Tuesday, 6 March 2012

Richard Doll teaches us that financial or ideological vested interests can be used to stifle the truth

Today is the 50th anniversary of the publication of a groundbreaking report by the Royal College of Physicians in which doctors first tried to talk directly to the public about the catastrophic dangers of smoking.

Richard Doll (pictured) and Austin Bradford Hill provided the definitive study in the 1950s that demonstrated the lethal nature of tobacco by following a cohort of smoking and non-smoking doctors. But the study had an ambivalent and even hostile response in some quarters of the government, media and society.

With social barriers coming down in the 1960s, doctors at the RCP felt it was time to speak out to the public.

In the foreword to a booklet launched today, the RCP president, Sir Richard Thompson, looks back to a world 50 years ago ‘suffocated by the swirling clouds of tobacco smoke, in pubs, cinemas, trains, buses on the streets and even in hospitals and schools. Around 70% of men and 40% of women smoked. Smoking was omnipresent, accepted, established’.

It is easy for us to forget that the now well accepted link between smoking and lung cancer has not always been known or acknowledged. The tobacco industry, because of its powerful financial vested interests, provided a major obstacle to the publication of incriminating research, and the matter was not really finally resolved until the $206 billion settlement with 46 US states which the industry made in 1998 to pay for the costs of smoking-related health care.

Financial or ideological vested interests can be used to stifle the truth when medical issues become highly politicised, and perhaps on this notable anniversary it is worth reflecting on other more contemporary examples.

I have previously reported on the Royal College of Obstetricians and Gynaecologists abortion guidance which underplays the evidence linking abortion with mental illness and pre-term delivery.

Or take the instance of the RCOG misrepresenting the evidence for fetal pain sensation in fetuses under 24 weeks. In February 2011 a senior (pro-choice) neonatologist likened their 2009 report on the matter to ‘the Emperor’s new clothes’.

Then there is the case of a Christian doctor sacked from the Advisory Committee on the Misuse of Drugs (ACMD) for claiming a link between homosexuality and paedophilia. Ironically Dr Raabe’s claims were based on peer-reviewed articles including one quoted in previous Home Office documents. But it is not acceptable to hold such views in the current political climate.

Challenging politically correct scientific views, especially those expressed in peer-reviewed journals, involves investment of time and effort and risks to reputation and career. Writing on such issues will generally not be good for one's CV and may result in ostracism by colleagues or even in lost appointments. There may be long waits on editors and frequent rejections of manuscripts.

But such challenges need to come from people who have both the credibility and the standing to make them, and also the courage to stick their heads above the parapet.


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