John Crown (Independent)

This is an issue in which I have a great interest. On a daily basis, practising doctors in Ireland, particularly practising cancer specialists, see the results of the carnage caused by cigarette smoking. A quick, off the top of the head, list of the cancers for which cigarettes are the principle cause makes for frightening reading, beginning with lip, mouth, tongue, throat, oesophagus, pancreas, bladder and some other rare forms. Lung cancer in particular has been a critical problem in Ireland.

It is very interesting to look at what has happened in the case of the two leading causes of death from cancer in women in Ireland and other western countries. The incidence and mortality of breast cancer have both gone down quite dramatically. On the other hand, lung cancer among women has increased strikingly, and the death rate for lung cancer among women has risen dramatically throughout the 1950s, 60s, 70s, 80s and 90s to the present day. The reason for this is that it became socially acceptable for women to smoke in the aftermath of the Second World War, to the extent that Virginia Slims, one of the leading cigarette brands, targeted a specific product at women. It used a feminist advertisement showing a woman not allowed to play tennis without a long skirt 50 years ago but telling her "You've come a long way, baby" and now she can smoke Virginia Slims. It is a sad mark that so many lung cancer doctors, when they give a talk on lung cancer in women, show the "You've come a long way, baby" slide, because that is exactly what happened.

Lung cancer is becoming a particular problem for women and there are some other quirks in that story. The disease appears to appear in women with a more trivial smoking history than in men. Also, some kinds of lung cancer are becoming more common, even in people smoking lower tar cigarettes. This is not only a general health issue, but also a critical feminist issue. Lung cancer has now taken over from breast cancer and become the number one cause of cancer death in the western world for women. There are two reasons for this - lung cancer became more common because women smoke and we have got much better at treating breast cancer. Advances in lung cancer treatment have been much slower and early diagnosis of lung cancer is much slower.

The point needs to be made that people sometimes blithely assume that giving up cigarettes quickly restores them to their pre-smoking risk. That is untrue. It is always a good idea to give up smoking because that has a powerful impact on circulatory risk, heart attack risk and on the risk of ending up horribly disabled by stroke. All of these risks drop dramatically and quickly when one stops smoking. The lung cancer risk also reduces, but not as completely nor as quickly. The later one leaves it to give up smoking, the less the impact. The time for a smoker to give up cigarette smoking is now, not next Monday or new year's eve. People must understand that the longer they delay the decision to give up smoking, the more cumulative carcinogenic damage they have done to their lung. The greater proportion of that damage will be irreversible.

The biggest impact is where people under the age of 30 are persuaded to stop smoking. While we are justifiably happy that the prevalence of cigarette smoking has reduced dramatically over the past several decades, for which I credit enlightened public policy and the former Minister's, Deputy Martin's, courageous decision to lead the world with a smoking ban, I note with alarm the numbers of people in the younger age group, under 30, who are still smoking, where the incidence is approximately 30%. This is the target audience we must reach. We must do everything in our power to get at these people because once they cross the threshold of 30 years, the lung cancer reduction impact starts to dwindle. It takes on average 20 years after smoking exposure for lung cancer to occur. It usually occurs in people's 40s, 50s or 60s. Therefore, it is people under 30 we must reach and that is the reason I strongly support any measures the Government can take.

We are all aware of a general tendency to regard people who get pernickety about smoking as being unctuous or politically correct. This is not true. Every time somebody tries to defend his or her decision to be allowed to smoke in a given place or at a given time we must remember it is an addict talking and it is "addiction thinking". It is the same level of addiction as one would ascribe to someone craving the next fix of a more serious registered drug. All of the arguments advanced in favour of continuing smoking are spurious. People say it reduces their tension, they get on better with their spouse or it stops them from beating their children. None of these arguments is worth a toss. All of these arguments are addiction thinking. In addiction circles the kinds of rationalisations people use are called "stinking thinking".

We have largely succeeded in curbing smoking because of enlightened public policy, but also because there is now a general sense that it is no longer socially acceptable. People who smoke are now often seen by non-smokers as having some kind of personal failing, because they cannot control something which is so obviously bad for them. While I hate being judgmental about anybody with any degree of substance abuse addiction, this perception is not a bad societal standard for us to try to encourage. We must constantly hammer home the message that smoking is a bizarre, unnatural and unhealthy habit which has its roots in addiction.

It is entirely justifiable to be as explicit as we can with the warnings given to people who smoke. If we were starting off now and if Sir Walter Raleigh returned with tobacco tomorrow and we tried to start manufacturing cigarettes, they would be banned and the smoking habit would never be legalised. No part of smoking would be made legal if smoking was only starting now. However, we have kind of grandfathered it into legal acceptability because it has been done for 600-odd years in Europe, since tobacco was introduced by returning explorers from North America. We should feel zero compunction for doing whatever we can to penalise the manufacturers of this addictive drug and should constantly ratchet up the pressure on them so as to make the manufacture of these drugs as unappealing and as commercially unacceptable as possible. It is not being health fascist to make it our goal to eradicate smoking. This should be something we regard as a bizarre, historical quirk, in the same way that it was socially acceptable for people to smoke opium, chew betel or do any one of number of other bizarre addiction based behaviours. We must set out our stall and be the country that aims for zero tolerance for anybody smoking anywhere.

I speak with some authority on this issue because among my credentials, I am an ex-smoker. I can recall all of the rationalisations I would have offered back in my addiction-addled day's thinking of how unfair it was of people to try and stop me getting access to the cigarette I needed so badly. However, we have the moral imperative to work on the consumers and the suppliers. I know we in this Chamber are not permitted to suggest anything which involves the evil spending or collecting of money, but before being ruled out of order I will quickly say we should slam a fiver on each pack of cigarettes as a health tax. In addition to all the other excise duties, another fiver should be imposed on every pack. This money should be ring-fenced for health and health research.

Am I out of order for making that suggestion? If I see the security guards, I will go quietly.