The reality is that smoking will kill 50 per cent of smokers and 50 per cent of them will die prematurely, before they are 70. In addition, 25 causes of death are significantly related to smoking. Contrary to that stated by the tobacco industry, tobacco is a highly addictive product, anyone that has ever smoked will testify to the difficulty in quitting. Quitting is a difficult process, usually no more than 2 per cent of smokers successfully quit their addiction in any one year on their own.

The first thing we need to do in discussing issues like tobacco control is accept we have failed. 'We' must be inclusive; tobacco control is a societal issue. However, the Department of Health and Children and its institutions play a major part in dealing with this problem. The policies that we as a nation have adopted up to now are not working as well as we had hoped. The uptake of smoking among our young population is a testament to that failure. We need to look afresh at what we are doing to minimise the impact of the tobacco companies on our young people in particular.

Over the years, the IMO has taken an increasingly strong public stance on the tobacco issue and, at our most recent AGM, we unanimously adopted as policy for our organisation the position statement of the World Medical Association on tobacco. This policy is a comprehensive statement covering all aspects of tobacco control and I have included it in our submission to the Chairman. In addition, the IMO has also called on the Minister for Health and Children to extend the restrictions on smoking in public places to include the workplace and requests the removal of tobacco from the Consumer Price Index. The IMO has also called for a ban on the sale of duty free tobacco products.

As well as putting forward a public stance on this issue, our members are constantly involved in counselling smokers on a day to day basis about smoking and we welcome the recent initiative with our colleagues in the Irish College of General Practitioners and the health board smoking target action group which provides further training for GPs in the whole area of smoking cessation counselling.

However, we are strongly of the view that tobacco control is not just an issue for health care professionals - when health care professionals get involved, it is often too late. In order to properly control the problem of tobacco in our society, we need to adopt a more comprehensive approach as recommended by available research.

No one single item will work on its own, it is the synergy we need when all aspects of the strategy are working together. Due to time constraints, I wish to concentrate on four areas; advertising and sponsorship, price, sales to children and passive smoking.

On advertising and sponsorship, research shows that 80 per cent of regular adult smokers begin smoking before they are 18 years of age. Indeed, the tobacco industry in Ireland needs about 25 new smokers every day just to keep market share current and at least 20 of them will be children. Advertising and sponsorship are crucial to the tobacco industry in achieving this aim.

Advertising serves several useful purposes for the tobacco industry. It conveys the message that smoking is socially acceptable and even pleasurable and sophisticated. It encourages smoking. Advertising revenues received by the media may influence editorial policies and deter them from pointing out the dangers of tobacco or the antics of the tobacco industry and those who support them.

Advertising and sponsorship bans serve many useful purposes and the IMO is anxious that the recently adopted EU advertising ban is brought into play immediately. Such action on the part of the political system announces society's verdict on this dangerous product. In addition, it removes support for smoking behaviour, it takes away the glamour that surrounds tobacco, it stops the industry from implying that light or low-tar cigarettes are safe and advertising bans free the media from their potential conflict of interest.

It is interesting to note that only one national Irish newspaper, The Irish Times, does not promote tobacco. Unfortunately, the same cannot be said of the national broadcaster, RTE. While the IMO welcomes the recent RTE decision to cease advertising tobacco in the RTE Guide- after a sustained campaign by many organisations - it is still probably the most significant source of advertising and glamorisation of tobacco products to our young population by virtue of its coverage of Grand Prix Formula 1 racing which, in reality, is a key source of advertising for the tobacco industry.

Research from the UK clearly shows that even children as young as 12 years of age who are regular viewers of Formula 1 are twice as likely to smoke as those who are not. The IMO would hope that this committee and the Minister responsible for RTE would engage that organisation in real debate about this issue.

It is also interesting to note comments made by the tobacco industry about the issue of advertising and sponsorship when they appeared before this committee. They were adamant that advertising and sponsorship programmes were not aimed at anyone under 18 years of age. I would like to remind the committee that those same companies, particularly P J Carrolls, have been engaged in the distribution of free cigarettes for promotional purposes, a practice that is illegal in this country, to students at UCD. They and other tobacco companies were caught red handed by the Irish Cancer Society and are subject to further investigation by officials from the Department of Health and Children on this matter.

On this whole issue of tobacco advertising and sponsorship, the recent EU Directive, which our own Commissioner, Mr. Flynn, and MEPS played a key role in getting through the European Parliament is instructive. We would be anxious that the Directive be introduced within the minimum timeframe and that no derogation be sought on extending the timeframe for its introduction. In the past, successive Ministers for Health argued that we could not move unilaterally because of the significant influx of tobacco advertisements from the British media, thus placing our own print media at a disadvantage. That situation is now changed; not only has the British Government fully adopted the new Directive, it has stated in its recent White Paper on tobacco, entitled 'Smoking Kills' that it can see no strong reason to grant the print media the additional year permitted.

The next area I want to address is price. Together with advertising and sponsorship, price plays a crucial role in the prevalence of smoking in our society, especially for children. Research in this country and elsewhere shows that the demand for tobacco products is directly related to their price. If one increases price by 1 per cent, consumption falls by 0. 5 per cent, and more importantly, especially in this era of the Celtic tiger, if incomes rise by 1 per cent, consumption will rise by 0.5 per cent. Young people are particularly sensitive to both price and income effects. It is against this background that one can understand the disappointment of those in the health care sector about the recent 5p price increase on a packet of 20 - the lowest for some time. In reality, the price of tobacco in Ireland is, in real terms, becoming cheaper and this reduces the incentive to give up smoking. This is in sharp contrast to the situation in the UK, where the Government, not the Department of Finance, has made a decision that tobacco prices will rise by 5 per cent above the rate of inflation in its budgets.

It would appear that the prevailing philosophy within the Department of Finance is one of maximising tax returns. The IMO believes that the protection of the public health is a far more important issue and our fiscal policy with respect to tobacco should reflect this. The tobacco industry very successfully lobbied the current Minister for Finance prior to the last budget on this issue. In their submission to the Minister, which I was able to obtain under the Freedom of Information Act and in a pre-budget meeting they had with him, they made great play of the dangers of increased smuggling that might arise if he significantly increased the price of tobacco products. This is a spurious argument. It is interesting to note that the parent bodies of two Irish based tobacco companies who appeared before this committee, are currently under investigation by the European Parliament and the anti-fraud division of the European Commission for their possible involvement in assisting smuggling tobacco products. In many countries around the world, there is evidence accumulating that it is the tobacco industry itself, which is facilitating smuggling in order to put pressure on governments not to increase the price of tobacco.

As committee members are well aware, it is illegal to sell tobacco products to those under 16 years of age. Yet, any survey carried out in this area shows that children as young as 12 years of age can freely buy cigarettes. In simple terms, the law is ignored. Most people believe that health boards are obliged to enforce the legislation in this regard. However, the truth of the matter is somewhat different. The legislation states that health board officers may enforce the regulations. The 'may' needs to be changed to 'shall', as is the case with other legislation surrounding the protection of our children. However, even then there are problems with the legislation itself as environmental health officers who usually try to enforce the law, have identified specific deficiencies within the legislation. Significant changes need to be made if we are to get anywhere on this issue. In the first instance, we need to reintroduce the concept of tobacco licences, which were done away with prematurely some years ago. Surely a product which causes so much harm needs to be properly controlled so that children cannot buy it. The issuing and monitoring of these licences could be self-financing and the charge for them levied to the tobacco industry. The existing legislation needs to be strengthened so that those found guilty of selling tobacco products illegally can be prosecuted and would lose their licence to sell tobacco products. There is also a need for all tobacco vending machines to be placed under direct adult supervision at all times as children easily access these. We also need to bring our tobacco laws into harmony with our Child Care Act which defines a child as someone who is 18 years of age or younger.

It is estimated that the Department of Finance pulls in several million pounds every year from illegal sales of tobacco products to children. This is money they should not have and which they should not budget for. It is surplus. Surely it is reasonable for these moneys to be put back into the system in an effort to prevent young people from taking up smoking and becoming addicted.

I now want to turn to the issue of passive smoking.

I am aware the tobacco industry told this committee that the jury is still out on this issue, that scientists disagree, and that the World Health Organisation study was not conclusive with respect to passive smoking and lung cancer. Common sense alone tells us otherwise. The jury is not out on this issue - there is not one reputable medical or scientific body in the world that does not accept that there are damaging health effects from passive smoking. The only scientists that say otherwise are those whom the tobacco industry bought - and they bought many. Recent documents that the industry was forced to release in litigation cases in the United States show how they manipulated science in this area. Indeed the World Health Organisation brought out a press statement last March entitled "Passive Smoking Does Cause Lung Cancer, Do Not Let Them Fool You", "them" meaning the industry. I have included that press release in my submission. Yet representatives from the tobacco industry came in here and tried to suggest that it was not proven. It is.

The amount of evidence accumulated against passive smoking is substantial. It is now known that exposure to passive smoking causes a number of fatal and non-fatal health effects. Heart disease mortality, sudden infant death syndrome, and lung and nasal sinus cancer have been causally linked to passive smoking. Serious effects on the young include childhood induction and exacerbation of asthma, bronchitis and pneumonia, middle ear infection, chronic respiratory symptoms, and low birth weight. In adults, acute and chronic heart disease and lung cancer are causally associated with exposure to passive smoking. Of course the risks to one's health are lower than those from active smoking, However, because the diseases are common the overall health impact is large.

In view of the considerable health impact of passive smoking, there is a need to restrict smoking in indoor environments, especially in public places and in the workplace. Proper legislation and its enforcement are needed to achieve the protection of those who want to breathe clean air. Whilst we do have legislation on our statute books, there are problems with it. It is far from comprehensive and it is impossible to enforce properly as it is full of legal minefields for the enforcers surrounding such issues as "right of entry", obligation to give one's name, etc. It is inequitable in that it affords some people protection and others none and in the main, the workplace is excluded.

On the issue of inequity, the legislation rightly protects barbers and hairdressers from passive smoking in their workplace - but what about barmen or anyone sharing a work environment with a smoker? In addition, workers employed by the State are afforded a greater level of protection from passive smoking than those in the private sector. Surely this cannot be allowed to continue unchecked. If the decision was taken that passive smoking is harmful, as it must have been to introduce any protective legislation, then it should apply to all, with no one group of people getting preferential treatment.

The workplace is of crucial importance. Whilst many argue the toss about passive smoking in pubs, clubs, etc., the position in the workplace is different. The tobacco industry consistently argues for a voluntary approach and that we have smoking and non smoking areas side by side. This is akin to suggesting that we should have a urine free area in a swimming pool - this is nonsense and does not work, and it is in exactly those places where it does not work that workers need the protection of the legislation. Imagine the reaction if we said that there should be a voluntary code of practice with respect to the control of any other indoor air pollutant such as asbestos - we would be laughed at.

I think it is important for the committee to be aware how we arrived at the notion of a voluntary code of practice, despite the strength of evidence against passive smoking in 1994, and how the Irish tobacco industry secretly manipulated and misled those who were involved in drawing up the current voluntary code of practice that has existed since then. Towards the end of 1993, the then Minister for Health, Deputy Howlin, convened a consultative committee on smoking in the workplace, consisting of representatives from the Department of Health and its Health Promotion Unit, the Department of Enterprise and Employment, IBEC, ICTU, the Irish Cancer Society, the Irish Heart Foundation, ASH Ireland, the Eastern Health Board and the Health and Safety Authority. Its brief was to review the implementation of the existing voluntary code and to make recommendations on further measures, if any, in relation to smoking control in the workplace. The committee met on several occasions and agreed to continue the voluntary code for a further two year period, at which stage the implementation and effectiveness of the code was to be reviewed again. Incidentally, no such review has taken place.

Disturbingly, many on the consultative committee were unaware that officials from the Department of Health and the IBEC and ICTU representatives were privately having side meetings with a representative from the tobacco industry on this issue, which sought to protect workers from passive smoking. I have given the Chairman documentation to support this position, which outlines the extent to which the tobacco industry was able to influence some officials on the committee. These documents were part of the set of documents that the tobacco industry were forced to release in the United States some time back. They make interesting reading. Within 24 hours of one of the consultative committee meetings, the tobacco industry had a detailed minute of themeeting, outlining who said what and how the committee was progressing. This was immediately forwarded to his colleagues in Ireland and Europe and subsequently to the tobacco industry in America. Members of the Committee may be surprised that people abroad are taking such an interest in our affairs. These documents outline the extent to which the tobacco industry will go in order to stop any legislation to protect those at the workplace, for its own self-interest.

Since 1994, the evidence has grown considerably on the harmful effects of passive smoking. Legislation to protect non-smokers needs to be brought forward as a matter of urgency, in an open and transparent manner, with no input from the tobacco industry, to ban smoking in the workplace. I reiterate my opening remarks - so far we have lost the battle to protect our population from the health effects of active and passive smoking. In order to regain lost ground we need to be much more proactive into the future. The issues of advertising and sponsorship, sales to children and protection from passive smoking require changes in our legislation. The time is opportune to review and update all tobacco control legislation and to consolidate it in a single Act. In addition we need to be strong on fiscal policy, on helping smokers to quit and on providing soundly based health promotion and health education to our young people. The Irish Medical Organisation is ready and willing to play Its part in trying to reduce the scourge of tobacco on the health of the Irish population.

Acting Chairman: Thank you for a comprehensive, concise and informed presentation. You obviously have strong feelings on the issue. A number of different points of view have been presented to us and we heard much about smoking being addictive - everyone except the tobacco industry has strong views on this. The points you made were extremely relevant, especially about the age limit, law enforcement, price and tobacco licensing, which was a new idea.

Deputy Shatter: I thank Dr. Howell for his interesting address. He has brought interesting information before the committee, which indicates our research difficulties in that we are dependent on people coming before us. The staff of this committee also staff other committees and we lack the capacity to do as much independent research as is required. I request that the paper delivered to us this morning be distributed to us, which is the usual practice at other meetings, and perhaps that could be arranged while we are here. I also ask that the additional documentation which Dr. Howell brought, which I found interesting, be immediately copied and made available to Members of the Committee. It is important that the full submission be furnished to all of us so that we can reflect on it. I hoped we could have received it in the course of the discussion because it may be relevant to questions which arise. Perhaps a member of the committee staff could organise this.

I have a couple of comments and I apologise for boredom I may cause to other Members of the Committee. I regard the tobacco companies as public enemies which are destroying the health of many young children and making many of them addicted to tobacco before they reach adulthood.

I do not believe this issue is being addressed with any dynamism or insight by the Department of Health and Children or the Minister. The Government has an extraordinarily laid back approach to the issue, which was clear from the approach in the budget. I recall a time in the Dáil when on budget night it was traditional for the Opposition parties to oppose the increase in the price of tobacco. I have been in the House for the past 18 years and in almost every budget there has been some increase in the price of tobacco. Uniquely in the debate on the night it was announced, the main Opposition party criticised the budget because the increase in the price of tobacco was too small, although this was largely ignored by the media as it happened after 7 o'clock, something which is par for the course. I made this point in the Dáil and it went unnoticed.

I agree with the case made that price increases in tobacco is one of the many factors which are important in the context of teenagers and younger children who purchase cigarettes. People are selling these children cigarettes in circumstances which are clearly against the law. In this context the issue of price is important and must be addressed. An overall policy is necessary and I hope the committee, when it finishes its hearings, will put together a series of recommendations which will be taken on board by the Government.

I am disturbed by two issues which to some degree are new. Many of us agree with much of what Dr. Howell said and which was also raised in some of our previous hearings. I would be very interested to see what documentation exists concerning the secret meeting between the Minister for Finance and representatives of the tobacco industry. It is usual for pressure groups to issue a press release when they meet the Minister, if for no other reason than to highlight the issues for which they are seeking Government support and so that the people the group represents feel their views are in the public domain. The untrumpeted meeting which the tobacco industry had with the Minister for Finance and which resulted in neither a press release from the Minister or the tobacco industry is indicative of the way the tobacco industry does its business. I deplore the giving of that level of access to the tobacco industry. The industry is responsible for in the region of 6,500 deaths per year in Ireland and many, many thousands of people suffering illnesses which they otherwise would not suffer. I do not believe the tobacco industry should be granted private meetings with the Minister for Finance which go unreported in the media, about which no announcements are made and during which they make a secret submission to the Minister. The current and future Ministers for Finance should not hold any secret meetings with the tobacco industry. I am not saying that in no circumstances should the industry be talked to, but if they are the nature of the discussion which takes place should be in the public domain. It should not require somebody applying under the Freedom of Information Act to receive the submission. The written submission is one thing, but what is said in oral conversation at such a meeting is different. It is of very major importance in the context of the public health of people.

I congratulate Dr. Howell for discovering this meeting and for gaining access to the submission made. Interestingly it was not furnished by any of the tobacco companies to the committee. When we have had an opportunity to read the submission we may want to return to it.

The other issue I find extremely disturbing is the suggestion and statement that the group put together to seek to agree a code concerning passive smoking was effectively infiltrated in some form by the tobacco companies, to such an effective degree that the tobacco companies received verbatim reports of exchanges by individuals in the group. This is extraordinary and I would like to see the submission and documentation Dr. Howell has provided to us. From the documentation, which he has submitted to the committee, does he know the identity of the individual or individuals who gave this information to the tobacco companies? Was this information furnished to a representative group of the tobacco industry in general or to an individual tobacco company? Does he believe it is appropriate that there be a connection between the chairmanship of a major tobacco company and a health insurance body? Has the IMO a view on this? Dr. Howell has gone through four different areas where action is required. Does he believe the medical profession or the Department of Education and Science through the schools can do anything more to try to ensure that the large number of children who take up smoking, become addicted and remain addicted as adults, do not take up smoking in the first place?

Acting Chairman: I wish to remind Members and witnesses of the situation pertaining to privilege.

Dr. Howell: The documents I have submitted to the committee are in the public domain. The tobacco industry was forced to release them on the Internet and that is how I found them when searching for references to Irish tobacco companies. The individual who represents all tobacco industry members in the Irish Tobacco Manufacturers Advisory Committee is well known in the tobacco industry and I think is a former member of the House. He met with officials of the Department of Health and Children, IBEC and ICTU, separately and without the knowledge of the other members of the committee. This is very clear from the documentation.

Deputy Shatter: Who are we talking about?

Dr. Howell: Flor O'Mahony. It is very clear the extent of the influence which was brought to bear. He talks to his colleagues about documentation which he gave them which rubbished the report of the United States' Environmental Protection Agency's report. In his interpretation he felt this had a significant effect in swaying IBEC, ICTU and officials of the Department of Health and Children in his direction. His documentation and his letter are quite extensive. Committee Members when they read it will see that it speaks for itself. It is disappointing when one sees the influence an industry which causes so much harm could have had on an issue concerning the protection of public health. The only way one can redress this is be turning it around and introducing legislation to ban smoking in the workplace as this is where it hurts the most. The industry is most concerned in the area where it concentrates most of its resources.

I find it extraordinary that the chairman of a tobacco company is also chairperson of BUPA. It was discussed at an IMO AGM and we noted the issue quite strongly. Many of us feel it is an extraordinary situation. Elsewhere I have described it as profiting when people smoke and when people die. It is a win win situation which very few of us can experience.

I was asked about what additional work can be undertaken by the Department of Education and Science. Increasingly over the years there has been a development in health promotion and education programmes. They are not extensive enough and need to be further developed. However, sometimes we look to them as being the answer. In fairness campaigns on health promotion and education do not work very well. What works are what we have addressed, namely, the key issues of advertising and price. The current Department of Health and Children campaign encouraging people to quit is quite interesting and well run. It cost about £250,000, which is a lot of money for the health promotion unit in the Department of Health and Children to spend. However, when that is contrasted with the sums in the region of £10 million to £15 million, which the tobacco companies spend a year in this country alone, it pales into insignificance. If one brings on Eddie Jordan it all just goes away.

Recently, one of the drivers, Eddie Irvine, was on "Kenny Live" dressed in Marlboro clothing. What hope does someone like me - a fuddy duddy with glasses and a beard - have of convincing children not to smoke when he is glamorising the issue? It is very difficult as we are on a very unequal playing pitch. The global resources of the industry are mind boggling - it is almost funny money. There is always a need to continue our education campaigns as we must keep putting out that message. However, we must tackle the real issue: the glamorisation of the product through advertising campaigns.

Many organisations - the IMO, the Faculty of Public Health Medicine, the Irish Heart Foundation, the Cancer Society - lobbied for years to try to get RTE to withdraw tobacco advertising from the RTE Guide. It has agreed to do so from henceforth, but it broadcasts Formula One motor racing, which is a much stronger form of advertising. Many of us feel that the 1978 Act prohibits such advertising. The IMO might request the Attorney General to examine this to see if they are breaking the law in this regard - the definition of tobacco advertising is a grey area in the Act. Unfortunately, there are many loopholes in the legislation which allow people to get around it.

Senator Gallagher: I was interested in the chair's reminder about the situation regarding privilege and witnesses. That question arose during our deliberations in 1998 on the extension of the legislation to the work of this committee. I would like some reference to be made on page seven of our draft report to the fact that we need the full extension of the legislation to our proceedings. It is not satisfactory to say we are happy with our powers to date.

I thank Dr. Howell for his clear, concise and forceful presentation. We heard about the implementation of the EU directive today and also from Commissioner Flynn. I would like the committee to invite the Minister for Health and Children and the relevant Department officials to appear before us to outline the measures they are taking to ensure that legislation is implemented in this jurisdiction without any undue delay.

In regard to price, I strongly recommend to the Minister for Finance that he adopt the practice put in place by his predecessor in regard to pre budget submissions from the tobacco industry, or any other group, which was that those groups should make their presentations in a public forum to a committee of these Houses, which would then make recommendations to the Minister for consideration in the budget. That was a more democratic practice and it opened up the lobbying system, which is very strong in this country. I would like the committee to invite the Minister, Deputy McCreevy, to appear before it to discuss, first, the issue of his consultations with the tobacco industry prior to the past two budgets and, second, to discuss the reintroduction of the practice of such lobbying being done in public, by way of presentations to committees of these Houses.

I fully agree with the necessity for changes to legislation, both in respect of tobacco sales to children and smoking in the workplace. I would like the committee to undertake the job of preparing legislative proposals in both those areas because I do not believe the Department will do it with any haste.

In regard to the question of research, which Deputy Shatter has raised on more than one occasion, I would like some clarification on whether the arrangements which applied to the previous Dáil and Seanad, whereby committees had a facility to commission research themselves, still apply. We cannot effectively discharge our responsibilities as a committee in this important area unless we are in a position to commission outside research. If the chair can confirm that facility is still available to us, I would like us to engage someone on a contract basis to assist us in our efforts in that regard.

I am shocked by what Dr. Howell told us this morning about the side bars and leaking which took place from the consultative committee to the tobacco industry. When we have had a chance to examine the relevant documentation, I would like us to call the necessary persons before us to discuss that in more detail, including officials of the Department of Health and Children, IBEC, ICTU and representatives of the tobacco industry. I would like the relevant papers to be circulated to us and we should revisit the issues raised by Dr. Howell at our next meeting.

Acting Chairman: I apologise that the papers have not been distributed - we received them quite late and there was no facility to photocopy them at that time. The intention, however, was to circulate them and I hope that will be done very shortly.

I have been informed there is a consultancy budget for outside consultants, although I do not know the amount. There is a meeting of committee chairmen next week and I will forward the concerns to our chairman, in order to ensure there is an adequate budget for any consultancy work we wish to pursue.

Senator Gallagher: Engaging a consultant would be vital in the reviewing of any evidence presented to us, but also in assisting us in carrying out research and our work.

Acting Chairman: I agree. I will now call Senator Connor and then Dr. Howell can respond to both contributors.

Senator Connor: Dr. Howell made some interesting points, including points on the relationships between price and prosperity and the consumption of tobacco. Is there not something wrong with the counter propaganda offered by the Department of Health and Children and others? Tobacco kills in the region of 40,000 people in this country every year.

Dr. Howell: The figure is 6,500.

Senator Connor: It probably kills several hundred thousand people throughout the EU. The strange thing is that although it kills so many of its customers, it can replace them every year. There is a total failure of the propaganda war, if that is what one wishes to call it, against the sale of tobacco. Does Dr. Howell think we are saying or doing the right things in regard to this war against tobacco sales? I am a convert and I am now fanatically opposed to tobacco.

Another interesting issue is that we are subject to a great deal of EU legislation in this regard. The EU has a not insignificant tobacco growing industry itself. I raised this with the Commissioner when he addressed a joint session of this and the Joint Committee on European Affairs on this issue a few months ago. There is also the question of imports of tobacco at concessionary trade arrangements; for example, Turkey exports huge amounts of tobacco to the European Union under very concessionary terms because it has signed various trade protocols with the EU. We should be very concerned about that and perhaps Dr. Howell will comment on it.

There is a complete interdiction in our law on the sale of alcohol to people under 18 years of age. I was interested to read that the interdiction on the sale of tobacco applies to those under 16 years of age, which I confess I did not know. We should take that up very vigorously with the Department because I am sure it could easily be addressed. Under the Child Care Act we recognise everyone under the age of 18 years as children.

I am interested to know why the advertising and propaganda against tobacco has failed so badly. It appear that an industry, which kills it customers on such a massive scale, can continue to replace them by advertising.

Dr. Howell: The reason for that is that the arguments are not balanced because we are not on a level playing pitch.

The tobacco industry in this and in most countries spends ten or twenty times as much money promoting its product as the health care lobby. We spend very little money on pointing out the dangers of smoking. Many people will say that everyone knows smoking is bad for one's health. Everyone knows smoking is bad for someone else but not himself. Most smokers begin to smoke before they are 18 years of age. They do so for many different reasons. Smoking is glamorised, there is peer influence from friends who smoke and advertising plays a role. However, by the time a smoker has passed through that phase and wishes to give up the habit, he finds he is heavily addicted. I know school teachers throughout the country who tell me they have pupils who are addicted to smoking. Colleagues of mine who are doctors deal with children who are addicted to smoking. It does not take long to become addicted. It is fine to be a rebellious youth for two or three years. We were all rebellious and I hope young people will continue to be so but the problem arises when young people become addicted to nicotine and are hooked forever. Many people find it impossible to give up smoking. The tobacco industry has made light of the addictive nature of their product but we must take that with a grain of salt. The industry merely needs to glamorise smoking in the early stages and entice the consumer to take up smoking. Once a smoker becomes an addict the industry is sure of a customer who will buy twenty cigarettes a day, 365 days a year for 40 uninterrupted years. That is why it is so crucial for the industry to get the youth market. In the United States one tobacco company decided it was losing so much market share to its competitors that it introduced the cartoon character Joe Camel. Within two years their market share had almost trebled because they were targeting young people. Documents released in the United States show this to have happened but I have no doubt a similar situation has arisen here on a smaller scale. The company to which I refer spoke of the need to target the 14 to 18 year age group in order to maintain their market share. On the other side, the health promotion unit, for example, has nothing like £10 billion per annum to cover all health projects of which smoking is only one.

With regard to the issue of EU subsidies, for years many health care organisations have pointed out the anomaly between the minimal amount of money the EU spends on preventing tobacco related illnesses and the huge subsidies given to the tobacco industry. Commissioner Flynn did his best to correct this anomaly but I am afraid he lost the battle. Mr. Flynn opposed Commissioner Fischler on the issue of subsidies for the tobacco industry but he did not have sufficient support and he was not successful. I believe he will continue to address the issue for as long as he is a member of the Commission because he has strong feelings on this matter. He is to be congratulated for that. The anomaly is almost silly. The EU would be better advised to adopt a set aside system whereby tobacco growers would be paid not to produce anything rather than be subsidised to produce bad tobacco which is sold to third world countries. We are merely exporting our health hazard to them.

Acting Chairman: Three other Members, Deputy Kenneally and Senators Glynn and Moylan, wish to speak. I suggest we group questions so that Dr. Howell may respond to groups of questions.

Deputy Kenneally: I welcome Dr. Howell. I found his presentation very interesting. A number of speakers have addressed the committee on this topic but I learned more about the tobacco industry and the health problems associated with it from Dr. Howell's brief ten minute submission than from many others. Dr. Howell was very concise and, more importantly, very forthright. What he said about members of the consultative committee, namely IBEC, the ICTU and representatives of the Department of Health and Children meeting with representatives of the tobacco industry outside the consultative committee was extraordinary. I was reminded of a novel which I read over the Christmas holidays. Like many works of fiction, this novel is based on fact and deals with a court case taken against a tobacco company by a person whose health had been damaged by smoking. The legal representatives of the tobacco companies gave extraordinary attention to detail in all aspects of the preparation of the case, including jury selection, to try to force a decision favourable to the company. I found their methods extraordinary and I am sure the novel is based on fact. I was, perhaps naively, surprised to hear Dr. Howell claim that tobacco companies are behaving in a similar manner in this country, albeit on a smaller scale. I found his allegation very interesting.

I take Dr. Howell's point about people such as Mr. Eddie Jordan being glamorised on programmes such as "Kenny Live". It is very difficult for the anti-smoking lobby to compete with that. I know of the stance of the Irish Medical Organisation in trying to discourage people from smoking. What efforts are made to discourage smoking within the IMO? People have said to me that their GPs discourage them from smoking while, at the same time, smoking themselves. GPs often do not practice what they preach and many patients find it difficult to accept that.

Of people who smoke 40 cigarettes a day over a period of 20 or 30 years what percentage will die from lung cancer or heart disease?

Senator Glynn: It is interesting to note the similarity between the tobacco industry and the illicit drugs trade. Both have huge resources and a ready supply of clients who are addicted to their product. Hence the figure of 6,500 deaths per year which Dr. Howell quoted. In my part of the country some people refer not to cigarettes or cigars but to cancer sticks or coffin nails.

The Midland Health Board conducted a survey of tobacco and alcohol abuse. We discovered that if a group leader smokes the subservient members of the peer group will almost certainly smoke too. Does Dr. Howell think enough is being done and are we tough enough with the tobacco companies? Members of this committee have questioned representatives of tobacco companies in many ways and on many occasions. They flatly deny that there is any addictive substance in tobacco. The future of the tobacco industry is secured in the same way as the future of the illegal drugs trade. They both have compulsive users.

In fact, they are addicted and, until the tobacco companies admit their responsibility, which they are not doing and are being irresponsible in not doing so, the committee will discuss this matter again in future with Dr. Howell or some other doctor. I do not believe the powers that be, including public representatives and leaders in the community, are tough enough on the tobacco companies which are not accepting their responsibilities.

Senator Moylan: I compliment Dr. Howell on his presentation which we have an opportunity to examine in detail. Has any survey been conducted on the number of smokers and non-smokers in the health care area because it is important? Many young people, especially those involved in GAA or other sports, whom one would advise not to smoke in the interests of their future in sports point to the fact that people in the health care area smoke. Something should be done about that.

I hope Dr. Howell's organisation takes steps to ensure he has an opportunity to make the presentation he made this morning or a similar one on "Kenny Live". As Dr. Howell pointed out, given that an opportunity to appear on television was afforded to prominent sports people sponsored by the cigarette companies, I hope the same opportunity is given to him to spell out to the nation the dangers of smoking.

Senator Jackman: Are the pages given to us by Dr. Howell selected pages from the Irish Tobacco Manufacturers' Advisory Committee? They seem to jump from page one to page four.

Dr. Howell: The pages are sequential in terms of events and are as I printed them from the World Wide Web. There is a time sequence to them if they are followed through. It is instructive to follow the dates. The first is from Flor O'Mahony to Joanna Sullivan in December 1993. The next is a memorandum from Flor O'Mahony to John Lepere on 23 September. Another is dated 20 January and another 30 May. That is what I was able to obtain.

Senator Jackman: There is a jump from January to October and there is no sequence there.

Dr. Howell: I am not sure what way the Senator is looking at it. The pages may have been put in the wrong order.

Senator Jackman: When I was a teacher, I was aware of an alarming fondness for smoking among young girls. They were addicted by the time they came to us in first year despite stringent anti-smoking measures in schools. It seems they had to have cigarettes. That changes when women become pregnant because they are told there will be a danger to the health of their unborn children and that they will be born underweight. I noticed that anti-cigarette smoking advertising in the United States stressed the effects on children. I was in Alabama and the advertising specified in great detail the effects of smoking on the unborn child. That is very strong advertising which would have an effect on young teenagers.

What is the strategy of Dr. Howell's organisation for dealing with women patients? Can a pregnant woman expect to be told that she should not smoke for various reasons? Is the approach a haphazard one which relies on doctors who feel as strongly as Dr. Howell or does the organisation have a coherent policy?

Dr. Howell: Some doctors and health care professionals smoke. Different surveys have been conducted from time to time and the national average is about 30 per cent of the general population with 16 to 20 per cent of health care professionals and 10 per cent of doctors smoking. They are as addicted as anyone else and many of them find it very embarrassing. It is a measure of the strength of the addiction that people who know so much about the product cannot give it up. The proportion of doctors smoking is small. It is about 10 per cent.

As to how they relate to people when dealing with the issue, encouraging people to give up smoking tobacco is not as simple as telling them to do so because it is bad for them. Smokers are sick to death of hearing that because most of them know it. That is not the approach they want. We must move away from this approach and I feel strongly about that. I would never blame a smoker or accuse them of being wrong for smoking. They are addicted to a substance and we must help them get around that. The health boards through their smoking target action groups and the Irish College of General Practitioners in association with the Department of Health and Children have compiled a programme called "Brief Intervention Training" for general practitioners to assist them in delivering smoking cessation counselling. Many doctors would not have had that training to deal with the issue. This is now being spread throughout the country, and it is hoped that many GPs will take it up to allow them engage with people in a more realistic way in dealing with their habit. It is a complex and difficult area.

The issue with respect to pregnant women is also important because we are often unfair to pregnant women and women generally regarding the smoking issue. Men are told that smoking can cause lung cancer and heart disease whereas women are told they will age earlier and that their babies will be harmed. It is as if they are more important as an object to look at and for producing babies rather than their health being important in itself. The greatest damage a pregnant smoking woman does is to her own health. Many pregnant women find it difficult to give up because of ongoing stress at the time and other reasons. It helps enormously if the partner also gives up. We can provide the information but they usually need the support of a partner. It is very difficult to quit if one's other half still smokes. We are providing the information, some of the maternity hospitals are running smoking cessation programmes and many of the health boards are examining the area to try to address it. With regard to women's issues and advertising, research I carried out some years ago addressed this issue. I decided to look at what messages were being sent to women through women's magazines. I read every women's magazine produced by Irish companies over five years, a total of over 600 magazines. All of them carried tobacco advertising and most of them had no editorial on the harmful effects of tobacco. Members will be familiar with the full page tobacco advertisements that are supposed to carry a Government health warning. The health warnings can be rotated. One of the warnings is "Smoking when pregnant can harm your baby". Not one issue of the magazines, which covered a period of five years, carried that warning. That is not a coincidence. That is the power of the industry in deciding, when placing its advertising with a publication, what health warning it will carry. That is an instructive feature.

With regard to other issues, such as smoking 40 cigarettes a day for 20 years, the general feeling is that 50 per cent of smokers will be killed by their smoking habit. In other words, there is a 50:50 chance that smoking will kill the smoker. That is a very high proportion. Half of those smokers will die prematurely. Everybody must die sometime but we want to live a healthy life for as long as possible. Smoking causes the smoker significant disability before it kills them and that is the problem. It is not a case of the person getting lung cancer and dying the following day; he or she will be ill for some time. If one has chronic respiratory diseases or emphysema, one could be debilitated for 20 years living a life of hell. Members of the Committee have met such people. That is the quality of life for many smokers. It is not a case of a quick, clean cut such as in a road traffic accident. It is a slow process.

Are we doing enough? I do not believe we are. Our legislation is weak and muddled. It was good legislation when it was introduced in 1978 by the former Taoiseach, Charles Haughey. I came across a comment on it on the Internet in which Mr. Haughey was described as an anti-smoking militant. That is probably the best praise he has received to date. However, that legislation needs to be strengthened. Deputy McDowell put down a parliamentary question last June asking the Minister to make known to him the constituents of tobacco products. The Deputy is still waiting for a reply although the industry is obliged to give that information to the Minister. I am not sure if the information has yet been made available to the House.

When one purchases a food product, there is a detailed outline of its contents on the pack. One has no idea what is contained in a packet of tobacco, whether it includes additives or other chemicals even though there are substantial numbers of them in the product. We are not nearly strong enough on the industry; we have pussy footed around it for too long. A national lifestyle survey was carried out last year by University College Galway on behalf of the Department of Health and Children. Provisional figures suggest that in the last five years no progress has been made in reducing the prevalence of smoking. If anything, it has increased significantly in the young population.

We have lost the battle. We thought we were doing a decent job but we need to do more.

Deputy Shatter: I have glanced at the documentation submitted by Dr. Howell and I am greatly disturbed by the memorandum from the former Senator, Flor O'Mahony, of 30 May 1994. He says in the memorandum that he met a Department of Health official that morning who was chairing the subcommittee of the consultative committee on smoking on the workplace. Mr. O'Mahony goes on to describe his belief that he influenced the views of this official. Clearly, Mr. O'Mahony was a lobbyist for the tobacco industry at the time and was involved in public relations on its behalf.

I do not know what business that Department of Health official, appointed to chair a committee investigating the issue of smoking in the workplace, thought he was engaged in by having a behind the scenes meeting with Mr. O'Mahony about the work of that committee. I propose that this Committee send a letter to the Secretary General of the Department of Health and Children or to the Minister requesting that the relevant official be brought before this Committee to discuss this issue. The official was chairman of a committee which clearly should have had an agenda which did not include private meetings with lobbyists for the tobacco industry.

Acting Chairman: The problem is whether we can compel people to attend. We can invite them-----

Deputy Shatter: This is an Oireachtas Joint Committee and the person concerned is an official in the Department of Health and Children. We could request that the official come before the Committee to further examine this matter. I am sure he or she will comply with that request.

I am concerned about this not simply in the context of past events but with how the Department is now formulating its policy on tobacco and tobacco related matters. If there is similar access behind the scenes and similar influence being exercised by lobbyists for the tobacco industry, this Committee is entitled to know. Lessons should be learned from these events.

I am not suggesting that the official be asked to attend the Committee so that he or she can be pilloried but I am interested in future policy and in ensuring that other committees dealing with tobacco are not being similarly influenced. There is a committee examining the possibility of the State bringing proceedings against tobacco companies, either alone or in conjunction with health boards or other EU states, of a nature similar to court cases which took place in the United States. I want to know who is chairing that committee and whether somebody such as Mr. O'Mahony is exercising influence over the committee's deliberations.

Acting Chairman: I will take that on board. The Secretary General of the Department of Health and Children is due to appear before the Committee on 11 February. It might be possible to pursue the matter at that meeting.

Deputy Shatter: I hope that before that date the relevant official who chaired this subcommittee would be given the opportunity to come before this Committee to deal with this matter. We could also deal with other meetings that might have taken place behind the scenes between the tobacco industry or its representatives and successive Ministers for Health or officials in the Department.

Acting Chairman: This day fortnight would be another opportunity to invite that official. We will do that through the secretariat.

Deputy Shatter: I hope on that day the Committee might deal with both that issue and the nursing crisis.

Acting Chairman: We will deal with that under other business. Another suggestion has been made in that regard.

I thank Dr. Howell for his attendance. Committee members tend to use the phrases "very useful" and "very informative" at random but on this occasion I found your comments extremely informative, as did the other members. They were straightforward and you presented them in a concise manner which is much appreciated. The Committee will take account of the information you submitted and will pursue the points you raised. We plan to draft a report on health promotion and tobacco advertising and consumption and we hope to present it, with the assistance of a rapporteur, at an early date. A copy of the report will be forwarded to you.

The witness withdrew.

The Joint Committee went into private session.