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Rapid Responses: Rapid Responses published:
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Uninformed editorial
- Jeffrey R Johnstone (30 June 2004)
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BMJ front cover June 26 2004
- Miles Weatherall (30 June 2004)
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Re: Uninformed editorial
- George F Sedlacek (30 June 2004)
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Re: BMJ front cover June 26 2004
- Trish Groves (1 July 2004)
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Jeffrey R Johnstone, Self-employed 7 Bruce St,, Nedlands 6009, Western Australia
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This fawning and uncritical editorial does medical science a disservice. There is much that can and should be said about the British doctors study. It had an inauspicious beginning. Sir Ronald Fisher (Fisher, 1959) had examined the results of Doll and Hill’s preliminary study (Doll and Hill, 1950) and confirmed that men who inhaled were significantly less likely to get lung cancer than those who do not. If smoking causes lung cancer then this is a most unexpected and indeed extraordinary result. Any good scientist would realise that it could provide important information about the causation of cancer. Doll and Hill did not see it that way. Their response was to delete the question about inhaling from the British doctors study. But the study had a far more serious failing: its smokers, nonsmokers and exsmokers were all self-selected. There were no controls. Hill himself was sternly critical of such work (Hill, 1971) .He said it uses “inferior” and “second-best” methods and gave his reasons for saying so: “The same objections must be made to the contrasting in a trial of volunteers for a treatment with those who do not volunteer, or in everyday life between those who accept and those who refuse. There can be no knowledge that such groups are comparable; and the onus lies wholly, it may justly be maintained, upon the experimenter to prove that they are comparable, before his results can be accepted.” The British doctors study stands condemned by the words of one of its chief authors. The study appears not to be mentioned in his book, although he describes many other trials. Had he done so the incongruity of his words and deeds would have been starkly obvious. Just how inferior its results are can be seen from the results of 7 controlled trials with 100,000 subjects to determine the effects of giving up smoking either alone, (the Whitehall study) or combined with other factors eg diet, (WHO Collaborative Trial, Finnish businessmen, MRFIT, North Karelia study, Goteborg study, Oslo study); full references are available at: http://members.iinet.net.au/~ray/ps.html Not one showed any improvement in total mortality, cancer mortality or cardiovascular mortality in the quit group. Your editorial seems to have been written in a sciolistic vacuum by someone who knows little of the subject he has been commissioned to write about. But in the pseudo-scientific world of anti-smoking that is unfortunately all too common. Doll R, Hill A.B. (1950): Smoking and carcinoma of the lung. BMJ, 21(ii): 739-48. Fisher,R.A.(1959): “Smoking: The Cancer Controversy”, Oliver and Boyd, Edinburgh Hill,A.B.(1971): “Principles of Medical Statistics”, 9th edition, The Lancet Limited, London Competing interests: None declared |
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Miles Weatherall, retired Willows, Charlbury, OX7 3PX
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Why does the replica of the article by Doll and Hill published fifty years ago have pictures superimposed of Doll and Crofton? What has Crofton to do with the article, admirable though his work against tobacco has been, and why is Hill not pictured? Competing interests: None declared |
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George F Sedlacek, Community Health Education Director Marquette County Health Dept 49866
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It's hard to fathom anyone questionning the contribution of tobacco to the rise in morbidity including lung cancer. Sir Ronald Fisher while a masterful statistician, simply did not live long enough to see the rise of lung cancer in women. He was statistically correct when he noticed that the cancer rate in men was largely static while the huge growth in women smoking in the 1930's and 40's did not lead to an expected rise in lung cancer. Well...we know the rest of the story. Fisher who died in 1962 simply did not understand that the rise in lung cancer deaths accelerate after 30 pack year histories. Competing interests: Community Health Education Director |
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Trish Groves, coordinating editor, BMJ BMJ Editorial, BMA House, Tavistock Square, London WC1H 9JR
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Thanks to Miles Weatherall for asking about this cover. We wanted to mark the 50th anniversary of this work by celebrating doctors who took part in the research and are still alive. Sir Austin Bradford Hill had a very long life (1897-1991) and made immeasurable contributions to medical research, including this study, but he is, sadly, no longer alive. Competing interests: I was involved in producing this BMJ cover |
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