Soon after the second world war ended, British scientists began worrying about a mystery epidemic. Lung cancer, previously a rare disease, was turning into a mass killer. “In the 1920s, it became more common,” recalled the British epidemiologist Richard Doll in his patrician tones decades later, “and it became commoner and commoner. Clearly something had happened.”
But nobody knew what. Which new factor was driving lung cancer? Some blamed exhaust fumes from motor cars. Doll suspected the tarring of roads. However, when he began comparing patients with lung cancer to those without, he had a eureka moment. Checking diagnoses after patients left hospital, he noticed that “if someone had been described as a non-smoker, the diagnosis always turned out to be wrong”. In 1950, he and his mentor Austin Bradford Hill published a paper proving the link between smoking and lung cancer. Later they discovered that smoking causes many other diseases besides. Doll, born 100 years ago this Sunday, saved more lives than probably anyone else in 20th-century medicine. And, in part, it’s because he was a communist.
Doll grew up in London’s Knightsbridge in “a magnificent 18th-century house”, writes his magnificent biographer Conrad Keating. He attended Westminster School, smoked cigarettes, loved maths, but became a doctor. He also joined the Communist party and, in 1936, accompanied the Jarrow March against unemployment. One evening he saw a marcher take the ham from a ham sandwich and put it in an envelope, to send home to his meatless family. That made an impression.
Doll was part of the momentous 1940s shift to the left within British medicine. A new generation of researchers decided that simply curing rich people wasn’t enough. Medicine had to care for everyone, and to understand the social conditions that caused disease. Virginia Berridge, historian at the London School of Hygiene & Tropical Medicine, cites “the one-nation citizenship idea carried through from the war”. Leftwing doctors helped create Britain’s free National Health Service in 1948.
Just then, British medicine was also experiencing a golden age. During the war, Oxford scientists had begun producing penicillin. Afterwards Doll nailed smoking; Jerry Morris showed that exercise could prevent heart disease; and, in 1953, Francis Crick and James Watson discovered DNA.
Statistics, previously rather scorned by doctors, had driven Doll’s and Morris’s discoveries. Morris’s eureka moment came when he spotted in the data that London’s mostly sedentary bus drivers had more heart attacks than the active bus conductors. Doll recorded endless numbers in fountain pen.
A few earlier studies had suggested links between smoking and lung cancer – including a Nazi-financed paper published in Germany in 1943 – but Doll was the first to prove the connection. However, he was too rigorous a scientist to claim at once that smoking caused lung cancer. His 1950 study merely noted the correlation. Nonetheless, he stopped smoking, and bribed his wife to stop. Jerry Morris read Doll’s findings, and quit too. “Long before they claimed it was clear, it was quite clear to me that this was evil stuff,” Morris told me months before his death aged 99.
But few others took the study seriously. “Its publication … was greeted with … apathy, disbelief and scientific condemnation,” writes Keating. Doll’s work irritated the British government, which got 14 per cent of its tax revenues from tobacco. And many people simply couldn’t believe that so ordinary a habit could be deadly.
Gradually, though, further studies by Doll and Hill settled the question: smoking kills. “It must be regarded as established that there is a relationship between smoking and cancer of the lung,” the health minister Iain Macleod told a press conference in 1954 – while he and most of the journalists present chain-smoked. Eventually, even Geoffrey Todd, the tobacco industry’s statistician, concluded that Doll and Hill were right. Todd told his employers, and they sacked him, but reinstated him six weeks later, writes Keating. Doll had won the argument.
And he kept winning it. Just as exercise turned out to protect against far more than only heart disease, smoking turns out to cause many more diseases than just lung cancer. Half of all smokers died from their habit. The expanding discoveries by Doll, Morris and others helped trigger the west’s “cardiovascular revolution”: in developed countries, mortality rates from cardiovascular diseases have fallen by more than half since 1960.
Epidemiologists didn’t merely cause the rise in human longevity: they also epitomised it. Bradford Hill lived to 93, and Doll was still working late nights aged 92. His ambition, he once said, was “to be a valuable member of society”. That he was. He died in 2005, largely unknown outside his field, having surely contributed more to human happiness than any other communist. Given the decline of smoking in western countries, he must have saved millions of lives. Even so, cigarettes killed about 100 million people last century. This century, says Keating, given the worldwide spread of smoking, they could kill nearer one billion.