term and that is why lots of people like myself will urge for a ban on sales of cigarettes in less than packets of 20. That would have been a recommendation from the Oireachtas joint committee the last time as well. Price sensitivity is very strong. It does exist. It is not as strong as one would wish but overall it is probably the strongest method you can use.

The other question was about sweets laced with nicotine. That is true. Do we need to bring in legislation to stop it? We probably do. This country was, I think, the first to ban oral tobacco products when they came on the market. There was a huge court case. The tobacco industry took Barry Desmond to court over it and the State won the case so that oral smokeless tobacco products were not allowed here. We will probably have to do the same again. The tobacco industry and companies will say here is another way of --- with smoking it is the nicotine that makes you addicted but it is the tar that kills you. It is all the rest, the carbon monoxide and the tar. It's not the nicotine that kills you it's the nicotine that makes you addicted and the delivery system does the harm.

Now some people say if you made nicotine products available in a form that doesn't give you tar nicotine then that might get over the problem but there is a strong recognition that the delivery system of cigarettes is just about the fastest delivery drug system in the world. If you know anybody who smokes, one puff within about six seconds and the nicotine has settled the crave. It is quicker almost than giving somebody an injection and a drug because you take it into your lungs where there is a huge amount of blood there just picking it up, it gets whacked to the brain straight away and no delivery system will ever beat that. Smokers might use the nicotine sweets from time to time, let's say on flights or whatever but we would rather see them using nicotine replacement therapy; the gum, the patch and things like that which are medically controlled and improved. It is very dangerous to allow a product like that to be used and put out in the market where you are going to continue an addiction.

Regarding the tobacco companies denying smoking health problems, it's quite interesting that several of them have put up on their websites that they recognise this and they have done it in a very discreet way. Practically all the companies in the tobacco industry have said they accept that tobacco is a risk factor for various diseases.

Now various companies in the States have recognised that it is a big problem but it is interesting that while they say it on their websites they are denying it in the courts so they are still fighting all their court cases using their old arguments. They have decided now, I think quite clearly, that no one believes this line any more so they will get rid of it and say that they have changed, that they are now responsible. They now want to work with government and to have sensible regulations. They see that strong regulation will come in so if they try to dilute that legislation in western democracies it will not be easy. Realistically they believe the battle is beginning to be lost in western democracies but in developing countries it is a wide open market so they can go to those countries and say: "we are responsible now, we are not the bad guys, we do recognise this, let us in on your trade agreements, let us take over your companies and we will promote tobacco products in a defensible way". We are seeing a phenomenal rise in tobacco smoking in third world countries, in particular in China, where it is just frightening.

Senator O'Meara: You have made it very clear, Dr. Howell, in your submission that we would be better off if we didn't have tobacco, there are no benefits to tobacco. I just want to ask two questions. Is there a tolerable level of smoking in the population? Is there even a tolerable level of smoking for the individual, five cigarettes a day, seven, ten or so on or does it vary? What about the effectiveness of cessation products if the recommendation is there to make sensation products widely available across the board, should we be examining how effective they are? I am particularly interested in examining the issue of smoking and low income groups and smoking in women and girls and the issue of body image. In terms of the marketing of the no smoking message, don't we need to look at how cigarettes have that message for girls and for young women associated with the thin body image? In other words you can be thin by smoking or you can repress your appetite and so on and I think that's something that has to be looked at carefully in relation to the whole marketing message and the effectiveness of the message, particularly to young people. Finally, in terms of your recommendations to the Oireachtas and to the sub-committee in particular, why are you not putting it to us that cigarettes should be banned?

Senator Jackman: I will be very quick. Dr. Howell, you referred there to the sophistication of the representatives of the tobacco company when they tried to put across the idea that tobacco is not addictive. I think we saw through that, because I was at that meeting where they talked about it and said it was as addictive as surfing the net. The more sophisticated they try to be with us, the more we see that there is a cover up. But my question relates to very young girls - 12, 13 year olds - I'm very conscious of the high incidence of lung cancer among women in Ireland where I think it outstripped men in statistics I read recently. Is there damage done, even at that very early stage, to those young girls? The 11, 12 , 13 year olds are still developing and they are fairly heavy smokers. There is also a belief if you give up smoking that within a certain length of time you counteract the negative effects on your health almost completely. Is there a residue of damage done after so many years smoking as a young person, even if you give up, if you like for the rest of your life? In relation to the Canadian way of dealing with young people, they went the same route as Massachusetts where they said to young people: "look are you in control or your lives? Are you going to listen to the multinationals? Are you going to be duped into problems for the rest of your life because these people want to make money, if you like on your back?". That attacked the pride element of being in control as young people like to feel that they're in control and, secondly, they had stark uniform packaging which was quite dramatic, almost like a mortuary card, black and white, and I felt that that took the glamour from the cigarette packet. They just did it, it didn't seem to be a big deal. Dr. Howell mentioned at a previous meeting that he felt we would do far more if we combined all the research money that you possibly, whatever you would have as an organisation, with the money that the Department of Health spends and various other organisations, rather than having a piecemeal approach to research, that there would be far greater impact if every bit of funding was combined.

Dr. Howell: Well just on the last one, I think there is a very important issue going to happen tomorrow. We went to the former Minister for Health, Brian Cowen, several years ago and suggested that issue and he did ask us to set up a committee which we did under David Kennedy's chairmanship, to investigate setting up a tobacco control and research information centre. Over the last couple of years we have been in negotiations with both the Department of Health and the Office for tobacco control about setting up such a body. And tomorrow, which is 'World no smoking day' the Minister for Health will oversee the setting up of what would be called 'The Research Information centre for a Tobacco-Free Society', and that will happen tomorrow, after a lot of work. It's an actual research institute for a change. It will be set up as an independent body which is separate from, let's say from the Department of Health and the Office for Tobacco Control, to carry out research on tobacco issues in Ireland. We are a partner to it, the Office For Tobacco Controls is a partner to it, and it's set up independently. It is a big step forward. As regards a tolerable level of smoking for the individual, all the science shows that there is no safe level of smoking, I suppose the phrase is "Every cigarette is doing you harm, every cigarette is doing the damage". So that, when they've looked at those studies as well, when you look at mortality from various things, from people who smoke five, ten, 15, 20, 30 a day, there is a constant gradient and there is no level of smoking which the gradient falls to that of a non-smoker. So at any level of smoking harm is being caused.

The effectiveness of cessation products is an important issue. The two most important medicinal products are a drug called bupropion or zyban which has recently come on the market and would probably have an effectiveness rate of somewhere around 20-25% and the nicotine replacement therapy would probably have half that. Then there's various stages of counselling and brief intervention programmes by general practitioners. The background quit rate is about 1- 2% if people try to quit on their own. It's very low. It's very difficult for people to quit and even with cessation products it's still not great. Colleagues of mine will say imagine if you went in with a chest infection and the GP gave you an antibiotic and said there's a 75% chance that won't work, it's not very motivating and that's the problem. It is because it's so addictive. But there has been a lot of work done on cost effectiveness. Health economists in the UK have looked at the cost effectiveness of smoking cessation programmes and even with those low rates they are still deemed to be, after immunisation, the most cost effective measure we can get involved in because if you reduce the number of people smoking by even 25% you remove them from being sick from tobacco related diseases much earlier.

As regards young girls and the damage it does them, yes it certainly does damage at different stages. At that stage, people will not have fully developed lung function so it will inhibit the development of lung function very definitely and it certainly does so for young athletes as well. When you talk to them they'll tell you how it affects them and it certainly does begin to affect them. If people give up is there any residual damage? It all depends. If you get chronic lung damage that won't recover but what it means is it won't get worse. As regards heart disease, for most people who give up within about two years their risk of heart disease begins to get closer to that of a non-smoker, certainly by five years. For lung cancer it's a tough call because if the damage is done that started the lung cancer then stopping doesn't change it. If you've got it, you've got it and stopping won't change that. It takes a while because lung cancer takes a long time to develop in the first instance and even when it develops it takes a long time to become visible. So you could actually have lung cancer for two or three years before you would know it. You've got the tiniest cell growing and it's only when it gets to a critical mass - cancer cells double and double - but when you think about something that you can't even see and it is doubling - it takes a long time before it is big enough to be seen and usually you don't see it in X-rays until it's about 2 cms, I mean it's a good knob, so you could have that for a number of years. You could have given up the fags and if you develop a cancer cell then there's little you can do about that. Stopping won't help the cancer but what it will help is how you can deal with it. If you continue to smoke you're also continuing to compromise your body's function and how it takes in oxygen and all of those things. So you make matters a lot worse if you continue smoking.

On the issue of the Canadian way and how they did it, yes, they have stark warnings. We will have those now. The recent EU Directive on which Irish members to a person were very much to the fore, Irish MEPs across party lines displayed tremendous capacity to ensure that legislation got through, means that in the next two years the packs will have to have warnings which will occupy 30% on the front, 40% on the back of warnings. What that does is, it's not so much the warnings to be honest in one sense, it removes that space from the industry to use as a marketing tool because the industry use the pack as a badge. If you look at young people, watch them come into the pub, they will take out their packet of whatever it is and put it there and that says who I am, that's me, be it whatever brand and the companies use the pack, many of them would believe that it is the most important element of the whole advertising, it's the image and it's associating me with that and a lot of clever design goes into it, so hopefully we reduce that.

Should cigarettes be banned and why don't I say that? Because I'm pragmatic and reasonable about this, because it would be nonsensical to be honest. It won't happen. Tobacco is a multi-billion pound industry in the world. It has huge influence, huge power, and it is hugely profitable. Millions of people are addicted to tobacco products and I think it wouldn't be reasonable tomorrow to say "right, that's it". I don't think it's practical. It wouldn't happen but we have to work towards that day. I believe that in 50 years' time people will look back and say "were they off the wall to allow this to happen?". Were we all off the wall to allow this to happen? It's madness. I think that will happen in time because we are becoming more aware of it. We are starting to take it much more seriously. The fact that we're here today is evidence of that, that this committee and the Government are looking at things seriously. It's not only happening here, our counterparts in the UK had their inquiry. They have looked at the role of the tobacco industry in smoking, all of those things and people are beginning to see that this is just an awful business, not a good business to be in, and we've got to try to work towards reducing it. We have made big improvements in Ireland I suppose. We often forget about it but smoking problems here in the 1960s and 1970s were up to 50%/60% for adults, now we're down to 31% and we seem to have been stuck on that for the last five or six years. We've got to start hitting at the next stage and come down again and I think we can do it if we put the money in it.

Chairman: Can I kindly interrupt you and let Deputy Keaveney in?

Deputy Keaveney: It's good to see you Dr. Howell again and I thought the presentation was very, very good. I'm glad to see our researchers are in place - or will be soon - because part of the problem is obviously getting to know about all the research and information because there's tons of it. The Department is doing their thing, the health board is doing their thing, ASH is doing their thing and there's a lot of different groups doing different things and people don't know what the other group is doing. I only know that because I have recently been appointed to the health board in the north west. I found that they're doing something on smoking and pregnancy and they didn't realise that we had been doing quite a lot as well so information exchange is important. I assume that the UK study to which you referred hasn't been out long enough to come to any conclusion. You were saying that the UK parliamentarians, the Health Committee in the UK had done a report.

Dr. Howell: Their report is available. They called in the tobacco industry in the UK and they were delighted to get your report as I sent them a copy. Because they were questioning some of the same people they were delighted to see how they responded to the questions that you asked them so they were ready for those at the other side and they found your report very useful in that regard.

Deputy Keaveney: I would say that probably their report is still too new to have the impact coming through.

Dr. Howell: Yes.

Deputy Keaveney: We were in Florida and we met the various people involved in having the settlement and definitely people in the media campaign. I thought that was a very important point that you raised there about the adult thing, to keep on telling the children that they shouldn't be smoking because they're not the right age and it's a bad thing for them. Smoking is manna from heaven for people because they want to rebel, they will rebel, whereas the media campaign in Florida was by peers and you're right, it's the whole thing of their trying to fool you. I wonder have you any information about the current level of funding that's going into that campaign. I understand that the original governor had a lot of funding and I wonder if it's still as sustained now as it was a couple of years ago. At one point we came across the subliminal message as well, I think it was the camel being seen in different places. Has the banning of smoking in public places worked in any country and what is the best example perhaps in relation to that? You've mentioned the EU advertising. I have heard Commissioner Byrne and I got the impression that he thinks it might still be rechallenged, or maybe not. Do you think that will work? I think that, as you pointed out, pregnancy has not been to the fore from the tobacco industry as to their warning signals. Should we maybe suggest that this would be one of the major ones that we would be focusing on or should we open it up?

I'm not sure now about the advertising, because it has to be a certain size, do they still have the choice of what goes on? Will this particular option still not be chosen? You have asked the question that I really would like to ask, how can so many underage people get away with buying cigarettes and drink in this country? Children have money now and unless the price goes up phenomenally it will not matter because children are working as well as being at school and they can afford an awful lot of money. I agree that maybe the huge packs might be the answer. Are there any costings being done on smoking related illnesses? How much is it costing the State? There are multifaceted causes of cancer according to the industry and it might be an interesting figure to attain. I think we said that to the Department at the time because people outside here laugh when you talk about tackling the smoking issue because they say "but the Government are getting so much revenue that that you don't want to seriously address this issue so what are you talking about."

We need that information to fight back with and I think that the question I asked the industry themselves was how much but when they said that it wasn't addictive I asked how much was spent each year on developing the patches and the different things to get people off smoking. The Roy Castle experience I thought was the same as the Australian experience but it didn't yield much of a reaction. Roy Castle didn't take anybody to court but he did say that smoking or cleaning the trumpet in a smoky atmosphere has caused his illness and it's funny that that didn't trigger litigation in the UK at the time. I don't know whether it did or not. When you raised the issue there of lobbying I think Flor O'Mahony, Brendan Halligan and Fergus Finlay before them, it is a very good reason for bringing in the register of lobbyists and at that rate I hope that there would be all party support in relation to bringing that forward as soon as possible.

Dr. Howell: Yes. I agree.

Senator Glynn: Dr. Howell, in relation to the numbers smoking, you say here in your first page, the prevalence of smoking with the younger population is approximately 31% and then you go on to say that between 35% and 40% of children are smoking before they reach the age of 18 years of age so it would be reasonable to assume taking the lower percentage figure there that approximately 66% of the population is smoking. Is that correct?

Dr. Howell: No. It is 31% of the adult population, people over 18. If you look at the younger, if you take people under 18 you see that 30-40% of people who are 17 or 18 are smoking.

Senator Glynn: That's a significant percent of the population.

Dr. Howell: It is. It becomes a third of the total population. If you take it then that you move down the way then you're going to have fewer than 20% of the 14-15 year olds and about 10% of the 9-ten year olds. And then 0% further down.

Senator Glynn: You say that one of the arguments of the tobacco companies is that people can give up smoking but you point out that only 2% of smokers actually manage to kick the habit and as a statistic of one of those 2%, I had tremendous difficulty in giving up cigarettes. Would you say the plus of tobacco tax to national governments outweighs the implications of tobacco smoking on public health, in other words does the plus of the tax outweigh the implications that arise due to the pressures of tobacco smoking on the Exchequer? Deputy Keaveney also referred to this. In other words, does the tax we receive as a Government influence our intention to bring forward the necessary legislation to say the polluter should pay? The tobacco companies are the polluter.

I agree with Deputy Kenneally who said he didn't think the cost of tobacco has any great effect on reducing the number of people who smoke. I believe that to be true. I heard people say that they would give up cigarettes when they cost £1 a packet. That did not happen and it won't happen.

You said there is evidence that the tobacco industry was actively involved with the VFI in promoting the concept of ventilation as a means of reducing environmental tobacco smoke so as to avoid the threat of legislation in the hospitality industry. You went on to develop that, saying that it was the same air that was being circulated all the time. On balance it's fair to point out that most pubs now do not stock cigarettes or tobacco on the shelves. They don't sell them over the counter. They are sold in vending machines and, to be fair to the publicans, I believe they get no remuneration whatsoever. They allow the vending machines into the pubs as a convenience to their customers. That point has to be made.

In relation to smoking areas, that point has been made. We are a marvellous country for introducing legislation but we never enforce it. The no smoking ban is not enforced. Deputy Keaveney referred to Roy Castle. That is the case in practically every pub and indeed most restaurants. No-smoking areas are not being provided so that is not being addressed.

I agree with 99.9% of what you say but you will appreciate the tobacco companies have a position to which they steadfastly adhere. In order to give due process, although I've already heard what they have to say I suppose I'll have to hear them again.

As regards the point that consideration be given by Government to taking legal action against the tobacco industry in order to recoup the high cost of treating tobacco-related illnesses, I don't know how we are going to do that, short of banning -----

Chairman: Senator, that does not come within the remit of the committee. That is a matter for Government.

Senator Glynn: But reference was made to it in the document.

Chairman: I know but I want to clarify that it does not come within the remit of this committee. We do not want to express any opinion on it because we want ensure due process.

Senator Glynn: Fair enough, but we are on a hiding to nothing the way things are going, and I'd like to hear your views. I know you have given your views on this document, but what other measures do you think we can take in order to address the problem that arises? It obviously has huge implications for the public purse.

Dr. Howell: It certainly does. As regards the cost implications, after the 50p price rise even just before the last budget, Minister McCreevy admitted there had been a reduction in the actual consumption of cigarette products, in the total number of cigarettes smoked in the State. So I think, the price, when you do it right, works and all the economic evidence is there. Even when Deputy Harney was defending the position of not putting up the price against a very strong and robust attack by Deputy Shatter in the Dáil, I think she admitted as well that the 50p had an impact and they were seeing a decline in the total consumption of cigarettes.

Chairman: And we concluded in our own report, from the American experience, that it did impact.

Dr. Howell: It does work. As regards tobacco tax and does it outweigh - the positive side and the negative side, I could throw that back at you to some degree and say, what do we elect our politicians to do? We don't elect them to collect taxes, we elect them to safeguard our rights, to protect our health, to make sure we all grow and live -----

Senator Glynn: That's right.

Dr. Howell: So I don't think its a duty to collect tax, however, there's a lot of myth about the tax side of things. Let's be honest, the Government pulls in about one billion a year. Now, if everybody stopped smoking tomorrow, that billion doesn't go away. If I was a smoker and I spent £3.50 or .70 a day buying cigarettes, that's disposable income, I will spend it on something else, I will buy apples, I will buy bananas, I will buy chocolate, I will go on a holiday and I pay tax on all those things so the money comes in. It's a very good collection system and it's an efficient collection system of tax, but the money doesn't go away. So you'd get all that money in, using other taxes and, more importantly, there is a lot of evidence to show that when people switch their money, and there has been a lot of work done in the UK on this, on the economic impacts of decrease of tax and ....... it actually causes an increase in employment because the tobacco industry is highly mechanised and there is very low labour involved, whereas, all the other things that you might buy have more labour involved in them so when you decrease the number of smokers you actually create more jobs in the economy from other means of how people's monies move around.

So all in all, the benefits, you'd get the tax in, you'd create more jobs which bring in more tax and you wouldn't have the health effects, so it's win, win, win, in my sense, if you look at the economic arguments on that whole side of things. Roy Castle was mentioned, there were various cases taken in the UK about environmental tobacco smoke and all of them were settled out of court. Once they are settled out of court no judgment is made, there is no precedent set and they are always taken against the employer as against the industry. The tobacco industry says "it's nothing to do with me that somebody else was exposed to the environmental tobacco smoke, it's to do with your employer or whatever". So I think the case in Australia though, is being looked at, very seriously there by the legislators. I think the Minister for Health there, Kenneth Clarke, is now in the position where he saying "We are going to have to ban smoking in public places and in pubs". Do public bans work? They do when they are properly enforced and where do you want to go to see it? California, absolutely incredible. It is amazing, they introduced a ban on smoking, and they are probably the first place to introduce a full ban in restaurants and pubs.

The tobacco industry funded huge campaigns with various front groups for the hospitality industry which said that the business would collapse, they will all run out of business, takings would go down, similarly in Massechusetts, similarly in New York. Independent studies have shown that is what happens when you ban smoking in public places, certainly in the entertainment side of things. Yes, you lose some of your smokers, but all your non-smokers come back. So retail sales in most of those places went up, money started coming back in, they found that they are now attracting, and it's the whole argument, if you think about it, there in California, it's 20/80 smoker/non-smoker, here it's 30/70, so if 30% smoke, 70% don't smoke and that 70% are a bigger spend, a bigger group of people who want to go into pubs, and there are many people who don't go to pubs and to restaurants and various places like that, because they are too smoky. You would get all them back, unfortunately the hospitality industry have been too narrow on how they've looked at this, despite all the prophets of doom from the tobacco industry.

In places that have introduced tobacco bans, it hasn't been a disaster, and they are doing it in Canada now as well, and it's working, and I think we will see it in workplaces. Certainly, it's very true because not only do you get the desired effect of not having people suffering from environmental tobacco smoke, but anywhere that they have proper workplace bans, it helps people to quit. You see, in the first instance, the reduction in the actual number of cigarettes that people smoke and you see an increased uptake of quitting by people. And it's an offshoot, so as well as protecting people from environmental tobacco smoke you are helping people to quit. Of course, the tobacco industry have a position. I would say, yes they are quite entitled to come in and tell you the truth.

Senator Glynn: As they see it.

Dr. Howell: No, they are entitled to tell you the truth, not as they see it, the truth. And the truth can only be one thing. You make the decision on the evidence that is there in front of you, on history, on what they - I suppose it was massive in the United States when they were forced to put all those secret documents on the web. There is so much of it that people still cannot get through it. I believe that there is - and if you have researchers - a lot to be gained from looking at the Irish situation with respect to the tobacco industry and what documents might be on the Gallagher site and on the Philip Morris site. I think there is more to be found about elements of the tobacco industry's role in the Irish situation. Even in those documents that have come from across the water you will find involvement and it just takes a lot of time. It is hugely time consuming work. You need dedicated researchers to do it.

The issue of who do we do work with, women and pregnancy, obviously it is a key area and there has been a lot of research on how do you help pregnant women who smoke because you are hitting two people there. We tend to find that unless the partner also quits, it is very difficult for the main person to quit. It's probably a stressful period for a lot of people, a lot of different pressures are put on them. It is a hard time to quit but is an extremely important time to quit because smoking does have an impact on the development of the baby in the uterus. But equally you see an increased incidence of Sudden Infant Death Syndrome which it is so distressing. The rate I think is about 60% of Sudden Infant Death Syndrome occurs in houses where there is smoking. It is desperately distressing and it is an awful guilt that people carry with them subsequently but it is a big risk factor and I think we have to work much harder on this.

Deputy Keaveney: I see the miscarriage rate increases.

Dr. Howell: Yes it does increase. I can't give you the exact figure but I can get it for you. That is not a problem. It does increase and smoking also decreases fertility but we wouldn't promote that as a contraceptive.

Senator Glynn: Briefly, Dr. Howell, in relation to price deterring people from smoking, is it not true that in the case of people in the lower income brackets, especially young single mothers many of whom live on the lone parent allowance, that the price increase, and I would have personal experience of this as a local practising politician, did not deter them from smoking?

Dr. Howell: It helped some. It is not going to help everybody. I thoroughly agree. The addictive nature is so strong that it will not help everybody but I think what we have to try to do is keep chipping away. We will not get 50% of the population to quit smoking tomorrow and I think we need all the elements in place. I have argued that is almost immoral to put the price of tobacco up if you don't put in place the packages to help people quit. And I have argued for years about making nicotine replacement therapy products available but it is more than that. We should also make smoking cessation counsellors available to people up front, openly. It shouldn't be difficult to fund that. We should give general practitioners more support in working on a one to one relationship with people. We just haven't put that money-----

Senator Glynn: But who should pay?

Dr. Howell: The State has to pay.

Senator Glynn: Is it the long suffering taxpayer who should have to pay or is it the tobacco companies?

Dr. Howell: Well, we take in a billion pounds a year from tobacco taxes, so a small hypothecation of taxes to this area would be pennies, half-pennies really. I mean what is £25 million, what is £50 million from that amount?

Deputy Keaveney: As regards advertising on the packets, do we determine what is put on or is it still up to the industry?

Dr. Howell: No, that will all come in under the EU directive and they have to rotate. They will have to rotate on the packets. The other thing I was talking about earlier on was the ads on the paper but we have banned those.

Deputy Keaveney: I know but I if they have a choice of what goes on then it will never be there.

Dr. Howell: No. There must be rotation and that is in the new EU directive. The types of messages have been determined by parliament.

Deputy G. Mitchell: What did you say tomorrow was, international day against smoking?

Dr. Howell: It's world no smoking day, 31st of May every year. It's the world's Lent, the world's Ash Wednesday, in a sense.

Deputy G. Mitchell: It is world no smoking day?

Senator Jackman: And it lasts all day?

Deputy Keaveney: With emphasis on the ash?

Dr. Howell: Traditionally Ash Wednesday in Ireland is the day you quit...every other country has its own non-smoking day.

Chairman: I will wrap up this session, I thank Dr. Howell for a very fine presentation. It has been very helpful to us, and particularly for our future deliberations. We will discuss the recommendations that you've made and we may seek to call you back at a later stage.

The sub-committee went into private session at 11.46 a.m. and adjourned at 11.48 a.m. until Wednesday, 6 June 2001.

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