Education And Debate

The price of coffins: specious arguments by eminent doctors against the dangers of tobacco

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7225.1621 (Published 18 December 1999) Cite this as: BMJ 1999;319:1621

Doctors and Tobacco

Sir

It is sad but true, as P Cowen points out, that many doctors and
other scientists were for long unconvinced by the clear evidence about
smoking and lung cancer produced by Doll and Hill. Some, of course -
such as HJ Eysenck and the statistician Sir Ronald Fisher (mentioned by
Cowen) - entered the pay of the tobacco industry. Others were simply
unwilling to allow science to overcome their incredulity about a habit so
common and accepted.

An exception was Dr Horace Joules, who urged the need for warning
the public in the Minister's Standing Advisory Committee on Cancer and
Radiotherapy immediately their 1950 paper 1 came out. But the committee's
distinguished chairman, Sir Ernest Rock Carling, a life-long heavy smoker,
rejected the idea, and continued to do so until at last he was outvoted,
the sole dissentient, in November 1953: Sir Ernest "feels that the
evidence is insufficiently conclusive", to quote a minute on the Ministry
of Health file 2. Moreover, Dr Joules by his persistence had made himself
a nuisance and so lost his place on the Committee to a doctor who in her
letter of acceptance confessed her ignorance of its field of work. 3

This was perhaps unsurprising, since the Ministry's Medical Officers
- notably Dr Neville Goodman and the CMO Sir John Charles - were
remarkably concerned to water down the draft advice from the Committee.
Doll and Hill's sponsors at the Medical Research Council had already
noticed this sceptical attitude at the Ministry. Dr Goodman minuted a
private meeting with Dr Ernst Wynder, who with Evarts Graham had published
a similar study 4 just before Doll and Hill's:

"He is a young man ‘far gone in enthusiasm' for the causal
relationship between tobacco smoking and lung cancer. (I had been told
when I was in New York this spring that he was the son of a revivalist
preacher and had inherited his father's antipathy to tobacco and alcohol.
The American Cancer Society were very suspicious of his early work for
this reason.)"

Dr F H K Green at the MRC recorded the comment:

"Dr Goodman's slightly ‘sour' minute about his talk with Dr Wynder
seems to me symptomatic of the great reluctance of the Ministry's M.O.s to
accept what we regretfully believe to be the ‘facts of life (and death)'
on smoking and lung cancer." 5

That reluctance persisted until Sir George Godber took over as CMO in
1960, when with Enoch Powell as Minister of Health and Lord Hailsham
responsible for the MRC at last a genuine attempt was made to reduce
smoking. The whole fascinating story is told in my recent book Denial
& Delay. 6

Yours sincerely

David Pollock

(Former director of Action on Smoking and Health)

London N16 5PU

1. BMJ 1950; ii: 739-748.

2. File MH 55/1011 at the Public Records Office.

3. Dr Janet Aitken: see file MH 133/450 at the Public Records Office.

4. JAMA 1950; 143: 329-336.

5. File FD 1.2009 at the Public Records Office

6.Pollock D: Denial & Delay, Action on Smoking and Health, 1999:
available price £8 incl p&p from "D&D", 13 Dunsmure Road, London
N16 5PU.

Competing interests: No competing interests

23 December 1999
David Pollock
Director
The Continence Foundation