Smoking Kills

Conrad Keating

Description

At the end of the Second World War, Britain had the highest incidence of lung cancer in the world. For the first time lung cancer deaths exceeded those from tuberculosis - and no one knew why. On 30 September 1950, a young physician named Richard Doll concluded in a research paper that smoking cigarettes was 'a cause and an important cause' of the rapidly increasing epidemic of lung cancer. His historic and contentious finding marked the beginning of a life-long crusade against premature death and the forces of 'Big Tobacco'. Born in 1912, Doll, a natural patrician, jettisoned his Establishment background and joined the Communist Party as a reaction to the 'anarchy and waste' of capitalism in the 1930s. He treated the blistered feet of the Jarrow Marchers, served as a medical officer at the retreat to Dunkirk, and became a true hero of the NHS. A political revolutionary and an epidemiologist with a Darwinian heart-of-stone, Doll fulfilled his early ambition to be 'a valuable member of society'. Doll steered a course through a minefield of medical and political controversy. Opponents from the tobacco industry questioned his science, while later critics from the environmental lobby attacked his alleged connections to the chemical industry. An enigmatic individual, Doll was feared and respected throughout a long and wide-ranging scientific career which ended only with his death in 2005. In this authorised and groundbreaking biography, Conrad Keating reveals a man whose life and work encapsulates much of the twentieth century. Described by the British Medical Journal as 'perhaps Britain s most eminent doctor', Doll ushered in a new era in medicine: the intellectual ascendancy of medical statistics. According to the Nobel laureate Sir Paul Nurse, his work, which may have prevented tens of millions of deaths, 'transcends the boundaries of professional medicine into the global community of mankind.''A well-crafted biography of Doll, [who] single-handedly saved millions of lives with his findings.' - New Scientist'As this fascinating and fair-minded biography makes clear, while Doll's political instincts were radical, he was nevertheless a conservative scientist, always cautious in causal inference. . . Impressive and engaging.' - International Journal of Epidemiology

Sujets

• Médecine
• History of medicine

Informations

• Publié par: Andrews UK
• Date de parution: 05 juillet 2016
• Nombre de lectures: 0
• EAN13: 9781909930407
• Langue: English

Extrait

Title Page
Smoking Kills
The Revolutionary Life of Richard Doll
Conrad Keating
Signal Books
Oxford



Publisher Information
First published in 2009 by
Signal Books Limited
36 Minster Road
Oxford, OX4 1LY
www.signalbooks.co.uk
This digital edition converted and distributed by
Andrews UK Limited
www.andrewsuk.com
© Conrad Keating, 2009, 2016
The right of Conrad Keating to be identified as the author of this work has been asserted by him in accordance with the Copyright, Design and Patents Act, 1988.
All rights reserved. The whole of this work, including all text and illustrations, is protected by copyright. No parts of this work may be loaded, stored, manipulated, reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information, storage and retrieval system without prior written permission from the publisher, on behalf of the copyright owner.
Production: Devdan Sen
Cover Design: Devdan Sen
Cover Image: courtesy Nick and Cathy Doll
Photographs: courtesy Nick and Cathy Doll and Clinical Trials Service Unit, University of Oxford



Dedication
To My Parents



Preface
The first time I met Richard Doll he cried; but this was not because he had just discovered how little I knew about medicine. Rather it was an emotional response to the memory of what he had seen on the Jarrow Hunger March over sixty years before when at first hand he experienced the waste and despair of the 1930s. As a writer I thought, “He’s vulnerable, he’s emotional; a biography could provide a unique narrative window into the life and times of a great scientist.” All I needed to do was some excavating, some digging. As with anyone starting out on a biography, there was a sense of curiosity mixed with optimism.
Yet for those who knew and worked with him, Doll was far from being an open book. His heart was certainly in the right place, but it was accustomed to being subordinated to his intellect. In nearly every way Doll embodied Charles Darwin’s definition of a value-free experimenter. “A scientific man ought to have no wishes, no affections - a mere heart of stone.” He was not an enigma, but while his friends described him as “gentle and kind”, his emotional detachment and what some perceived as his “unconscious intimidation” led to him being both feared and respected. What was certainly true was that he had an unusual ability to camouflage his emotions. This made the writing of his biography a far more difficult task than I had first imagined. Every biography is partly fictional in that it is impossible to know or write a complete life, and the story is necessarily partial and selective. Even so, it must follow the documented record and the obligations to history; it cannot be made up.
I decided on the title Smoking Kills: The Revolutionary Life of Richard Doll because smoking forms the main thread of Richard Doll’s story as a scientist. One of his great intuitive skills was the ability to see patterns and he did this in an enduring way when he explained the epidemic of lung cancer. In 1950 British men had the highest lung cancer rates in the world and by 1970 almost half of all male deaths in middle age and increasing number of female deaths in middle age in Britain were being caused by smoking. Since 1970, when the media truly got behind the public health campaign, Britain has seen the greatest decline in tobacco-related deaths in the world. Doll’s careful statistical science marked the Big Bang in thinking, and today in Britain two-thirds of all smokers wished they had never started the habit. Doll changed the health of the nation and caused a revolution in medicine.
While Doll was born into a conventional bourgeois family in the 1930s, he was also a political revolutionary and he wanted the overthrow of Stanley Baldwin’s government. He remained a Marxist and communist for over a quarter of a century and his politics gave him clarity, pointing him in the direction of the greatest good for the greatest number: preventive medicine. He ushered in a new era in medicine, shaped by the intellectual ascendancy of medical statistics, a revolution built primarily on Doll’s political and ideological foundations.
Any history of modern Britain should contain something of Doll’s life. I did not want to fit him into a prescribed straitjacket, but I wanted to walk with him through the history of twentieth-century Britain. Because it was all there: his birth in the same year the Titanic was launched, his life in the aftermath of the First World War, his politics, the Jarrow March, Dunkirk, the greatest ever advance in the history of medical science, the rise of the new epidemiology, the Cold War, the Agnostic Adoption Society, the end of his communist dream - and, above all, how he exposed the true hazards of smoking. All these subjects had to be investigated if I was to get an understanding of Richard Doll the man. As so many physicians around the world say that they were inspired by Doll, I wanted to find out what inspired him to dedicate his life to the prevention of cancer.
Nothing in life is flawless, and while Doll achieved the accolade of being described by the British Medical Journal as “perhaps Britain’s most distinguished doctor”, some of his work has been criticised. His pioneering work on the dangers of asbestos, the most lethal of all industrial carcinogens, has been rewritten by the environmental lobby. His humanitarian beliefs compelled him to establish the Agnostic Adoption Society in the 1960s yet his decisions taken as chairman led him to be vilified as a racist by the New Statesman . To some he will be remembered as the most influential Regius Professor of Medicine at Oxford University ever, yet he was initially cold-shouldered by the city’s medical establishment. And even in death the forces of evil gathered in posthumous attack. Doll’s passion was work. He never retired and continued his scientific experiments into his 93 rd year. In some ways it was for Doll as it had been for Goethe: “There has been nothing but toil and care. It has been the perpetual rolling of a stone, which I have always had to raise anew.”
The last time I saw Richard Doll was the first time his exemplary good manners failed him. It was the last week of his life and he knew it. While I was reading through the mass of cards and letters from well-wishers that covered his hospital bedside locker he looked at me and said, “What are you looking for now? You’re always digging around my life.” Of course, it must be a question those who achieve world-renown often ask themselves: “Who would I trust to meddle with my immortality?” I admired Richard Doll, but I had to do the digging, I had to find the man. He would have respected me less if I had not.



Acknowledgements
During the epic journey of researching and writing this biography I interviewed 191 people: too numerous to name individually but for their generosity and kindness, I will forever be in their debt. However, there are four people without whom this book would not exist. First is Richard Doll for his full co-operation in telling the story of his life, even though he knew it would uncover some uncomfortable truths. His willingness to answer questions that revealed my ignorance of medical science, statistics and literature only rarely caused him to look at his watch or fix me with a perplexed gaze. But he gave me the strength to do what I had never done before while knowing, that he would not be alive to see the finished product - in fact insisting that this would be the case. Secondly, I thank my friend Rory Collins for introducing me to his colleague Richard Peto, Doll’s scientific protégé. Richard Peto gave my work scientific guidance and the institutional support which allowed me the opportunity to devote myself wholeheartedly to writing, liberated from any other consideration. Lastly, this book would not have been possible without the help and encouragement of my friend Richard Ramage. His incisive intellect and feel for the English language have informed me as a writer and honed any skills that I may have. Without these four individuals I would still be floundering in vast sea of papers, scribbles and uncertainty.
And how could I have prevailed without those small crumbs of encouragement that made my heart swell? As when the historian Charles Webster said to me one morning on Broad Street in Oxford: “You’re a good writer, Richard Doll’s lucky to get you.” Or when I received a phone call on a long winter afternoon from someone who remembered working with Doll on a hospital ship in the Mediterranean in 1941. What is certain is that the human intellect is more moved by affirmatives than by negatives. While writing this book I received my fair share of negatives, but it is the affirmatives that I wish to list here. I would like to thank the Wellcome Trust and the Wellcome Unit for the History of Medicine for supporting me from the beginning, and I would like to extend my appreciation to Green Templeton College for their goodwill. For much of the twenty-first century I have hibernated in libraries to such an extent that I am now addicted to their atmospheres of tranquillity and relaxed creativity. The final long stretch of writing was done in the Taylor Bodleian Slavonic and Modern Greek Library at 47 Wellington Square, where the staff were truly magnificent in their professionalism and encouragement. All books need a good editor and Polly Pattullo’s dedication to detail gave this one the cohesion that it previously lacked. Many people read the book before the final draft but the wisdom and advice of Georgina Ferry and Leo Kinlen have been invaluable. As indeed has been the institutional and financial support of Jud