Richard Doll, the British epidemiologist whose pioneering studies of the link between smoking and lung cancer saved millions of lives by persuading smokers to quit, died Sunday at John Radcliffe Hospital in Oxford after a short illness. He was 92.
His 50-plus years of studies showed that half of all smokers were killed prematurely by their habit, losing an average of 10 years of life from cancer and other diseases induced by tobacco smoke. On the brighter side, he also demonstrated that quitting could sharply reduce the risk of premature death, even for longtime smokers.
"Sir Richard's enormous contribution to medicine ... cannot be overstated," said Dr. John Hood, vice chancellor of Oxford. His research "led to the dramatic reduction in smoking rates in Britain over the past 50 years, especially in men. This research has saved many millions of lives."
Doll also performed valuable research illuminating the side effects of oral contraceptives, the harmful effects of radiation, the benefits of aspirin in preventing heart disease and the hazards of radiation.
"He was probably the most renowned epidemiologist in the world," said Dr. Stanton Glantz of UC San Francisco, a leading anti-tobacco activist. "He was a giant."
But his name is most indelibly linked to the studies of smoking that he began shortly after World War II.
Postwar Britain was in the throes of a massive lung cancer epidemic and no one seemed to know why. Many researchers attributed it to air pollution because of the presence of known carcinogens in foul air. Others thought it might be linked to the tar used on hundreds of miles of British roads.
"My own guess was that it had something to do with motorcars," Doll said years later.
The Medical Research Council, Britain's equivalent of the National Institutes of Health, recruited medical economist Austin Bradford Hill to study the causes of the epidemic. He enlisted Doll, then a young scientist at the council.
The two devised a questionnaire about lifestyle, environmental exposures, food consumption, smoking history and other personal data that social workers administered to everyone entering London hospitals with a possible diagnosis of lung cancer.
At first, the data did not show much. But when Doll went back and checked the patients' final diagnoses, the results were startlingly clear. Virtually all of those patients whose diagnosis was changed from lung cancer to some other, less serious disease were nonsmokers. However, 647 of the 649 who ended up with a final diagnosis of cancer were smokers.
Doll and Hill prepared a report for publication in 1949, but disbelieving bureaucrats held it up, arguing that perhaps the situation was unique to London. Doll and Hill expanded their survey to more than 5,000 patients in hospitals throughout the country.
When results from those hospitals began to support their initial findings, the scientists got their report published in late 1950. But by then, Americans Ernst L. Wynder and Morton L. Levin had published similar conclusions in the Journal of the American Medical Assn., albeit on smaller study groups.
Doll, who had begun smoking at the age of 18 against his father's wishes, stopped abruptly at 37 when he saw which way the wind was blowing, calling the habit "a mug's [fool's] game."
Altogether, five papers establishing the link were published that year, but they fell largely on deaf ears. "It didn't create any impression at all, really," Doll recalled later.
Tobacco companies rejected the findings out of hand and government officials ignored them, arguing that publicizing the results would unduly scare the nearly 80% of men who smoked.
Looking for further evidence, Doll and Hill decided to focus on smokers rather than cancer patients. Doll wrote a letter to every physician in Britain, enclosing a questionnaire that covered whether, and how much, they smoked. Nearly two-thirds of the physicians, about 40,500, responded, triggering a half-century study that provided immensely valuable information.
Within 2 1/2 years, the team began to see an increase in lung cancer patients among the physicians, but not enough to force anyone to pay attention. By 1956, however, 400 of the smokers had died of lung cancer, but virtually none of the nonsmokers had died.
By 1957, the evidence was overwhelming, and the Ministry of Health called a major news conference to release the findings. Ironically, Doll noted, "the minister who announced it was smoking a cigarette at the same time."
That study "laid the foundation for the 1964 Surgeon General's report on smoking," Glantz said.
The public and the media were slow to accept the findings, but physicians were not. When Doll and Hill started their study, physicians smoked as many cigarettes as everyone else. But by 1971, the doctors smoked only 37% as many cigarettes as other men. Today, only about 26% of Britons smoke.