ANTISMOKING CRUSADER SIR RICHARD DOLL

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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_at_yahoo.com
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SIR RICHARD DOLL (October 28, 1912. TO July 24,
2005)

• Epidemiologist
• Activist
• Researcher
• Public health
• lobbyist

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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

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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

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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.

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HIS MIND

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

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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
  fathers 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

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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
  Thomass Hospital, from which he graduated in
  1937.

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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
  Thomass to research asthma, only to become
  disillusioned.

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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.

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RESEARCH CAREER

• He joined Dr Francis Avery-Joness unit at the
  Central Middlesex Hospital with an attachment to
  Sir Austen Bradford-Hills statistical research
  unit of the Medical Research Council.

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MAJOR ACHIEVEMENT

• SMOKING
• LUNG CANCER RESEARCH

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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.

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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.

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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".

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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.

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BRITISH DOCTORS STUDY(1954)

• In 1954 a follow-up study showed prospective
  mortality in a sample of 40,000 doctors, followed
  over 20 years.

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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

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(No Transcript)
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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

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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."

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IMPACT OF DOLLS STUDY

• Change in the publics 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.

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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

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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.

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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".

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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.

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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.

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OTHER WORKS
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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

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PEPTIC ULCER WORK

• WORK AT AVERY JONES UNIT HILLS 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

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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.

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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.

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DOLLPETO
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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.

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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.

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HARMFUL EFFECTS OF NUCLEAR RADIATION.

• The harmful effects of nuclear radiation.
• The worldwide nuclear test ban treaty stemmed
  partly from this work

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TEACHERS 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.

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GREEN COLLEGE AT OXFORD

• Regius Professor of Medicine in 1969 and
  established single faculty medical college ,
  Green college.
• Doll enhanced Oxfords 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.

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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.

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AWARDS

• Awarded Saudi Arabias King Faisal International
  Prize for medicine for their continuing work on
  smoking-related diseases.
• Doll also held honorary degrees from 13
  universities.

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THE SAD DEMISE MONDAY, JULY 25, 2005 094505
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.

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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.