I’m a sucker for the lives of great men (and, occasionally, women) of medicine. It is particularly the case of those in the twentieth 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. Theirs is a time of 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 (http://www.signalbooks.co.uk/2014/07/smoking-kills/). Some I knew but much I didn’t know – the paradoxes of an introverted product of the establishment who kept a thirty 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. The man who was reprimanded in the army for drinking with non-commissioned officers and yet who introduced his housekeeper of forty 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 on the Jarrow marchers in the hungry thirties, 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 (http://taralamont.blogspot.co.uk/2014/05/on-failing-well-archie-cochranes-other.html), who showed similar political commitment, he was an early proponent of the scientific method and spirit of experimentation – for instance, just after enlisting, carrying out a small randomised trial of prophylactic use of sulphonamides to prevent wound infection in his fellow soldiers. 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.” http://www.bmj.com/content/2/4682/739 At the time, received wisdom suggested atmospheric pollution as 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 which 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, 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, 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 seventy 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 (http://www.4thestate.co.uk/tag/emperor-of-all-maladies/). 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 gets 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 to life his subject and make it compelling to the reader. We need stories as well as science.
This blog also appears on BMJ guest blogs at http://blogs.bmj.com/bmj/2014/10/27/tara-lamont-on-biography-cancer-and-richard-doll/