ANTISMOKING CRUSADER SIR RICHARD DOLL

1. ANTISMOKING CRUSADER SIR RICHARD DOLL AUTHOR Dr. A. K. AVASARALA MBBS, M.D. PROFESSOR & HEAD DEPT OF COMMUNITY MEDICINE & EPIDEMIOLOGY PRATHIMA INSTITUTE OF MEDICAL SCIENCES, KARIMNAGAR, A.P.. INDIA: +91505417 avasarala@yahoo.com .

2. SIR RICHARD DOLL (October 28, 1912. TO July 24, 2005) • Epidemiologist • Activist • Researcher • Public health • lobbyist

3. SIR RICHARD DOLL • 1912:Born in Hampton, England, on 28 October • 1937: Graduated from St Thomas's Hospital Medical School in London • 1939-45: Served in the Royal Army Medical Corps • 1946: Started work at the Medical Research Council • 1951: Co-authored a paper suggesting smoking causes lung cancer • 1954: Co-authored a paper confirming the link between smoking and lung cancer • 1956: Awarded an OBE

4. GLOBAL RECOGNITION • 1962: UN award for cancer research • 1974: New York Academy of Science Presidential Award • 1981: Bruce Medal, American College of Physicians • 1983: Gold Medal, British Medical Association • 1986: Royal Medal from the Royal Society • 2000: Gold Medal from the European Cancer Society • 2002: Norway's King Olaf V award for outstanding work on cancer • BBC NEWSTUESDAY, 22 June, 2004

5. WHAT ELSE CAN ANYBODY ACHIEVE • Every human being wishes to become somebody but not a nobody. • Sir Doll fulfilled his earthly mission by his yeomen service to the people of the world through his breakthrough research on ill effects of smoking. • He did not stop there , he fought for that cause selflessly in courts.

6. HIS MIND • Relatively speaking, I was always more interested in prevention than in therapy. • DURING BBC INTERVIEW

7. FAMILY BACKGROUND • Richard Shaboe Doll was born in 1912 in Hampton, the son of Henry Doll and William Amy Shaboe, into a background of some affluence, despite his father’s having had to abandon medical practice because of multiple sclerosis. • Richard Doll married, in 1949, Joan Mary Faulkner, also a doctor, who died in 2001;

8. EDUCATION • He first went to Westminster and lost his chance to go the Trinity College, Cambridge, after bungling his mathematics scholarship exam, and instead went to St Thomas's Hospital Medical School. • Doll was educated at Westminster School and St Thomas’s Hospital, from which he graduated in 1937.

9. BEGINNING OF HIS CAREER • The war closely followed his membership of the Royal College of Physicians, and his service in the RAMC was spent largely as a medical specialist on a hospital ship in the Mediterranean, until he was found to have tuberculosis. • After the war, Doll returned briefly to St Thomas’s to research asthma, only to become disillusioned.

10. TURNING POINT (PROMPT FOR RESEARCH) • His disillusionment drew him away from clinical practice and towards a career in research. • Moving to the Central Middlesex County Hospital in 1946, working in the emerging field of epidemiology, he sought to find the causes of a disease combining his knowledge of statistics with his knowledge of Medicine.

11. RESEARCH CAREER • He joined Dr Francis Avery-Jones’s unit at the Central Middlesex Hospital with an attachment to Sir Austen Bradford-Hill’s statistical research unit of the Medical Research Council.

12. MAJOR ACHIEVEMENT • SMOKING & LUNG CANCER RESEARCH

13. HIS GROUNDBREAKING RESEARCH 1950 • His 1950 study, which he wrote with Austin Bradford Hill, showed THAT SMOKING WAS "A CAUSE, AND A MAJOR CAUSE" OF LUNG CANCER.

14. LUNG CANCER WORK • After surveying lung cancer patients in 20 London hospitals finding that smoking was the only thing common to them, implicated smoking as the overwhelming cause of lung cancer.

15. FIRST FAMOUS REPORT 1950 • Sir Richard Doll authored his famous report in 1950 that claimed "the risk of developing the disease increases in proportion to the amount smoked" and concluded that “it may be 50 times as great among those who smoke 25 or more cigarettes a day as among non-smokers".

16. FAMOUS REPORT 1950( contd) • The report was published in the British Medical Journal in 1950, and helped bring awareness to what many scientists today are still trying to prove. • The report concluded ,"The risk of developing the disease increases in proportion to the amount smoked. It may be 50-times as great among those who smoke 25 or more cigarettes a day as among non-smokers." • They concluded that it was rare for a non-smoker to suffer from the disease.

17. BRITISH DOCTORS STUDY(1954) • In 1954 a follow-up study showed prospective mortality in a sample of 40,000 doctors, followed over 20 years.

18. FINAL FOLLOW-UP REPORT • It concluded that men born between 1900 and 1930, who smoked only cigarettes and continued smoking throughout their lives, died on average about 10 years younger than lifelong non-smokers. • Those who gave up at 60, 50, 40 or 30 improved their life expectancy by, respectively, about three, six, nine or 10 years

20. HIS LATER PRONOUNCEMENTS • 1981 --Incidence of cancer of the lung by late middle age is more than 10 times greater in regular big smokers than in lifelong non-smokers". • 1983--Two years later, as director of the Imperial Cancer Research Fund Epidemiology Unit at Oxford, Doll reported that smoking cigarettes was responsible for 30 per cent of deaths from cancer of all kinds;

21. HIS QUOTE ON SMOKING EFFECTS • In 1991 he said: "Young people say smoking cannot be all that bad or the Government would never allow it to be promoted in the way it does… • I accept that millions of pounds are at stake, but no price can be put on the misery and suffering of smokers who die of cancer and of their families and friends who are forced to watch one of the most painful ways of dying."

22. IMPACT OF DOLL’S STUDY • Change in the public’s attitude to smoking was slow coming. • Although cigarette commercials were banned from British television in 1965 and from radio in 1971, billboards and newspapers were permitted to carry advertising until February 2003.

23. PUBLIC HEALTH IMPACT OF HIS STUDY • In 1954, some 80 percent of British adults smoked. • Half a century later, that figure was down to 26 percent, largely because of the fear of cancer and other smoking-related diseases. • Hats off to Sir RICHARD DOLL

24. PASSIVE SMOKING &LUNG CANCER • In 1986 Doll supported the findings of research which suggested that lung cancer could also be caused by "passive" smoking, • During the 1990s he was prominent in the campaign to persuade the Government to ban tobacco advertising.

25. CONGRESS ASSENT • It was only in 1981 finally that the Congress accepted that "incidence of cancer of the lung by late middle age is more than 10 times greater in regular big smokers than in lifelong non-smokers".

26. CONTINUOUS CRUSADING • Doll, who later became director of the Imperial Cancer Research Fund Epidemiology Unit at Oxford, reported that cigarette smoking was responsible for 30 per cent of deaths from cancer of all kinds. • In 1986 he further extended his theories to "passive" smoking, and campaigned in the 1990s to persuade the Government to ban tobacco advertising.

27. COMMITTED PUBLIC HEALTH CRUSADER • Always one to be involved with the public concern of health, Doll's pronouncements often made the headlines. • He appeared in court cases against companies that were accused of public health offences and in lobbies against government policies that permitted companies to get away with health damaging products.

28. OTHER WORKS

29. OTHER WORKS • Alcohol increases risk for breast cancer • Oral contraception • Peptic ulcers and electrical power lines • Aspirin protection against heart disease • studying the early epidemiology of AIDS, even calling for the introduction of widespread confidential testing

30. PEPTIC ULCER WORK • WORK AT AVERY JONES UNIT& HILL’S STATITISTICAL RESEARCH UNIT OF MRC PRESENTED PAPERS ON • DUODENAL ULCER :- Stress & strain not risk factors for duodenal ulcer formation • CLINICAL TRIALS FOR THE TREATMENT OF GASTRIC ULCER :- showing the value of bed rest only in the healing of gastric ulcer but not diet, alkali, anticholinergic drugs and admission to hospital

31. CONTRACEPTIVE PILL. • From the 1950s onwards Doll published a steady stream of reports into both the causes of disease and the side-effects of new medicines. • In 1968 he published a study on the side-effects of the contraceptive pill. • This suggested that women taking the Pill faced a nine to 10 times increased chance of developing a blood clot in their legs, but dismissed suggestions by some American researchers that the Pill caused a cancer-like change in the cells of women.

32. CTSU ,OXFORD • RESEARCH INTO CARCINOGENS. • At CLINICAL TRIAL SERVICE UNIT (CTSU) of oxford university ,Doll and Richard Peto conducted research • And concluded that environmental pollution might amount to only 2 per cent of cancers worldwide — blaming tobacco, diet and infections for 75 per cent of them.

33. DOLL&PETO

34. DIET & CANCERS • He also suggested that the carcinogenic effects of smoking could be affected by diet; • Smokers who consumed above average levels of beta carotene - a vitamin present in carrots - could lower their risk of lung cancer by an estimated 40 per cent.

35. ALCOHOL & CANCERS • Alcohol, on the other hand, was implicated as a cause of cancer in upper respiratory and digestive tracts; • The adverse effect was far greater in smokers because tobacco opened the way for alcohol to attack. • He suggested that cancer deaths could be cut by 35 per cent by smokers regulating their food and drink intake.

36. HARMFUL EFFECTS OF NUCLEAR RADIATION. • The harmful effects of nuclear radiation. • The worldwide nuclear test ban treaty stemmed partly from this work

37. TEACHER’S ROLE • Alongside his work at the Medical Research Council, Doll continued to teach. • For 20 years until 1969 he was an associate physician at the Central Middlesex Hospital. • He was a lecturer at the London School of Hygiene and Tropical Medicine for six years until 1962.

38. GREEN COLLEGE AT OXFORD • Regius Professor of Medicine in 1969 and established single faculty medical college , Green college. • Doll enhanced Oxford’s reputation for teaching and research • When Doll retired from Green College in 1983 he left a flourishing foundation and a happy society whose increasing reputation owes much to the guidance of its first warden and his wife, Dr Joan Faulkner.

39. HONOURS • He was named an Officer of the Order of the British Empire in 1956, • Was knighted in 1971 and • In 1996 was made a Companion of Honor - a select group limited to 65 persons at any one time - for services of national importance.

40. AWARDS • Awarded Saudi Arabia’s King Faisal International Prize for medicine for their continuing work on smoking-related diseases. • “Doll also held honorary degrees from 13 universities.

41. THE SAD DEMISE MONDAY, JULY 25, 2005 09:45:05 AM • LONDON: Sir Richard Doll, the British scientist who first established a link between smoking and lung cancer, died today at age 92, Oxford University said. • The epidemiologist, whose research was credited with preventing millions of premature deaths, died at the John Radcliffe Hospital in Oxford after a short illness, according to the university, where Doll worked at its Imperial Cancer Research Center. The exact cause of death was not immediately released.

42. May His soul rest in everlasting and eternal peace. • How does one mourn the passing of a giant? • A legendary researcher and teacher who inspired all the doctors who read his work, even those who never heard or saw or met him?An irreparable loss to Medicine, to Science, to Humanity and verily, to this Earth.