Medicine and the public: The 1962 report of the Royal College of Physicians and the new public health

Bulletin of the History of Medicine

Volumn 81, Issue 1, 2007, Pages 286-311

  Berridge, Virginia ^a,b  

^a LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE   (United Kingdom)

^b Centre for History in Public Health   (United Kingdom)

Author keywords

Consumerism; Evidence based medicine; Media; Permissive society; Public health; Smoking; Social medicine

Indexed keywords

EID: 34047098705     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: 10.1353/bhm.2007.0000     Document Type: Conference Paper

References (88)

1. "Smoking and Lung Cancer: Publicity Suggestions," Ministry of Health files, MH 151/23, National Archives, Kew (hereafter NA).
2. Ibid.
3. David Armstrong, A New History of Identity: A Sociology of Medical Knowledge (Basingstoke: Palgrave, 2002), p. 51.
4. Mark Harrison, Medicine and Victory: British Military Medicine in the Second World War (Oxford: Oxford University Press, 2004), p. 4.
5. Howard Glennerster, British Social Policy since 1945 (Oxford: Blackwell, 1995), p. 96.
6. Jeffrey Weeks, Sex, Politics and Society: The Regulation of Sexuality since 1800 (London: Longman, 1981), pp. 267-68.
7. See, e.g., James Obelkevich, review of The Sixties: Cultural Revolution in Britain, France, Italy, and the United States, c1958-c1974 (1998)
8. by Arthur Marwick, Twent. Cent. Brit. Hist., 2000, 11 (3): 335-36.
9. The work of Dorothy Porter on social medicine and the organizational relationship with the social sciences is the main example: see Dorothy Porter, ed., Social Medicine and Medical Sociology in the Twentieth Century (Amsterdam: Rodopi, 1997).
10. Jane Lewis, What Price Community Medicine? The Philosophy, Practice and Politics of Public Health since 1919 (Brighton: Harvester, 1986), pp. 1-12.
11. James Le Fanu, The Rise and Fall of Modern Medicine (London: Little Brown, 1999);
12. Michael Fitzpatrick, "Take Two Aspirins and Thank Your Caring PM," Times Higher Educ. Suppl., 19-26 December 2003, pp. 28-29.
13. See also Fitzpatrick, The Tyranny of Health: Doctors and the Regulation of Lifestyle (London: Routledge, 2001).
14. E.g., Joan Austoker, A History of the Imperial Cancer Research Fund, 1902-1986 (Oxford: Oxford University Press, 1988), pp. 186-99;
15. Charles Webster, "Tobacco Smoking Addiction: A Challenge to the National Health Service," Brit. J. Addict., 1984, 79: 8-16.
16. George Davey Smith, S. A. Strobele, and Matthias Egger, "Smoking and Health Promotion in Nazi Germany," J. Epidemiol. & Commun. Health, 1994, 48; 220-23;
17. Robert N. Proctor, The Nazi War on Cancer (Princeton: Princeton University Press, 1999), pp. 173-247.
18. Richard Doll and Austin Bradford Hill, "Smoking and Carcinoma of the Lung: Preliminary Report," Brit. Med. J., 1950, 2: 739-48.
19. Ernest L. Wynder and Evarts A. Graham, "Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of Six Hundred and Eighty-four Proved Cases," JAMA, 1950, 143 (4): 329-36.
20. Richard Doll and Austin Bradford Hill, "The Mortality of Doctors in Relation to Their Smoking Habits: A Preliminary Report," Brit. Med. J., 1954, 1: 1541-55;
21. Doll and Austin Bradford Hill, "Lung Cancer and Other Causes of Death in Relation to Smoking: A Second Report on the Mortality of British Doctors," ibid., 1956, 2: 1071-81;
22. Edward Cuyler Hammond and Daniel Horn, "The Relationship between Human Smoking Habits and Death Rates: A Follow- up Study of 187,766 Men," JAMA, 1954, 155 (15): 1316-27.
23. Webster, "Tobacco Smoking Addiction" (n. 11).
24. Written answer from Ian Macleod, Minister of Health, 12 February 1954, Parliamentary Debates, Commons, 5th ser., vol. 523 (1954), cols. 173-74.
25. Paolo Palladino, "Discourses of Smoking, Health, and the Just Society: Yesterday, Today, and the Return of the Same?" Soc. Hist. Med., 2001, 14: 313-35.
26. This is discussed in Virginia Berridge, "Denial and Delay? Analysing the Policy Response to the Smoking and Lung Cancer Connection in the 1950s and 60s," Hist. J., 2006, 49: 1185-209.
27. Dorothy Porter, "From Social Structure to Social Behaviour in Britain after the Second World War," in Poor Health: Social Inequality Before and After the Black Report, ed. Virginia Berridge and Stuart Blume (London: Cass, 2003), pp. 58-80.
28. Jerry Morris, Uses of Epidemiology (Edinburgh: Livingstone, 1957).
29. J. N. Morris, J. A. Heady, P. A. B. Raffle, C. G. Roberts, and J. W. Parks, "Coronary Heart Disease and Physical Activity of Work," Lancet, 1953, 2: 1053-57, 1111-20.
30. Kelly Loughlin, "Spectacle and Secrecy: Press Coverage of Conjoined Twins in 1950s Britain," Med. Hist., 2005, 49: 197-212.
31. Francis Avery Jones to Lord Brain, quoted in Christopher Booth, "Smoking and the Gold Headed Cane," in Balancing Act: Essays to Honour Stephen Lock, ed. Christopher Booth (London: Keynes Press, 1991), pp. 49-55, on pp. 51-52.
32. Ibid.
33. Fletcher continued this "pressure from without" during the course of the committee. See his correspondence with Godber on what the Ministry was doing on lung cancer and on health education; e.g., Fletcher to Godber, 18 January 1960, NA MH 55/2226.
34. Committee to Report on Smoking and Atmospheric Pollution (hereafter RCP Committee), Minutes, vol. 1, 1959-63, n.p., Royal College of Physicians Archive, London, U.K.
35. There is a wide literature on this which is summarized in Virginia Berridge, ed., Making Health Policy: Networks in Research and Policy since 1945 (Amsterdam: Rodopi, 2005).
36. Virginia Berridge, "Doctors and the State: The Changing Role of Medical Expertise in Policy-making," Contemp. Brit. Hist., 1997, 11 (4): 66-85.
37. Peter A. Coventry and John V. Pickstone, "From What and Why Did Genetics Emerge as a Medical Specialism in the 1970s in the UK? A Case History of Research, Policy and Services in the Manchester Region of the NHS," Soc. Sci. & Med., 1999, 49: 1227-38.
38. Comment made in interview with Roger Braban, June 1996, London School of Hygiene and Tropical Medicine, London.
39. Fletcher's media work is discussed in Kelly Loughlin, "'Your Life in Their Hands': The Context of a Medical-Media Controversy," Media Hist., 2000, 6 (2): 177-88.
40. Loughlin, "Spectacle and Secrecy" (n. 23).
41. Jerry Morris, "Twentieth Century Epidemic: Coronary Thrombosis" (transcript of BBC Third Programme talk, 1 December 1955), BBC written archives, Caversham, Reading. The printed version is "Coronary Thrombosis: A Modern Epidemic," Listener, 8 December 1955, pp. 995-96.
42. See Virginia Berridge and Suzanne Taylor, eds., Epidemiology, Social Medicine and Public Health, transcript of the witness seminar held on 21 July 2000 on the 90th birthday of Professor Jerry Morris (London: Centre for History in Public Health, 2005), p. 18; available at http://www.lshtm.ac.uk/ history/jerrymorris.html (last accessed 31 October 2006).
43. Interview with Jerry Morris, June 1995, London School of Hygiene and Tropical Medicine.
44. Older colleagues at LSHTM remember how it was customary for the epidemiologists to wear white coats to show that they were doctors, even though they did not see patients. Photographs of Morris from the 1970s show him with a white coat.
45. RCP Committee, Minutes, 17 March 1960.
46. Ibid.
47. Ibid., 18 February 1960.
48. Ibid., 17 March 1960.
49. Ibid., 4 January 1961.
50. For the history of this relationship, see Virginia Berridge and Penny Starns, "The 'Invisible Industrialist' and Public Health: The Rise and Fall of 'Safer Smoking' in the 1970s," in Medicine, the Market and the Mass Media, ed. Virginia Berridge and Kelly Loughlin (London: Routledge, 2005), pp. 172-91.
51. RCP Committee, Minutes, 23 February 1961.
52. Royal College of Physicians, Smoking and Health (London: Pitman, 1962).
53. Braban interview (n. 31).
54. Charles Fletcher, "The Story of the Reports on Smoking and Health of the Royal College of Physicians," in Ashes to Ashes: The History of Smoking and Health, ed. Stephen Lock, Lois Reynolds, and E. M.Tansey (Amsterdam: Rodopi, 1998), pp. 202-5, on p. 203.
55. There is a transcript of the program in the Ministry of Health papers; see Public Health Propaganda: Smoking and Lung Cancer, Publicity Policy, 1961-, NA MH 55/2204.
56. Fletcher, "Story of the Reports" (n. 47); RCP Committee, Minutes, 6 December 1961.
57. Charles Fletcher, Common Sense about Smoking (London: Penguin Books, 1963).
58. For the earlier history of surveys, see Martin Bulmer, K. Bales, and K. K. Sklar, eds., The Social Survey in Historical Perspective, 1880-1940 (Cambridge: Cambridge University Press, 1991).
59. P. W. Cary, the civil servant who chaired this committee, was reluctant to reveal its existence: see note from him to the other officials on the committee, 27 April 1962, NA CAB 21/4648.
60. Minutes of third meeting, 13 April 1962, NA CAB 130/185 GEN 763.
61. For discussion of this point, see Public Health Propaganda: Smoking and Lung Cancer, Publicity Policy, 1957-60, NA MH 55/2203.
62. Lord President to Prime Minister, 25 July 1962, NA CAB 21/4878.
63. Notes of a meeting with representatives of the TAC (Tobacco Advisory Committee), 31 July 1962, NA CAB 21/4878.
64. Lord Hailsham to Sir Alexander Maxwell of the Tobacco Advisory Committee, 14 November 1962, NA CAB 21/4878.
65. For discussion of how the differential taxation question evolved, see Berridge and Starns, "'Invisible Industrialist'" (n. 43).
66. Minute from Enid Russell Smith, 5 February 1962, NA MH 55/2204.
67. Smoking and Health: Memorandum by the Secretary of State for the Home Department, 2 March 1962, Annex A 26, February 1962, Memorandum by the Secretary of State for Scotland, the Minister of Education and the Minister of Health, NA CAB 129/108 C(62)43.
68. These developments are discussed in more depth in Virginia Berridge and Kelly Loughlin, "Smoking and the New Health Education in Britain, 1950s to 1970s," Amer. J. Pub. Health, 2005, 95: 956-64.
69. The report was widely circulated within government. See Tobacco Smoking and Health: Restrictions on Advertising, 1962-65, NA CAB 124/1672.
70. Philip Noel Baker, MP, to Harold Macmillan, 29 May 1962, NA CAB 21/4878, 1962-63.
71. Ministry of Health, Note of a meeting with the Advertising Inquiry Council to discuss cigarette advertising, July 1963, Smoking and Health 16/2/3 part 4.24, NA CAB 21/5083, 1963-64. Fletcher and Morris were present at the meeting along with Noel Baker and representatives from the Baptist Union, the Methodists, and others. The Advertising Inquiry Council also met with the TAC on 13 May 1963 and agreed to differ about advertising control.
72. G. J. MacMahon of the Board of Trade to Fife Clark of the COI, 15 June 1962, NA CAB 21/4878, 1962-63.
73. "The Role of Publicity in the Smoking and Health Campaign," April 1962, Report for the COI by Armstrong Warden Ltd., NA MH 55/2237.
74. Ann Cartwright, Fred M. Martin and J. G. Thomson, "Health Hazards of Cigarette Smoking: Current Popular Beliefs," Brit. J. Prevent. & Soc. Med., 1960, 14: 160-66;
75. Cartwright, Martin and Thomson, "Distribution and Development of Smoking Habits," Lancet, 1959, 2: 725-27.
76. Louis Moss, The Government Social Survey: A History (London: HMSO, 1991), pp. 134-36.
77. Study by the Social Survey, report to Cabinet committee on smoking, February 1964, NA CAB 130/185 GEN 763.
78. Margot Jefferys and W. R. Westaway, "'Catch Them Before They Start!' A Report on an Attempt to Influence Children's Smoking Habits," Health Educ. J., 1961, 19: 3-17.
79. Margot Jefferys, "Social Medicine and Medical Sociology, 1950-70: The Testimony of a Partisan Participant," in Porter, Social Medicine (n. 8), pp. 120-36. Smoking among school-children was also one of the early pieces of research carried out at St. Thomas's where one of the first health-services research units was set up by Walter Holland, a pioneer of such research in the United Kingdom: Interview with Walter Holland, 6 March 1997, London School of Hygiene and Tropical Medicine.
80. The connection with smoking and research is not noted in Jeanne Daly, Evidence Based Medicine and the Search for a Science of Clinical Care (Berkeley: University of California Press, 2005), in her discussion of the lineages of evidence-based medicine (pp. 128-53), although the connection between social medicine and the rise of health-services research in Britain is made.
81. Note from Lord Hailsham, 6 April 1964, NA CAB 21/5083.
82. Ibid.
83. Adjournment debate speech by Lord Hailsham, 12 February 1964, Parliamentary Debates, Commons, 5th ser., vol. 630, col. 522.
84. Minute from Enoch Powell, 11 November 1961, NA MH 55/2227.
85. Interview with Enoch Powell, October 1975, William Norman Papers, ASH (Action on Smoking and Health) archive, SA/ASH R.27, box 79, Wellcome Library, London.
86. Interview with Kenneth Robinson, 18 January 1976, ibid., SA/ASH R31 box 79.
87. R. Crossman, The Diaries of a Cabinet Minister, vol. 3, Secretary of State for Social Services 1968-1970 (London: Hamish Hamilton and Jonathan Cape, 1977), entry for 19 July 1968, p. 147.
88. It is arguable that this belief in the power of the mass media may have been a distinctive "stage" in British public health, which is now undergoing significant change. See V. Berridge and K. Loughlin, Records Relating to the Health Education Council, Health Education Authority, and Health Development Agency: Thematic Mapping Exercise, July/August 2006, Report produced for NICE (National Institute for Clinical Excellence), September 2006.