(Published 13 November 2012)
Cite this as: BMJ 2012;345:e7605
- Tony Delamothe, deputy editor, BMJ
Richard Doll and the BMJ (and BMA) go back a long way together
Notoriously forgetful, science has made an exception for Richard Doll. The 100th anniversary of his birth was marked by a reception at Green-Templeton College, Oxford. Three days of presentations followed at the Richard Doll Building, which houses part of Oxford’s Medical Sciences Division. According to Richard Peto, the driving force behind the celebrations, every major epidemiological study of smoking was represented at the meeting.
Both the Lancet and BMJ published articles to coincide with the anniversary. The Lancet’s Million Women Study reported that among UK women smoking causes two thirds of all deaths of smokers in their 50s, 60s, and 70s; smokers lose at least 10 years of life.1 The BMJ’s Life Span Study found that Japanese men and women who smoke from early adulthood also lose about 10 years of life, settling the question of whether the Japanese people were truly “different” when it came to the effects of smoking.2 A coauthor of both papers, Peto summed up the message of the Lancet study as, “If women smoke like men they die like men,” and that of the BMJ study as, “If the Japanese smoke like Brits they die like Brits.”
He also warned the meeting against expecting many surprises from the 60 year follow up of the British Doctors Study, which is heading into print soon. By now almost all the smokers are dead, Peto said. And anyway, he preferred the Million Women Study, whose enormous numbers allow the calculation of effect sizes with much greater confidence.
So with so few mysteries left to solve about the lethal effects of smoking, is it time to wrap the whole epidemiological project up, I asked Peto. His answer was that if you wanted to convince the policy makers in countries such as India and China, they needed data on their own populations. By themselves the results of the British Doctors Study are not enough.
Still, it would be understandable if readers (and staff) of this journal felt a little nostalgic over this study. As described in Conrad Keating’s biography of Doll, Smoking Kills: The Revolutionary Life of Sir Richard Doll,3 its genesis lay in a case-control study of cancers of the lung, stomach, colon, and rectum reported by Doll and Austin Bradford Hill in the BMJ in 1950.4
The logical next step was a prospective study, and with the assistance of the BMA Doll and Hill sent 59 600 British doctors a questionnaire about their smoking habits. An open letter from Hill, chivvying them to respond, followed in the BMJ, 61 years ago this month.5
The British Doctors Study was the first major prospective study of smoking and death anywhere in the world. And when British doctors read its findings in the BMJ, beginning in the mid-1950s, they became the first group in the world to reduce their smoking. Although some of them undoubtedly influenced their patients to follow suit, it was the Royal College of Physicians’ Smoking and Health (1962) that marked the beginning of the concerted fightback against tobacco in the United Kingdom.6
Despite being intensely political when young, Doll did not lobby politically for the changes that his epidemiological work indicated, according to Keating. Instead he saw his role as being “a neutral dispassionate scientist describing the relationship and leaving the public and physicians to draw their inevitable conclusions.”
The role of dispassionate scientist is not one that would appeal to Judith Mackay, who spoke to the Oxford meeting on the topic “From tobacco research to policy.” Mackay, who won the BMJ Group’s first ever lifetime achievement award in 2009, has been a scourge of the tobacco industry for almost 30 years.7
For Mackay the battle is ultimately political and will happen “in the corridors of power, not on wards.” She regrets that some people believe that putting research findings in the public domain is somehow “unprofessional” and that few medical schools’ curriculums teach health advocacy (that is, how to communicate research findings to influence policy). The tobacco industry is not shy to lobby, noted Mackay, although over the past few years it has taken to the courts to try to block antitobacco legislation. The latest Tobacco Atlas (coauthored by Mackay) lists 18 countries where legal challenges have been mounted recently (www.tobaccoatlas.org).
But there have been many successes. Despite several legal challenges, Australia switches to plain cigarette packaging on 1 December. In the UK the prevalence of smoking has fallen from 82% in 1948—the highest in the world—to closer to 20% now. New Zealand is working to become smoke free by 2025; Mackay predicts that her own Hong Kong will beat them to it. Nevertheless, a billion people may die from smoking related diseases this century, compared with “only” 100 million last century, such has been the explosion in smoking.
The heirs of Doll, who made their way to the Oxford meeting from the countries that will bear the brunt of the 21st century smoking epidemic, will need to team up with a Mackay when they get home. Robust scientific evidence on its own is not enough.
Notes
Cite this as: BMJ 2012;345:e7605
References
- Pirie K, Peto R, Reeves GK, Green J, Beral V, for the Million Women Study Collaborators. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet2012, doi:10.1016/S0140-6736(12)61720-6.
- Sakata R, McGale P, Grant EJ, Ozasa K, Peto R, Darby SC. Impact of smoking on mortality and life expectancy in Japanese smokers: a prospective cohort study. BMJ2012;345;e7093.
- Keating C. Smoking kills: the revolutionary life of Sir Richard Doll. Signal, 2009.
- Doll R, Hill AB. Smoking and carcinoma of the lung: preliminary report. BMJ1950:ii:739-48.
- Hill AB. Do you smoke? BMJ1951;ii:1157.
- Delamothe T. Deaths from smoking: the avoidable holocaust. BMJ2012;344:e2029.
- Hawkes N. Promoting hand washing, stroke prevention, and tobacco control are recognised at BMJ Group award ceremony. BMJ2009;338:b1428.