Richard Doll 1912–2005

Abstract

Few researchers can probably imagine they will live to see a brand new, world-class institute established and named after them, but Sir Richard Doll, who died last month at 92, lived to see just that. Few researchers can probably imagine they will live to see a brand new, world-class institute established and named after them, but Sir Richard Doll, who died last month at 92, lived to see just that. As the doyen of epidemiologists, he proved the link between lung cancer and cigarette smoking. He came to prominence in 1950 when, with Sir Austin Bradford Hill, he shattered government and public ignorance with research among patients in 20 London hospitals. Over three decades the registrar general’s records had shown a very rapid and unexplained increase in lung cancer deaths amongst men. The search, involving patients with and without lung cancer, had no obvious causes to target. The prime suspects were the smuts from coal fires, exhaust fumes from cars, and tarring of the roads in response to the increase in car ownership. Doll, working with Bradford Hill, recorded the lifestyle and habits of men admitted to London hospitals with suspected lung cancer. Later, after the patients had a diagnosis, he found that those whose suspected lung cancer was confirmed were the smokers, and those in whom lung cancer was ruled out were the non-smokers. Within a few months, cigarette smoking, then believed to be generally harmless apart from ‘smoker’s cough’, had emerged unambiguously as the only dominant factor — so dominant as to seem causal. Yet publication of this Medical Research Council study was delayed because the council found the results so important and unexpected that they should not be published until they had been confirmed by a second study in hospitals around the country. Doll and Bradford Hill quickly confirmed that cigarette smoking was the single and overwhelmingly most powerful connection with lung cancer. In the 1950s, Doll and Bradford Hill launched a long-term prospective study of the effects of smoking on British doctors (a group of around 20,000), which confirmed the connection with lung cancer. It also showed how risk related directly to the extent of smoking and how chronic bronchitis and coronary disease were also, according to this and other studies, caused by smoking and was quickly accepted in the US. Doll’s later meticulous approach to the structure of studies, to the statistics used and to the collection, analysis and quality of information needed to render them valid, sprang from this and earlier work. He was interested in other problems — at the MRC, on the scientific committee of the International Agency for Cancer Research and at the ICRF Unit in Oxford. Long after his formal retirement, working jointly with Richard Peto, he set up a major study to disentangle conflicting evidence about cholesterol levels and heart disease. He remained academically productive and in good health in his notional retirement. His wife died in 2001 but in 2002 he gave evidence on behalf of the wife of a smoker who had died at the age of 48 of lung cancer after smoking 60 cigarettes a day and was suing tobacco manufacturers. Doll testified that the industry had been aware of the risks since around 1950, when he published his results. He was involved in several projects right up until his death. He was a little apprehensive about a move to space in the new institute as the old ICRF unit in the heart of the city centre to which he could walk from home closed down in June. The Sir Richard Doll institute outside the city required a taxi ride but he was keen to keep on working and his death came just a few weeks after the new Oxford institute carrying his name opened.