BATES, Mr Clive, Director, Counterfactual Consulting

WOODWARD, Mr Stephen, Private capacity

Committee met at 12:33

CHAIR ( Mr Zimmerman ): Welcome and thank you for joining us today, particularly as you have come from so far away. You know the background to the inquiry we are undertaking and you have probably seen some of the evidence that has been presented to us. We invited you here because, as part of this process, we have been interested in developments in the United Kingdom. That has been subject to divergent opinions about how successful or otherwise it has been, so your input in that regard would be helpful. By way of background, this is considered to be a private briefing for the committee. The hearing is being recorded by Hansard and you will be provided with a copy of the transcript. At some stage we may consider publishing the transcript, effectively making it not private, but if that happens we will give you forewarning. Did either of you wish to add anything about the capacity in which you are appearing here today.

Mr Bates : I am a former director of Action on Smoking and Health, in the UK. I am currently the director of Counterfactual Consulting. I do not have conflicts of interest. The trip has been independently financed and there is no e-cigarette or tobacco industry money involved.

Mr Woodward : I am appearing in a private capacity. I was formerly the director of Action on Smoking and Health, here in Australia, having served in that role for a number of years. Like Clive, I am regarding this as unfinished business. I, too, am funded privately—no grants or anything like that from anybody whatsoever.

CHAIR: We've all got your submissions, but would you like to make opening statements?

Mr Bates : Thank you for inviting us; we're really pleased to be here. We've organised our presentation under five headings which we have drawn from the Royal College of Physicians report of April 2016. We've put that into—

CHAIR: Could you collectively be around the 10-minute mark.

Mr Bates : We'll be very quick, I promise. We've marshalled our arguments under five headings drawing on quotes from the Royal College of Physicians report of April 2016. The first is about the relative risk of vaping and smoking. The royal college says that e-cigarette use is unlikely to exceed five per cent of the risk of smoking and may be substantially lower than that.

The second area that we're drawing on in the memo provided is the concerns about population effects—that e-cigarettes will lead to renormalisation of smoking, will stop people quitting and will cause people to start smoking. The royal college says that there is no sign of that happening. They refer to Britain but, in fact, there isn't any sign anywhere else to our knowledge. We know the health minister raised concerns about this earlier in the week, and we've provided some supplementary evidence on those points on what the literature says to the committee in the hope that that will be helpful.

The third area that we're concerned about is the potential for unintended consequences, and this is how the precautionary approach plays out. The danger is that an excessively precautionary approach might seem responsible and cautious but, if it has the effect of making it harder to use a much lower-risk alternative, it makes them less appealing, more expensive and less accessible. If it makes the pharmacokinetics less compatible to smoking, and then the danger is that you get an unintended consequence in the form of more smoking than there would otherwise be. In other words, people who could switch to these products don't. We think that the uncertainties and the potential cost of excessive regulation are really important considerations for the committee to get into.

The fourth area is that the royal college highlights the role of these products as consumer products that work as alternatives to cigarettes and less so as medication or therapeutic products. Therefore that invites questions about a different style of regulation for them, one in which you would tend to use consumer-protection techniques, standards and so on to regulate the product.

The fifth and final point is that we are seeing change all the time. The evidence is evolving all the time. Countries are moving at different paces. I would say that the attitude in Britain in early 2013 was more or less the same as it is here in the official government approach and by the main health lobby. We have seen a complete change in Britain. The government now actively promotes switching from smoking to e-cigarettes. In fact, there are television ads airing at the moment in the UK. We've seen a tremendous effect. We've seen smoking drop faster than it's ever dropped.

CHAIR: Television ads from the government?

Mr Bates : Television ads from the government now air in the UK as part of the Stoptober campaign to encourage people to switch from smoking to e-cigarettes. It's a really big development, and it's evolving all the time. I think that's because we saw, between 2014 and 2016, a fall from 9.7 million to 8.2 million smokers in the UK—a very rapid decline over that period. At the same time, we now have 1½ million vapers who are ex-smokers. You can't say they're ex-smokers because of vaping, but it is a very large scale phenomenon in the tobacco market now in the UK. The government has been convinced by the arguments for this and is now running with it as a public health concept. They're doing it for public health now.

The final point I want to make is about a very interesting development just last week. The New Zealand government announced a change in its approach. It now sees e-cigarettes and vaping as something that will contribute to its Smokefree 2025 objectives, which are to try and get smoking down to five per cent, and also, importantly, something that will help with health inequalities. Some of this seems to have been coming from the Maori side of the public health lobby. I have written more about this extensively in a note. I will leave it at this point and perhaps hand over to Steve.

Mr Woodward : Thank you. In addition to the matters raised in my submission and other matters you may wish to question me on, I want to raise a couple of issues. First of all, there is my work as a research scientist on the Wittenoom asbestos miners follow-up study way back in the 1970s. Wittenoom was a mistake of public policy. The government of the day was warned by the health authorities what was going to happen, and appropriate actions were not taken. Very sadly, the asbestos company made no money out of it either, and it closed in 1966 because there was no money being made.

Back in 1979, we estimated how many people would die as a consequence of asbestos exposure at Wittenoom, right up until 2020 when the last person would die. Sadly, those estimates are pretty well on the money—a bit up here, a bit down there, as the estimate has been repeated over the years—but, because the effects of asbestos are so great, we were able to confidently make these estimates into the future.

Likewise, for tobacco we can confidently estimate into the future what the death toll will be from active smoking. And we can have a very good idea of what the health benefit will be if a significant number of our smokers who cannot quit move onto vaping, because vaping is far safer. We cannot give a pinpoint accurate number but the effect will be so large we will be in the right ballpark.

Secondly, there is the precautionary principle. I won't repeat what Clive has just said, but I think the precautionary principle is being wrongly applied. We do not operate in public life with an absolute zero risk. We could eliminate motor vehicle crashes by having a national speed limit of 30 kilometres per hour, but that would be horrendous for moving freight around the country, not to speak of personal inconvenience. We accept a reasonable level of risk. We try to reduce that risk, but we do not expect a completely harmless situation. Dr Freelander is possibly the only one in the room who has taken the Hippocratic oath and I won't read it in its original Greek, but in summary—

CHAIR: It’s a few years ago, so you might need to remind him.

Mr Woodward : It boils down to about four words: 'First, do no harm'. By banning e-cigarettes we are doing a lot of harm to the people who could switch and enjoy the health benefits that flow therefrom. I spoke about the fact that I am not in any way funded by the tobacco industry. The honourable member for Curtin knows my relationship extremely well with the tobacco industry from her former life as managing partner with Clayton Utz, because they were the lawyers that had the tobacco industry brief and sued me several times—unsuccessfully. So she knows all about my relationship there.

What can e-cigarettes can do for marginalised smokers? Marginalised smokers are not people in this room. While we are enjoying fantastic results with mostly white, middle class Australians with a very downward fall in the prevalence of smoking, there are marginal groups in our community for whom smoking rates remain intractably high—for example, people who suffer from mental illness, our Indigenous population, as Clive mentioned, and a number of other groups. Those smoking rates are still high and stubbornly refuse to go down to any significant extent. Those marginalised groups can be greatly advantaged by e-cigarettes.

Lastly, I want to mention the contribution of individual vapers' evidence. I have seen in the evidence you have heard before that some witnesses seek to downplay the evidence that individual vapers give, and say that individual experience and observation is not evidence. Alexander Fleming noted penicillin spores falling on his agar plate. One observation became a very important fact in science. William McBride's nurses noted that the women who were taking thalidomide had children with birth defects and told Dr McBride. He wrote a letter to The Lancet. Individual observations have a very powerful role in our scientific process. Mick Fanning got his surfboard chomped by a shark. His individual observation that sharks chomp surfboards is evidence of an effect that individual observations are extremely important and I think that we should pay proper heed to those observations that those individual vapers have given you.

CHAIR: Thank you for your opening statements. The committee members now have some questions for you.

Dr FREELANDER: What is the problem with having it available on prescription?

Mr Bates : There is a sort of in-principle problem and a practical problem. The practical problem is that having it available on prescription as a licensed medicine has meant in Australia that these products are simply not available. Whatever the reason for that is, the effect is that the products are not available and people have to buy them via the internet or from China or New Zealand, or mix their own or whatever. So there is a straightforward practical problem at the heart of it.

The in-principle problem is that these products are not really medicines. They are not therapeutic products in the way that one thinks of a therapeutic product. They are a kind of recreational consumer product that fits in the same space that cigarettes do, but just do much less harm. An example would be that if you were to approach something like diet cola and say, 'You need a licence for that as an anti-obesity drug before you can put it on the market,' you would struggle to ever have diet cola on the market. So there's something about medicines regulation—it doesn't really fit with the products, because the products aren't medicines.

Another example would be the experience in Sweden, where they have the lowest rates of smoking in the developed world. Current smoking is seven per cent of the population and daily smoking is five per cent, so it's much lower even than here. The reason for that is that people, particularly men, use nicotine in a different way: they use snus, which is a form of smokeless tobacco. No-one would ever think of snus as a medicine or something to have on prescription, but it has had the effect of entering the market and displacing smoking, providing nicotine to people who would otherwise have been smokers, and has greatly reduced it as a result. It is the most intensively studied case of tobacco harm reduction. The country has very low levels of smoking and we actually now have the data to show that there are significant health benefits, in terms of cancer, cardiovascular and respiratory illnesses, as a result. It is because I think it fits in the same place as e-cigarettes do.

Mr Woodward : The cost of tobacco in this country is $30 billion a year. The tax revenue is about $15 billion a year. If we have e-cigarettes available only on prescription, the cost of that solution would be 10 to 15 times higher than it needs to be.

Mr GEORGANAS: On the question of having it on prescription through the TGA, it is a harm reduction—a lot of people are saying the harm is reduced dramatically—it is also used as an aid to give up smoking. People are saying that to us. Why not have it through a prescription, where you have to see your doctor and get the advice and the monitoring, and use all the health expertise that is required to do that, as we do with a lot of the drugs that are around for giving up smoking. Zyban comes to mind, and a couple of others. So why not use that model? Acknowledging that it is a harm-reducing product, with your doctor or health experts you can get a point where you are giving up nicotine instead of still being addicted to a particular substance?

Mr Bates : I certainly think you should have that option as well. The issue here is how do you get this to scale? Remember that many smokers either don't want to quit or are unable to quit. In the UK there are now 2.8 million vapers—1.5 million are ex-smokers and 1.1 million are current smokers.

Mr GEORGANAS: You said 'ex-smokers' out of that 2.8 million. They no longer vape or smoke?

Mr Bates : No. There are 1.5 million who vape but no longer smoke, 1.1 million who vape and smoke, I think around 750,000 who no longer vape or smoke and 180,000 who had never smoked but vape. Because these are projections from relatively small surveys, by the time you get down to that level you are getting into measurement error. So the argument is to get the large-scale effect on smoking this has to be a behaviour that people who currently smoke find attractive. We have quite extensive smoking cessation services in the UK. If you want to, they are there for you. The local authorities run them and you can go in, but very few people actually do that. Very few people want to have their smoking treated as an issue by the GP. That might change if that were the only way you could get vaping, but that has been the history. We have tried that approach where we use smoking cessation services; it doesn't reach that many smokers. It tends to reach people who are already quite highly motivated to quit and are prepared to go through a program with one of these things.

So the argument here is that this competes with cigarettes on the home turf of cigarettes. It is essentially a disruptive technology within the dominant market that there is for consumer nicotine, which is the cigarette market. Therefore, it is sold in the same way. The basis of selling it is that it is an appealing product to smokers. This is one of the problems with medicines: it's quite hard to have products that are appealing because often medicines regulation tries to stop things being appealing so that there is no abuse liability. So the appeal is quite an important aspect of it. Some think the flavours and branding are important aspects of it. It is that that is persuading people to try these products so it is a consumer choice rather than a decision to enter a sort of medicalised pathway. I think that is at the heart of it really.

If you want to be able to scale, you have to make it more accessible and more appealing. So it's back to the Royal College of Physicians' statements about unintended consequences. If you narrow the pathway that is available to people to try this, you will get fewer people going down it and you will risk having more people smoking.

CHAIR: Have you had a chance to look at the regulatory environment that New Zealand is establishing?

Mr Bates : I think they have essentially announced a change of policy intent rather than a new regulatory framework. It happened on Friday.

Mr Woodward : They've done it without the government being in place.

CHAIR: No, they made announcements in April that they were going down this path.

Mr Bates : They ran a consultation earlier in the year and they took in views, rather like this process because it was a government thing. They took in views and listened to the evidence. I think what they have announced is a change of policy intent. That for us is the crucial thing. All of the problems about all of the challenges of regulation and everything change completely when you start to focus on the opportunity rather than focus exclusively on the threat. It is the idea of an opportunity forgone is a harm is what is troubling if you have excessive regulation and people can't make that switch.

CHAIR: Obviously, the two issues that cause people most concern about e-cigarettes are, firstly, the lack of 20-year longitudinal studies.

Mr Bates : Yes.

CHAIR: We had some good evidence from Public Health England on that issue. The second issue is the gateway issue. In the statistics you just mentioned you said there were 180,000 people vaping who had never smoked.

Mr Bates : Yes, that was interesting.

CHAIR: I am wondering why you would not describe that as a gateway effect?

Mr Bates : First of all, remember that is a tiny fraction of the total of 2.8 million. We have seen people who classify themselves as 'never smokers' but, when you ask them the reason they took up vaping, they say 'to stop smoking'. Unfortunately, that is what I'm saying: in the data you are starting to get into messiness in the actual data and so we really don't know how many of them are actually real. It's 180,000 out of 2.8 million. We would never say never to anything. A gateway effect has to have a magnitude. There will always be one person somewhere in the world who will have followed a particular pathway. The question is whether a particular pathway is material. Are there a lot of people going down that route? What's the consequence of that? Remember this isn't really a gateway effect; this is people going to what is actually quite a low-risk behaviour in our view. It would be a gateway effect if they went on from that and started smoking—which we haven't really seen any example of.

CHAIR: That is a slightly different twist to the argument—

Mr Bates : There is a difference in what you count as a gateway effect.

CHAIR: Is there any age profile of the 180,000 you've seen?

Mr Bates : That's the adult data. The difficulty with doing it with youth is you don't have the counterfactual. You don't know what would have happened in the absence of the availability of vaping products. Someone who started on vaping and went to smoking might have gone straight to smoking. That's quite likely in many respects because the same things that incline people to vaping also incline them to smoke.

CHAIR: That was going to be my next question. There are statistics on the people who are vaping who were smokers—people who are vaping and smokers simultaneously. Is there any statistical information about smokers who were previously vapers?

Mr Bates : I can't remember anything in the statistics that I'm drawing on to give you the UK—

Mr Woodward : It's so small. I can't think of them either. If it's there it's tiny.

Mr Bates : What we are seeing in the survey data in the United States and in the UK is that these vaping products are overwhelmingly used by smokers and are used as an alternative to smoking—not always as a complete substitute; sometimes there's dual use. Most people are trying, unsurprisingly, to reduce their personal health risks by using a much safer product. We see very little extra smoking—I don't know of a survey that would show extra smoking—as a result of vaping. What we have seen in the United States is an anomalously rapid decline in adult smoking since vaping emerged. We have also seen an anomalously rapid decline in teenage smoking since vaping emerged. The Monitoring the Future study, which is a University of Michigan study, shows that current smoking amongst high school students in the US has fallen since 2010 at four times the rate of the long-run average between 1975 and 2010. In terms of just the macro numbers there doesn't seem to be anything going wrong and a lot seems to be going right. We had a survey done in the UK, and I think it is in our updated evidence briefing, which said that there is just no sign of teenagers who are messing around with vaping emerging as smokers. It's just not something that happens.

Mr ZAPPIA: Can you tell us why you think the tobacco companies are so much in favour of the laws on vaping being changed in Australia?

Mr Bates : It's a thing going on in their world. In their world the consumers are saying, 'Hang on a minute—here's something I like; it's much cheaper; it's going to do me 95 per cent less harm, at least; it doesn't come with all the stigma and smell and mess.' What's happening with them—whoever they are, they're not stupid—they're seeing the customers going that way, and therefore they're saying, 'That's a market we need to be in.' In the end, the consumers are determining all this. Even the tobacco companies can't make them buy rubbish products that they don't want. What tobacco companies are seeing—obviously I can't speak for them, but this is my impression of them—is these markets have emerged—originally in China, then in New Zealand, the United States and everywhere—that are basically eating their lunch. And they're compromising one of the key platforms of their marketing strategy, which is to be able to raise underlying prices. Even as volumes have been going down, tobacco companies have been raising their underlying prices, which you don't always see because they're covered in a big headroom of tax.

That model is starting to fail now, partly driven by aggressive tax policies like Australia has, but also because consumers can switch if paying too much gets too much. I think that's why they're doing it. Personally, I think it's a good thing. They're not the best advocates for anything, as you're probably aware, but if they can start selling products that do much less harm, I am one that says that's a good thing not a bad thing.

Mr TIM WILSON: In the hearing we had in Melbourne the tobacco companies basically accepted that if people substituted to e-cigarettes they would live longer lives, they would obviously be alive to consume longer—without wanting to verbal them—and the profit margin on e-cigarettes were higher. So they get a longer life span and higher profits. Would you agree with that as a proposition?

Mr Woodward : The toxic dose that the vaper is getting is a fraction of the toxic dose of the cigarette smoker, so you're going to get less disease and longer lives. Exactly.

Mr Bates : They say that. I've heard them say the same thing: that what they call the margin story is actually very encouraging on this. In some ways I find that quite encouraging, because it means that they won't put their formidable lobbying resources in the way of these things. They'll actually try to encourage them.

Mr TIM WILSON: Have you seen any studies that look at different policy measures that reduce the accessibility and likely uptake rates?

Mr Bates : One of the areas that needs a lot more study is what the consequences are of different policy interventions. There's a lot of policy out there that isn't being studied. One of the most interesting studies is on a policy that literally everybody agrees with, which is that these products should not be sold to under 18-year-olds. Researchers looked at data from the United States where these age restrictions were introduced. They found that when the age restrictions on the e-cigarettes came in the underlying rate of smoking actually increased. There are a couple of studies on that. The argument is—this is an economic argument—that they made it difficult for younger people to get access to e-cigarettes, and therefore they carried on smoking, when they would otherwise have messed around with vaping. A couple of studies have looked at that and that's what they found. I don't know whether that's what was actually going on. Those studies highlighted the danger of policy intervention that literally everybody agrees with—and I agree with it—that may have unintended consequences.

There was another piece of modelling done on advertising that suggested that if you reduce the volume of advertising of e-cigarettes, essentially you're favouring the incumbent. The incumbent is cigarettes, and therefore you'll get fewer people switching. I think in one of the evidence submissions that I put in earlier in the process I included a grid of all the possible unintended consequences that you could experience from different vaping policies. That was in one of my submissions to this inquiry. Almost everything can go wrong in some way.

Mr TIM WILSON: Finally, on tax rates, we've heard pretty consistently from people that, if taxes were applied like they were to cigarettes to e-cigarettes, what you would get is less a substitution versus, if you had ordinary tax rates like the VAT, which we heard last night in evidence, and that therefore it would be treated as an ordinary consumer good rather than a tobacco based product. Do you agree with that?

Mr Woodward : As Clive said, the health benefits are going to come from scale only if we get a large number of smokers moving to e-cigarettes. Every impediment we put in the way of that switch occurring is going to be a cost in a reduced health benefit. If these things are lightly taxed and there's a clear differential between the price of cigarettes and the price of e-cigarettes, you're going to get a much bigger movement to the safer product.

Mr Bates : One of the things that vapers report and one of the reasons why it would be valuable here where cigarette taxes are really quite high is that, if they switch, there's a benefit to the household budget and that has knock-on effects for other aspects of welfare. So when you ask vapers for reasons for switching, one of them is saving money. That's really important from a welfare point of view. Again, there's a good paper on this—Chaloupka, Warner and Sweanor—in which they have set out a sensible policy framework for a fiscal approach, and we're very clear that having a fiscal advantage is a form of behavioural intervention that encourages people to switch and there's a health benefit from that. So we wouldn't want to see taxes racked up too high on these products, and the right starting place is GST and no more.

Mr GEORGANAS: Just on the 180,000 people who have taken it up—

Mr TIM WILSON: It's eight per cent.

Mr Bates : Six per cent of the vapers, but it's a much smaller number of the nonsmokers, remember—it's like 0.6 per cent.

Mr GEORGANAS: I know you said there were no studies around this—are you aware of any studies that have been done around those 180,000 people to monitor throughout the next few years what happens to them and where they go? Do they go onto smoking? Because we have heard evidence from earlier submissions that there is a possibility of people taking up smoking using this as the first step.

Mr Bates : This is a cross-sectional survey: the Office of National Statistics goes out, gets a sample of 3,000 or 4,000 people and asks them what they're doing. Those numbers like 180,000 are multiplied up to the representative population from really a quite small sample size. They're not followed in any way. There's not a surveillance on them, and no-one's really investigated why they're doing it—whether it was occasional, they were just messing around, trying it or what when they answered those questions. We don't know much about that group, but what we're not seeing is, in any of the data or any of the surveys that we've got, people going from vaping to smoking. Given the cost of smoking, given the social stigma, given all the other things—the restrictions on use—it really would be quite unusual for someone. I would find it unimaginable for someone to make that journey really. I think it's quite unlikely. You can't rule it out in the case of one or two individuals, but—

Mr GEORGANAS: But none of those people were ex-smokers of the 180,000?

Mr Bates : I think there's also a misclassification problem. As I said, when you actually ask those people why they're doing it, some of them will say, 'I'm doing it to stay off cigarettes,' so they may have classified themselves wrongly in the first place. But it's a tiny proportion of the total. They may have other reasons for doing it. They may be vaping dessert flavours at the end of a meal. They may be using alcohol favours instead of having a drink. It's an area we don't really know much about.

Mr GEORGANAS: I've got to say, I'm finding it very appealing as an ex-smoker. It's the addictive side of the brain, obviously, because smoking is one of the most addictive drugs that we have so therefore for someone like me, who's given up over 10 years—

Mr Woodward : Don't go back.

Mr GEORGANAS: No. It's appealing, and I wonder how many people would be in the same situation that I'm in—not that I'd take it up.

Mr Bates : We're not seeing much of that. There would be an advantage in going down that route, if it was an alternative to relapse. One argument on this is that it actually stabilises someone who's quit smoking so they never have those sorts of crisis moments where they go back to smoking. So, relapse prevention is one of the ways in which this actually helps to reduce the number of smokers compared with what it otherwise would be.

But the other—I suppose more libertarian—view is, well, what if people just like it? What if people find it welfare enhancing, they find the trade-off between risk and enjoyment acceptable for them? Why not? It's not a view I'd particularly encourage, but as long as the risks are not off the scale, as they are with smoking, you don't need to be quite so worried about people who are doing that. And usually people who've gone down that route would find it easiest to quit, if they start to get concerned about it. It's interesting: it could create all sorts of new behaviours, but so far the dominant effect is people quitting smoking and using it to reduce their risk—by far, by miles.

CHAIR: I am conscious of time. Does anyone else have any more questions?

Mr TIM WILSON: The only other question I have is, are you aware of any studies? Obviously with tobacco consumption there are kind of profile communities that you could say are at a higher risk of consumption than other people. Generally, people from lower socioeconomic backgrounds are more likely to be smokers et cetera. Have there been any studies looking at profiling the socioeconomic backgrounds of vapers and whether they're more likely or less likely to take up tobacco in the first place?

Mr Bates : There have been some studies like that. I'm struggling to remember the detail.

Mr TIM WILSON: You can take it on notice.

Mr Bates : But I think what they found was that often when a new technology comes in the people who are a little bit more capable, a little bit more savvy, are the first people to use it. So, it's possible that within the population of smokers the first users would be people who had a higher socioeconomic status within that group. But there's been a lot of interest in whether these products can be used in particular settings where vulnerable people are—for example, psychiatric institutions, prisons and so on—and whether they can do interventions in those settings that would get people onto a track where they were starting to vape rather than smoke. But if it would be helpful, I could look at the study that I have in mind and drop you a line on it.

Mr TIM WILSON: Yes, if you could take that on notice.

Mr Woodward : If I could just add one thing: this is the NHMRC CEO's statement.

CHAIR: Yes, I've read it.

Mr Woodward : It is preciously thin in terms of its analysis.

CHAIR: Well, it is a very small font!

Mr Woodward : All of the international studies are much, much bigger. What would be really, really good would be if this committee encouraged the NHMRC to take an urgent look at this matter again and report in a lot more detail the issues that Clive's been talking about, rather than this brief thing. The health consequences of this move could be enormous. But if we just kick it into the long grass it'll be business as usual.

CHAIR: I must say, at the start of this inquiry I was told that the NHMRC had done a report and I went looking for it and allocated enough time to read a 300-page report, but—

Mr Bates : We've benefited hugely from the evidence review of the Royal College of Physicians and Public Health England. Canada's got a similar thing. It's a good thing to do, to get some neutral scientists to look at all the evidence and come back.

CHAIR: Yes. Thank you both for making your time available. This week's been all-England week! Your evidence comes on top of evidence we had from the all-party parliamentary group and Public Health England. Are you happy for the additional information you provided to us to be treated as a proper submission?

Mr Bates : Yes, we'd like it to be.

CHAIR: And are you happy for the transcript of today's proceedings to be published?

Mr Bates : Yes. That is no problem at all.

Mr Woodward : No problem.

CHAIR: Good. Well, thank you again. We'll send you a copy of the transcript, obviously, and I think that last question from Mr Wilson you took on notice, so if you are able to come back on that, that will be great.

Committee adjourned at 13 : 14