[Intl-tobacco] Sir Richard Doll dies at 92

[Robert Weissman]

The Times

Obituaries


July 25, 2005

Sir Richard Doll
October 28, 1912 - July 24, 2005
Epidemiologist who first demonstrated the link between smoking and lung
cancer

ALTHOUGH fears about the effects of smoking were raised as early as 1858
in /The Lancet/, it was left to Sir Richard Doll, working with Austin
Bradford Hill, to make the first credible link between cigarettes and
lung cancer in 1950. He calculated that, on average, smokers die ten
years earlier than nonsmokers, and that as many as two thirds of them
are killed by their habit.

Even without this credit, Doll=92s contribution to the evolution of
medical thought and practice would stand out in a way rarely achieved by
a non-clinician. He gave a new impetus to epidemiology, and to
preventive work in general.



William Richard Shaboe Doll was born at Hampton, the son of Henry Doll
and Amy Shaboe, into a background of some affluence, despite his
father=92s having had to abandon medical practice because of multiple
sclerosis. Doll was educated at Westminster School and St Thomas=92s
Hospital, from which he graduated in 1937.

In his student years Doll developed radical ethical views and joined the
Communist Party, but became disenchanted after the Nazi-Soviet pact. The
war closely followed his membership of the Royal College of Physicians,
and his service in the RAMC was spent largely as a medical specialist on
a hospital ship, until he was found to have tuberculosis.

After the war, Doll returned briefly to St Thomas=92s to research asthma,
but his real career began when he joined Dr Francis Avery-Jones=92s unit
at the Central Middlesex Hospital with an attachment to Sir Austen
Bradford-Hill=92s statistical research unit of the Medical Research Council=
.

Doll became successively a member, deputy director and director of that
unit over 21 years. The early collaboration with Avery-Jones resulted in
a series of papers concerning peptic ulceration. Duodenal ulcer was
shown not to affect particularly those with heavy responsibility (as had
been taught). There followed a series of model clinical trials of
treatment of gastric ulcer showing that diet, alkali, anticholinergic
drugs and admission to hospital all had no detectable benefit, whereas
bed rest promoted healing.

He and colleagues at the council interviewed hundreds of lung cancer
patients. Doll thought that the increasing incidence of the disease
might owe something to the hundreds of tonnes of tarmac being laid down
across Britain at this time, but soon discovered that in 649 lung cancer
cases there were only two non-smokers.

Doll himself gave up the habit two thirds of the way through the
research. In 1954 a follow-up study showed prospective mortality in a
sample of 40,000 doctors, followed over 20 years. It was a spectacular
success of epidemiological method, the results so startling that Iain
Macleod, the Health Minister, called a press conference. He announced:
=93It must be regarded as established that there is a relationship between
smoking and cancer of the lung.=94 Almost everyone at the meeting was
smoking =97 as did 80 per cent of the population.

Doll had a great ability to apply mathematical skills to clinical
problems, a considerable triumph in a profession always suspicious of
the nonclinician.

His international reputation was already established when he came to
Oxford as Regius Professor of Medicine in 1969. He succeeded Sir George
Pickering, who had been at the head of a team distinguished for clinical
research. At that time, clinical skills were widely admired but
epidemiological ones much less so. Doll nonetheless enhanced Oxford=92s
reputation for teaching and research.

Within a few months of his arrival at Oxford, Doll had set up a working
party on the development of the Clinical School, taking a cue from the
report of the Franks Commission of Inquiry in 1966. Doll had been the
prime mover in the decision by the university to form a new medical
collegiate society, Green College, in Oxford.

The concept of a single-faculty college was not regarded with much
enthusiasm by students or many senior members, and the early years of
Doll=92s wardenship of Green College were soured, yet the college began to
forge links between medicine and industry =97 not only in the
pharmaceutical field but also in toxicology, engineering and
electronics. When Doll retired from Green College in 1983 he left a
flourishing foundation and a happy society whose increasing reputation
owes much to the guidance of its first warden and his wife, Dr Joan
Faulkner.

Doll travelled widely and was much in demand as a lecturer or adviser in
medical circles all over the world. He received many honours, including
the fellowship of the Royal Society, a UN Award for his work on research
in cancer, and the Presidential Award of the New York Academy of
Sciences. He was a member of the Royal Commission on Environmental
Pollution, of the Standing Committee on Energy and the Environment and
of the Scientific Council of the International Cancer Research Agency.

Doll helped to set up the National Blood Service and insisted that
Britain avoid the American path of paying donors for their blood.

At Oxford University=92s Clinical Trial Service Unit he continued research
into carcinogens. The World Health Organisation based many of its
conclusions on a landmark study conducted at CTSU by Doll and Richard
Peto, which concluded that environmental pollution might amount to only
2 per cent of cancers worldwide =97 blaming tobacco, diet and infections
for 75 per cent of them.

Doll was knighted in 1971 and made a Companion of Honour in 1996 for
services of national importance. In April this year Doll and Peto were
awarded Saudi Arabia=92s King Faisal International Prize for medicine for
their continuing work on smoking-related diseases. =93So great has been
the impact of their studies that several national health policies have
been modified as a result of these findings,=94 the judges proclaimed.
Doll also held honorary degrees from 13 universities.

Despite these honours, Doll =97 a tall, elegant figure with a
dispassionate manner =97 remained unassuming and friendly to his
colleagues and concerned for the plight of the underprivileged.



Change in the public=92s attitude to smoking was slow coming. Although
cigarette commercials were banned from British television in 1965 and
from radio in 1971, billboards and newspapers were permitted to carry
advertising until February 2003. In May this year Lord Nimmo Smith
dismissed a widow=92s case against Imperial Tobacco, seeming to suggest
that the link between smoking and cancer remained unproven. Doll offered
to show him the evidence, to clear up his apparent misunderstanding.

Posterity may regard the epidemiology of non-communicable diseases as
Britain=92s most important contribution to medical science in the second
half of the 20th century. If so, then Richard Doll=92s name will come
first to mind.

He has published hundreds of papers. His discoveries suggested that
aspirin can help ward off heart disease, and that women who binge-drink
may increase their risk of breast cancer. He recently said that evidence
suggested no link between cancer and overhead power lines.

He quoted only from his figures and was no absolutist. When questioned
recently on second-hand smoke, he exasperated the anti-smoking lobby by
replying: =93The effects of other people smoking in my presence is so
small it doesn=92t worry me.=94

He was also wont to point out that the idea that smokers cost the
taxpayer millions in hospital fees is in fact a myth, stating that
smoking efficiently killed its adherents before they could retire or
become old =97 and that the habit might actually be of economic benefit to
the country. It was, as one journalist pointed out, =93an argument that
only Richard Doll could get away with airing=94.

*Sir Richard Doll, CH, epidemiologist and scholar, was born on October
28, 1912. He died on July 24, 2005, aged 92.*