Foreword by Sir Richard Doll Foreword by Sir George Godber
Foreword by Sir Richard Doll CH FRS FRCP
In retrospect, it is now clear that evidence of the harmful effects on health of smoking tobacco had been accumulating for some hundred years before 1950, but until then it had made little impact on the medical profession and none at all on the general public. In Britain, the increase in the mortality from lung cancer had attracted the attention of pathologists in the 1920s, but it was not until after the second world war that the increase had become so pronounced that intensive efforts were made to find an explanation for it. Then, in 1950, five reports were published linking the risk of the disease to the individual’s smoking habits, which led to the conclusion that smoking was an important cause of the disease. By that time, however, smoking had become such a normal habit – 85 per cent of middle aged men being regular smokers – that people found it hard to believe that it could be an important cause of disease and even the massive data contained in these five papers continued to be almost totally ignored, as had been the less detailed data in the three other similar papers that had been published in the previous decade.
Not everyone, however, ignored them. Dr Horace Joules, in particular, Medical Director of the Central Middlesex Hospital and a distinguished physician, was determined that the Ministry should do something about them. Moreover, he was in a position to see that they did, for he was a member of both the Ministry’s Central Health Service Council and its Standing Advisory Committee on Cancer and Radiotherapy, and the action he proposed started a series of events at government level that it would be hard to believe was not conceived by a satirical novelist, if they had not been documented in official reports, memoranda, and committee minutes which have been released for public examination 30 years after they were written.
The result of David Pollock’s research into these official documents provides a detailed account of how, at first advisory committees, then health ministry staff, and finally cabinet ministers themselves were able to prevaricate and postpone any decisive action to discourage smoking for 13 years after Dr Joules had proposed that the Ministry should undertake a publicity campaign about its dangers. The tobacco industry, not surprisingly, played a major role in delaying action, but it would not have had so much success had it not been aided first by the hesitation of some of the Ministry’s scientific advisers to accept the validity of findings that had not been made by standard procedures of laboratory research and later by the economic interests of the Treasury and the Board of Trade
The account of how these various interests influenced political action provides a notable example of the way in which government policies are determined in a market economy. It will, I suspect, find its way into many political textbooks. Meanwhile it is as absorbing to read as a good detective novel. It is, however, much more. For its publication should help to avoid any similar delay in the future, when medical research has revealed ways in which tens – or, as we now know, hundreds – of thousands of premature deaths can be avoided in this country alone every year.
Richard Doll
Oxford
July 1999
Foreword by Sir George Godber FRCOG FRCPsych
Almost half a century ago we learned that smoking was the main cause of lung cancer. Albeit our knowledge in 1950 was so limited, it would have led to real action at once had it not been for opposition for commercial and political reasons – the latter due to the substantial tax revenue from tobacco.
An emphatic reduction in smoking in the mid-1950s could have prevented millions of premature deaths by now. I calculated for an annual report as Chief Medical Officer thirty years ago that eliminating smoking would preserve 180,000 years of working life each year. By today’s knowledge that must be a vast underestimate.
One must not, of course, judge the authorities of the 1950s by the standards of today. We were not attuned then to the idea of preventive change that would yield assessable benefit in twenty or more years. Our experience was rather in such action as diphtheria immunisation with 50,000 cases and 2,000 deaths preventable each year in the short term. Yet one can only look back with a feeling of guilt at doing so little.
What this book makes plain, however, is that the Government knew at least a large part of the harm smoking did but needed the tax revenue so much that it did not want prevention to succeed. Iain Macleod was a good Minister and my friend – but how could one now accept a health minister who faces a press conference on the strong reasons for refraining from smoking – and smokes while he does it?
But politicians are not alone in this. It was disturbing for me to learn from this book of the close relations in the 1950s between the tobacco industry and some of my senior colleagues in the Ministry of Health. But even in the late 1960s when members of the Medical Research Council were photographed at their 50th anniversary meeting, I had to point out that there was an ash tray between each pair of members at the table: they were hastily removed! The Royal College of Physicians went on allowing smoking at its meetings and occasions for over twenty years after the report of 1962. I had persuaded the Ministry’s Standing Medical Advisory Council and Central Health Services Council to ban it long before that – and WHO to remove smoking impedimenta from their meetings..
In the years that followed we have discovered that even more premature deaths from many other conditions are also due to smoking. Yet the commercially oriented opposition has steadily mounted and the message reaching much of the public remains unclear. Still today far too many people smoke.
This book records how proven facts can be obscured by commercial interests and even more how a habit linked to an addictive drug can lead to the disregard of danger. We need to learn the lessons it offers.
George Godber
Cambridge
July 1999