In the last week I was sent information from three different sources - the Tasmanian Department of Human Resources web site; a fact sheet from the Washington State Department of Health on cancer clusters; and information provided by the Israeli Cancer Society. All three organisations are making statements on the causes of cancer that are largely based on research by Richard Doll - information that has long been discredited. We read statements such as:
"... most common types of cancer are associated with lifestyle factors."
"... scientists at the Harvard School of Public Health estimate that only about 10% of cancer deaths are related to environmental factors such as radiation and toxic chemicals."
So I think it is time to revisit 'epidemiology' as practiced by Doll and his partner in crime Peto. It seems that no matter how many times this stuff is deconstructed as biassed research, it is still quoted by organisations that unthinkingly regurgitate the same old party line. The problem being that self perceived'experts' tend to uncritically accept as truth anything published by their 'peers' - so the contagion renews itself and spreads around the world.
According to one cancer society spokesperson in Israel, Doll and Peto are the top epidemiologists in the cancer issue. Research referenced include:
Doll R and Peto R. The causes of cancer: qualitative estimates of avoidable risks of cancer in the United States today. Journal of the National Cancer Institute 1981; 66: 1191-1308
Doll R. Epidemiological evidence of the effects of the behaviour and the environment on the risk of human cancer. Recent Results in Cancer Research 1998; 154: 3-21
If Doll and Peto are the top epidemiologists then it is a sad state of affairs for the profession.
Consider a history lesson:
Sir Richard Doll: A Questionable Pillar of the Cancer Establishment,
by Martin Walker, The Ecologist, Vol 28, No. 2, March/April 1998.
The Imperial Cancer Research Fund writes in its current publication, Preventing and Curing Cancer:
"One of the biggest myths in recent years is that there is a cancer epidemic caused by exposure to radiation, pollution, pesticides and food additives. The truth is that these factors have very little to do with the majority of cancers in this country. In fact, food additives may have a protective effect - particularly against stomach cancer." One would presume that the Imperial Cancer Research Find would only dare make a statement of this sort, which runs counter to endless serious studies on the subject, after exhaustive research over many decades on the possible carcinogenic effects of exposure to these environmental factors. However, unbelievable as it may seem, this august institution fully admits that it has never carried out any such research! How then can it conceivable make such a statement? The answer is that it is entirely based on the pronouncements of Sir Richard Doll, seen to be the greatest living expert on the subject, and whose every word is gospel among the members of Britain's cancer establishment.
Let us look carefully at the career of Sir Richard Doll in order to trace the origin and development of this most questionable pillar. On October 17, 1997, the news programmes and the newspapers made frequent mention of new evidence from three studies supervised by Sir Richard Doll, and originally published in the British Medical Journal, which purported to show that 'passive smoking' caused lung cancer.1
That same day, in London's High Court, Mrs Justice Smith handed down her judgement in the case of John Hill, who had taken a civil action against the owners of a farm upon which he had worked. He claimed that exposure to organophosphate (OP) insecticide at work had adversely affected his health. Mrs Justice Smith ruled that his ill health was partly at least "attributable to psychological factors".
With the exception of Britain's most subversive 6 am radio programme, Farming Today, little publicity was given to the court hearing.2,3
Curious double standards
These separate sets of circumstances. occurring as they did on the same day, give voice to a number of issues relating to the way we perceive health and the environment. The first and most obvious is that thirty years after Richard Doll and Bradford Hill published their first epidemiological study on the high rates of lung cancer amongst GPs who smoked,4 the public are still in thrall to the idea that cigarette smoking is the single most important public health problem we face in Britain.
Secondly, the judgement on the OP case demonstrates something which is difficult to understand within the context of truthful scientific research. It has been recognised for hundreds of years that agricultural and industrial chemicals, especially those of which we have had no evolutionary experience (xenobiotic chemicals), can have serious adverse effects upon humans, but, unlike the public issue of cigarette-induced lung cancer, the history of both academic judgements and plaintiff actions with respect to chemical is almost a secret history.
Research by the Medical Research Council into the use of organophosphorous compounds predates the work of Doll and Bradford Hill on cigarette smoking.3
Initial scientific conclusions in the late 1940s and 1950s were not in the least reassuring. There are presently hundreds of OP cases waiting to come before the courts, including over 100 Gulf War syndrome cases. The great majority of complaints involving OPs have been made by farmers who were pressed, by law, between 1975 and 1993 to dip sheep and treat cattle with washes of OP as a deterrent to warble fly. Almost all the cases which have so far reached court have, like cases brought by others suffering from Multiple Chemical Sensitivities (MCS), floundered on two medical, legal and scientific arguments. First, that it cannot be "proved" that exposure to apparently toxic chemicals can cause long-term and ongoing systemic damage to health. Secondly, that any damage caused by chemicals is relative, dependent first upon their method and duration of use, and second upon the susceptibility of the injured party. In this way the chemical company is defended and the sufferer blamed for having a weak constitution.
One question raised by these issues is why the medical research establishment and the State have allowed a confused, unscientific and sometimes almost mystical appraisal of the risk of cigarette smoking to entirely shape the public policy debate over cancer? Why have so many research scientists in developed societies and particularly in Britain, refused to investigate the chemical causes of cancer, despite their increasingly telling effect upon the epidemiological picture of cancer, ill-health and philosophy of Sir Richard Doll emerges as a convincing guide and marker to changing perceptions and modalities.
The Career of Richard Doll
Sir Richard Doll has been considered England's most influential epidemiologist for the last thirty years. Doll first did work on mortality in asbestos workers in the 1950, producing a paper in 1955.6 His conclusions came down decidedly on the side of asbestos workers, whose health he said was being put in jeopardy.
In his first Rock Carling Fellowship Lecture in June 1967, Richard Doll stated clearly that prevention of cancer was a better strategy than cure.7 He considered that an "immense" number of substances were known to cause cancer. In 1954, for instance, he stated, along with Bradford Hill, that besides cigarette smoking, exposure to nickel, asbestos, tarry products in gas production, and radioactivity, were major causes of cancer.8 He believed that cancer rates varied with environment, geography and class, and he argued that poor, working class people, able to afford only a poor diet, were more likely to get cancer of the stomach. In the late sixties, Richard Doll could nave been considered a radical.
Following the announcement of a 1968 study, which suggested that more women than was previously realised might suffer complications from the Pill, Doll found himself in a head-on confrontation with both the pharmaceutical companies and the moral hegemony of his profession.
The 'medical authorities' chose to interpret his report in such a way as to justify the conclusion that "the new assessment need cause no alarm among the million British women now believed to be using the pill'.9
In common with other 'public health' scientists of the pre-war and immediately post-war periods, Richard Doll considered that workers faced the greatest and most consistent threat to their health in the workplace. In October 1977 Doll spoke out against the research carried by the National Radiological Protection Board (NRPB) and British Nuclear Fuels (BNFL) into the health risks of the nuclear industry; his message was unequivocal. Research by these organisations, he said,"had not been carried out in a way that would satisfy even an ordinary university department. They did not so what was recognised as necessary in epidemiological studies - analyse all the available data.10
Again, in 1977, Doll came into conflict with the medical establishment, when he was outspoken about the yellow card scheme, a scheme used by doctors to report adverse drug reactions to the Committee on the Safety of Medicines. In the year it had become apparent that there were adverse effects to the use of Practolol (Eraldin), a heart drug which was withdrawn after five years, when it became apparent that it caused various illnesses in patients.
The importance of Doll's earlier work in shaping public health policy is beyond dispute. As he has grown older, however, his frequent public appearances on the world stage, like those of an ageing rock star, have increasingly articulated an industry-accommodating view of public health risks.
The Two Paradigms
In the contemporary world, two paradigms vie for ideological power over public health, especially in the area of cancer diagnosis and treatment. The two paradigms do not present whole or homogeneous conceptual worlds; there are conflicts between them and on occasions they confoundingly dissolve into each other. Within the first paradigm, which has for some time been referred to, by detractors, as the 'lifestyle' paradigm,11 it is held primarily that lifestyles by themselves, and without reference to the environmental conditions in which they are conducted, determine the individual's susceptibility to cancer and other chronic illnesses. For Sir Richard Doll, the leading exponent of this view, the cancer rate is not increasing - nor indeed could it increase, because lifestyles are becoming healthier. In fact, he assures us, in the most important areas cancer cases are now falling and will continue to fall. Indeed, in 1985 12 Doll was of the opinion that cancer could be largely eradicated within the next few decades, which meant, in his opinion, that there was clearly no need for any further corporate or political regulation.
In reality there is a rising level of certain specific cancers, such as male testicular cancer, myeloma, cancer of the bone marrow, female breast cancer, make cancer of the mouth (which has doubled over 30 years), and deaths from cancer of the pancreas, which have increased considerably in women while staying level in men. There have been increases in cancer of the cervix and melanoma in the 20 - 44 age group and a rising death rate among men suffering from prostate cancer. In 1990, Sir Richard, discussing these figures, was still sure that on the whole "there is, to my mind, good evidence we have been winning the fight in Britain."13 He reiterated this same message in 1992, when the Independent reported his views under the title of 'Doctors gaining ground in battle against cancer'.
Nevertheless, Doll favours more cancer research and he is personally very much involved with the Imperial Cancer Research Fund (ICRF). However, like other lifestyle proponents, he insists that the focus should be largely on research into the minutest details of cell biology in order to determine the exact mechanism of carcinogenesis.
Doll has stated that major cancer charities like the ICRF, he said, "as it name implies, is there to do research."14 Needless to say this does not include research into the effects of environmental carcinogens, which the ICRF generally refuses to consider. The second paradigm, which we might call the 'dissident' paradigm, represents a more socially holistic view of disease. Dissidents argue that many forms of cancer are rising alarmingly. Research as to the exact mechanism of carcinogenesis is a waste of energy and money, for chemical toxicity is partially or even largely to blame for many, if not most, cancers, as well as for the fall in the general level of public health. Dissidents argue that policy makers have got to act now to phase out the production of all reasonably well-established carcinogens.
Though Doll started off as a dissident, one who was clearly concerned with the health of the people he was serving, as his career developed his views gradually changed and he became one of the most powerful and influential promoters of entrenched industrial and political interests.
The Controversies
Smoking and Lung Cancer
Sir Richard first began publishing on smoking and lung cancer with Professor Bradford Hill in 1950. His two mist effective early papers, published in 1954 and in 1956 15 recorded the results of a longitudinal epidemiological study based upon 40,000 postal interviews sent out to general practitioners in 1951. The first results analysed the deaths of 789 of the doctors aged 35 and over who had died during the three years of the study. Thirty-six of them had died of lung cancer.
The conclusion, as has been continually reflected in the media, was, and has continued to be, that smoking is responsible for the huge increase in deaths from cancer of the lung. However, some responsible health care workers have asked whether or not smoking was perhaps not the sole cause, but one of a number of factors which might be "weakening the system in a way which makes it susceptible to cancer". Major concerns along these lines have been raised by research carried out in China where the peasant population smokes heavily and where there appears to be little difference in the rates of lung cancer between smokers and non-smokers.
Nevertheless, Sir Richard Doll's first major study has been bolstered by further studies that have come out with the same answer - lung cancer is almost entirely attributable to smoking. The political, social and economic effects of this singular message are still reverberating, despite the fact that today, lung cancer mortality rates for non-smokers are rising.17 To a degree, the success of this first work has become a screen behind which Sir Richard has dodged with increasing frequency, to avoid awkward but substantial issues about other man-made carcinogens.
Medical professionals, politicians, and health educationalists, reached a very speedy consensus on this issue, and other lines of investigation were consequently quickly abandoned.
By 1986, when The Big Kill, a 15 volume series was published by the Health Education Authority 18 with consultative advice from Doll, an exact figure of individuals killed by smoking in England and Wales was given as 77,774 even though these deaths included those in which heart disease, bronchitis, and emphysema clearly also played an important role. In 1993 when Sir Richard was interviewed,19 he cited a figure of 150,000 individuals who died prematurely as a consequence of smoking.
Questions have also been raised about the recorded incidence of death from lung cancer, said to be caused from smoking in the elderly. In the deaths of those over 65 it is exceptionally difficult to assess cause and even more difficult to establish what brought it on. These figures are not even addressed in The Big Kill, because as the Royal College of Physicians makes clear, "...this could not be done with much confidence, partly because certification of the cause of death in older people, who may suffer from a variety of disabilities, is less accurate than in younger people...no attempt has been made to estimate the number of deaths due to cigarette smoking in older people".20
this is a very weak excuse for excluding the elderly from the study - precisely those people who are most susceptible to cancer, and until recently those who constituted the major statistical group for the disease.
In the USA Doll's thesis has always been rejected by Professor Samuel Epstein, Professor of Environmental Medicine at the University of Illinois, and founder of the Anti-Cancer Coalition, who for decades has fought a lonely battle against the medical establishment on this issue, though today at least sixty other scientists working in the field have now endorsed his position. (see Epstein in this issue)
In the UK, opposition to Doll's views came from Professor Simon Wolff, a toxicologist who was, before his death in 1995, the most committed of a new generation of scientists. Professor Wolff was particularly concerned about the effects of diesel and petrol exhaust pollution, which he saw as major factors on the development of lung cancer. He said: "There is no doubt that cigarette smoking causes lung cancer, but there is also no doubt that air pollution, particularly from diesel, is a contributory factor, so important that perhaps without air pollution we would see a much lower rate of lung cancer than we have. For example, in rural China, where people tend to smoke very heavily and where air pollution is much less, the differences in lung cancer rates between smokers and non-smokers is very small, and lung cancer rates are about one tenth of the lung cancer rates in industrialised countries."21
Cancer and Diet
Doll does not accept that air pollution of any king may be regarded as a cause of lung cancer or of any other diseases of the respiratory tract. These can only be attributed to smoking which he sees as accounting for 30 per cent of cancer deaths. Nevertheless, he does incriminate various natural - as opposed to man-made carcinogens. In a study commissioned by the American Academy of Sciences, which Doll conducted with his colleague Richard Peto in 1981,22 he identified various natural contaminants of raw food as natural carcinogens produced during cooking. He sees these, together with obesity and the consumption of unspecified refined foods, as responsible for 35 per cent of cancer deaths.
Another "natural carcinogen" - alcohol - was incriminated in a report to the ICRF in 1982,23 as both a cause of cancer of the respiratory tract and of the digestive tract. By 1983, the accent had shifted to the consumption of fats as a dietary factor in the induction of cancer.
Doll has advised people to consume more fresh fruit and vegetables, though, needless to say, he does not distinguish between fruits and vegetables produced organically and those produced by means of chemical agriculture, which contains all sorts of pesticide residues. Nor does he see the large number of food additives in the average modern diet as playing any role in the development of cancer. On the contrary he has denied this over and over again, notwithstanding the fact that an ever-increasing number of these chemicals have been classified by such organisations as the World Health Organisation (WHO) and the Environmental Protection Agency (EPA) as proven or suspected carcinogens. This attitude very much coloured his 1992 keynote address entitled 'The Lessons of Life' at the Nutrition and Cancer Conference in the UK.
Agent Orange
Doll's refusal to accept that any man-made chemicals can cause cancer and other serious health problems could not have been better reflected than in the testimony he gave against the Australian veterans of the Vietnam war whose health had been devastated by exposure to "Agent Orange". Agent Orange was a mixture of the two well-established carcinogenic herbicides 2,4,5-T and 2,4-D (the former having since been taken out of production in every country in the Western world). Produced by the Monsanto Corporation, Agent Orange was used as a defoliant by the US forces, and it was in the interest of that company that Doll acted. 2,4,5-T is generally contaminated with an impurity known as dioxin, one of the most toxic substances known. The smallest amount of this substance can produce a total degeneration of the liver, and it has been found to be 70,000 times more deadly than cyanide. This did not prevent the American forces from using 2,4,5-T to defoliate Vietnam - to strip away the tree cover, so important for their Vietcong opponents. Great swatches of jungle were destroyed and as much as one tenth of South Vietnam's rural countryside was devastated.
Monsanto did very well out of it, as production of 2,4,5-T rocketed from 5.8 million pounds in 1958 to 13 million pounds in 1964 and to 42 million pounds in 1968.24 In 1964, the National Cancer Institute commissioned a report to test the carcinogenicity of 2,4,5-T and it was found to cause birth defects, cleft palate and malformation of the kidneys in the animals tested. The report was kept secret. In the meantime a large number of Australian veterans, whose health had been seriously affected while serving in Vietnam, campaigned for an inquiry into its effects.
A Royal commission was eventually set up. Its focus was on soft-tissue sarcoma, the incidence of which had been linked in Sweden with the use of 2,4,5-T by two Swedish researchers, Olar Axelson and Lennart Hardell, at the University of Umea.25 The Commission went out of its way to discredit the evidence provided by these researchers and ended up by giving 2,4,5-T a clean bill of health.
Axelson and Hardell, however, refused to give in. Supported by other scientists, they accused the Royal Commission report of being "a most questionable document" and of being "full of misquotations, distortions of information, and even falsification of facts". In a later paper they accused the Royal Commission of "lying in order to be able to disregard apparently inconvenient results".26 Going even further, they showed that almost all the conclusions of the report had been taken word for word from the evidence of Monsanto's Australia Ltd.
Sir Richard Doll wrote, a personal letter to the judge who headed the Royal Commission, in which he gave the Commission's report his seal of approval, validated the defence evidence of Monsanto, and defended Agent Orange, while also attempting to destroy Hardell's scientific reputation. "Hardell's conclusions", Doll wrote, "cannot be sustained and in my opinion, his work should no longer be cited as scientific evidence. It is clear, too, from your review of the published evidence relating to 2,4-D and 2,4,5-T (the phenoxy herbicides in question) that there is no reason to suppose that they are carcinogenic in laboratory animals and that even TCDD (Dioxin), which has been postulated to be a dangerous contaminant of the herbicides, is at the most, only weakly and inconsistently carcinogenic in animal experiments."27
This letter, the contents of which are irreconcilable with all the serious evidence on the subject, coming as it did from one of the most prestigious scientists in the field, had an electrifying effect. It could not have done more for Monsanto had he taken out a full-page advertisement in the world's biggest circulation newspapers.
Low-level Radiation
Establishment scientists, politicians, medical researchers, and doctors, have almost always argued that exposure to low levels of radiation has a negligible effect on human health. If the opposite could be proved to be true, the consequences for the nuclear weapons and the nuclear power industries would be intolerable. William H Taft, US State Department attorney, in 1981 stated himself that "The mistaken impression (that low-level radiation is hazardous) has the potential to be seriously damaging to every aspect of the Department of Defence's nuclear weapons and nuclear propulsion programmes. ...It could adversely affect our relationship with our nuclear allies."28
Of course this view has not been endorsed by serious and objective scientists. Professor Linus Pauling, the double Nobel Laureate in the US, and Professor Andrei Sakharov in the USSR, calculated in the 1950s that millions of people would die prematurely from the ingestion of fission products resulting from fall-out from atmospheric bomb tests,29 and many others have said likewise.
Inevitably, Sir Richard Doll has been heavily involved in this field. In the 1950s, he was asked by the Government to look at the possible carcinogenic effects of strontium-90, a radio nuclide generated by nuclear installations that mimics calcium and is taken up in the bones of growing children.
Doll was also engaged by the Medical Research Council (MRC) at that time to review all the research conducted on the Hiroshima survivors. In his report on this issue Doll accepted that those who had been directly exposed to the bomb when it exploded would have a higher risk of leukaemia and other cancers; not so, however, those who had been exposed only indirectly to the bomb. For them there was little risk of cancer or other health damage, and hence no evidence that low-level radiation in the form of fall-out could do amy damage.
In 1957 Doll had been engaged by the Government to assess the quantitative relationships between exposure to radiation and the development of cancer. He had carried out two epidemiological studies, the results of which suggested that there could be a quantitative relationship between radiation and leukaemia. At that time he still had an open mind on the subject.30 However, by 1992 his tune had totally changed and he stated quite explicitly that "the effects of low-level radiation are so small as to be virtually zero." This has been the view he has expressed ever since, in spite of the mounting evidence to the contrary.
In 1987 Doll presented the findings of a study on 'Cancer near nuclear installations' in Nature,31 which looked at the cancer rate in the vicinity of all Britain's 15 nuclear power stations (made up of 36 nuclear reactors). Predictably it concluded that there was "no increase in childhood leukaemia near any nuclear power station. "However, very shortly afterwards reports clearly demonstrating the existence of leukaemia clusters around nuclear installations began to appear. In August 1987, for instance, a government advisory group tried to establish the causes of the alleged increases in child leukaemia at Aldermaston, where atom bombs are produced, Harwell, the nuclear research centre south of Oxford, and Burghfield. The fact that leukaemia clusters existed in these areas was no longer denied, but the government advisory group still reported, very predictably, that they could not possibly be attributed to the activities of these three nuclear installations.
Even more embarrassing to Sir Richard Doll was the report, published in the British Medical Journal in October 1987.32 The report contained the results of two studies of childhood leukaemia in Seascale, the village which borders on the Sellafield nuclear reprocessing plant. The first study looked at one group of 1,068 children born near Sellafield between 1950 and 1984, and another a group of 1,546 children born outside the area but attending local schools. The leukaemia and cancer cases occurred only in those children born in Seascale. This fitted in well with the findings of a report by Sir Douglas Black, former chief scientific adviser to the Department of Health, in 1985.33 Both studies were conducted by Dr Martin Gardner, Professor of medical statistics at Southampton General Hospital, and Dr John Terrell, District Medical Officer of Health at west Cumberland Hospital, Whitehaven.
Gardner and Terrell concluded that the children with leukaemia and other cancers were those whose parents had worked at the Sellafield processing plant. These results endorsed the campaigning views of CORE (Cumbrians Opposed to a Radioactive Environment), the key environmental group in that area, who believed that "the damage is from radioactive particles first inhaled by prospective mothers from the atmosphere. In pregnancy the radioactivity is transferred to the foetus where it collects in concentrations up to a thousand times the level in the mother". Their spokesman, Jake Kelley insisted that the retreatment plant was not to blame, and that "leukaemia in children can be caused by many things." It was predictably Sir Richard Doll who was engaged to give scientific weight to this denial.
In March 1989 Doll was engaged by the MRC and the ICRF to conduct yet another research programme to assess cancer risks (lymphoid leukaemia) in under 25 year olds in the population living within ten miles of a nuclear installation. The results of the study were again embarrassing.34 The death rates were found to be 21 per cent higher than the national average, yet this still did not persuade Sir Richard that there was a connection between radiation and leukaemia. In an interview with the Daily Mail he admitted that "until we find some other cause, we cannot say that it (radioactivity) is not responsible." Clearly though, he was very keen to find another cause, and hit on the idea of a leukaemia virus, which could easily have been introduced by newly arrived workers coming to work at the Sellafield installations. The novel theory was also advanced that the over-clean homes of nuclear workers rendered their children more susceptible to leukaemia viruses. 35 Shamefully, this speculative viral infection, for which there is not a shred of evidence, remains the official explanation spouted by the nuclear industry and the Government alike.
that same year the conference organised by the United Kingdom Atomic Energy Authority (UKAEA) advised the Government not to reduce the maximum annual dose for radiation workers, as had been proposed the year before by the National Radiation Protection Board (NRPB) and also by the United Nations Scientific Committee on the effects of low-level radiation, in the face of mounting evidence of the carcinogenicity of even extremely low levels of radioactivity. Clearly industry interests had to come first. Indeed, the new safety levels proposed from (50 to 15 millisievers a year) would have led the nuclear industry to incur extra costs which it would have has difficulty in meeting. 36
In March 1992, the UK Co-ordinating Committee on Cancer Research, which consists of the major cancer charities, announced a 6 million pound study to test the various hypotheses that have been put forward to explain childhood cancer around nuclear installations. Soll predictably, expressed his firm belief in the viral hypothesis. a colleague of Doll's, Professor Mel Greaves, tried to rationalise an embarrassingly unconvincing thesis on the grounds that homes had become much cleaner and that the risk of leukaemia increases with rising living standards. In this way cleaner homes, which made us vulnerable to persistent viruses, rather than the much more chemicalized environment of our more affluent society were conveniently incriminated.
The Bomb Test Service Men
In the same way that Doll offered evidence against the Australian Vietnam war veterans, whose health had been devastated by exposure to Agent Orange, so was he engaged to demolish the case brought by Mr Ken McGinley, Chairman of a group of 1,500 members of the Nuclear Test Veterans Association, who in the 1950's were used as guinea pigs in test trials and whose health was seriously affected by radiation.
The case was first investigated by the Ministry of Defence. the study was then funded by the NRPB and the ICRF, who, in spite of the fact that not one of the servicemen had been examined clinically, decided that there was no evidence to prove that any of them had suffered from higher than normal radiation exposure. The testimony given by Doll and Darby, based on a statistical study that revealed a high incidence of deaths from leukaemia and multiple myeloma (attributed, Doll said, to a "statistical quirk") among those
servicemen who had been exposed to radiation, confirmed the conclusion of the study.38
A further study in 1993 on this same issue, by Doll and Darby, further confirmed their previous position, with minor reservations.
Significantly, though Doll has always refused to accept the connection between man-made radioactivity and cancer, he has always seen, for reasons best known to himself, natural background radiation as a major cause of leukaemia and other cancers.
Quite early on the NRPB had estimated that at least 2500 people who lived in areas where there is a lot of granite, as in Cornwall, and were exposed to high levels of radon gas in their homes died of lung cancer every year in Britain. In 1990 however, Doll and Darby published a report for the ICRF in Nature which suggested that the figure may be as high as 5000 cases a year.39 Why, we may ask, if man-made radioactivity is so totally harmless, is natural radioactivity on the contrary so incredibly dangerous?
Doll's estimates of natural low-level radiation from Radon were based on an assessment of the levels of lung cancer among uranium miners exposed to high levels of radon gas. They came only months after Doll and Darby had yet again denied cancers are sites of nuclear installations. They showed that a decreasing exposure to radiation, instead of leading to a lower risk of cancer, actually increased the risk of cancer - in other words, that very low levels of exposure to this natural radioactivity were particularly harmful. Given these conclusions, why have Doll and his colleagues always insisted that only very high levels of man-made radioactivity were harmful?
It is easy to demonstrate that in every field in which Doll has been involved he has systematically defended the interests of industry and the State, even then these are in total conflict with those of people in general, and are irreconcilable with all the established knowledge on the subject.
Asbestos and Cancer
In 1955 Doll had carried out a study if mortality in asbestos workers. His report 40 was considered a landmark publication showing that workers in the asbestos industry had a high risk of cancer.
By 1983 he was singing a different tune. His career as a defender if corporate interests was now well under way. A new report done by him and his assistant Julian Pero came to a totally different conclusion.41
The society for the Prevention of Asbestosis and Industrial Diseases (SPAID) criticised the methodology used by Sir Richard in a letter to the Sunday Times on the 26th April 1985: "Sir Richard Doll", SPAID insisted, has "used so many estimates, adjustments, approximations and hypothetical figures in order to assure us that only one person in 100,000 working in an office containing undamaged asbestos risks death, that SPAID is not reassured"42
Nor, for that matter, one must assume, were the 30,000 people in the USA whose health had been devastated by exposure to asbestos and who were seeking compensation from their insurance companies - not to mention the 500 new ones who were deciding to do likewise every month.
Anaesthetics
There is some evidence that substances used as anaesthetics have a damaging effect on health.43 The results of a study carried out on the subject was published in the April 1979 issue of the British Medical Journal.44 It was based on a survey of the health of 10 per cent of all the anaesthetists in England and Wales - and it suggested that working with anaesthetics had a generally adverse affect on their health status. In particular it noted that there were excess spontaneous abortions in the families of anaesthetists, a lower fertility rate, a greater incidence if cancer, and a greater likelihood that children of anaesthetists would be born with congenital defects. The Medical Research Council predictably qualified the paper as "a one-sided review", 45 and Sir Richard Doll, one of its leading lights, did not waste any time in stating his complete rejection of the study's findings.
Fluoridation
Sir Richard Doll's role in the debate on the fluoridation of water supplies was equally predictable. It has been known for a long time that fluoride is a poison. In October 1944 the Journal of the American Medical Association published an editorial stating "that the use of drinking water containing as little as 1.2 to 3 parts per million of fluoride will cause such developmental disturbances in bones as osteosclerosis, spondylosis, and osteopetrosis, as well as goitre.46
In 1990 the American National Toxicology Program announced that it had established a clear link between fluoride and a type of bone cancer called osteosarcoma. It also indicated that fluoride might be responsible for a particular type of cancer of the mouth. However, it was in the interest of many powerful bodies that fluoride be added to our drinking supplies. This included the sugar industry and the aluminium industry, which was desperate to get rid of the vast amount of fluoride waste that its activities has generated.
Industrial interests were sufficient to influence the Royal College of Physicians' 18-member committee, which included Doll, to recommend the addition of fluoride to drinking water in January 1976.47 The widespread criticism was raised that to impose this medication on the population at large without its prior informed consent, would be a breach of medical ethics.
Sir Richard Doll fully backed the report's conclusions, going even further than they did in declaring that, if anything, it was "unethical not to add fluoride to drinking water."48
Lead in Petrol
The role played by Sir Richard Doll in the long controversy over the effects of exposure to lead in petrol on the health of children was equally predictable. Lead was originally added to petrol in the form of the organic lead compounds: tetramethyl and tetraethyl, both of which are absorbed through the skin and are extremely neurotoxic.49
In the 1960s and 1970s, it became increasingly clear that children absorbed this lead into their blood through their lungs and by eating contaminated fruit and vegetables. Clear evidence of health damage from organic lead in petrol began to appear in the late 1970s. However, in Britain and America, the petrochemical companies ran a continuous campaign in favour of maintaining lead in petrol and generally denying its deleterious health effects.
In May 1980 the Department of Health and Social Security (DHSS) published the report of a study carried out by the MRC entitled Lead and Health, written by the Lawther Working Party set up by the Department of the Environment (DoE).50 The Working Party concluded that there was no evidence for clinical lead poisoning, which fitted in perfectly with the propaganda of the petrochemical companies. It even went further, claiming that the removal of lead from petrol would lead to increased cancer-causing hydrocarbon emissions.
A study carried out by two members of the Lawther Working Party, Dr Yule and Dr Lansdown,51 drew conclusions that totally contradicted those of the Lawther Working Party. They found that, in almost every case, among a group of schoolchildren whom they examined, body-levels correlated with IQ and school performance, more strongly than did the social class of the children. The British Medical Journal (BMJ) declined to publish this paper.
In 1983 Professor Derek Bryce-Smith and Dr Robert Stephens refuted the DHSS report, accusing the MRC team of being hypercritical of all the studies which showed evidence of a relationship between levels of lead in petrol and mental function.52 They also showed that the blood lead safety levels set by the DHSS report were without "real scientific or medical basis"53
However, in 1983 Sir Richard Doll was still arguing the case of the petrochemical companies. He insisted that there was not enough lead in the air to damage children's brains. Any adverse health effects caused by lead, he also insisted, were due to drinking water that had passed through lead piping. Lead in petrol could not be incriminated.54
From a Friend of the People to a Friend of the Powerful
What lessons can be drawn from the career of Sir Richard Doll? How can we explain, in particular, his and other research scientists' failure to appraise seriously the subject of cancer and the environment?
Today nearly all the major institutions of scientific research which study the effect of chemicals and other toxins on health are financed, managed, supported or aided, by chemical and pharmaceutical companies. As a result it is increasingly difficult to find independent scientists within the area of environmental health. Those academics who fight the corner for sufferers of chemically induced illnesses are an eclectic grouping of medical clinicians, social scientists, philanthropists and community activists. They have, however, one thing in common: they lack funding and have on the whole been prised away from real power.
The first British Labour government which came to power in 1945, the Medical Research Council, which had been created before the war, set up a toxicology research unit.55 Its aims was to monitor the growing use of chemicals, including insecticides, fungicides, and organic solvents, and their effects on human health.
In the early fifties, the MRC Toxicology Unit did indeed research pesticides, and especially the effect of organophosphate insecticides on human health. By the mid-fifties, however, the unit was moving slowly away from its original brief, pushing chemicals to one side and liberally extending the research to cover more esoteric subjects. Significantly, in 1956, one of the Unit's nine research subjects was the "toxic properties of certain plants used as herbal remedies in primitive societies."56 The accent was already on natural rather than man-made poisons.
Over the next thirty years, the MRC, while preserving its Toxicology Unit, gradually dropped its research into toxic chemicals. During the 1970s, and 1980s, as the drug companies increasingly offered funding, support and partnership projects, the focus of research turned towards cell-biology, pharmaceuticals and genetics. The emphasis was on the good rather than the harm that chemicals and industrial scientific processes could do. In the mid-nineteen eighties the Wellcome Foundation used the MRC as a vehicle for providing the scientific justification for the production of the first AIDS drug, AZT.57 This was possible because by then the Council of the MRC was already dominated by individuals with vested interests in the chemical and pharmaceutical industry.58 The very companies whose products should have been critically investigated by the MRC were, in one form or another, represented on the Council of Britain's most prestigious medical research body. It is no coincidence that Sir Richard Doll has held office in that august institution for most of his professional career. Nor is it a coincidence that its present Chairman, Sir David Plastow, instead of being someone with a lifetime professional preoccupation with the health of British people, is a man whose interest have been with the motor industry, whose polluting activities are a major source of lung disease, including lung cancer.
What is true of the MRC is also true of the main cancer charities. Decades ago they were relatively independent from industry, arguing the case for 'the people'. Now they are all but departments of large pharmaceutical companies. The Imperial Cancer Research Fund, for which Doll worked for a large part of his career, is a case in point. While most lay people imagine that it is simply a worthy charity collecting money to research cancer, few will understand that it is itself a multi-million pound corporation which hardly makes a move independently of professional science, or industrial pharmaceutical patrons and backers.
Through its council and its benefactors, the ICRF is run by, and mainly for, the profit of the pharmaceutical companies, the very corporations whose products would have to be investigated in amy wide-ranging investigation of cancer and the environment. The sort of cancer research that is supported by the ICRF and other cancer charities is that which seeks to find 'cures' for specific forms of the disease.
The dissident position is of course that most of the money should go into searching for the environmental causes of cancer and then into wideranging preventative campaigns to eliminate the environmental factors involved. This emphasis, however, would bring cancer-research into head-on conflict with its industrial backers.
In the introduction to his book Wings of Death, Dr Chris Busby notes how: "...the control of research and publication in the area of radiation-dose and effect, has been assumed by the nuclear and military establishment, a powerful international lobby which grew out of the need for secrecy relating to defence uses of nuclear fission, and the realisation of the opportunities that there were for making immense amounts of money in this area.59
Thus, much of the research undertaken by the UK Co-ordinating Committee on Cancer Research (CCR) in leukaemia and radiation, from the early 1990s onwards, has been funded by British Nuclear Fuels, the very company that operates the Sellafield nuclear retreatment plant right next to Seascale, where the biggest child leukaemia cluster in the UK has been found. BNFL and other nuclear industry groups gave the UK CCR between 3 and 6 million pounds. The research undertaken was headed by none other then Sir Richard Doll.60
From 1979 to the end of his career, Sir Richard Doll also received a very substantial yearly reward for research into cancer from General Motors.61 This is of course hardly surprising given the wide range of problems which are increasingly associated with motor vehicle exhaust emissions, from global warming to cancer and various respiratory diseases.
Sir Richard has never hidden the source of this funding and has not even bothered to defend it. He does not feel there is any need to. In 1993, Doll wrote to Cumbrians Opposed to a Radioactive Environment (CORE), that brought up the matter of the UK CCR BFNL grant: "To imply that the UK CCR was in some way under the influence of the nuclear industry.....this is certainly untrue."62
The answer to that, of course, is that industry is not in the habit of funding research for the publication of studies which demonstrate the carcinogenicity of their products. On the contrary, all the evidence shows that it goes out of its way to suppress any such information which may occasionally surface.63 64
In 1996, researchers from the Centre for Public Integrity (CPI), an American non-profit investigative research organisation, set out to discover "how chemical companies manufacture controversial products, year in and year out, in the face if government regulatory efforts, and civil litigation by citizens who feel victimised, and investigative news stories."65 They found that time and again Congress and regulatory agencies put the interests of the chemical industry before those of the public; that scientific studies financed by the chemical industry tended to find that suspected carcinogens, such as atrazine, formaldehyde and perchloroethylene, were "innocent", while scientific studies by non-industry sources tended to find then dangerous to human health.66
The CPI also uncovered an extensive PR machine operated by the chemical industry, often with the complicity of the regulatory agencies, as well as a million-dollar service industry organised by chemical companies and associated organisations, to provide courtesy trips for regulatory officials.67
"Today, in Europe and America wherever chemicals are likely to become the subject of criticism, the companies move in, balancing, propagandising, controlling, mediating protests, funding pseudoscientific research, buying people off and funding social ventures to enhance their reputation."68
The dissident who questions the chemical companies, the industrial food companies, and inevitably the State, is branded as irrational, anti-science and anti-technology, and hence as a subversive standing in the way of progress.
In his 1983 Harveian Oration, Sir Richard Doll warned against environmentalists, who might "whip up irrational prejudice, unfounded in science."69
again, in 1992, writing in the Daily Mail at the time of the Rio summit, Doll warned that er may be seeing "a new attitude emerge; an irrational ideology opposed to science, to industry and to progress".70 That attitude, he told us, exists already.
"There is, for example, a large and powerful lobby against pesticides, which they say leave cancer-causing residues in our food. Yet scientific research has shown that those residues are some 1800 times less than the amount of cancer-causing agents naturally present in the plants. The lobby does not seem to object to natural carcinogens; only to the infinitesimally small amounts introduced by man.71
If this is the level of intellectual reasoning of Britain's greatest epidemiological scientist, then we should all pray for British science. Which edible plants have carcinogens in them 1800 times more powerful than which pesticides? This, of course, he doesn't
tell us. Nor could he, because these and similar statements routinely made by Doll and his sponsors, are pure fabrications.
The unbridled alliance of science and industry is transparent in Doll's Daily Mail article.72 He defended industry on six different occasions in the short article and asked us, not without a dash of desperation, to trust industry and industrialists, science and scientists. These, he said, are the people with the key to the future. He ended the article with a warming that we must stop environmentalists whom he describes as the "anti-science Mafia", from "hijacking" the Rio summit.73
Sir Richard Doll believes strongly that whatever criticisms might be "laid at the door of industry and science", only "industry and science" can solve the problems of the modern world.74
He tells us too, against all the evidence, that the continual, unregulated and untested introduction of chemicals into our food, can do the land, the farmers, and ultimately the consumers, nothing but good.
Fortunately Sir Richard and his colleagues are fighting a losing battle. It is becoming increasingly clear to the people that all this is not only false but the very opposite to the truth - mere propaganda for the chemical and nuclear industries that are, like the tobacco industry also, responsible for the present cancer pandemic.
How may people today really believe that the leukaemia clusters found around just about all nuclear installations in the UK and elsewhere are caused by viruses introduced by outsiders? Who will believe that the main environmental carcinogens are natural ones like blue cheese, mushrooms and radon gas? How many people really believe that asbestos, lead and petrol, and organophosphate pesticides are harmless? Fewer and fewer, as the serious, independent evidence inexorably accumulates.
References and Notes
1. Law MR, Morris JK, Wald NJ. Environmental tobacco smoke exposure and ischaermic heart disease: and evaluation of the evidence. BMJ 1997; 315:973
Hackshaw AK, Law MR, Wald NJ. The accumulated evidence on lung
cancer and environmental tobacco smoke. BMJ 1997; 315:980-8.
Davis RM, Passive smoking:history repeats itself.(editorial) BMJ 1997;315-961-2.
2. Farming Today. BBC Radio Four, October 17, 1997.
3. Gaurdian. October 18, 1997.
4. Bradford Hill A, Doll R. 1950 Smoking and carcinoma of the lung. BMJ 1950; ii,1271.
5. Medical Research Council, Annual Report 1948.
6. Doll R. Mortality from lung cancer in asbestos workers. Br J Indust Med 1955; 12:81-6
7. The Times, June 8 1967.
8. Ibid.
9. Daily Express, April 25, 1968.
10. Guardian, October 31, 1977.
11. Epstein S S, Swartz JB. fallacies of the life-style cancer theories. The Ecologist (Vol 11 No 5).
12. Daily telegraph, August 28 1985.
13. Guardian, September 27 1990. Cancer: a killer 'moving into retreat'.
14. The Times, January 10 1980.
15. Bradford Hill A, Doll R. The Mortality of doctors in relation to their smoking habits. A preliminary report. BMJ 1954, i, 15
Bradford Hill A, Doll R. Lung cancer and other causes of death in relation to smoking. A second report on the mortality of Brithish doctors. BMJ 1956,ii, 1071
16. Daily Mail, June 29 1951.
17. See Epstein in this issue.
18. Roberts JL, Graveling PA. (eds.). The big kill: smoking epidemic in England and Wales. Published for the Health Education Council and the British Medical Association. 15-volume series. Manchester: North Western Regional Health Authority, 1985.
19. Typescript of interview by Andrew Baron with Simon Wolff, May 13 1993.
20. Royal College of Physicians of London. Smoking or helath. London: RCP, 1983.
21. Typescript of interview by Andrew Baron with Simon Wolff, May 13 1993.
22. Gardian 27 November 1981. Doll R, Peto R. The causes of cancer: quantitative estimates of avoidable risks of cancer in the United Stated today. n Oxford: OUP, 1981.
23. Imperial Cancer Research Fund. Scientific Report, 1981.
24. Margerison T, Wallace M, Hallenstein D. The Superpoison, Macmillan, London, 1981.
25. Axelson O, Hardell L. Herbicide exposure, mortality and tumor incidence: An epidemioligical investigation on swedish railroad workers. Work Env. Hlth 11:21-28. 1974.
Axelson O. Herbicides exposure and tumour mortality: an updated epidemiological investigation on swedish railroad workers. Scand J Work Environ Helath 1980:6:73-79.
Hardell L, Sanderson A. Case control study: Soft tissue sarcomas and exposure to phenoxy acids and chlorophenols. Br J Cancer, 39; 1979; 711-717.
Hardell L. Epidemiological studies on soft tissue sarcoma and malignant lymphona and their relation to phenoxy acid or chlorophenol exposure. Umea University, Medical Dissertations. New Series No 65. Umea 1981.
26. Axelson O, Hardell L. Australian epidemonology (sic): On Royal misruling in the realm of epidemiology. (presented at the 5th International Symposium, Epidemiology in Occupational Health, 1986).
27. Letter from Richard Doll to Hon Mr Justice Phillip Evatt, Dec 4 1985.
28. Cited in; Gould JM, Goldman BA, Deadly Deceit; Low Level Radiation High Level Cover up: Four Walls Eight Windows, New York 1991.
29. Cited ibid..
30. Jones G. From Cancer to Cholestoral. New Scientist, 21 Nov 1992.
31. Forman D, Cook-Mozaffari PJ, Darby SC, Doll R, et al. Cancer near nuclear installations. nature, 1987; 329; 499-505 (8-14 Dec).
32. Gardner MJ, Hall AJ, Downes S, Terrell JD. Follow up study of children born to mothers resident in Seascale, West Cumbria (birth cohort) BMJ 1987; 295: 822-7.
Gardner MJ, Hall AJ, Downes S, Terrell JD. Follow up study of children born elsewhere but attending schools in Seascale, West Cumbria (schools cohort). BMJ 1987; 295: 819-22.
33. Black D. Investagation of the possible increased incidence of cancer in West Cumbria, London: HMSO, 1984.
34. Cook-Mozaffari P, Darby SC, Doll R. Cancer near sites of nuclear installations. Lancet 1989; 2:1145-7. (11 Nov).
35. Sunday Telegraph, November 26 1989, and later in The Times, March 13 1992.
36. The Times, July 1, 1989.
37. The Times, March 13, 1992.
38. Darby SC, Kendall GM, Doll R, et al. A summary of mortality and incidence of cancer in men from the United Kingdom who participated in the United Kingdom's atmospheric muclear tests and experimental programmes. BMJ 1988; 296: 332-8 (30 Jan).
In The Times of 29 Jan 1988, Doll is reported as saying that the statistical difference was curious. Darby on the other had was reported in the Guardian of the same date saying that they were puzzling.
39. Darby SC, Doll R. Radiation and exposure rate, Nature 1990; 344; 824.
40. Doll R. Mortality from lung in absestos workers. Br J Inust Med 1955;12:81-6.
41. Doll R, Peto R. Effects on Health of Exposure to Asbestos, HMSO. 1985.
42. Letter from SPAID to the Sunday Times, 26 April 1985.
43. rea WJ. Chemical Sensitivity. Vol 3. Boca Raten, Fl: Lewis 1995.
44. 1979, April BMJ, paper on the lealth of anaesthetists.
45. Daily Telegraph, May 4, 1979.
46. Health damaging affects of fluoride. JAMA. October 1944.
47. Royal College of Physicians of London. Flouride, teeth and health. London: Pitman Medical. 1976.
48. Daily Telegraph, January 7, 1976.
49. Wilson D. The Lead Scandal. Heinemann Educational Books, London 1983.
50. Lead and Health, DHSS, 1980. The Lawther Working Party.
51. Lansdown R, Yule W, Urbanowicz M, MillarI. Relationship between blood-lead intelligence, attainment and behaviour in school children: Overview of a pilot study. Paper presented at CLEAR Int. Symp. London, 1982. In Lead versus health.(ed) M Rutter and R Russell Jones.
52. Bryce Smith D, Stephens R. Lead or Helath: A review of the Lawther Report. The Conservation Society, 1983.
53. Cited in, Wilson D, op.cit. 48.
54. Daily Telegraph, February 7 1983.
55. Medical Research Council Annual Report 1947.
In 1947 the Council established a Toxicology research Unit, under the direction of Fe JM Barnes, to assist in the solution of toxicological problems referred to them by other bodies, and to pursue research on fundamental questions which may emerge during routine work. The Unit has had accomadation at the Chemical Defence Experimental Station, Porton, by arrangement with the Ministry of Supply.
56. 1956 MRC Annual Report.
57. Walker M. Dirty Medicine, Slingshot Publications, BM 8314, London WC1N 3xx. 1993.
58. Walker M. Ibid.
59. Busby C. Wings of Death: Nuclear Pollution and Human Health. Green Audit. Wales. 1995.
60. Waste Paper, August 1989, published by CORE (Cumbrians Opposed to a Radioactive Environment).
61. Sir Richard Doll. Interview with Andrew Baron. April 7 1993.
62. Letter from Richard Doll to Miss Jean McSorley of CORE, May 10 1989.
63. Epstein SS. Corporate crime: Why we cannot trust industry-derived safetystudies. Int. J. of Health Services, Vol 20. November 3: 443-458, 1990
Beder S. Global Spin : The corporate assault on environmentalism. Green Books; Dartington, 1997.
64. D Fagin, M Lavelle and the Centre for Public Integrity, Toxic Deception; how the chemical industry manipulates science, bends the law and endangers your health, Carol Publishing Group, New Jersey 1996.
65. Ibid.
66. Ibid.
67. Ibid.
68. Ibid.
69. Daily Telegraph, February 7 1983.
70. Daily Mail, June 3 1992.
71. Ibid.
72. Ibid.
73. Ibid.
74.From Cancer to Cholesterol, Glyn Jones, New Scientist, November 21, 1992.
Informant: Don Maisch
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Workshop on Biological Effects of EMF, Kos, Greece
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http://omega.twoday.net/search?q=World+Health+Organization
http://www.next-up.org/Newsoftheworld/WHO_OMS.php#10
