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Sir Richard Doll and the deadly habit

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Sir Richard Doll

I am old enough to remember when a visit to the cinema meant peering at the silver screen through a fog of tobacco smoke — an obscurity to which I contributed. (I hasten to add that I have long since given up smoking.)

As early as 150 years ago a paper in The Lancet raised fears about the health effects of the habit. Equally surprisingly, an association between smoking and lung cancer was established in 1930s Nazi Germany.

In post-war Britain attempts to trigger cancer in animals with tobacco tar failed but subsequently the experimental procedures were shown to be faulty.

The name that first comes to mind in the causative relationship between smoking and lung cancer is Sir Richard Doll. In 1948 he joined a team that investigated the rising incidence of the disease. They discovered that among 649 lung cancer cases there were only two non-smokers. The team was able to conclude that the risk of developing the disease increases in proportion to the amount smoked.

Further work followed the prospective mortality of 40,000 British doctors, and published findings in 1954 confirmed a direct link between smoking and lung cancer. The findings had a huge international impact.

Stopping smoking was later shown to cut the risks. The 50-year results of this study provided the most comprehensive picture yet of the perils of smoking.

Doll maintained that promoting cigarettes is immoral but he was sympathetic to those who took up the habit. He also discomfited the passive smoking lobby by downplaying the effects of second-hand smoke.

He disagreed with the theory that smokers are an economic drain on the country, stating that smoking efficiently kills its adherents before they can retire or grow old.

The work of Doll and his co-researchers saved millions of lives: in 1954, 80 per cent of British adults smoked compared with 26 per cent today. Sir Richard provided the world with a truth it still has to come to terms with completely.

Doll also published papers on topics as diverse as binge drinking, electrical power lines and asbestos. He was the recipient of many honours and awards.  Epidemiology, a marriage of medicine and mathematics, perfectly suited his talents. The discipline used to be held in low regard, but Doll reversed this in his time as Oxford’s Regius professor of medicine.

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