Robin McKie 

Topic of cancer

The Observer Profile: Richard Doll. He didn't want to be a doctor, but his brilliant medical research has saved more lives than a host of glamorous drug discoveries. Still working at 89, the credit for last week's plummeting cancer figures is entirely his.
  
  


It is startling to realise that the man who has done more than any other to save Britain from the chemical excesses of modern life only became a doctor because he got completely plastered at college. It's a bit like being told that Mother Teresa only became a nun after being sacked as an escort girl.

Nevertheless, in the case of Richard Doll, the link is real. In 1931, the young school-leaver was being put under intense paternal pressure to become a doctor. The country was suffering a major economic slump and his father was anxious for his son to pick a well-paid job. Doll was determined to take a maths degree at Cambridge, however.

'I went up to take the open scholarship in mathematics and met some so-called friends who gave me dinner at Trinity College,' he recalls. Unfortunately, colleges then brewed their own beer and that made by Trinity weighed in at an awesome 8 per cent proof. The young lad swigged several pints, and in a beery haze the next day, sat - and flunked - his exam.

He was offered a second (outside) chance by the university's examiners but declined. 'I was so annoyed with myself, I said, "Oh, damn it, I won't do mathematics, I'll do medicine as you want, Father, and stay in London."'

Thus Britain acquired the services of one of its most remarkable medical scientists, a man who would go on to link several major ailments to the use of everyday products, such as cigarettes, and helped launch campaigns that have curbed their dangers. In other words, we have to thank the master brewers of Trinity College for the fact that our nation now leads the world in the battle against killers like lung and breast cancer - for as Doll, and his protégé, Sir Richard Peto, revealed last week, smoking-related fatalities among British men are now less than half their level 30 years ago, while those among women have also dropped significantly, some of the best recent reductions in the world.

And that is not all. Doll's influence on British life goes far further than merely leading to the instigation of smoking bans and general antagonism to cigarettes. It touches on a now general suspicion of all potential environmental insults, from mobile phone microwaves to MMR vaccines. Gone are the days when British people unquestioningly took what was dished out to them - the ever-rebellious Doll, drinker and ex-smoker, has seen to that.

Yet his background was anything but radical. William Richard Shaboe Doll was born into comfortable, middle-class affluence (his father was a GP, his mother - Kathleen Shaboe - a gifted concert pianist), and was educated at Westminster before taking a place at St Thomas's Medical School in London. For all the conformity of his background, his leanings were clearly to the Left, however. He joined the Inter-Hospital Socialist Society; campaigned against poverty and fascism; spent his twenty-first birthday money on a trip to the Soviet Union; and took part in the Jarrow March, the 1936 mass protest against unemployment. As he recalled on Desert Island Discs: 'Capitalist society was just not working.'

During World War II, Doll served at Dunkirk, and then worked on a hospital ship in the Mediterranean. He returned to St Thomas's in 1945 but objected to the sycophancy he was expected to display to senior staff. So he turned from clinical practice to research, and chose epidemiology, the study of disease distribution - a marriage of medicine and mathematics that was perfectly suited to his talents.

It was propitious timing. Doctors had been noting with increasing alarm the rising numbers of lung cancer cases in their wards. The Medical Research Council (MRC) decided to launch a study of possible environmental causes, and asked Doll to join a team led by Austin Bradford Hill. At the time, few suspected a link with smoking. Most blamed atmospheric pollution - in the form of coal smoke - while Doll put his money on the car, or more particularly tar, which was known to contain several carcinogens.

Thousands of patients who had been newly diagnosed with lung cancer were interviewed, but at first no common denominator could be found. Then Doll decided to follow up the fates of each of these patients. 'I found that in cases where a cancer diagnosis was wrong, the patient always turned out to be a non-smoker,' he says. 'But when the diagnosis turned out to be correct, the patient was always revealed to be a smoker.'

The team published their results in 1950, providing the world with a truth which it still has to come completely to terms with, and which was received with either derision or scornful silence. Even medical researchers were dismissive. They had already tried to trigger cancer in animals using tobacco tar but had failed, they pointed out. Only later was it shown that their experimental procedures contained serious errors.

Eventually, the Ministry of Health set up an advisory committee which concluded that Doll and Hill were indeed right, but still the Government refused to admit publicly that smoking was a killer, this time for fear of frightening the population. Given that 80 per cent of men then smoked, and that Doll and Hill were claiming that most would die prematurely unless they gave up the habit, this tardiness may seem understandable, though not necessarily forgivable.

Slowly the truth leaked out, and has become hardened fact over the decades - though even today some dispute the connection, and continue to promote and extol smoking's virtues. Doll remains contemptuous. 'Promoting cigarettes is as immoral as keeping a brothel,' he says, although he is sympathetic to those who take up the habit.

Smoking is not a life sentence, he argues. So keep your cool when your daughter or son starts puffing. People who begin in their teens, but give up after 15 years or so, are at only a marginally higher risk of developing lung cancer than those who never smoked. And at the age of 89, Doll - who took up cigarettes when 18 and continued until he was 37 (in the process, failing to collect his father's promise of a £50 reward if he quit before the age of 21) - is living proof of the accuracy of his own research.

Having established an irrefutable link between cancer and smoking, Doll turned his attention to the other ills and boons of the twentieth century, showing that there was absolutely no safe dose of radiation (contrary to popular scientific thinking); that an aspirin a day provided critical protection against heart disease; and that the risks of blood clots posed by oral contraceptives are outweighed by their benefits in protecting against cancer (again against the medical orthodoxy). In 1969, he was appointed Regius Professor of Medicine at Oxford and knighted.

Richard Doll retired, theoretically, a couple of decades ago, but continues to display a voracious appetite for research. He now has more than 400 works and more than 20 major scientific awards to his name, the last - the King Olaf V award for outstanding work on cancer - being given last week in Norway. He still works every day at Oxford's cancer studies unit, his only concession to age being his 10am start - so he can have breakfast in bed.

'He was a true medical pioneer,' says George Radda, the MRC's current chief. 'Thanks to him, Britain now leads the world in the field of epidemiology.' Certainly, this is a man who has done more than any other to expose the deadly complexities of modern life. Yet Richard Doll remains cheerfully simplistic in his attitude to existence. Success is easy, he maintains. The key is a happy marriage - Doll has a son and a daughter, but lost his wife of 52 years, Joan, last year - to not get fat, to avoid smoking (naturally) and to make sure you have a couple of drinks on a regular basis. Of course, given what the latter did for his career, this last piece of advice may not be all that surprising.

· Additional research by Hannah Richards

Born: 28 October 1912 (Hampton)

Family: Married to Joan (deceased), one son and one daughter

Job: Now retired, but was the country's leading epidemiologist and the pioneer (with Richard Peto) in research linking lung cancer to smoking

Likes: Food, conversation, breakfast in bed, an occasional drink

The following correction was printed in the Observer's For The Record column, Sunday July 14 2002

The above piece said that the young Richard Doll succumbed at Trinity College, Cambridge to some home brew which 'weighed in at an awesome 8 per cent proof'. Proof spirit is defined as containing 49.2 per cent by mass (= weight) alcohol (ethanol), so Trinity's beer would have contained just under 4 per cent alcohol - rather weaker than beers today. We meant 8 per cent alcohol.

 

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