Sir Richard DollBMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.331.7511.295 (Published 28 July 2005) Cite this as: BMJ 2005;331:295
Sir Richard Doll was the world's most distinguished medical epidemiologist. He established his reputation alongside Sir Austin Bradford Hill, showing that cigarette smoking caused lung cancer. He then went on to show it caused bladder and other cancers, and cardiovascular disease. He did seminal work with Richard Peto on the health of doctors and their families, demonstrating an increased incidence of suicide and liver disease. He also carried out major research on the risks and benefits of the contraceptive pill, on low level radiation, and the dietary treatment of gastric ulcers.
Doll went to work with Bradford Hill at the Medical Research Council in January 1948. Government statisticians had drawn the MRC's attention to a huge recent increase in lung cancer deaths, and the MRC held a conference to decide whether the increase was real and, if so, whether a cause could be identified.
At the time, said Doll, smoking seemed a normal and harmless habit. Eighty per cent of men smoked. Doll and Hill both thought the most likely cause would prove to be pollution—smuts from coal fires were terrible in those days, but had been for decades, and the expansion of the motor industry had meant more tarring of roads, and more exhaust fumes. There was a known association of pipe smoking with lip cancer, but that was thought to be caused mainly by the heat of the pipe stem.
Doll and Hill designed a short questionnaire, administered by social workers, to 650 male patients in London hospitals. The interviewees were newly admitted patients with suspected lung, liver, or bowel cancers. To reduce bias, the interviewers were not told the suspected diagnosis. They also interviewed hospital patients with other diagnoses. After the proper diagnoses had been made, it was startlingly clear that those whose lung cancer was confirmed were smokers, and those who were given the all clear were non-smokers.
The results were so compelling and so unexpected that Doll and Hill took the results to the MRC head Sir Harold Himsworth, who advised them that the results might be peculiar to London, and suggested that they repeat the study in other cities. So they studied 750 similar patients in Bristol, Cambridge, Leeds, and Newcastle.
While they were doing this, they were beaten to publication in the Journal of the American Medical Association (JAMA 1950;143: 329-36). Hill and Doll, whose study was more robust, went to the BMJ's then editor, Hugh Clegg, and the BMJ published their paper quickly (BMJ 1950;221(ii): 739-48).
The government took no action on smoking for several years, but Bradford Hill advised that it was the researchers' job to report, not to campaign—otherwise they might get too attached to their conclusions. Instead, they tried to disprove their findings by doing a prospective study of doctors' smoking habits.
This study soon showed that there was a strong association between smoking and lung cancer and also between smoking and cardiovascular disease. Although there were only 36 lung cancer deaths in the first 29 months of the study, after four years there were 200, almost all of them in heavy smokers. The incidence in non-smokers was negligible. Doll and Hill began publishing their results in the BMJ in 1954 (BMJ 1954;228(i): 1451-5).
It was not long before they were visited by two men from the tobacco industry—the chairman of Imperial Tobacco and his statistician, who disputed Doll and Hill's findings. Five years later the statistician told his employers that unless they accepted that tobacco smoking caused cancer he could not work for them any longer.
William Richard Shaboe Doll was born in Hampton, Middlesex, the son of a general practitioner. During the second world war he served in France and the Middle East and took part in the invasion of Sicily. Doll's Dunkirk diary, detailing his experiences as a battalion medical officer in the retreat to Dunkirk, was published in instalments in the BMJ in 1990.
Doll contracted renal tuberculosis in the middle of 1944 and was discharged early in 1945 after a nephrectomy. He convalesced by working as a psychiatrist in an army hospital for six months before returning to St Thomas' as a junior medical assistant.
The 1950 BMJ paper on smoking and lung cancer was largely ignored by the public. The Department of Health's cancer committee was not convinced by the findings and thought that urging people to quit could start a mass panic. Finally, on 12 February 1954, the health minister Iain Macleod held a conference to announce that the government accepted the link. He famously chain smoked throughout the event. The Royal College of Physicians brought out a report in 1962 that linked smoking and death, and this turned the tide of public opinion.
Doll, who was at one stage a smoker, but gave up when he discovered the association with lung cancer, remained well and productive until nearly the end of his life.
Predeceased by his wife, Joan Faulkner, he leaves a son and a daughter.
William Richard Shaboe Doll, epidemiologist Medical Research Council 1946-69 and regius professor of medicine Oxford University 1969-79 (b 1912; q St Thomas' Hospital, London, 1937; CH, OBE, FRS, DSc, MD, DM, FRCP, FFPHM), d 24 July 2005.
Longer versions of these obituaries are available on bmj.com
Doll and Hill's 1954 BMJ paper, “The mortality of doctors in relation to their smoking habits: a preliminary study,” is available in PDF format at http://bmj.bmjjournals.com/cgi/reprint/328/7455/1529