Intended for healthcare professionals


More reluctance in accepting evidence on smoking and cancer

BMJ 2000; 320 doi: (Published 18 March 2000) Cite this as: BMJ 2000;320:804
  1. David Pollock, director, Action on Smoking and Health, 1991-4
  1. London N16 5PU

    EDITOR—It is sad but true, as Cowen points out,1 that many doctors were long unconvinced by the clear evidence about smoking and lung cancer produced by Doll and Hill.

    An exception was Dr Horace Joules, who urged the health ministry's Standing Advisory Committee on Cancer and Radiotherapy of the need to warn the public immediately their 1950paper came out.2 But the committee's distinguished chairman, Sir Ernest Rock Carling, a lifelong heavy smoker, rejected the idea and continued to do so until he was at last outvoted, the sole dissenting voice. A minute on the Ministry of Health file in November 1953 records: Sir Ernest “feels that the evidence is insufficiently conclusive” (file MH 55/1011, Public Records Office).

    Moreover, Dr Joules had made himself a nuisance and so lost his place on the committee. This was perhaps unsurprising, since the ministry's medical officers—notably, Dr Neville Goodman and the chief medical officer Sir John Charles—were remarkably concerned to water down the committee's draft advice.

    At the Medical Research Council this sceptical attitude at the ministry had already been noticed. Dr Goodman minuted a private meeting with Dr Ernst Wynder, who with Evarts Graham had published a similar study just before Doll and Hill's3 : “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.)”

    Dr F H K Green at the Medical Research Council recorded the comment: “Dr Goodman's slightly ‘sour’ minute … seems to me symptomatic of the great reluctance of the Ministry's MOs [medical officers] to accept what we regretfully believe to be the ‘facts of life (and death)’ on smoking and lung cancer (file1.2009, Public Records Office).

    That reluctance persisted until Sir George Godber took over as chief medical officer in 1960, when, with Enoch Powell as minister of health and Lord Hailsham responsible for the Medical Research Council, at last a genuine attempt was made to reduce smoking. The whole story is told in my recent book Denial and Delay. 4


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