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- - - DOLL AND HILL ON SMOKING AND LUNG CANCER

Friday, 29th of March 2013

 

• DOLL AND HILL ON SMOKING AND LUNG CANCER

  

Rarely has a ten page article caused such an impact as 'Smoking and Carcinoma of the Lung: Preliminary Report,' published by Richard Doll and A. B. Hill in the British Medical Journal in September 1950. The authors carefully review, and demolish, the alternative explanations to a causal relationship between smoking and lung cancer.

'Consideration has been given to the possibility that the results could have been produced by the selection of an unsuitable group of control patients, by patients with respiratory disease exaggerating their smoking habits, or by bias on the part of the interviewers. Reasons are given for excluding all these possibilities, and it is concluded that smoking is an important factor in the cause of carcinoma of the lung.’ (see full text available at  http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=14772469 ).

 

Giving credit where due, Doll and Hill  reference in 1950 the earlier work of German and American researchers on the same subject. Knowing that their analysis of hospital records would draw criticism, they followed this 'preliminary report' with a prospective study of comparative mortality in smoking and nonsmoking British physicians. This confirmatory study, published in 1954, is athttp://www.bmj.com/cgi/reprint/328/7455/1529

Before his death, Doll gave an interview to Cancer World, accessible atwww.cancerworld.org/CancerWorld/getStaticModFile.aspx?id=269

 

Herewith, excerpts from the interview:

'Sir Harold Himsworth, the Secretary of the Medical Research Council (MRC), who had commissioned the study, accepted the results straight off. But most cancer research workers did not accept it, and in fact they advised the Department of Health that they shouldn’t take any action because they were uncertain about what it meant.

'It wasn’t until 1957, when the Government asked the MRC for a formal opinion as to whether our conclusion was correct or not, that the MRC formally considered it and said it was correct and advised the Government to that effect. The result was that the Minister of Health in 1957 called a press conference to announce the results of the MRC consultation.

'He announced that the MRC had advised them that smoking was the cause of the great increase in lung cancer. While he was reporting this to the media, he was smoking a cigarette himself!'

. . .  'The tobacco industry in America . . . tried to get a colleague of mine, Ernst Wynder, sacked from his job with the Sloan-Kettering. They put pressure on the Director not to allow Wynder to publish anything that claimed smoking caused disease, and the Director did try to suppress his studies. Wynder, however, responded by setting up his own organisation and getting support from somebody else to carry on doing the research. So when he published his results, they didn’t have the Sloan-Kettering stamp. Sloan-Kettering came out of it very badly. However, despite this sort of pressure, the leading epidemiologists in America all got together fairly early on – in the late 1950s – and said they regarded it as proved that smoking causes disease. The trouble was the American law courts. The industry made it so expensive to sue them that it wasn’t for some years that you got very wealthy groups of lawyers who were prepared to take them on. The industry could make it so expensive by raising objections and making it last a very long time.'

Reviewing, in the Bulletin of the World Health Organization, the early reactions to tobacco research,

Michael Thun, of the American Cancer Society, wrote  about 'when the truth is unwelcome' at

http://www.scielosp.org/scielo.php?pid=S0042-96862005000200015&script=sci_arttext&tlng=en