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Sir Richard Doll (1912-2005), Physician, Epidemiologist, Teacher, Humanitarian, Legend, A ctivist, Researcher, Public H

Sir Richard Doll (1912-2005), Physician, Epidemiologist, Teacher, Humanitarian, Legend, A ctivist, Researcher, Public Health lobbyist . Smoking and Health. Cough. Gout. Asthma. Diseases of women. Headaches. Intestinal worms. Stomach cramps. Open wounds. Malignant tumours.

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Sir Richard Doll (1912-2005), Physician, Epidemiologist, Teacher, Humanitarian, Legend, A ctivist, Researcher, Public H

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  1. Sir Richard Doll (1912-2005), Physician, Epidemiologist, Teacher, Humanitarian, Legend, Activist, Researcher, Public Health lobbyist Smoking and Health

  2. Cough Gout Asthma Diseases of women Headaches Intestinal worms Stomach cramps Open wounds Malignant tumours CONDITIONSTREATED WITH TOBACCO16th Century

  3. SÖMMERING 1795DOCTORAL THESIS “Carcinoma of the lip is most frequent when people indulge in tobacco pipes. For the lower lip is particularly attacked by carcinoma because it is compressed between the pipe and the teeth”

  4. PERCENTAGE OF MEN ATTENDINGMASSACHUSETTS CANCER CLINICSWITH DIFFERENT CANCERS: BY SMOKING HABIT(Potter & Tulley, 1945)

  5. USE OF TOBACCO BY DISEASE CATEGORY:86 MEN WITH AND 86 MEN WITHOUT LUNG CANCER(after Müller, 1939)

  6. Author No. of men Percent of: Lung cancer Controls Non-smokers Heavy smokers Lungcancer Controls Lungcancer Controls Müller, 1939Germany 36 86 3.5 16.3 65 36 Schairer &Schöniger, 1943Germany 93 270 3.2 15.9 52 27 Wassink, 1948Holland 134 100 4.5 19.0 55 19 SMOKING AND LUNG CANCERCASE-CONTROL STUDIES BEFORE 1950

  7. Men aged(yrs) Percent smokers P* Coronary disease Others 40-9 79.7 (149/187)† 61.9 (187/302) <0.001 50-9 71.7 (274/382) 73.9 (274/371) ─ 60+ 63.8 (275/431) 61.8 (202/327) 0.28 40+ 69.8 (698/1000) 66.3 (663/1000) 0.05 *P, one-sided †Number of smokers and all men in age group in parentheses TOBACCO AND CORONARY DISEASE(English, Willius & Berkson, 1940)

  8. Men aged(yrs) Percent coronary disease in: P* Smokers Non-smokers 40-9 4.8 (10/208)† 1.0 (2/208) 0.01 50-9 6.2 (24/388) 2.6 (10/388) 0.01 60+ 5.0 (20/404) 6.4 (26/404) ─ 40+ 5.4 (54/1000) 3.8 (38/1000) 0.04 *P, one-sided †Number of men with coronary disease and all diseases in age group in parentheses TOBACCO AND CORONARY DISEASE(English, Willius & Berkson, 1940)

  9. Author No. of men Percent of: Lung cancer Controls Non-smokers Heavy smokers Lungcancer Controls Lungcancer Controls Schreck et al.USA 82 522 14.6 23.9 18 9 Levin et al.USA 236 481 15.3 21.7 ─ ─ Mills & PorterUSA 444 430 7 31 ─ ─ Wynder & GrahamUSA 605 780 1.3* 14.6* 51 19 Doll & HillUK 649 649 0.3* 4.2* 26 13 *Lifelong non-smokers, with ex-smokers carefully excluded SMOKING AND LUNG CANCERCASE-CONTROL STUDIES PUBLISHED IN 1950

  10. Age(yrs) No. ofdeaths Regular cigarette smokerssmoking (per day): Cause ofdeath Less than10 10-19 20or more 50-69 167 42 8.8 lung cancer 50-54 377 1.7 2.1 2.5 coronary heart disease 55-59 571 1.1 1.9 2.1 60-64 594 1.5 2.2 2.0 65-69 605 1.0 1.3 1.1 MORTALITY BY AMOUNT SMOKEDRELATIVE TO THAT IN NON-SMOKERS(after Hammond & Horn, 1954)

  11. BERKSON’S ALTERNATIVES “The findings were the result of the interplay of various subtle and complicated biases or had a constitutional basis, involving people who were non-smokers or relatively light smokers, being the kind who were biologically self-protective and this “correlated with robustness in meeting mortal stress from disease generally”

  12. FISHER’S OBJECTIONS (i) Smokers with lung cancer reported inhaling less than smokers without (Doll & Hill, 1950) against causation unless it was concluded that “Inhaling cigarette smoke was a practice of considerable prophylactic value in preventing the disease”

  13. FISHER’S OBJECTIONS (ii) Secular changes in smoking habits could not be related to the increase in lung cancer since “lung cancer has been increasing more rapidly in men relative to women” while “it is notorious, and conspicuous in the memory of most of us, that over the last 50 years the increase among women has been great, and that the increase among men (even if positive) certainly small”

  14. Bladder *Lung Oral (incl. lip & tongue) Cervix Myeloid leukaemia *Oro- & hypo- pharynx Kidney Nasopharynx Pancreas *Larynx Nose & nasal sinuses Stomach Liver *Oesophagus Ureter *Increased more than fivefold CANCERS CAUSED IN PART BY SMOKING(International Agency for Research on Cancer, 2004)

  15. *Pulmonary heart disease Subarachnoid haemorrhage Ischaemic heart disease Cerebral thrombosis Myocardial degeneration Cerebral haemorrhage Hypertension (fatal) *Chronic obstructive lung disease Arteriosclerosis Pneumonia *Aortic aneurysm Asthma *Peripheral vascular disease Pulmonary tuberculosis *Buerger’s disease *Increased more than five-fold VASCULAR AND RESPIRATORY DISEASECAUSED IN PART BY SMOKING

  16. Gastric ulcer Periodontitis Duodenal ulcer *Tobacco amblyopia Crohn’s disease Age-related macular degeneration Osteoporosis Cataract Reduced fecundity Facial skin wrinkling Reduced growth of fetus *Palmoplantar pustulosis *Increased more than five-fold OTHER CONDITIONSCAUSED IN PART BY SMOKING

  17. UK male doctors born 1900-1930: continuing cigarette vsnever smokers. 50-year follow-up of mortality, 1951-2001

  18. Evaluation

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