Tara Lamont: On biography, cancer, and Richard Doll

Tara_Lamont_3I’m a sucker for the lives of great men (and, occasionally, women) in medicine. This is particularly the case when it comes to those who lived in the 20th century, whose lives are punctuated with big moments: from the great depression, to active service overseas in the second world war, to the formation of the NHS shortly after. Their lives are marked by quiet heroism and lives well lived—before you even come to their impact on health and science. There seems to be that much more space for these individuals to make their mark on history.

So I turn to the exhaustive (and, to be honest, rather exhausting) authorised biography of Richard Doll, the clinical epidemiologist who shifted our thinking on the links between smoking and lung cancer. Some of his story I already knew, but much I didn’t know: the paradoxes of an introverted product of the establishment who kept a 30 year commitment to communism (and longer adherence to its ideals). Staunchly socialist and democratic, yet with the patrician air of his class making him “a very scary person to be around” and intimidating during ward rounds at the Central Middlesex Hospital. The man who was reprimanded in the army for drinking with non-commissioned officers, and yet who introduced his housekeeper of 40 years by title only. You can see the difficulties for the biographer in capturing this intensely private, reserved man. There is a slightly plodding style in this long, chronological account, but the times and his life of science speak for themselves.

We hear of Doll’s attendance of the Jarrow marches in the hunger stricken 1930s, with the poignant detail of him witnessing one man extracting ham from his sandwich to send to his family. His near miss with death at Dunkirk. Like Archie Cochrane, who also showed similar political commitment, he was an early proponent of the scientific method and spirit of experimentation. For instance, just after enlisting he carried out a small randomised trial of prophylactic use of sulphonamides to prevent wound infection in his fellow soldiers. We also hear of his love of mathematics and tutelage under Austin Bradford Hill, combining a flair for statistics with clinical knowledge and experience to forge a new (or, at least, fledgling) discipline of clinical epidemiology.

The big story, of course, is the series of studies, starting with the 1950 BMJ paper by Doll and Hill, which concluded that “smoking is a factor, and an important factor, in the production of carcinoma of the lung.” At the time, received wisdom suggested that atmospheric pollution was the most likely cause, and the association established in this study took some time to take hold in professional and public worlds. The evidence journey was indeed a long one from publication to impact.

This is interesting enough as a story. But the biographer makes rather hard work of it, for some reason devoting a whole chapter to explaining common statistical techniques (who is he writing this for?). And yet I am grateful for the many delightful incidental details he has uncovered. Who could forget those marvellous side characters, such as Somerville Hastings, the ENT surgeon who became a Labour MP and “father of the NHS” in the post-war period, or Horace Joules, a tireless advocate of Doll’s research amid great professional and industry scepticism (and damage to his own career). Or the Conservative minister presenting a press conference on what he called the “ambiguous” findings of links between smoking and health, all the while chain smoking throughout. And who knew that Nazi Germany was an early sponsor of research into links between smoking and cancer, and then introduced an effective public health policy of banning smoking in public places some 70 years before the UK?

So, my mind snags on the details. I have the image in my mind of Doll, marching to Ladbroke Grove with a black baby in his arms, as one of the few white people to join a protest after the racist murder of a young black man in west London in 1959. But one wades through 454 pages to get there. You can understand why the chronological individual biography is falling out of fashion.

I happened to be reading at the same time the brilliant book The Emperor of Maladies by Siddhartha Mukherjee. Its ambition is no less than to present the biography of cancer. It is a bravado sweep of history, from the first recorded case of a mastectomy in a 500BC Persian queen to the more recent advances, such as Sidney Farber’s development of chemotherapy in the last century.

His genius trick is to yoke together these accounts, in their complex social and political contexts, with stories of his own cancer patients or developments in the laboratory. Like Atul Gawande, he combines clinical insights with fine writing and humanity. He also gives cancer itself an identity (hence, his decision to sub-title this a biography), and shows how different moments and movements have shaped our understanding of the disease.

Richard Doll and his work get more than a passing reference here. But reading these two books together, I am struck by the way in which Mukherjee has used the real skill of biography to bring his subject to life and make it compelling to the reader. We need stories as well as science.

Tara Lamont has worked for over 20 years in health services research, audit, and patient safety. She currently works for the National Institute for Health Research and is an honorary fellow at the University of Warwick, but blogs in a personal capacity.

Competing interests: The author has no competing interests to declare.