ALTHOUGH fears about the effects of smoking were raised as early as 1858 in The Lancet, it was left to Sir Richard Doll, working with Austin Bradford Hill, to make the first credible link between cigarettes and lung cancer in 1950. He calculated that, on average, smokers die ten years earlier than nonsmokers, and that as many as two thirds of them are killed by their habit.

Even without this credit, Doll’s contribution to the evolution of medical thought and practice would stand out in a way rarely achieved by a non-clinician. He gave a new impetus to epidemiology, and to preventive work in general.

William Richard Shaboe Doll was born at Hampton, the son of Henry Doll and Amy Shaboe, into a background of some affluence, despite his father’s having had to abandon medical practice because of multiple sclerosis. Doll was educated at Westminster School and St Thomas’s Hospital, from which he graduated in 1937.

In his student years Doll developed radical ethical views and joined the Communist Party, but became disenchanted after the Nazi-Soviet pact. 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, until he was found to have tuberculosis.

After the war, Doll returned briefly to St Thomas’s to research asthma, but his real career began when 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.

Doll became successively a member, deputy director and director of that unit over 21 years. The early collaboration with Avery-Jones resulted in a series of papers concerning peptic ulceration. Duodenal ulcer was shown not to affect particularly those with heavy responsibility (as had been taught). There followed a series of model clinical trials of treatment of gastric ulcer showing that diet, alkali, anticholinergic drugs and admission to hospital all had no detectable benefit, whereas bed rest promoted healing.

He and colleagues at the council interviewed hundreds of lung cancer patients. Doll thought that the increasing incidence of the disease might owe something to the hundreds of tonnes of tarmac being laid down across Britain at this time, but soon discovered that in 649 lung cancer cases there were only two non-smokers.

Doll himself gave up the habit two thirds of the way through the research. In 1954 a follow-up study showed prospective mortality in a sample of 40,000 doctors, followed over 20 years. It was a spectacular success of epidemiological method, the results so startling that Iain Macleod, the Health Minister, called a press conference. He announced: “It must be regarded as established that there is a relationship between smoking and cancer of the lung.” Almost everyone at the meeting was smoking — as did 80 per cent of the population.

Doll had a great ability to apply mathematical skills to clinical problems, a considerable triumph in a profession always suspicious of the nonclinician.

His international reputation was already established when he came to Oxford as Regius Professor of Medicine in 1969. He succeeded Sir George Pickering, who had been at the head of a team distinguished for clinical research. At that time, clinical skills were widely admired but epidemiological ones much less so. Doll nonetheless enhanced Oxford’s reputation for teaching and research.

Within a few months of his arrival at Oxford, Doll had set up a working party on the development of the Clinical School, taking a cue from the report of the Franks Commission of Inquiry in 1966. Doll had been the prime mover in the decision by the university to form a new medical collegiate society, Green College, in Oxford.

The concept of a single-faculty college was not regarded with much enthusiasm by students or many senior members, and the early years of Doll’s wardenship of Green College were soured, yet the college began to forge links between medicine and industry — not only in the pharmaceutical field but also in toxicology, engineering and electronics. 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.

Doll travelled widely and was much in demand as a lecturer or adviser in medical circles all over the world. He received many honours, including the fellowship of the Royal Society, a UN Award for his work on research in cancer, and the Presidential Award of the New York Academy of Sciences. He was a member of the Royal Commission on Environmental Pollution, of the Standing Committee on Energy and the Environment and of the Scientific Council of the International Cancer Research Agency.

Doll helped to set up the National Blood Service and insisted that Britain avoid the American path of paying donors for their blood.

At Oxford University’s Clinical Trial Service Unit he continued research into carcinogens. The World Health Organisation based many of its conclusions on a landmark study conducted at CTSU by Doll and Richard Peto, which 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.

Doll was knighted in 1971 and made a Companion of Honour in 1996 for services of national importance. In April this year Doll and Peto were awarded Saudi Arabia’s King Faisal International Prize for medicine for their continuing work on smoking-related diseases. “So great has been the impact of their studies that several national health policies have been modified as a result of these findings,” the judges proclaimed. Doll also held honorary degrees from 13 universities.

Despite these honours, Doll — a tall, elegant figure with a dispassionate manner — remained unassuming and friendly to his colleagues and concerned for the plight of the underprivileged.

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. In May this year Lord Nimmo Smith dismissed a widow’s case against Imperial Tobacco, seeming to suggest that the link between smoking and cancer remained unproven. Doll offered to show him the evidence, to clear up his apparent misunderstanding.

Posterity may regard the epidemiology of non-communicable diseases as Britain’s most important contribution to medical science in the second half of the 20th century. If so, then Richard Doll’s name will come first to mind.

He has published hundreds of papers. His discoveries suggested that aspirin can help ward off heart disease, and that women who binge-drink may increase their risk of breast cancer. He recently said that evidence suggested no link between cancer and overhead power lines.

He quoted only from his figures and was no absolutist. When questioned recently on second-hand smoke, he exasperated the anti-smoking lobby by replying: “The effects of other people smoking in my presence is so small it doesn’t worry me.”

He was also wont to point out that the idea that smokers cost the taxpayer millions in hospital fees is in fact a myth, stating that smoking efficiently killed its adherents before they could retire or become old — and that the habit might actually be of economic benefit to the country. It was, as one journalist pointed out, “an argument that only Richard Doll could get away with airing”.

Sir Richard Doll, CH, epidemiologist and scholar, was born on October 28, 1912. He died on July 24, 2005, aged 92.