New insights from the British doctors study
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7455.1507 (Published 24 June 2004) Cite this as: BMJ 2004;328:1507All rapid responses
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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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
Re: BMJ front cover June 26 2004
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
Competing interests: No competing interests