Profile: A life against tobacco: Steve Connor meets Sir Richard Doll, the doctor whose pioneering work was the first to show that smoking cigarettes can cause lung cancer

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SIR Richard Doll was driven to medicine by drink. In his youth, after a night on Trinity College beer, he flunked the last paper in his Cambridge mathematics scholarship exams. The college would still have offered him an exhibition (worth less money than a scholarship) but the young Doll was 'muck sick' with himself. So he went to St Thomas' Hospital, London, to study medicine, going on to become the most distinguished cancer specialist in Britain, if not the world.

In any social history of post-war Britain, Sir Richard, who has just celebrated his 80th birthday, ought to have a central role. When Princess Margaret went into hospital for treatment for pneumonia last week, nobody doubted that heavy smoking was the greatest cause of her illness. Helping people to stop smoking has become almost as lucrative as the tobacco industry; last week, the nicotine patch (allowing the craving to be satisfied by the absorption of nicotine through the skin) went on sale, with a big advertising campaign. British Rail has driven smoking even further beyond the pale of acceptable social behaviour by banning it from its commuter trains on Network SouthEast. This week the Science Museum launches an exhibition on the hazards of passive smoking.

All this stems from Sir Richard Doll's work. Nearly 43 years ago - roughly when Princess Margaret started smoking - he published the first research showing the link between smoking and lung cancer. It is hard now to imagine how startling the idea seemed. Nobody, least of all Doll, had previously suspected the link.

He can still recite without notes the way things were at the time. 'Of men between 45 and 75, we found that life- long non-smokers were less than 5 per cent. Only 10 or 15 per cent had given up; over 80 per cent were smoking.'

In 1947, the Medical Research Council set up an investigation into the dramatic increase in cases of lung cancer. Suggestions included atmospheric pollution, the tarring of roads and arsenic, which had been used to treat syphilis. Nobody seriously thought it could be the result of smoking cigarettes. 'It was such a normal thing to do,' Sir Richard says.

It was many years before even the majority of doctors accepted Doll's research. This, perhaps, is one reason for Sir Richard's relaxed attitude to nicotine addicts. Another is that he once smoked himself, failing to collect on his father's promise of pounds 50 if he was a non- smoker by the age of 21. 'I would say - by all means do it. It is a question of how much you enjoy life. Do you want to die 15 years earlier than you need? I personally don't. A lot of young people think life is not worth living over 50. But as you get older you value it more and as far as I'm concerned, life is well worth living at the age of 80.'

WILLIAM Richard Shaboe Doll was born in Hampton, on the Thames, in 1912. His father, a GP, was, afterthe Trinity ale, the strongest influence on his decision to study medicine.

He enjoyed a comfortable middle- class home and had a public school education at Westminster. Like many of his contemporaries, in the 1930s he was concerned about poverty and the rise of fascism. He joined the Inter-Hospital Socialist Society while a student at St Thomas'.

In the Second World War he worked on a hospital ship in the Mediterranean and, in the retreat to Dunkirk, carried morphine in his hand rather than his medical bag in case he was wounded and unable to reach for it quickly. After the war he returned to St Thomas' but became disillusioned by the obsequiousness of the junior doctors towards senior staff. 'I was not happy with the sort of behaviour necessary to get a decent appointment.' He decided to be a researcher rather than a clinical physician.

The decision led to more than the establishment of the smoking/lung cancer link. Doll became the pioneer of epidemiology. This branch of medical science attempts to find the causes of a disease by using statistics rather than chemistry or biology. The precise mechanism by which cigarette smoking causes cancer is still poorly understood. Doll established the link by looking at who suffers from it, when and where.

Doll - and his late mentor, Austin Bradford Hill - thus took medical research out of the laboratory and into society. As part of the MRC study, they had thousands of lung cancer patients interviewed about their lifestyle and habits. They soon concluded that smoking was the only factor overwhelmingly implicated in the disease.

Sir Richard is well aware that there are lies, damned lies and statistics. Inadequate statistics will 'prove' that storks really do bring babies - in northern Europe, dramatic falls in the birth rate have twice in the past century coincided with a demise of mating storks. In fact, world wars simultaneously remove men from their wives and storks from their nesting grounds.

So how does the epidemiologist distinguish between such a chance association and a causal link - smoking and lung cancer? 'It's difficult,' he says fumbling for a form of words that a layman can understand. But one of the most important things is whether, if you take away a particular agent (say, cigarette smoke), there is then a big reduction in the risk of disease. 'We found,' Sir Richard explains, 'that 0.5 per cent of the patients with lung cancer were non-smokers and 5 per cent of the general population were. You had a 10-fold difference. That was the key figure. You rarely got the disease unless you had been smoking.'

That conclusion was published in 1950. It took seven years for the Ministry of Health to take it seriously. The tobacco industry proved more difficult. It hired its own statistician, Geoffrey Todd, to show that atmospheric pollution was causing the rise in lung cancers. After a few years of fruitless research, Todd told Doll that he was right. Eventually, the British tobacco industry agreed 'not to say smoking did not cause lung cancer', a double negative that was nevertheless a huge concession. The American industry is still reluctant to admit even that. Sir Richard's tolerance of addicts does not extend to the actual peddlers of nicotine. 'Personally, I can't understand how any person with any conscience can in fact employ himself in trying to market cigarettes,' he says, pausing for effect. 'It seems to me as something as immoral as keeping a brothel.'

Married for more than 40 years, with a son and a daughter, Sir Richard has numerous scientific awards, medals and honorary degrees. A knighthood came soon after his appointment as Regius Professor of Medicine at Oxford, a post he held from 1969 to 1979.

His conviction about the smoking- lung cancer link is all the more impressive for his caution about other medical risks. In the 1960s, for example, doctors noted the first signs of ill-health in women taking the Pill - blood clots in the leg. Thousands of women were advised to use other forms of contraception. Doll advised a wider, long-term study to weigh the overall risks and benefits. He was vindicated. After 30 years' research, it seems that the slight risks associated with the Pill are outweighed by the protection it provides against certain cancers.

Sir Richard has been equally careful about the health risks of radiation. In 1955, he researched the dangers of fallout from testing H-bombs in the atmosphere. The Cabinet had set a deadline of New Year's Day 1956. 'We got the answer at 3am on 1 January,' he says. But 'it turned out to be the wrong answer' because he was given inaccurate data. Another year's work established that the risk of cancer increased in direct proportion to radiation dose. He nevertheless thinks that people are unduly worried about radiation. 'They don't realise just how very, very small this risk is, and they think of it in terms of nuclear weapons.' Radiation, he says, contributes to about 5 per cent of cancers and 99 per cent of these involve naturally occurring rather than man- made radiation.

TWENTY years after the age at which most people retire, Sir Richard shows no sign of flagging energy. He continues to work furiously from a small office next to the Radcliffe Infirmary in Oxford where he holds an honorary position at the Cancer Studies Unit of the Imperial Cancer Research Fund.

Sir Richard can still talk with passion about the medical issues of the day. He describes cholesterol in the blood, for example, as 'the most important medical issue confronting the public at the present moment'. He has little doubt of the health benefits of lowering cholesterol levels and is scornful of recent research indicating the contrary.

So is he a killjoy? He accepts that, if they are to reduce the risk of cancer, people need to do things that they 'would choose not to do'. But he approves of some pleasures. His research demonstrated how moderate drinking is not just harmless but positively beneficial to health - providing, that is, you don't smoke as well. The crusading zeal is to convince people of risks - it is up to them whether they take them or not.

A one-time dinner guest at his Oxford home recalls Sir Richard briskly dismissing a fanatical American anti- smoker who spoke of the huge costs of treating cancer victims. The state saved money if smokers died before drawing their pensions, he pointed out. 'I don't mind in the least if someone in the room lights up a cigarette,' he told the Journal of Addiction in 1990. 'It's their decision and their life, not mine.'

(Photograph omitted)

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