Sir Richard Doll; the Passing of a Remarkable Scientist and the Completion of a Remarkable Study

Within a few days time of each other, I had the opportunity to first read the final report of a remarkable study commonly called the British Drs. Smoking Study,¹ and watch an interview of its primary author, Sir Richard Doll who died shortly after the interview.

The study was remarkable in many ways. First was its magnitude. Despite the fact that it started in 1951, when England was still recovering from the economic devastation of World War II, the field of epidemiology was just emerging, and 13 more years would pass until the U.S. Surgeon General’s Report on Smoking and Health, Dr. Doll was able to recruit 34,439 of the 40,000 male physicians in the United Kingdom to participate in the study. Second was its duration. The study spanned 50 years, capturing the time in the subjects’ lives when tobacco use was just starting to show an impact on mortality, and continuing through most of their deaths, when the risk of use again met the risk of no use. This is illustrated in Figure1, which approaches perfection and evokes accelerated heart beats and gasps for air among statisticians, much as Michelangelo’s David does among artists. Third was its execution, which resulted in attrition of only 8.8% over 50 years, an average of 63 people or .147% per year. Finally are the results, which tell us that smoking cigarettes reduces life span by approximately 10 years, and increases the likelihood of death by 100% at age 50, 111% at age 60, 121% at age 70, 45% at age 80, and 26% at age 90 and will be the likely cause of death for two thirds of the people who smoke. It also tells us that quitting smoking adds 10 years to a person’s life if they quit by age 30, 9 years if by age 40, 6 years if by age 50, and 3 years if by age 60.

Figure 1

Fig 3 Survival from age 35 for continuing cigarette smokers and lifelong non-smokers amoung UK male doctors born 1900-1930, with percentages alive at each decade of age

Copyright ©2004 BMJ Publishing Group Ltd.

The scientist, Sir Richard Doll, was remarkable in many ways as well. His contribution to science is indisputable and has been confirmed by countless awards. Equally important was his pioneering work in applying science to influence public policy. When he started the study at age 39, he was a smoker and dispassionate scientist who had no interest in motivating people to quit smoking and believed scientists had no place in public policy debates. After three decades of analyzing the data, and seeing the devastating impact of smoking on health, he quit in his 70s. He became an outspoken advocate of policies to make people aware of the health impact of smoking. He also proved conclusively that even a small amount of ionizing radiation posed a risk of leukemia and other illness. Sir Richard Doll died on June 22, 2004 at age 92.

References

1. Doll R, Peto R, Boreham J, Sutherland I, Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004;328:1519

Michael P. O'Donnell, PhD, MBA, MPH
Editor in Chief, American Journal of Health Promotion