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Denial and Delay

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ALEX MOLD: So Richard Doll and Austin Bradford Hill first established an association between smoking and lung cancer in 1950. Can you tell us how the British government responded to their findings?
VIRGINIA BERRIDGE: Well, I think the British government was a bit wary at first, and in fact for quite some while, because this was a very different sort of proof that Doll and Hill were advancing. The chief medical officer of the time, the main public health official, Sir John Charles, said, well, this isn’t laboratory proof. It’s only statistical proof. And nowadays, we’re so used to dealing with statistics, but in those days, they weren’t. And something that was just a statistical correlation didn’t have as much weight in a way as something which came out of the laboratory and investigation. So there was debate, but I think a lot of the medical profession were convinced.
ALEX MOLD: You mentioned the media. Didn’t the Royal College of Physicians put together a report that talked about the need to make more use of the media and how–
VIRGINIA BERRIDGE: Yeah. The Royal College of Physicians set up a committee in the late 1950s, which reported in 1962, and that was the first international global report on smoking. But interestingly, it was set up originally as a report which was looking at the rise in lung cancer, but it was looking at smoking and air pollution– and so another example of the air pollution connection. But they decided to leave air pollution because they thought smoking was something that was easier to deal with because it was an individual habit. They didn’t realise 50 or 60 years later, we’d still be dealing with it in some respects.
But that report did place a lot of emphasis on using the media, reaching out to the public.
ALEX MOLD: Can you tell us a little bit about how the tobacco industry responded to all of this?
VIRGINIA BERRIDGE: Well, the tobacco industry produced its own report, and it had its own scientists working on the issue. And there was also a tobacco manufacturers standing committee, which brought together all the tobacco manufacturers of the time to produce a common view. And so they were, in a way, a kind of alternative source of expertise producing their own research.
But remember also, we’re talking about the 1940s, the 1950s, just after the Second World War, and tobacco was a major staple of the British public. And the tobacco industry had been a major partner of government during the war because tobacco was seen as a basic thing that people had to have. So the industry, I think, was in a very different position to the way the industry is perceived today. And I think the idea, both amongst the anti-tobacco forces and in the industry, that there was something perhaps harmful in cigarettes and in tobacco– and the priority was to try and find out what was harmful and to remove it, and then tobacco would be safe.
So the idea of the safer cigarette was something which went on as a shared agenda for quite a while, probably 20 years or more.
ALEX MOLD: That’s very interesting. Some people have characterised the response to tobacco and to smoking as one of denial and delay. Is that something that you would agree with? Or what’s your take on that?
VIRGINIA BERRIDGE: Well, I think in some respects, that’s right. People couldn’t accept this at first. They found it difficult to accept. And the sort of response there was, was not exactly low key. It was health education originally, campaigns at the local level and eventually a more national campaign, which is a very typical way for governments to respond to an emergent public health issue. But I think there’s a kind of implication behind using those words that implies that government was somehow at fault or it was under some obligation to the tobacco industry. The tobacco industry was a kind of evil empire plotting a way to undermine the health of the British public.
But I think that’s really an example of what we in the history profession call presentism, when we’re looking at things through the perspective of what we know now rather than what we would have known then. And I think if you look back into the late ’40s, the early ’50s, you would think about, well, here you’ve got a habit which the majority of the population indulges in. Most people smoked. You and I during this interview would probably have been smoking, if we’d done it 50 or 60 years ago, and there would have been nothing wrong with that.
So I think if we think back to what things were like at that time, it’s easier, perhaps, to understand the denial and the delay of the government. And it did take a long while, probably 30 or more years, before people began to take things seriously and also to begin the process of changing culture, which I think was as important as changing the law and imposing bans as we did later on with the ban on indoor smoking and so on. So I think that’s the model that you quite often see with a public health issue.
Something comes on the agenda initially in a low key way, and people look back later on and say, well, why on Earth didn’t we do more earlier on? But if you were there at the time, you would probably see things differently, I think.

In this step Dr Alex Mold and Virginia Berridge discuss the slow transition from evidence to policy and practice in the case of smoking and lung cancer. They discuss Doll and Hill’s findings, and the initial public health response, including health education campaigns. They also highlight the difficulties of implementing restrictions on smoking, as it was a very common habit at the time.

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A History of Public Health in Post-War Britain

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