Sir Richard Doll: A Questionable Pillar o f the Cancer Establishment
by Martin Walker
The Imperial Cancer Research Fund writes in its current publication, Preventin g an d Curin g Cancer :
u One of the biggest myths in recent years is that there is a cancer epidemic caused by exposure to radiation, pollution, pesticides and food additives. The truth is that these factors have very little to do with the majority
of cancers in this country. In fact, food additives may have a protective effect — particularly against stomach cancer." One would presume that the Imperial Cancer Research Fund would only dare make a statement of
this sort, which runs counter to endless serious studies on the subject, after exhaustive research over many decades on the possible carcinogenic effects of exposure to these environmental factors. However, unbelievable
as it may seem, this august institution fully admits that it has never carried out any such research! How then can it conceivably make such a statement? The answer is that it is entirely based on the pronouncements
of Sir Richard Doll, seen to be the greatest living expert on the subject, and whose every word is gospel among the members of Britain's cancer establishment. Let us look carefully at the career of Sir Richard Doll
in order to trace the origin and development of this most questionable pillar.
On October 17, 1997, the news pro grammes and the newspapers made frequent mention of new evidence from three studies supervised by Sir Richard Doll, and originally published in the British Medical Journal, which pur ported to show that 'passive smoking' caused lung cancer.1
Bradford Hill published their first epi demiological study on the high rates of lung cancer amongst GPs who smoked,4
the public are still in thrall to the idea that cigarette smoking is the single most important public health problem we face in Britain.
That same day, in London's High Court, Mrs. Justice Smith handed down her judgement in the case of John Hill, who had taken a civil action against the owners of a farm upon which he had worked. He claimed that exposure to organophosphate (OP) insecticide at work had adversely affected his health. Mrs. Justice Smith ruled that his il l health was partly at least "attributable to psychological factors". With the exception of Britain's most sub versive 6 am radio programme, Farming Foday, little publicity was given to the court hearing.23
Sir Richard Doll ; considered the greatest livin g expert on cancer.
Secondly, the judgement in the OP case demonstrates something which is difficult to understand within the context of truthful scientific research. It has been recognized for hundreds of years that agricultural and industrial chemicals, especially those of which we have had no evolutionary experience (xenobiotic chemicals), can have serious adverse effects upon humans, but, unlike the pub lic issue of cigarette-induced lung cancer, the history of both academic judgements and plaintiff actions with respect to chem icals is almost a secret history.
Curious double standards These separate sets of circumstances, occurring as they did on the same day, give voice to a number of issues relating to the way we perceive health and the environment. The first and most obvious is that thirty years after Richard Doll and
Martin J Walker M.A. , is the author o f six books. He is a writer, investigator and lecturer, who since the publication o f his" last book Dirty Medicine has been writin g mainly about the social history o f environmental health. A t the present time, he is researching organophosphate pesticides, factory farming and the history o f alternative cancer therapies i n Britain .
Research by the Medical Research Council into the use of organophospho
rous compounds predates the work of Doll and Bradford Hill on cigarette smoking.5 Initial scientific conclusions in the late 1940s and 1950s were not in the least reassuring. There are presently hundreds of OP cases waiting to come before the courts, including over 100 Gulf War syndrome cases. The great majority of complaints involving OPs have been made by farmers who were pressed, by law, between 1975 and 1993 to dip sheep and treat cattle with washes of OP as a deterrent to warble fly. Almost all the cases which have so far reached court have, like cases brought by others suffering from Multiple Chemical Sensitivities (MCS), floundered on two medical,
The Ecologist, Vol . 28, No . 2, March/Apri l 1998 SI R RICHAR D DOLL : A QUESTIONABL E PILLA R O F TH E CANCE R ESTABLISHMEN T
legal and scientific arguments. First, that it cannot be "proved" that exposure to apparently toxic chemicals can cause longterm and ongoing systemic damage to health. Secondly, that any damage caused by chemicals is relative, dependent first upon their method and duration of use, and second upon the susceptibility of the injured party. In this way the chemical company is defended and the sufferer blamed for having a weak constitution.
One question raised by these issues is why the medical research establishment and the State have allowed a confused, unscientific and sometimes almost mystical appraisal of the risk of cigarette smoking to entirely shape the public policy debate over cancer? Why have so many research scientists in developed societies, and particularly in Britain, refused to investigate the chemical causes of cancer, despite their increas ingly telling effect upon the epidemiological picture of cancer, ill-health and the quality of life?
In comparing the responses of scientists, doctors and the media to both cigarette smoking, chemicals and cancer, the career and philosophy of Sir Richard Doll emerges as a con vincing guide and marker to changing perceptions and modalities. The Career of Sir Richard Doll Sir Richard Doll has been considered England's most influen tial epidemiologist for the last thirty years. Doll first did work on mortality in asbestos workers in the 1950s, producing a paper in 19556. His conclusions came down decidedly on the side of asbestos workers, whose health he said was being put in jeopardy.
all the available data."10
Again, in 1977, Doll came into conflict with the medical establishment, when he was outspoken about the yellow card scheme, a scheme used by doctors to report adverse drug reac tions to the Committee on the Safety of Medicines. In that year it had become apparent that there were adverse effects to the use of Practolol (Eraldin), a heart drug which was withdrawn after five years, when it became apparent that it caused various illnesses in patients.
The importance of Doll's earlier work in shaping public health policy is beyond dispute. As he has grown older, how ever, his frequent public appearances on the world stage, like those of an ageing rock star, have increasingly articulated an industry-accommodating view of public health risks. The Two Paradigms In the contemporary world, two paradigms vie for ideological power over public health, especially in the area of cancer diag nosis and treatment. The two paradigms do not present whole or homogeneous conceptual worlds; there are conflicts between them and on occasions they confoundingly dissolve into each other. Within the first paradigm, which has for some time been referred to, by detractors, as the 'lifestyle' para digm,11 it is held primarily that lifestyles by themselves, and without reference to the environmental conditions in which they are conducted, determine the individual's susceptibility to cancer and other chronic illnesses. For Sir Richard Doll, the leading exponent of this view, the cancer rate is not increasing - nor indeed could it increase, because lifestyles are becoming healthier. In fact, he assures us, in the most important areas
cancer cases are now falling and wil l continue to fall. Indeed, in 198512 Doll was of the opinion that cancer could be largely eradicated within the next few decades, which meant, in his opinion, that there was clearly no need for
In the late sixties, Richard Doll could
In his first Rock Carling Fellowship Lecture in June 1967, Richard Doll stated clearly that prevention of can cer was a better strategy than cure.7 He considered that an "immense" number of sub stances were known to cause cancer. In 1954, for instance, he stated, along with Bradford Hill, that besides cigarette smoking, exposure to nickel, asbestos, tarry products in gas production, and radioactivity, were major causes of cancer.8 He believed that cancer rates var ied with environment, geography and class, and he argued that poor, working class people, able to afford only a poor diet, were more likely to get cancer of the stomach. In the late six ties, Richard Doll could have been considered a radical.
have been considered a radical.
any further corporate or political regulation.
Following the announcement of a 1968 study, which sug gested that more women than was previously realized might suffer complications from the Pill, Doll found himself in a head-on confrontation with both the pharmaceutical companies and the moral hegemony of his profession. The 'medical authorities' chose to interpret his report in such a way as to jus tify the conclusion that "the new assessment need cause no alarm among the million British women now believed to be using the pill." 9
In common with other 'public health' scientists of the pre war and immediately post-war periods, Richard Doll considered that workers faced the greatest and most consistent threat to their health in the workplace. In October 1977 Doll spoke out against the research carried out by the National Radiological Protection Board (NRPB) and British Nuclear Fuels (BNFL) into the health risks of the nuclear industry; his message was unequivocal. Research by these organizations, he said, "had not been carried out in a way that would satisfy even an ordinary university department. They did not do what was recognized as necessary in epidemiological studies - analyse
In reality there is a rising level of certain specific cancers, such as male testicular cancer, myeloma, cancer of the bone marrow, female breast cancer, male cancer of the mouth (which has doubled over 30 years), and deaths from cancer of the pan creas, which have increased considerably in women while staying level in men. There have been increases in cancer of the cervix and melanpma in the 20 - 44 age group and a rising death rate among men suffering from prostate cancer. In 1990, Sir Richard, discussing these figures, was still sure that on the whole "there is, to my mind, good evidence we have been win ning the fight in Britain."13 He reiterated this same message in 1992, when the Independent reported his views under the title of 'Doctors gaining ground in battle against cancer'.
Nevertheless, Doll favours more cancer research and he is personally very much involved with the Imperial Cancer Research Fund (ICRF). However, like other lifestyle propo nents, he insists that the focus should be largely on research into the minutest details of cell biology in order to determine the exact mechanism of carcinogenesis. Doll has stated that major cancer charities like the ICRF should not become involved in education or preventive work. The ICRF, he said, "as its name implies, is there to do research."14 Needless to say this does not include research into the effects of environmental carcinogens, which the ICRF generally refuses to consider.
The second paradigm, which we might call the 'dissident' paradigm, represents a more socially holistic view of disease. Dissidents argue that many forms of cancer are rising alarm-
The Ecologist, Vol . 28, No . 2, March/Apri l 1998