This interview is with Professor Richard Doll, for CANCERactive and was originally published in icon Issue 1 2005
Interview by Melanie Hart
The Top Cancer Epidemiologist of his Time
It is the end of an era in cancer epidemiology. The man who has spent the last 56 years studying disease distribution - and made headlines around the world, with Professor Austin Bradford Hill, for being the first to prove that smoking is the main cause of lung cancer - is about to leave his office at the Radcliffe Infirmary for the last time.
Although Professor Sir Richard Doll was guest of honour at the topping out ceremony of the Richard Doll Building for Trials and Epidemiology, when his colleagues, Valerie move into their new home, in the spring, the 92-year-old will not be joining them.
After a couple of previous retirements, in 1979 and 1983, which only resulted in him reducing his hours, Professor Doll has finally decided that it is time to stop working. But as he arranges to book a room in London in preparation for his next talk, and excitedly reveals his involvement in a new report on the effects of radon, due out in March, you sense that it´s only the practicalities of getting to the new building that are forcing this amazing man to call a halt.
"I´ve never retired because the sort of work I´ve been doing is so interesting, and I haven´t found anything more interesting to do," he confesses. "I´ve been very fortunate that Professor Peto has made facilities for me here," he says, gesturing around the small office crammed with filing cabinets variously labelled "Cigarette smoking", "Radiation", "Phone masts".
"I had to give up driving two years ago (when he was 90) because my eyesight wasn´t good enough, so I shan´t go to the new building very often because it´s about two miles away."
Professor Doll has always been a man of routine, but he started adapting to a different way of life three years ago, when his beloved wife, Lady Joan, died. Before then one or other of the couple habitually got up at 7.30am and then went back to bed with cups of tea and bowls of stewed fruit or bananas and yoghurt for both of them. "We did that all our lives before starting the day," he recalls with affection. "But now I´ve moved to a smaller house and I come down in to have breakfast. Luckily I don´t have to cook much, because I am invited to eat with friends about three or four nights a week."
The professor is rightly very serious about his work, which has won him more than 25 major awards - including Gold Medals from both the British Medical Association and The Royal Society: the Ettore Majorana Erice "Science for Peace" prize in 1990, and last June he became the first recipient of the Shaw Prize for his contribution to modern cancer epidemiology - but he also loves to have fun.
"People can get too serious about their health. I like a regular drink. It doesn´t matter what it is," he adds chuckling, "The equivalent of one or two units of alcohol a day is definitely beneficial in old age. It´s a myth that it has to be red wine. It´s the ethanol (C2H5O) that´s good and you get the same effects with wine, beer or whisky."
If people remember me at all, I hope it will be as someone always concerned about how to improve health - whilst enjoying life to the full
Alcohol changed the course of Professor Doll´s life. Friends in Cambridge introduced him to Trinity College´s home brew the night before he was due to sit his open scholarship in mathematics, which he duly flunked. "It ruined my chances of being a mathematical scholar, so I did what my father wanted. I stayed in London to do medicine instead - which turned out to be a very good thing," he says.
Following the family tradition, Professor Doll´s son, Nicholas, is a GP (his daughter, Catherine, is a social worker). Like his dad, Nicholas also embarrassed his family but this time he was sent home from boarding school after being caught countless times for...yes, you guessed it, smoking.
Smoking and Lung Cancer
"That was in the early 1970s," recalls Doll, "and was embarassing considering all the work I´d been doing on the dangers of smoking, but Nicholas gave up a year later. Apparently he´d promised himself that when he passed a certain examination he´d give up and he did on the spot: whereas my daughter went on smoking until she was about 30."
This professor wasn´t surprised that his children seemed to ignore his findings, because years earlier, in 1950, when he and Bradford Hill were the first to draw a firm conclusion that cigarette smoking is an important cause of lung cancer no one believed them. "Even the cancer advisory committee to the Dept of Health advised the DoH not to do anything about it. They didn´t think it was true causation, which was frustrating as we had evidence to the contrary."
Bradford Hill and Doll had interviewed more than 1,000 patients, admitted to hospital on suspicion of having lung cancer, in 1949. "One of my jobs was to go back to the hospitals, a month or so after the patient had been discharged, to look at the records to see if they had lung cancer after all. I found that if the interviewee had said they were a non-smoker, the suspicion they had lung cancer turned out to be wrong nearly always; whereas if they were a heavy smoker it was very seldom wrong. We found there was a 15-fold risk of lung cancer if you smoked, and that the risk got greater the more you smoked. It made biological sense and I stopped smoking immediately.
"We then looked around at what we called the ecological evidence. Did it make sense in the world? We found places where people smoked a lot and, yes, they had a lot of lung cancer there, whereas in communities where they didn´t there was very little lung cancer. Also we looked at the distribution of smokers. Men smoked more than women and they had more lung cancer. The ecological evidence made sense and the combination of the two sorts of evidence enabled us to reach our conclusions."
Smoking for 30 years has about 16 times more harmful effects than smoking for 15 years
When no one believed them they designed their cohort study. The follow-up study of British doctors that was supposed to last five years, celebrated it´s 53rd anniversary last November and is still being continued by Doll´s protg, Professor Sir Richard Peto. Bradford Hill and Doll decided to ask a lot of people how much they smoked, to see if they could predict what their risks of getting lung cancer would be. "We chose British doctors because we thought they would be very easy to follow, as they have to keep their name on a register in order to be able to prescribe drugs." Some 40,000 doctors agreed to answer a short questionnaire, and within two and a half years the pair had enough evidence to show an association between smoking and lung cancer and scientists started to take notice. At the end of the five years everyone concerned in the cancer research field accepted it.
"The Government was not particularly keen on accepting it, though," Professor Doll recalls with a laugh. "The DoH asked the Medical Research Council for a formal opinion and it was only in 1957, when the MRC said that cigarette smoking was the cause of the great rise in lung cancer, that the Government held a press conference where the Minister of Health was smoking a cigarette as he announced that the Government accepted the report!"
Professor Doll likes to present the facts and leave the campaigning to others, but he is pleased that his initial conclusions have led to the "Smoking Kills" warnings on cigarettes, and the proposed ban on smoking in cafes, restaurants and most pubs from 2006. In 2002 tobacco was linked to five other cancer sites not previously shown to be associated with smoking - stomach, liver, uterine cervix, kidney (renal cell carcinoma) and myeloid leukaemia - in addition to the eight that had been previously recognised
Statistics have always been his first love, so he is continuously fascinated by the long study´s findings. "We have been able to look at 70 year olds in five different decades," he enthuses. "If you took the 70-year-old non-smokers in the 1950s, they had an 11 per cent chance of living to be 90. In the ´90s that went up to 32 per cent. That showed the benefits of modern treatment and care to have been enormous medical advances. But the cigarette smoker hadn´t gained any of that advantage. Eight per cent of 70-year-olds survived until 90 in the ´50s and actually seven per cent in the ´90s. Even though they´ve had the benefits of better medical care, the reason why it didn´t go up for the smokers is because a 70-year-old in the 1950s had probably started smoking at a time when many people smoked cigars and pipes so he wasn´t a consistent cigarette smoker."
Importantly, the study has shown the benefits of giving up at different ages because it included doctors aged between 21 and 98 at the beginning. "If you have children who have started smoking, don´t panic because they probably won´t be smoking as an adult, and 10 years really doesn´t do very much harm. But it does build up the longer you smoke," he explains. "Smoking for 30 years has more than twice the effect of 15 years. It´s about 16 times the harmful effect."
But what about the damage to, say, a girl´s developing body? "It doesn´t so much matter when you start smoking as how long you do it, but I don´t have a clear answer to the question about developing bodies," he admits.
How Dangerous is Living Near Phone Masts?
Hardly anyone could dispute Professor Doll´s findings on smoking, but there is quite a bit of confusion surrounding the conflicting studies on living near power lines and phone masts. He used to chair a committee for the National Radiological Protection Board looking at non-ionising radiation from 1990 until 2003.
"During that period we took a special interest in the effects of the passage of electricity. We carried out a large study in this country on children´s exposures to electro-magnetic fields from pylons and cables and the position, as far as I see it, is that there is no clear evidence of harm to the individual. Biologically, there is no evidence that it can do any sort of damage to tissue that one would expect might lead to cancer, so it´s not plausible biologically," he explains .
"I, certainly, and the committee, took the view that you couldn´t at this stage lay down the law to make a positive statement that they do no harm, because it´s very difficult to prove a negative and there isn´t enough evidence as yet to enable you to say that with confidence, but I can say that is is implausible and that what evidence has been cited up to now is not impressive. We later became interested in mobile phones and phone masts. Our committee reviewed all the evidence in very great detail and again there´s no epidemiological evidence to indicate any harm from masts or mobile phones."
There is no clear evidence of harm to the individual
But what about the Swedish study, amongst 2,900 people using analogue phones, that concluded that people who hold their phones to their head more than double their risk of a tumour? "There have been two Swedish studies, one relating to the use of analogue phones to brain tumours, which is scientifically of dubious validity, and another relating mobile phones to the development of a tumour on the acoustic nerve within the head. The latter is excellent, but based on very small numbers and its findings are negated by another excellent similar study in Denmark. At present we must wait for an answer. The incidence of brain tumours in young people has not gone up," Doll continues. "It has gone up in old people, and has done for the last 30 years, because old people are investigated in much more detail now when they have a stroke.
"Dr Roger Coghill has also warned about phones." So would the professor urge caution in the meantime? "No I wouldn´t. And I wouldn´t be worried if phone masts were all around, but I can´t take the responsibility at the moment on the evidence to say they have no effect. We´ve got to do more research. If people are worried then they don´t need to use mobile phones."
If he´s not convinced about the Swedish research, what about the Valladolid victory, where the Spanish village secured a court order for the removal of 36 mobile phone transmitters from a building 50 metres from their primary school? Three children aged five to 10 developed leukaemia, and a fourth had Hodgkin´s Disease in the 18 months since the masts went up. Before then there hadn´t been a single childhood cancer in the village for 32 years.
Professor Doll sighs. "This does create difficulties in people´s minds," he admits. "There will inevitably be clusters that occur. What you have to show is that the clusters occur more often than would be expected. For example you take a group of telephone masts and see whether in general there is more leukaemia around them and, certainly, up to the time that I gave up studying this, which was March 2003, there was no evidence. When you start from the basis of a group of masts and then see whether there´s any cluster of cases, the answer is always no. But if you look for clusters of leukaemia you´ll eventually find one which occurs around anything.
My view is that there´s nothing that can cause cancer from the masts. I cannot say certainly that there is no hazard, but that´s my guess."
What you have to show is that the clusters occur more often than would be expected
It´s the same reaction to pesticides used on our food, "absolutely trivial. Some pesticides are of hazard to the sprayer, but the amount that goes through to the market place by the time you buy them is trivial", and the whole mercury in fish debate "We don´t enough portions of fish a week to be poisoned. The benefits of fish oils far outweigh any dangers and I eat a lot of fish because it´s protective of the heart." But there is one danger that Professor Doll says is easy to remove and that is radon - a naturally occurring radiation in people´s homes.
He used to chair the European Collaboration Group on the Effects of Radon, which has been researching the subject for more than 14 years and has already produced a report. One of Doll´s colleagues, Professor Sarah Darby, has been working with him in the last few years pooling all the data from everyone, in Europe, who has studied the effect of radon in Europe. This has been done now and Professor Doll says there is now enough dada to give an absolutely clear idea of what the effect is. The findings will be published in the next month or so (March or April).
"Radon has quite a substantial effect and it´s worth knowing what the radon content of your house is because you can reduce it," Doll explains. "I´d like to see building regulations introduced that would prevent any radon entering a house in the first place. All it requires is a sheet of plastic in the foundations to stop the radon coming into the house from the ground.
"You can have your house checked free in certain parts of the country, where the levels are likely to be high (mostly in Devon and Cornwall but there are other areas scattered around including Banbury). If you have a house which is shown to have very high levels of radon you can reduce it by putting an electric fan in underneath in the basement and evacuating the air from under the floor. You can have a pump that will do that continuously.
"It´s only about 1/500th of the importance of tobacco in causing cancer. For one thing it only affects lung cancer, but it may contribute about one-to-two per cent of all lung cancers. It causes a risk which can be easily eliminated, at very little expense, and I hope that when the report is published action groups will take this up."
This will guarantee Professor Doll´s name being in the headlines again, but no matter how varied his latest work he will always be associated with his findings on smoking. "If people remember me at all, I hope it will be as someone who is concerned about how to improve health whilst enjoying yourself," he says modestly. "The second part is as important as the first. Smoking is silly, because there´s such a big effect, and too much alcohol can cause a lot of trouble, but if I was starting out today I would want to study diet. There is still such a mystery about it. We know so little apart from the fact that eating to the extent that you become obese is extremely bad. But sitting in front of the television, for hours a day, and not getting any exercise is one of the causes of that." No one could ever accuse Professor Doll of not being active. He walks everywhere and as he says goodbye, after showing icon around the Harkness Building and the beautiful Green College Observatory ( he was the first warden of Green College), you can sense his pride in years of association with his historic surroundings.
When his last day comes in spring Professor Doll will shut his office and walk down to the garden, behind the Observatory, and out through a wrought iron gate in the wall to his little cottage. He will always remain involved with Green College, and once a week will be found there happily dining opposite two portraits of himself and Lady Joan, side by side in the dining room - just as they loved to start every day together with breakfast in bed.
Professor Sir Richard Doll
October 28 1912 - Richard Doll was born in Hampton
1937 - He qualified in medicine at St Thomas´s Hospital Medical School
1939-45 - Served in France, North Africa and the Med with the Royal Army Medical Corps, before returning to St Thomas´s
1946 - Awarded his doctorate in medicine (MD)
1948 - Decided to turn from clinical practice to research when he was invited to join Professor Austin Bradford Hill in investigating lung cancer
1950 - They both published their famous paper saying that smoking causes lung cancer. No one believed them, so they started a five-year study which turned into a 50-year study
1956 - Doll was awarded an OBE
1957 - The Medical Research Council agreed with Hill and Doll´s report that cigarette smoking was the cause of the great rise in lung cancer. Doll was also awarded the Fellowship of the Royal College of Physicians and a higher doctorate (DSc) by the University of London in 1958.
1961-1969 - Appointed Director of the Medical Research Council (MRC) Statistical Research Unit
1969 - Became Regius Professor of Medicine at Oxford University
1979 - Retired, but became the founding warden of Green College, Oxford
1983 - Retired again, but became an honorary consultant with the Imperial Cancer Research Fund (ICRF) based at the Radcliffe Infirmary, Oxford
1990s - Given numerous prestigious awards from around the world
June 2000 - Celebrated the 50th anniversary of his smoking causes cancer finding
Spring 2005 - Professor Sir Richard Doll will finally retire
We would like to express our condolences to Professor Sir Richard Doll´s family and friends. Sadly, this most eminent Professor passed away on Sunday 24th July, 2005.