: "Professor Sir Richard Doll
(Filed: 25/07/2005)
Professor Sir Richard Doll, the epidemiologist and former Regius Professor of Medicine at Oxford University who died yesterday aged 92, was one of the first two scientists to link smoking with lung cancer.
Doll himself stopped smoking - untipped cigarettes - because of his findings in the celebrated report he wrote with Professor Austin Bradford Hill, of the Medical Research Council. The report, published in the British Medical Journal in 1950, was based on a survey of lung cancer patients in 20 London hospitals; it found that smoking was the only factor overwhelmingly implicated in lung cancer, and that it was rare for non-smokers to suffer from the disease.
'The risk of developing the disease increases in proportion to the amount smoked,' the report concluded. 'It may be 50 times as great among those who smoke 25 or more cigarettes a day as among non-smokers.'
This early study was the first in the world to show that smoking could cause not only lung cancer but also heart attacks and emphysema. It was the foundation for the first official reports on the dangers of tobacco.
At first, though, many greeted the connection between smoking and cancer with scepticism. Smoking was seen as just too 'normal' an activity to be so dangerous. It took seven years for the Ministry of Health to take Doll's findings seriously; the tobacco industry hired its own statistician to prove that air pollution was the main cause.
Even in 1958, one Harley Street physician objected to the Medical Research Council's link between smoking and cancer as 'a staggering and most unscientific claim'. He went on: 'They will be blaming mother's milk next.'
But by that time, Doll and Bradford Hill had produced more evidence to substantiate their findings. In 1952, after extending their investigations to other parts of the country, they announced that "the association between smoking and carcinoma of the lung is real". In 1956 they reported that the annual death rate from lung cancer in heavy cigarette smokers among doctors was about 40 times the death rate from that cause among non-smoking doctors.
After years of follow-up, Doll was able to provide even more damning evidence. Having tracked the health and smoking habits of more than 34,000 doctors for 20 years, he concluded that smokers were twice as likely to die prematurely as non-smokers and predicted that smoking would kill between a third and a half of all smokers.
After following the health records of the same doctors for a further 20 years, he concluded that the risks of smoking were even worse than he had predicted earlier. Prolonged smoking, he concluded, begins to take its toll at 35; and half of all heavy smokers can expect to die before the age of 70, compared with a fifth of non-smokers.
In 1981, after further research in America with Richard Peto, Doll confidently stated in a report to Congress that "incidence of cancer of the lung by late middle age is more than 10 times greater in regular big smokers than in lifelong non-smokers".
Two years later, as director of the Imperial Cancer Research Fund Epidemiology Unit at Oxford, Doll reported that smoking cigarettes was responsible for 30 per cent of deaths from cancer of all kinds; but he argued that smokers who changed to low tar cigarettes could halve their chances of getting lung cancer (though not of getting heart disease) - a finding which has since been called into question, following evidence that smokers who switch to low tar products tend to smoke more cigarettes.
He also suggested that the carcinogenic effects of smoking could be affected by diet; smokers who consumed above average levels of beta carotene - a vitamin present in carrots - could lower their risk of lung cancer by an estimated 40 per cent.
Alcohol, on the other hand, was implicated as a cause of cancer in upper respiratory and digestive tracts; and the adverse effect was far greater in smokers because tobacco opened the way for alcohol to attack. He suggested that cancer deaths could be cut by 35 per cent by smokers regulating their food and drink intake.
In 1986 Doll supported the findings of research which suggested that lung cancer could also be caused by "passive" smoking, and during the 1990s he was prominent in the campaign to persuade the Government to ban tobacco advertising.
In 1991 he said: "Young people say smoking cannot be all that bad or the Government would never allow it to be promoted in the way it does… I accept that millions of pounds are at stake, but no price can be put on the misery and suffering of smokers who die of cancer and of their families and friends who are forced to watch one of the most painful ways of dying."
Doll and his colleagues published their final follow-up report only last year. It concluded that men born between 1900 and 1930, who smoked only cigarettes and continued smoking throughout their lives, died on average about 10 years younger than lifelong non-smokers. Those who gave up at 60, 50, 40 or 30 improved their life expectancy by, respectively, about three, six, nine or 10 years.
Doll's findings contributed to the development of an increasingly vociferous anti-smoking campaign, and sparked controversy between health experts and civil libertarians about the role of the state in interfering with individual decisions.
But if Doll was sometimes accused of puritanism, the accusation was unfair; his advice to people worried by health scares was to ignore the majority of them: "Grilled and smoked foods carry a cancer risk, for example," he said in 1995, "but I haven't given up my grilled kipper or smoked salmon."
In 1993 Doll cheered the nation's drinkers by recommending far greater levels of alcohol consumption than previously thought healthy. The optimum amount of alcohol to protect men against heart disease could be up to almost five bottles of wine a week, he said, or an average of up to four single whiskies a day.
In 1973 he unintentionally stirred up a storm of controversy by declaring that people aged over 65 should "live dangerously" and be prepared to accept death. His point was not that the elderly should be "bumped off", but that they should live life to the full and take risks, rather than eke out a few more weeks of life in fear and boredom. Indignant pensioners nonetheless wrote to newspapers complaining that he was talking "absolute nonsense".
Doll was Regius Professor of Medicine at Oxford University for 10 years until 1979. For the next four years he was the first Warden of Green College, Oxford, the new graduate medical college founded by the British-born American businessman Dr Cecil Green.
William Richard Shaboe Doll, the son of a GP, was born at Hampton, on the Thames, on October 28 1912 and went to Westminster. He had planned to go up to Trinity College, Cambridge, but he ploughed the mathematics scholarship exam - due to an excess of Trinity beer the night before. Although offered an exhibition by Trinity, Doll was too ashamed to accept it, and instead went to St Thomas's Hospital Medical School.
During the war he served in the RAMC, for much of the time in a hospital ship in the Mediterranean. He then returned to St Thomas's, but became disillusioned with the kind of obsequious behaviour towards senior staff that seemed to him to be required to get a decent appointment. He therefore decided to pursue a career in research, rather than as a clinical physician.
He moved to the Central Middlesex County Hospital in 1946, working in the new field of epidemiology, the branch of medical science which seeks to find the causes of a disease by using statistics rather than by chemistry or biology. In 1948 he joined the Statistical Research Unit of the Medical Research Council, becoming its deputy director in 1959 and director from 1961 to 1969.
From the 1950s onwards Doll published a steady stream of reports into both the causes of disease and the side-effects of new medicines. In 1968 he published a study on the side-effects of the contraceptive pill. This suggested that women taking the Pill faced a nine to 10 times increased chance of developing a blood clot in their legs, but dismissed suggestions by some American researchers that the Pill caused a cancer-like change in the cells of women.
Six years later he concluded in a further report that the Pill was on balance beneficial to women's health. However, in 1990 he backed a study which claimed that the use of the Pill for four to five years led to a 60 to 70 per cent increase in the risk of breast cancer among women under the age of 35.
Over the years, Doll's research team highlighted, among other things, the harmful effects of asbestos; the beneficial effects of aspirin for heart disease patients; and the harmful effects of nuclear radiation. The worldwide nuclear test ban treaty stemmed partly from this work.
In 1986, as chairman of the Medical Research Council's committee studying the epidemiology of Aids, he led a group of doctors calling for the introduction of widespread confidential testing for Aids in order to monitor the spread of the infection through society. In the 1990s he collaborated with Prof Richard Peto, head of the cancer research unit at the Radcliffe, on a worldwide study of cholesterol.
He was also chairman of the National Council on Radiation Protection, which advised on the possible dangers of radon gas and on the effects of such sources of radiation as electricity pylons.
Doll was as concerned with disease prevention as with cure. In 1967 he published a book on The Prevention of Cancer; in 1976 he was one of the authors of a report which recommended the adding of fluoride to water supplies to prevent tooth decay; and in 1985 he warned that the dangers of contracting skin cancer through exposure to ultra-violet light may have been under-estimated, and recommended the avoidance of prolonged exposure to sunlight.
Public fascination with health meant that Doll's pronouncements often made the headlines. In 1987 he was cheered by a large crowd outside a Madrid courtroom after he had given evidence in the trial of 38 Spanish oil merchants accused of public health offences; it was alleged that adulterated cooking oil had caused the deaths of 485 Spaniards since 1981.
Alongside his work at the Medical Research Council, Doll continued to teach. For 20 years until 1969 he was an associate physician at the Central Middlesex Hospital. He was a lecturer at the London School of Hygiene and Tropical Medicine for six years until 1962.
For three years before becoming Regius Professor of Medicine at Oxford in 1969, he was a teacher in medical statistics and epidemiology at University College Hospital Medical School.
Doll was a member of the Royal Commission on Environmental Pollution for six years from 1973, and of the Standing Committee on Energy and the Environment for three years from 1978.
He sat on the Scientific Council of the International Cancer Research Agency from 1966 to 1970, and on the Council of the Royal Society in 1970.
For seven years until 1977 he was chairman of the Adverse Reaction Sub-Committee on the Safety of Medicines and for five years chairman of the UK Co-ordinating Committee on Cancer Research.
He was appointed OBE in 1956, was knighted in 1971 and became a Companion of Honour in 1996.
Richard Doll married, in 1949, Joan Mary Faulkner, also a doctor, who died in 2001; he is survived by their son and daughter.
