Nick Hopkinson: Smoking in “The Crown”

A youthful Christine Keeler sits in custody refusing to answer questions, cigarette in hand. Season 2 of Netflix’s The Crown, culminates with the Profumo affair. It is 1963, six years after The Medical Research Council had published a statement announcing “a direct causal connection” between smoking and lung cancer, and that scene sadly foreshadows Keeler’s recent death from COPD. There is, understandably, a lot of smoking in The Crown—in 1962 70% of men and 43% of women smoked. The consequences are not concealed, the first season dealing with King George VI’s death from lung cancer. His father before him had died from emphysema in 1936.

Successive generations failed properly to heed the “Smoking kills” message—action was taken but slowly. Christine Keeler’s betrayal by the political establishment is echoed by the tardy establishment response to an unequivocal health message. The Ministry of Health in 1956 had fully acknowledged the facts about the health risks, although the spokesman made this announcement while smoking a cigarette, repeating the government’s position that “we cannot interfere with what is a matter for the individual.”

There is a temptation to instrumentalise the deaths of notable people—to use them to raise awareness, stimulate action, promote donations to the relevant charity. A strange ambivalence too; sadness at the death while grimly accepting another “recruit” to the cause. Christmas is just passed and it wouldn’t have been Christmas without “Chestnuts roasting on an open fire”, though Nat King Cole’s voice was silenced by lung cancer in his mid-40s. George Harrison, the best Beatle, died at just 58 from lung cancer—a mournful thought whenever “Here comes the sun” comes on the radio. If you enjoyed “The Bloody Chamber,” imagine another 25 years of novels by Angela Carter.

The temptation is even greater in COPD. Despite being the world’s third leading cause of death it has a low status and a low profile. Characterised as a self-inflicted condition, it is much more common in poorer people. There are few famous faces associated with it—Leonard Nimoy, Liz Dawn, and now Christine Keeler. The cause and effect are distant in time. “The Crown” reminds us that most people start smoking when they are young. It is evident that smoking is not “a matter for the individual” but an addiction of childhood—recent data suggest around two thirds of people who try a cigarette will go on to become regular smokers. As the government makes further cuts to public health, we owe it to her memory, and to millions of less noted victims, not to allow the political establishment to carry on betraying young people to future ill health.

Nicholas Hopkinson, Reader in Respiratory Medicine, Imperial College London.

Competing interests: None declared.