Cigarettes: the most successful product ever (14 Mar 2013)


[ Silence ] [ Inaudible background
conversation ]>>Good afternoon. Hello and welcome to
this lunch hour lecture, which is given by
Allen Hackshaw. It’s a lecture–
Professor Allan Hackshaw from the UCL Cancer Institute. It’s a lecture entitled,
“Cigarettes: The most successful
product ever?” Thank you very much.>>Professor Allan Hackshaw:
Good afternoon everybody and thanks for coming. I wasn’t sure whether the title
was going to market cigarettes because I use the word
successful product ever and I’ve got a feeling it is. After all these years of research it’s still
heavily engrained in practice. A friend of mine in Italy a few
weeks ago went to see his doctor with some minor heart
palpitations and his GP said to him, “I think its stress
that’s the problem with you.” He then went into his pocket and
pulled out a cigarette and said to him, “I think you
should take some of these and that will calm you down.” This is his doctor during
a consultation in 2013. How can this not be the most
successful product ever? So what I’m going to cover
is I’m not going to talk about cancer and heart disease because everybody knows
what that’s about. But, I’m going to give
the bigger picture of the tobacco problem and touch
on some disorders that aren’t so well known and
also what happens next or what should happen next. So here, let’s create
a new product. If this were to be
a new product now with these attributes
they look really good. It can relieve stress, so even
doctors still think it does so, gives you pleasure, can
enhance your socializing, look and make you
feel more confident. These are all features that
most people want to have. So if you’ve got a product that can make you have these
features then excellent. So it looks like we’re on
a roll with these products. These are iconic photographs from when I was growing
up many years ago. This– the people inside the
pictures might have changed, but the look of them haven’t. And if you go elsewhere in the
world they look very similar. So there’s Marlboro man
and there’s Lauren Bacall who I always think of smoking
a cigarette almost every time I see her in a film. Again, how do you get this
innocuous looking thing being attractive, make you feel sexy
whether you’re a man or a woman? There’s not many products
that can do that by the way and it’s all from branding
and look how small this thing. But, look at those two, okay,
when you look at the imagery of it and this is what the
tobacco industry relies on all throughout the years
to make you think you can look like one of these two people. Remember Marlboro man, I’m
going to mention him later on. Look how fit and
healthy he looks. [Laughter] So consumers,
you’ve created this product that makes lots of
people feel really well. How popular could it be? Well this is how popular it is, it’s 1,000,000,000
smokers in 2010. That’s one in five of
the world’s population. It’s absolutely huge,
800,000,000 men and 200,000,000 women and in
many countries the prevalence of smoking women is going up. This is what the
tobacco industry say, it was few years ago. “If you can market a
product that kills people, you can market anything.” Do you agree? I think so. Again, I still think this is the
most successful product ever. And this is only– this
is not 1980’s or 1990’s. This is only 2003, so even
then the tobacco industry knows that there are lots
of mugs out there, so if you’d pardon
my expression. But, remember that
1,000,000,000 smokers in the world in one year. So if you’ve got a product you
could make to look attractive, you can market it well. What about the money
it brings in? Well in the U.K. alone
its 15,000,000,000 pounds of revenue. That’s in one country. The U.K. is quite good
at manufacturing it by the way and selling it off. They can’t grow tobacco as
you all know, but they’re good at manufacturing and sales. In the United States 8.5 billion
pounds spent just on markets and advertising by the
tobacco companies compared to only 457,000,000 spent on tobacco control
by the government. So just by looking
at the disparity between what the industry spends
and what governments do to try to counteract that
is absolutely huge. This is what I find staggering. The largest six tobacco
companies, their revenue and profits, okay,
look at the scale. So these are the– this is
in one year alone by the way. If this was looking at millions
you’d think quite a successful company wouldn’t you. The scale is not in millions,
it’s in billions of dollars. It’s absolutely huge. So even after decades of tobacco
research and everybody knows about smoking and
everybody knows a smoker, I’m still staggered by
the scale of this product and how many people use it and also how much money it makes
the companies that produce it. So this is just the six
biggest tobacco companies. The one that is more startling
as you can see is the one right on the right, one from China. It’s almost 92,000,000,000
dollars revenue. That’s where the tobacco
companies are marketing. And I and others when I
starting work in smoking about 20-22 years ago people — we knew then that’s what
the future is for tobacco. It’s not in the U.K.
or Europe or America. It’s in the developing countries
where health education is not so good as it is here. So total revenue of those six
companies, 346 billion dollars. It’s mind boggling,
35,000,000,000 dollars of profits, so that
should be dollars. The profit from those six
tobacco companies is the same as the combined profits
from McDonald’s, Microsoft and Coca Cola in
that one year alone. And if you think how
common those products are, well tobacco is even
more popular. And just put it in the scale of
things, the amount of revenue that those six companies
made was not far off from the Gross Domestic Product
of Venezuela, a whole country. So these big numbers I
find so truly startling after all these years. So that’s what this
product has done. It’s been marketed
incredibly well. Their lawyers, their marketing
people I think are amongst the best if not the best in the
world from any organization because of the product they have
to deal with, but at what cost? They’re expensive and in many
countries the cost of them, cigarettes is getting
higher and higher. So in the U.K., for example,
a smoker who smokes about 15 to 20 cigarettes per day, and that’s what an
average smoker smokes, can spend easily 2 to
2,600 pounds a year. That’s not a negligible
amount of money at all. There’s a clear social
divide between rich and poor and I’ll show this a bit more. Here’s some in New York where
they found that 25 percent of the income spent by low income workers is
spent on buying cigarettes. That’s a huge amount
of your salary if you’re not earning very
much in the first place. And again, it’s another
part of societies where they’re developed
or developing countries where the tobacco
industry tries to focus. It’s not when people who
know about the health aspects so much, but people
who don’t know as much. So these are some results from the U.K. This is the
average tobacco duty paid per household over time, from
1995 to the year 2010. And here we’re looking at people
in the bottom fifth of incomes, so they’re the poorest ones
in society versus the ones from the top fifth of incomes. They’re the richest
ones in society. And as you can see that
blue curve has steadily gone down over time, such
that between 1995 and 2010 the richest people are
now spending 31 percent less on cigarettes. But, the poorest people have
only reduced their spending by about 14 percent. So a huge difference between
the very rich and the very poor in the U.K. and you’ll
see this pattern in other developed
countries as well. So over time people
have been smoking less. There have been fewer smokers, but people who are richer
are smoking even more less than ones who are not so rich. So here are the health effects. I’m not going to go into cancer
and heart disease as I said , but here’s a statistic that’s
well, fairly well known is half of lifelong smokers
die from their habit. Not die from heart disease,
cancer and a whole range of things, but they die from those things plus
other stuff as well. But, half of them die because
of their smoking habit and many of them die in middle age. And middle age now really
is in your, is your 30’s and 40’s up to your 50’s. And one in five deaths
in the U.K. alone is due to cigarette smoking, so
a 100 to 120,000 a year. So if you think of
that half it’s like playing Russian
roulette with three bullets. So none of us here would
even play Russian roulette with one bullet,
I should hope not. So if you imagine
playing Russian roulette, but putting three bullets in. So you start smoking from the
age of say 16-18 years old and you get to 50-55 years old. You spin the wheel of the
gun and then you press, that’s what cigarette
smoking is like. So not trying to be too
much of a scare tactic, but these are very well
established figures. In the world, in worldwide
completely there are 6,000,000 deaths in 2011 and 80 percent of
those deaths were from the low and middle income countries. So I said a few minutes
ago this is where the big tobacco
companies are starting to focus their efforts. To put into scale of things
in terms of what else, what other I suppose bad
habits you could have and whether you die from it or
not, this is over 2004 to 2002 and 2004, so over
a five year period in the U.K. this is the number of deaths attributable
to three habits. So you have smoking,
alcohol and drugs and that drugs is all drugs
including illicit drugs, so a tiny number down there. I’m not advocating
drugs by the way; I’m just telling you
the scale of things. So drugs is just– you can
barely see it on this scale. It’s just down at the bottom. Then you’ve got alcohol and
that’s 25,000 is the minimum, maximum 200,000 so
even the upper estimate of the amount caused by alcohol
drinking is only 200,000 deaths in that five year
period and look at the number due to
cigarette smoking. It’s way at the top. It’s way bigger than
anything else you can imagine. So what else does
smoking do for you? Well if you continue throughout
your whole life you loose on average by about
10 years of life. This is a famous study from
the British doctor’s study. The U.K. is in a good position
in that in the early 1920’s and 1930’s most of
the population smoked and it’s the first country where
most of the population smoked and then in the 60’s
and 70’s most of the population quite smoking. So U.K. figures are a good
way of looking at what happens when lots of people continue
smoking for long periods of time and what happens when they quit
and I’ll show you that later on. So that red curve is the
death rate for people who have never smoked cigarettes
and that blue curve is the curve for people who have been
lifelong smokers all the way throughout. And as you can see, from about
the age of 50 that’s when cancer and heart disease starts
to kick in and as soon as you hit 50 the risks
starts to separate out. So people start to die off
much quicker if you continue to smoke compared to ones who have never smoked
a single cigarette. So on average you can lose
by about 10 years of life. Many smokers if not most
smokers, and I’ve got friends who are smokers,
think that their risk of any disease is proportional
to how much they smoke. So everybody– you all a smoker that says oh I only
smoke one cigarette a day or I only smoke a few
so I think it’s okay. That only applies to cancer. With cancer there’s a
linear line between risk and how much you smoke, but
there isn’t for heart disease and probably stroke and this
is what I’m going to be looking at next in the next year or so. So as you smoke more the risk of
you getting heart disease jumps. It doesn’t go up slowly. It jumps a lot and then
it starts to level off. Whereas with cancer it looks
more like a straight line and then it levels
off much later. And heart disease and
stroke are one of the most, two of the most common disorders
you can get as well as cancer. So let’s quantify
what the effect is. So this is the effect of smoking
one or 20 cigarettes a day of getting heart disease. And you– because heart disease
risk changes with your age its– here it is by age
group, 45, 55, 65 and 75. So if you smoke one
cigarette a day, that’s one, your risk of getting heart
disease is almost double that compared to a never smoker. So that’s where that
relative risk of 1.93 is. If you smoke 20 cigarettes a
day and you’re aged 55 your risk of getting heart disease
is three times greater, hence the relative risk three. So let’s put the two risks in
comparison with each other. The risk of smoking– the
risk of getting heart disease if you smoke one a day is
20 percent of seven percent of the risk if you
smoke 20 a day, okay. So if you smoke one cigarette
versus 20 that’s five percent and most people think
I’m only going to have five percent
of the risk. It’s not true with heart
disease and I think stroke. It’s not five percent,
it’s 27 percent of the risk if you’re age 45, but
as soon as you get to 55 or 65 the risk is much higher. To put it into context
that relative risk in those two columns for lung
cancer it’s about 20, okay. So you’re 20 times more likely
to get lung cancer if you smoke than if you don’t smoke. But, for heart disease even
heavy smokers their relative risk is only four to five
times greater than a nonsmoker. So smoking one a
day actually gives– that’s where you get a
lot of your risk and then as you smoke more than that
then you get some more. But, then it’s not
just a small amount of risk in smoking one a day. So this is one fact that
many smokers don’t realize. So as well as this
extraordinarily high risk of getting heart disease for smoking very few cigarettes
a day there’s a whole host of other disorders that smokers
can get that are chronic. So that most people focus on
the serious and fatal ones, ones that are going to kill you,
there’s a whole range of things that aren’t going to kill
you and they’re going to be chronic disorders
that you live– that you have for
most of your life. So just to give you a
flavor of some these, actually a few slides of them, these are so gastrointestinal
disorders. And you’ve got peptic ulcer, so
you’ve got 100 percent increase in risk if you’re a
lifelong smoker compared to if you are a nonsmoker. So in 100,000 smokers one
could expect 440 of those to be due to peptic ulcer. You’ve got Crohn’s disease,
you’ve got gall bladder disease, psoriasis for the skin, once
you get it because a lot of adults do get that and it’s
quite difficult to get rid of. So a 40 percent increase for
men, 150 percent increase for women and in every
100,000 smokers those who do get psoriasis 730
could be due to smoking, 2,000 if you’re a woman. So I’m not going to through
these numbers in great detail, but the flavor of the
range of chronic disorders that you can get if you smoke. It’s got neurological
disorders, Alzheimer’s. Many years ago people thought that smoking cigarettes was
protective against Alzheimer’s, i.e. the more you smoke you were
less likely to get Alzheimer’s. It’s not true. It’s the way those studies
were analyzed and interpreted. Smoking cigarettes actually
increases your chance of getting Alzheimer’s. And one of the few
things it does protect against is Parkinson’s,
but you don’t want to think I want Parkinson’s at
the expense of other things. Hip fracture quite common in
elderly women and elderly women who smoke are particularly
prone to getting hip fractures. You’ve got type 2 diabetes. You’ve got overactive
thyroid, periodontitis, things with the teeth. There’s almost every body
system that you can think of is affected by
smoking some way and there’s no big
surprise considering that smoking has got
6,000 chemicals in it. It’s bound to give you something
very nasty if not several things and smoking can directly harm
other people around them. The smoking ban came into place
a few years ago and it’s based on the evidence on lung cancer
with a 25 to 30 percent increase in risk and for heart disease,
30 percent increase in risk. But, plausibly any
disorder that acts of smoking causes
a nonsmoker can get if they’re regularly exposed
to passive smoke, okay. So it’s not just heart
disease and lung cancer, which is what most people
think of, but it’s any disorder that I’ve listed plus all
those other cancers you can plausibly get. The thing with smoking the
risk goes up and it goes down, so if you have passively smoked
you’re still having some– you’re still having a dose and
that dose doesn’t mean no risk. It means some risk even
if it’s a small risk, but it still means you’re going
to have a slightly higher risk than someone who’s not exposed
to any passive smoke whatsoever. One thing I was quite astounded
by was the number of women who smoked during pregnancy
even after all these years. So myself and Sadie, that I see in the audience did a very large
systematic review on smoking and birth defects a couple
of years ago and as we looked into this we put the
statistics behind it. In the U.K. one in seven women, pregnant women smoked
during pregnancy and a startling statistic
in this day and age. And again, is a social
inequality divide, again the smoking. And it– less than
20 years old– shoot to the next and it’s
routine and manual work, many more of those smoke
compared to those in manual, sorry those in managerial
professional jobs and is also a big age gap. Lots of young women and
young girls smoke compared to older women. So the one that I found most
surprising was women aged under 20 years old, 45 percent of those smoked during
pregnancy, okay. It’s a huge number. So some common outcomes of
pregnancy, there’s miscarriage, plenty of deaths where the
baby has died just before, sometime just before
pregnancy, premature births and low birth weights. These aren’t minor disorders. They can be quite stressing
to the woman and her partner and these are not minor in
terms of the number of cases that smoking has caused. So the number of
miscarriages is 5,000 caused by smoking each year
in the U.K., 19,000 with low birth weights. So it’s a big problem so
not heart disease or cancer, which are common as well. These are also just as
common in some respect. And one thing we found is the
whole range of birth defects and many of these
are lifelong defects, which you can’t fix so readily. So there’s something called
gastroschisis where parts of the abdomen protrudes from
the baby’s stomach, which is not so easy to fix, hernia where
the skull doesn’t fuse properly, club foot, missing or deformed
limbs and legs, a whole range of defects caused by smoking. So some milestones
over the 50 years, so that’s why the product
is so good, why it’s bad, but going through some things that you might not have
known of, known about and some milestones
over the 50 years. Over the years most
countries put a huge effort into tobacco control and I’ve
just picked out a smattering of them, ones that I thought
were quite interesting. So, 1962 and 64 the
U.S. and the U.K. came out with their first official
government health reports alarming people about the
health hazards of smoking. Then not so long afterwards 1965
the U.K. I thought was quite advanced for banning
smoking on television. It took other countries longer
than that before they started to ban it on TV, but
the U.K. were very quick with the mark soon after that
first report came through. And in 1971 an organization
called ASH started, wonderful name of course. But then many other
organizations such as ASH, but I particularly picked on
ASH because they are so good at their research and getting
information out there both in the U.K. and internationally. And they’re the ones that– they’re quite a thorn in
the tobacco industry’s foot. The U.S. Food and Drug
Administration came out and approved nicotine
gum in 1984. The reason I raised that was the
tobacco industry were very much against it for obvious
reasons and they actually tried for that not to be licensed. But, it’s good that it was
licensed because it’s one of the effective ways for
people to stop smoking. Nineteen ninety seven, remember
Marlboro man in the beginning, the healthy looking thing,
he died of lung cancer, so it’s a not milestone,
so I put it up there just to make sure it’s
not a good thing. It was quite sad and it’s
quite ironic in the same way that here’s their
front man for a product that probably eventually
killed him in the end. And then finally in 2005, again its seven years
ago this thing called the WHO Convention Tobacco Control, a huge international
concerted effort to get tobacco habits
down internationally. So some other general
achievements, nonsmoker is now
considered the norm. I mean everyone now
thinks this is obvious. If you go back 10-15 years,
that’s not the case at all and smokers very
acceptable in many places. Smoking is now unacceptable
in most places and you see peoples’
eyebrows raised when someone does
pull out a cigarette. Most smokers now want to
quit, lots of restrictions on where people can
smoke, advertising bans, most packets have got
cigarette warnings on them and a combination of that and other important tobacco
control policies have avoided a large number of people dying. If the U.K. population and
the U.S. and Europe carried on the way they did you
would have a lot more than 100,000 deaths per year. So even though it’s still a
large number it’s a large number that’s been avoided
in the first place. So how have smoking
habits changed over time? It’s changed a lot from 1974 to
2010, so it’s more than halved in both men and women, but it’s,
without sounding like a teacher, it’s still not good enough. You’ve still got one if
five of the population that are active smokers, so
this is the bit that we need to improve and find
ways of improving that. It still is too much
and the reason is if you do stop smoking
it does work. And in fact, any age that
people stop smoking you get some benefit, so the younger people
stop degrades the benefits, but even if a lifelong smoker
decides to stop in their 50’s and 60’s they can
still get some benefit. If you look at the
curve at the bottom, that blue curve are people who continue smoking
throughout their life. That red curve are lifelong
nonsmokers and as you can see that curve in the middle,
the dashed blue line, those are the ones who quit. So there risk will never be
the same as a never smoker, but it’s still going to
be better than someone who continues to smoke, so any
age of quitting is worthwhile. So when people say
I’m too old now to quit it’s not
really a good reason and you can still get health
benefits from it at the end. So what next? Tobacco industry are
absolutely stunning at how they market the product. I’m still after 20 years in the
business amazed at what they do and they find new
innovative ways of keeping this tobacco
product in peoples’ minds and keep it looking attractive. There needs to be more
government funding for tobacco control even though
it’s quite a lot at the moment, it’s probably not big enough. And don’t forget prevention
is better than cures, much better to stop people
from smoking in the first place such that they don’t get those
disorders later on in life to which most governments
then have to treat. And governments particularly
have to focus the developing
countries where the tobacco epidemic
is increasing so a lot of those deaths you will see in the future will
increase even more in places like South America,
China and India. China published its
anti-smoking plan last year because they were, not told
to, but they felt obliged to because they’re part
of this WHO framework. They want to reduce
their prevalence by 28 percent to 25 percent. It’s not a huge number, but you
might think well it’s a very large country, there’s
a lot of smokers. But, they’re not taking
the advice of this, of the WHO organization. They’re going their
own way, so we’re not– we’re a bit doubtful on how
effective this is going to be. Three hundred million
smokers in China alone and this is why it’s going to
be an uphill struggle in China. When there was an earthquake
in China a few years ago in the Sichuan region a year
later the tobacco company sponsored and setup
100 schools, okay. And can you see those
Chinese lettering? The first line means
genius comes from hard work. That’s quite good isn’t it for your young children,
yes, very happy. Second line means tobacco
helps you to be successful. [Laughter] So this is on the
front of the school in 2009 so when the children come into school these are
the two phrases they see. You need to be– you can be good
at what you do, but to help you to be good at what
you do, smoke. So can you think how wonderful
the tobacco companies are, but also the– like I said the
idiocy of the local government that allowed this to take
place in the first place. So it was an uphill struggle, tobacco control policymakers
have in developing countries when you’ve got this still
being done in this day and age. This is also, this is Australia, so they have cigarette
packets have been shortlisted for the Design of
the Year Award. So look at the packets,
tell me what you think. What’s it look like? What’s missing from the packets? It’s the branding, okay. It’s– the maker of the
cigarette company’s hidden and these packets have
been deliberately designed to look unattractive,
unappealing. And they actually did
market research that showed that olive green is the least
attractive color for customers. So they really put
it on thick here, which is why it was selected
to be design product of the, a design award of the year
because it’s encompassed all of these things and some people
actually think it looks quite beautiful because it gives
you so much information and it takes away
all the appeal. But, if you compare
this, the previous slide where you’ve got tobacco it
makes you successful you can see the disparity in the world
today and where we are. What next? The Royal College of
Physicians suggested access to other nicotine products. This is not ideal of
course, so things like snuffs that you can get
in parts of Sweden, but those other nicotine
products are much safer than cigarettes. So if people can’t kick their
nicotine habit rather than carry on and smoking find a
much safer alternative and hopefully wean
them off later on. More protection for
children of smokers: I still commonly
see small children with their parents
standing over them puffing, blowing their smoke
at them more often than I should be seeing really. And that goes back
to that figure of where you got 40 percent
of, 45 percent of young women who smoke during pregnancy. They’re going to smoke during
pregnancy and they’re going to smoke afterwards as well. Better coordinated cessation
programs are required for tobacco control. And one of the areas that
people are going to look at more are mental health
disorders where the smoke and prevalence is quite high, much higher than the
general population. And more smoke free
policies especially in developing countries,
but this can only come by local governments and the
big governments supporting these tobacco control policies. More legislation
and restrictions so you might say
oh God more laws like we haven’t got enough
already, but they do work and when you’ve got
a huge problem such as tobacco smoking
you need radical ideas. If you go back 50 years the
thought of having a smoking ban in most places would
seem quite unreal. Now, everyone accepts it. It’s been passed a norm so
you need radical thinking now for things to be accepted
as normal in the future. Did the legislation in
the U.K. affect businesses because you have lots of
people saying that it would and of course the tobacco
industry said it would? It didn’t. So the U.K. Department of
Health did some surveys and they actually found
the effect on businesses and licensed businesses had more of a positive impact
than a negative one. And whenever you see those
studies where the two things, there’s two columns are
switched the way around, guess who funds those,
the tobacco company. But, when you have an unbiased
study on what the effects of legislation is
there’s a consistency that the businesses have done
better or there have no change, but very few of them
said they had done worse. So the final slide, two ultimate
goals, more and more smokers to quit and discourage people
from taking up the habit in the first place and only with those two together can we
stop this huge number of deaths and or so morbidity and that’s
going to get higher and higher in developing countries. So National No Smoking
Day was yesterday. You may or may not
have realized. I didn’t see much of it on the
TV and World No Smoking Day in a few months’ time. Thank you. [ Applause ]>>Well thank you
very much Allan. Yes there is time for questions. Let’s see if there’s any
questions coming now. And when you ask the
question can you hang on for the microphone until we– can you hang on to the
microphone to get to you?>>How much do you think
the western government are responsible for encouraging
the tobacco smoking in third world countries
and you mentioned China too?>>Allan Hackshaw:
I’m not sure actually. I think this is a
manufacturing now for China, it’s done in China and some
of the U.K. Governments. I’m not sure. They’re supposed
to be anti-smoking, but even Australia, which is
very anti-smoking the tobacco industry still has quite a sway. It’s quite powerful so I imagine
there’s a similar effect here in the U.K. with the tobacco
companies on U.K. legislation. So I think things can– the
smoking ban, for example, probably could have
been quicker. In terms of their impact
elsewhere I don’t know. I hope it’s minimal. [ Laughter ] [ Silence ]>>At the back there. [ Silence ]>>Thank you very much. It was very interesting and
endorsed everything I felt. When I was young there
used to smoking cinemas and if you mentioned anything
there would something equivalent to road rage. And then I noticed when
they stopped people smoking in restaurants and they
kept one or two tables and you would mention, oh could
you stop smoking I have a child with me. There would be another
road rage. The question I wanted
to ask when– I’ve always hated smoking. I did smoke for one
year, my last year when I was doing my
undergraduate law degree we all smoked like crazy
and then I stopped.>>Allan Hackshaw: Great.>>And I had a theory– this
was my question, I had a theory that if you buy a
packet of cigarettes, this is how I stopped and
threw that packet away rather than saying I’ll stop when
I’ve finished the cigarettes that was the best way to stop. The question, which I
rambled a bit, is consultants when somebody’s dying of lung
cancer they always tell the family oh it’s nothing
to do with smoking and that’s why I found
your talk so refreshing. You were not saying that. I have friends who’ve
smoked all their lives and they’ve got arthritis. One of my best friends, her–
she’s the same age as me. She only goes up and down
the stairs three times a day as her exercise. Another one smoked all her life. She goes to bed with a bugroll
every night, has to sit up. And yet when I used to say stop
they would say oh your bike. Go away. I’m not interested. You know it was really
refreshing to hear you actually come out
with– sorry I went on so long->>Allan Hackshaw: That’s fine. I think it’s quite a start. I mean if someone does get
lung cancer you can’t say for sure it is due to smoking, but the chances are
that it actually is. And that’s the thing; it’s not
just cancer and heart disease. There’s a whole host of other
things and the chronic disorders that you can get as
well at the same time.>>You didn’t mention arthritis.>>Allan Hackshaw: No I just put
a smattering of ones up here, but arthritis I’m sure would
be one of them as well.>>A question there.>>You mentioned links
or potential links to mental illness to smoking. I was just wondering what
mental illnesses might, there might be a causal link to?>>Allan Hackshaw: There’s
some evidence that it– anxiety, people think
that, smokers think that it’s better for stress. There’s actually some evidence that it can make
you more anxious. Example, there’s a link
between schizophrenia and postpartum depression and there’s a [Inaudible] report
coming out later this year that I was involved in and that’s going to
summarize it all. So there’s actually quite a few. But, it’s been an area that
people have ignored so long because people in mental
care homes, for example, even if the prevalence
might be as high as 40-50 percent the view was
well it helps keep them calm. Well it might help
them feel calm, but then you’ve got all these
other disorders they might get as well.>>The next question is
just over there, oh sorry. [ Inaudible background
question ]>>Allan Hackshaw: Yes
there are and they’re going to be summarized in
this report this year.>>Fine, and then
that one over there.>>Could you be more specific
from your vantage point on what might usefully
be done in the U.K. to reduce smoking further? For example, given your emphasis on the tobacco companies should
there be a directed initiative against their activities? And again, for example, there
seems to be a shift of smoking from banned environments to
the periphery, for example, railway stations and
doorways of workplaces. And a further idea, could
the litter associated with cigarette ends be a
basis for targeted measures?>>Allan Hackshaw: I
think all of those– when the smoking ban was
first developed several years and I was partly
involved in that as well. The thought of banning
smoke in parks, for example, I thought
how weird. Why would you ban smoking in
a public are such as that? But you– when I think of it
now it partly makes sense. It’s to stop smoking
everywhere really and to help smokers think
well it’s not so easy to smoke in lots of these places. In terms of other
policies you could– the price of cigarettes
could probably– it can still go up and there
is a direct relationship between as the price
gets higher smoke– there are less smokers
or they smoke less. So even though you
think a packet of cigarettes might be expensive
now it can still go higher. In fact, in real terms a packet,
people still spend, people spend as much as they were
many years ago. So for you to out price
it is one of the ways and the protection of the
children is another one. So trying to stop people from
smoking in cars that carry kids, this might be another way that I thought was too
radical a couple of years ago. But again, I now see as not
something in its own right, which might look strange, but
as a whole package of policies.>>The question over there.>>Do you liken as a danger
in putting up the price of cigarettes when a lot of people are low income
families are buying those, sort of a danger of
putting the price up and the parents will still
buy them, but children sort of do less well, have
less money to spend?>>Allan Hackshaw:
That is an issue. I’m not sure. There might be evidence of it. But, we do know that as you put
the price up people do quit. So there’s going to be a balance
between how much do people quit and how much do the
children, for example, suffer. I think one question you could
ask is how high could it go before people think it’s so
high I really can’t afford this? I need to buy clothes
and food for the family. I don’t think anyone’s
really pushed the limit yet and the tobacco– I
think there’s one example where the tobacco companies do
try and keep the price back.>>There’s time for
just that one more. That’s just– yea.>>Hello. Thank you very much. I just wondered whether
you include in your research other forms of
tobacco, cigars, pipe smoking because you haven’t
mentioned those at all.>>Allan Hackshaw: Same
thing applies to cigar, cigarettes because
they’re the most common one and it still applies to
cigars and pipe smoking.>>Do you include
those in your figures?>>Allan Hackshaw:
They usually are, yes. So whenever you see smoking
it usually means all forms of smoking unless it
specifically says, it states cigarette smoking.>>I’m sorry I have
to close it now. We have to exit by
five minute to. So just make– thank you
very much indeed Allan for a data loaded case. Thank you very much indeed. [ Applause ]