Dr. Anthony O'Regan:

As a clinician and someone representing the clinicians who look after those with lung disease, I will try to focus on those issues. Deputy Kelleher asked about packaging. I suppose we have concentrated in this discussion on primary prevention but a big impact also is secondary prevention to try to get those who come into our clinics to stop smoking and address those issues.

If one stops smoking at 30, 40, 50 or 60 years of age, one gains years of life and productivity in life. One measure would be to get access to smoking cessation services. If one comes in and is already addicted to smoking, how do we improve that? There has been some suggestion it would be better if we could put a short line on the cigarette package so that the 81% who think they may quit on a daily basis would have better access to smoking cessation services, and an important knock-on effect may be investing more in those smoking cessation services.

We spoke about young people and smoking. As the committee will be aware, in the United States the next step along the line is Tobacco 21. Dr. O'Connell spoke about this. It is illegal to buy cigarettes, if one is under the age of 21, in New York and in certain cities in Massachusetts. Needham, in the middle of Boston, is one. Where other cities less than a mile away do not have this legislation, it still impacted on young people smoking. We could bring in legislation like that.

Following on from the issue with young women who do smoke more than young men now, Deputy Mitchell O'Connor is correct that there may be an issue relating to body image and weight loss. That is a problem. We have difficulty addressing it because of the peer pressures in this group. However, I would look at it a different way. The amount of sport uptake and professionalism in sport among women has expanded. There was a great image, that created a furore last week because the Super Bowl was on, of the quarterback smoking in the 1967 Super Bowl. Everyone thought it was extraordinary that sportspeople smoked in those days. Of course, it does not happen now. With more promotion and investment in the professionalism of sport among women, and all this positive energy that has come from sporting women, hopefully, we can move that idealistic issue of smoking to loose weight, which has impacted on men over the years as well, into the sporting arena.

There is another point that the committee should be aware of. A woman who smokes, per cigarette, is more likely to get lung cancer and other lung diseases than a man who smokes. Women are more susceptible to the effects of cigarette smoke. We are looking down the line at the impact the increased smoking in women over the past 20 years will have on the next 20 years. That is a scary vista because of the age of onset of this disease.

On the basis of this list of diseases that people get, Dr. O'Connell mentioned all the cancers but we have mentioned chronic obstructive lung disease and lung cancer. Asthma affects 7% to 15% of the population and smoking plays a major role in the exacerbation and possible cause of asthma. There is a disease called idiopathic pulmonary fibrosis that, if we were to list it as a cancer, would be the eighth commonest cause of cancer mortality in this country. Some 60% to 70% of it is caused by smoking.

On infections, we know that in tuberculosis, TB, the outcomes are worse in smokers. Whereas people think TB is not that common, it is still common. Other infection outcomes are probably also worse in those who smoke. The list goes on and on in terms of the lung diseases that we see.

My last comment relates to this issue of whether there is evidence that this will make a difference. All I would say is we do not yet have the evidence because this is new. In Australia, they are prospectively evaluating this and, hopefully, more evidence will come forth. It is pretty clear that if people find cigarettes less satisfying, if they perceive that they are of not as high a quality, which is what is coming out of Australia, they are less likely to smoke. Although we are not yet there with the facts and figures, because we are leading the way, hopefully, in two to five years time the evidence will be more compelling for this.