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Political history of smoking and health
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    Denial and Delay—The Political History of Smoking and Health, 1951-64; Scientists, Governments and Industry as seen in the papers at the Public Records Office. David Pollock. London: Action on Smoking and Health, 1999. ISBN 1 872428 444.

    The British Civil Service documents everything, and eventually makes its papers available to researchers. David Pollock has used some of the papers provided in the Public Records Office at Kew in London to tell the story of how action on smoking was delayed between 1951 and 1964, coincidentally a period of Conservative government. Little did we know at the time how true the 1964 Labour election slogan “Thirteen Wasted Years” would prove to be.

    Pollock's story is limited, for as he points out he has essentially investigated only one of the various sets of documents available, and his book is less a “political history” than an illustrated journey through official documents. But it is riveting reading and provides much splendid material to demonstrate the caution of civil servants, the short sightedness of politicians, and—as ever—the iniquities of the tobacco industry.

    The story has plenty of gems but few stars. In 1947, when “a large scale statistical study” on smoking and lung cancer was under consideration, Austin Bradford Hill recommended “ . . .a very good worker to whom it is well worth giving a wider experience in medical statistical work with an eye to the future . . .”: a judgement about Richard Doll with which none would now argue. A few researchers such as Doll, Hill, Wynder, and Graham recognised the importance of tobacco. A desperately limited number of medical administrators and civil servants (especially in Scotland) sought early action. Horace Joules, a distinguished chest physician, led the early medical campaigners, but his views were often discounted because of his perceived “left wing bias”. Among the bureaucrats, Sir George Godber characteristically became involved long before he was entitled to do so, and pressed every available lever from behind the scenes. Charles Fletcher and Robert Platt set the first Royal College of Physicians report in train. But heroes such as these are few and far between.

    Even some of the heroes were naive: they did little lobbying, and made the mistake of thinking that the industry's leaders were honourable. So the manufacturers received advance copies of Royal College of Physicians (RCP) and other reports, enabling their supporters and scientific lackeys to minimise any political damage.

    Some of the early politicians did their best. They may not have got it all right (and who can blame them, given the paucity of information at the time) but some credit surely belongs to health ministers such as Iain Macleod and Enoch Powell, who refused to prevaricate and pressed for immediate action. And as science minister, Lord Hailsham reluctantly agreed to meet the industry, but told his office to “give me some nasty things to say . . .”.

    For the rest, there are villains and prevaricators. Prime ministers, cabinets, and ministers found every possible reason to avoid doing anything, from worrying that telling the public about the dangers of smoking might generate “cancer phobia” to concern for the Rhodesian economy. Even in 1962, the chancellor of the exchequer, Selwyn Lloyd, persuaded his colleagues that “it would be preferable that the government should not at this stage appear to be assuming a responsibility for ‘discouraging’ adults from smoking”. Civil servants were generally cautious: some simply didn't like doctors (“by habit and training inclined to the pontifical in expressing their views”, according to Miss Boyes of the Board of Trade), while a Mr Selby-Boothroyd felt that the first RCP report could be dismissed on the basis that people were divided into “soft shells”, who were vulnerable to lung cancer, and “hard shells”.

    The tobacco manufacturers, of course used every possible device to question, deny, undermine, and oppose both the evidence and any worthwhile action. Mr (later Sir John) Partridge of Imperial Tobacco would not now be allowed by his company to concede, as he did in 1962, that the industry advertised “to young people”—but he and his colleagues used all the same techniques their successors use today: deny the evidence; denigrate the researchers; offer funding for irrelevant research; defend all forms of promotion; accept no restrictions; assert that the only worthwhile approach is (carefully limited) school based education. There is nothing new about the arguments they use today or their lobbying techniques.

    What are the lessons? Perhaps above all, it is distressing to see how little has changed: only a few doctors and health professionals campaign for action on tobacco; most bureaucrats remain cautious; health generally loses out when it comes into conflict with more important government departments; politicians with the determination to act on tobacco are rare and are soon moved; and the tobacco manufacturers and their agents are if anything tougher and nastier than ever.

    And in the UK, 50 years after Doll and Hill's first published reports and nearly 30 years after the first RCP report, just under 30% of adults still smoke, and literally millions have died because they smoked. Denial and delay shows that much of the responsibility for these deaths rests not only with the tobacco industry, but also with its many active and passive allies in government.