My perspective is based on having started in tobacco control in the UK around 1973 and then having worked here in Australia since ’84.

We certainly had the early evidence from 1950 with the work of Doll and Hill in the UK,[10] and Wynder and Graham in the US.[11] We had the first Royal College of Physicians’ Report from 1962[12], and then the first US Surgeon General’s report in 1964.[13] So those were probably the biggest sets of evidence available.

From the very earliest years we saw the tobacco industry strategy pretty much as it has continued, which is to deny, delay, obfuscate, and so on.

There was some international activity with a World Health Organisation (WHO) report in 1970 or ‘71 by Charles Fletcher and Dan Horn.[14] But the major international activity started in the early to mid- 1970s through Nigel Gray[15] and the UICC[16] program which we then translated into a WHO program.[17] And it was Nigel who really put that together in terms of not only setting out the evidence but setting out the case for action and achieving a consensus position for action based on that evidence.

When I look back, two or three things strike me. One is I still don’t know if the glass is half full or half empty. Yes, we’ve made progress, but there’s still so much more to be done.

Second, in retrospect, I think back to how incredibly hard it was in those early days. There were so few people in this area. It’s tough enough now but in those days, even some of the most distinguished scientists weren’t really persuaded of the need for action. I think back to Austin Bradford Hill[18] who believed the job of epidemiologists was to produce the evidence and nothing else, and even Richard Doll in the early days. [19] It was very hard and tough. Even today, the number of people contributing in this area is very, very few.

I think we need to give huge credit to the early epidemiologists, as indeed to the later epidemiologists including Bruce Armstrong,[20] D’Arcy Holman[21] and Konrad Jamrozik.[22]

Simon Chapman:[23] They’re all West Australians, aren’t they Mike?

Mike Daube: By chance. We should also acknowledge some of the early respiratory physicians and others who looked to generate action in this area.

In terms of the international scene, we saw development of the evidence and the great reports in the UK and US but we saw stunningly little progress in terms of action in the US. We still see that.

I think we need to give credit to the Nordic countries for the action they took that gave us a lead: Norway and Finland banning tobacco advertising in the early 1970s, and Sweden moving with rotating health warnings also in the 1970s.

Looking back, we had so much of the evidence and we knew so much about what to do, even back then. And still there were, and are, so few people who actually generated action.

One other thing is that where there has been action, it’s been because of the science and the advocacy, and it’s always been because of a very small number of politicians who generated action through legislation. They didn’t do everything we wanted but they were the ones who stuck their necks out and generated action around the states, nationally, as well as internationally.

Witness to the History of Australian Medicine