The record speaks for itself. Fourteen years after Hill and Doll were ‘satisfied that the case against smoking as such is proven’, ten years after the publication of the first report on their study of British doctors, seven years after the Medical Research Council told the Government that ‘the evidence now available is stronger than that which, in comparable matters, is commonly taken as the basis for definite action’ and two years after the Royal College of Physicians in exasperation produced a popular summary of the evidence with specific policy recommendations, the Government was still equivocal about taking effective action against this egregious cause of disease and premature death.
Of course, one must make allowances. ‘The past is a foreign country: they do things differently there.’ Government was still relatively small. It was less ready to intervene in people’s everyday lives. The tobacco industry was of enormously greater importance to the Treasury than it is now. Only part of the damage done by smoking had yet been recognised: its contribution to heart disease, in particular, was still only tentatively identified. The addictive power of tobacco had not yet been recognised, so that there was on the one hand greater willingness to leave to individuals the ‘free’ decision whether to continue smoking and on the other the fear that high-profile action to discourage smoking might precipitate a wholesale collapse in the market with serious economic implications. Few economists realised how resistant to price increases demand would be.
Nevertheless, the precedents and evidence were there for those with eyes to see. Government did conduct mass health campaigns directed at combatting diphtheria or promoting immunisation. Ministers and civil servants did not have to cow-tow to the potentates of the industry to the extent they did. In 1956 Robin Turton as Minister of Health was already telling the Cabinet that deaths from lung cancer had risen from 1,880 in 1931 to over 17,000 in 1955. Lennox Johnston back in the 1930s had even described smoking as an addiction and guessed that nicotine was the active ingredient. Enoch Powell noted the ‘probable flatness of the demand curve’.
But the prevailing ethic was one of doing the bare minimum to protect the Government from criticism for doing nothing while avoiding creating any effect for which one might have to answer. Among officials a few – notably Sir George Godber – struggled to overcome the inertia but too many – especially outside the Ministry of Health – sought only to reflect or encourage their Ministerial masters’ lack of enthusiasm. Among Ministers, indeed, throughout the whole period only Enoch Powell and Lord Hailsham treated the problem with the seriousness and application it deserved – and they were frustrated by colleagues unwilling to disturb the even tenor of their ostrich ways.
In 1964, NOP surveys showed that 67% of men and 36% of women still smoked, and that, when asked whether smoking was a cause of cancer, only one in three smokers answered Yes.
1. For another (similar) assessment, which I have discovered as this book goes to press, see Webster C: Tobacco Smoking Addiction: A Challenge to the National Health Service, British Journal of Addiction 1984; 79: 7-16. [back]
3. Sir George’s reports as Chief Medical Officer from 1960 were notably outspoken and a later article in The Times said that ‘Sir George Godber has embarrassed the Government about as much as a civil servant can’. Sir George himself comments that Sir Bruce Fraser, Arnold France (shortly to succeed Fraser as Permanent Secretary), James Dodds and ‘one or two others . . . went as far as they could against the obstruction of other departments.’ He adds in further mitigation that ‘the RCP report was the first good presentation of the case at a time when its full strength still wasn’t known, and the American follow-up two years later gave a huge boost.’ (Personal communication, 19 January 1998) [back]
4. 40% of all adults answered No, 17% answered that they did not know, and 43% (only 34% of smokers) answered Yes. The two surveys were in September and July 1964 respectively – PRO file MH 151.26.