Thursday, December 14, 2006

Tainted by association?
[This is the pre-edited version of my latest muse column for news@nature.]

Richard Doll's links with industry are disconcerting but hardly scandalous. And they don't make him a villain.

Few things will polarize opinion like the defamation of a recently deceased and revered figure. So the tone of the debate (here and here and here and here) that has followed the accusation that Sir Richard Doll, the British epidemiologist credited with identifying the link between smoking and lung cancer in the 1950s, compromised the integrity of his research by receiving consultancy payments from the chemicals industry, should surprise no one.

On the one hand, the disclosure of Doll's contracts with the likes of Monsanto and Dow Chemicals have provoked howls of outrage and accusations that his studies of purported links between the companies' products and cancer were nothing less than a cover-up. Much of this is crude conspiracy-theorizing; but there are also more weighty critics. Andrew Watterson, a professor of occupational and environmental health at the University of Stirling in Scotland, has said that "Doll's work… has limited the capacity of the UK over decades to take action on occupational and environmental carcinogens as quickly as it should have… His lack of transparency on and financial relationship with companies have seriously damaged the credibility of aspects of his research."

On the other hand, voices that will be no doubt dismissed by Doll's attackers as those of the 'establishment' have risen to defend his reputation. An editorial in the Times calls the charges "a cheap shot" made by "grave robbers". This, the newspaper intones gravely, is "a sad act of character assassination by people who should know better." Several leading UK scientists have written to the Times saying that "we feel it is our duty to defend Sir Richard's reputation and to recognise his extraordinary contribution to global health."

The situation is perhaps best exemplified by a leader headline in the Observer newspaper: "Richard Doll was a hero, not a villain." All of which brings to mind the comment of Brecht's Galileo: "unhappy is the land that needs a hero."

Unhappy we are indeed, if we cannot accommodate in our pantheons the complexities of real people. And while the collaborations of academe and industry certainly create tensions and problems, it achieves nothing to pretend that they ought not to exist.

Doll's consultancy work is not immune to criticism even by the standards of his time. But the suggestion that his research is invalidated, and his character besmirched, by such conflicts of interest (as they would now certainly be regarded) is one that smells of piety rather than an evaluation of the facts.

Here, then, is the case for the prosecution. Doll proclaimed that Monsanto's Agent Orange posed no carcinogenic hazard while receiving consultancy fees of $1000-1500 a day from the company for nearly 30 years. He compiled a review on behalf of ICA, Dow Chemicals and the Chemical Manufacturers' Association in their defence against claims of cancer induced in workers by exposure to vinyl chloride, for which he was paid £15,000. (Monsanto was also a big producer of vinyl chloride). And he argued that there was little basis for the idea that asbestos is a major health risk, while pursuing a long-term consultancy relationship with the UK's leading asbestos manufacturer Turner & Newall, which later donated £50,000 to set up Green College in Oxford, a medical school of which Doll was a founder and the first warden.

All of this would indict any researcher today who failed to declare such conflicts of interest. Doll was in fact rather inconsistent about such declarations – he made no secret of some of his links to industry, but the Monsanto connection was not disclosed until a court case over vinyl chloride in 2000. In any event, until the 1980s there was no expectation that academics should make this sort of paid work public, and so no reason to expect Doll to have been systematic about doing so.

That is one of the main lines of defence for Doll's supporters: it is absurd to judge him by today's standards, a notorious way of vilifying historical figures and events. It's a fair point, although we have to remember that we're talking here about the 1980s, not the nineteenth century. It doesn't take a great deal of insight to see that being paid by a company while assessing their products is not ideal.

Yet there is no obvious reason to regard this as venal or cynical on Doll's part. Using contract money to help set up a college does not seem particularly blameworthy. Doll donated other fees to charities such as the Medical Foundation for the Victims of Torture.

He gives every impression of being a man conducting his business in an environment that had not thought very hard about the proprieties of industrial research contracts. If he did not think too hard about it either, that does not make him a villain.

And he seems very much a man who knew his own mind. Overcoming industry's resistance to the link between smoking and cancer is hardly the act of someone in the pocket of corporations. Yet his scepticism about the effects of secondary smoking speaks of a man who was not turned into an ideologue by his conclusions.

On this count, we must remember that no evidence has been presented that Doll's conclusions were biased by his contracts. It's hard to see how that could be established either way; but certainly it is unfair to turn Doll into a yes-man bribed by industry.

Indeed, if anything, the affair has served to remind us how manipulative these industries could be. Peto says that Doll came under pressure (which he resisted) from the asbestos manufacturers not to publish any evidence of the harmful effects of their product. They claimed it would damage the national interest by undermining this important industry, and even threatened legal action. The Asbestosis Research Council, founded by Turner & Newall and others in 1957, has been accused of suppressing evidence of the dangers of asbestos, for example by vetting and censoring research on the topic [1].

A curious aspect of this whole business, not mentioned at all in media reports, is that it is all yesterday's news anyway. Doll's links with industry were reported by British newspapers after being discussed in an article published online on 3 November by the American Journal of Industrial Medicine [2]. But the information in that article on Doll's connections with Monsanto, Dow, Turner & Newall and others had all been documented in 2002 by one of the authors, Martin Walker [3]. In that latter paper, Walker states that Doll "has never made any secret of the fact that he has been funded by industry for specific research projects."

Quite aside from demonstrating the media's ability to generate its own content, this fact is notable because the American Journal of Industrial Medicine paper aims not to denigrate Doll but to call for a tightening of policies governing disclosures of interest today. There's still plenty of work to be done (see here and here) in that respect. We should recognise the shortcomings of the past, and move on.

1. Tweedale, G. Am. J. Ind. Med. 38, 723-734 (2000).
2. Hardell, L. et al. Am. J. Ind. Med. advance online publication (2006).
3. Walker, M. J.,


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