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Revista Brasileira de Epidemiologia

Print version ISSN 1415-790XOn-line version ISSN 1980-5497

Rev. bras. epidemiol. vol.8 no.3 São Paulo Sept. 2005

http://dx.doi.org/10.1590/S1415-790X2005000300002 

EDITORIAL

 

 

 

We lost Richard Doll.

We will never know for sure which names will be remembered in the future as landmarks in the field of ideas and production of knowledge in the realm of Epidemiology and Public Health, but in addition to John Snow, Richard Doll will certainly be one of them.

His work on the association between smoking and lung cancer is always included in textbooks of Epidemiology and in the training of health professionals and researchers in these areas.

Although his contributions to science go beyond the study on the effect of smoking on human health, I would not like to talk about that, but rather about the human being with a sweet and candid gaze who I had the honor to meet and to share a few, but always memorable days.

During the preparation for the IV Brazilian Congress of Epidemiology, EPI-RIO, which was held in August 1998, the name of Richard Doll came immediately into mind when defining the list of guest speakers. Unlike other names — fortunately not many and immediately rejected — who asked how much they would receive for speaking at the Congress, Doll readily accepted the invitation with satisfaction. It should be mentioned that then, at the age of 85, he already had a prior commitment to come to Rio de Janeiro the following month of September to speak at a conference in the World Cancer Congress, to be held two weeks after the end of EPI-RIO.

At the time, we had the chance to talk a lot, and in this manner, know a little about the man who had become a myth in 20th century Epidemiology. Friendly and pleasant to talk to, he told us he was a medical student when he got in touch with the intense ideological debate between liberal, socialist and fascist ideas already present in the English society of the 1930's. It was also as a newly graduated physician that he voluntarily enlisted in the English army to participate in the fight against Nazism.

When World War II ended, the debate between workers and conservative managers in England for the creation of the National Health System gained momentum; it was the first experience of this nature in the capitalist world. It was amidst this debate that Doll was invited by Bradford Hill — one of the great names of Biostatistics at that time — to help him analyze the growing number of men being diagnosed with lung cancer in the country.

Doll told us that he and Bradford Hill strongly believed that the cause of that phenomenon was the growing urban pollution resulting from the expansion of the automobile fleet circulating in London and in other large English cities. This conviction was so deep-seated that their initial studies were based on the analysis of the distribution of lung cancer among traffic wards, in comparison with other workers.

To their surprise, the similarity in both groups led them to widen the scope of possible risk factors, which eventually resulted in the classical studies revealing the association of the tumor with smoking, a hypothesis then considered unexpected and surprising. In the England of the 1940's, about 80% of men were smokers, a life habit then seen as sophisticated and of good taste. The back covers of leading medical journals of the time printed advertisements of the tobacco industry with conversations whose main characters were healthcare professionals. These physicians and nurses were mentioning their preferences for different cigarette brands and in this manner associating them to the image of credibility and social acceptance of those professionals. With the studies of Doll and the power of their results, smoking suffered one of its first major blows, and in a few years, the prevalence of smokers in the social brackets with more education and higher income in England dropped sharply. Its overall impact on public health and in health promotion activities was so great that Doll was knighted by the English royalty, and his name was suggested many times as a nominee for the Nobel Prize of Medicine, which never happened.

Of that tall and thin figure, simple but majestic man, the image of a true scientist remained: someone who enjoyed life, and who did not have retirement as a word in his vocabulary. His curiosity was limitless, from the secrets of Brazilian cuisine to the current challenges of knowledge, as the study on the association of electromagnetic fields and cancer in children.

As a scientist, he was a role model like few others, involved in the production of knowledge and with a clear position and understanding of the nature of his role in society.

As an individual, he was always aware of the life surrounding him, and the last image I have of him in my memory was when we said goodbye at Riocentro during the World Cancer Congress. He was in hurry, because he did not want to be late for the return flight, as his wife would be waiting for his arrival at the London airport for them to go straight to the theater...

Sergio Koifman

 

Associated Editor

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