Dr. Finbarr O'Connell:

I thank the Chairman and the members for the invitation to speak to the committee. I work in St James's Hospital and I run a large lung cancer practice so I see the real patients who suffer from the worst disease that smoking causes. Dr. O'Regan has outlined some of these points. Dr. Sadlier said that 90% of lung cancer is caused by smoking. In this country, it is 95% and that is not a big difference but it means that practically all lung cancer in this country is caused by it. We re-audit the figure year on year and in our lung cancer practice it is 95% of people. We have very few incidences of non-smoking lung cancer. Lung cancer could essentially disappear as a disease if long-term we were tobacco free as a country. That must be the goal.

Smoking also causes or contributes to many other cancers. Dr Sadlier said that 30% of all cancers are caused by smoking. That is approximately right, and the others include upper airway cancer of the nose, lips, throat, mouth and larynx, oesophageal cancer, stomach cancer, pancreatic cancer, kidney cancer, bladder cancer, cervical cancer and bone marrow and blood cancers. All these, which are most cancers, have a contribution from smoking. Smoking probably directly causes 30% of all cancers. Dr O'Regan referred to other chronic obstructive pulmonary diseases, COPD. Given that fewer than one in five people smoke, somewhere between one in four and one in five of those people will develop a COPD. That means that one in 20 people can develop a severe chronic disabling respiratory disease, ultimately ending up on long-term oxygen treatment and unable to breathe, at huge expense to the health sector and at a cost of terrible disability to themselves. It is a dreadful disease that is sometimes in the background but should be to the fore in this discussion. The other diseases caused by smoking are ischaemic heart disease, coronary artery disease, angina, heart attacks, cerebro-vascular disease or stroke, peripheral vascular disease, adverse effects in pregnancy and childbirth such as increased rates of pre-term delivery, increased rates of stillbirth and low birth weights. It will also lead to reduced potency and fertility in men, osteoporosis or thinning of the bones, dental and gum disease, cataracts and poor control of diabetes. These are not rare diseases but are diseases that people get, suffer and die from. Tobacco plays a role in most of these diseases. It plays a large role in those I mentioned first.

Quitting smoking reduces all the risks of the above diseases. That has been shown. Previous speakers referred to the long-term aim being the denormalisation of smoking. It is the greatest single preventable cause of death and illness in Ireland and worldwide. Perhaps 6 million deaths per year worldwide, or 7,000 Irish deaths per year, are directly caused by smoking. These are shocking numbers when we reflect on them.

Any legislation or measures which assist in de-normalising smoking must be supported. It is about a change in culture. Undoubtedly there has been a tangible change in culture in this country with regard to smoking. It is very real, it has momentum and this legislation will support that further.

I am not an expert on packaging but my understanding is that attractive packaging encourages young people to take up smoking. Preventing younger people from starting to smoke is essential and will allow the medium-term aim of Ireland becoming a tobacco-free country to be realised. The Irish body politic has shown global leadership in the area of anti-smoking legislation and must be congratulated for that. This Bill represents an important further step on the road.