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Finding a connection between smoking and lung cancer
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Medicine Through Time – Smoking and Lung Cancer, 1945-2015
In this course, Professor Virginia Berridge (LSHTM) examines the history of the connection between smoking and lung cancer. We start by looking at when the connection was discovered and how this linked to the sweeping changes occurring in public health in the 1940s and 1950s. We’ll then look at why people did not accept the evidence on smoking and lung cancer. The next module will examine how the issue finally got on the policy agenda from the early 1960s. The penultimate module will look closely at the health education campaigns on smoking and how effective these were. Finally, we’ll look at later developments, such as passive smoking and e-cigarettes.
Finding a connection between smoking and lung cancer
We start by looking at when the connection between smoking and lung cancer was discovered. This was linked to the sweeping changes that were occurring in public health in 1940s and 1950s.
Hello, I'm Professor Virginia Berridge,
00:00:05and I'm professor of history and health policy
00:00:08at the London School of Hygiene and Tropical Medicine.
00:00:11This is, of course, about medicine in modern Britain,
00:00:15and
00:00:19I'm going to be looking at the discovery
00:00:20of the connection between smoking and lung cancer.
00:00:22So I'm going to talk about changes which took place in public health in the 19 forties
00:00:26and where the smoking and lung cancer research fitted into that.
00:00:33Then I'm going to talk about why politicians and
00:00:37the public didn't accept that connection at first,
00:00:40um, and how it did eventually get on the policy agenda. How that happened,
00:00:45then I'm going to look at some of the issues around health, education
00:00:52and public information films which were produced to
00:00:57inform the public about the dangers of smoking.
00:01:02And finally,
00:01:05I'm going to look at some changes which have happened in
00:01:06the smoking and health field since the 19 sixties and seventies.
00:01:11Look at things like passive smoking
00:01:15and the arrival of e cigarettes.
00:01:18Well, um,
00:01:22looking at public health in the 19 forties
00:01:25and how the smoking and lung cancer research fitted in
00:01:28in 1950 the British Medical Research Council published a study which
00:01:33showed that there was an association between smoking and lung cancer.
00:01:39So I'm going to talk about how that study came to be carried out,
00:01:45who the researchers were
00:01:48and how this fitted into what was happening to
00:01:50public health at the time and health services.
00:01:53Um, so let's start with public health and how it was changing.
00:01:57Um, in the 19 forties and 19 fifties
00:02:02in the 19th century,
00:02:06public health had focused very much on epidemic disease
00:02:08and the impact of epidemic disease on society.
00:02:12Diseases like cholera, Um, and then, in the 20th century, diptheria,
00:02:16scarlet fever, tuberculosis.
00:02:22So epidemic disease had been what public health was all about.
00:02:25But then, by the time of the Second World War,
00:02:29um, epidemic disease was no longer as important as it had been.
00:02:33And what was happening was something called an epidemiological transition.
00:02:38A transition in the sort of disease that was happening in society.
00:02:43And this was away from epidemic disease, um,
00:02:48and towards things which were called chronic diseases, diseases like cancer,
00:02:52heart disease,
00:02:59the sort of things that were more used to looking at in present day society,
00:03:00and at the same time as this was happening. Um, public health, Um, as a profession.
00:03:06As a service, um, was losing the place which it used to have public health doctors.
00:03:12Medical officers of health had been running health services at the local level.
00:03:20But in 1948
00:03:26the NHS was created
00:03:29and that was not based on public health.
00:03:31It was based on hospitals and the role of general practitioners GPS.
00:03:33So public health was very much something which was, um, in limbo, really.
00:03:39In the 19 forties, it needed to find itself a new role,
00:03:45and that new role came through looking at chronic disease
00:03:49and looking at things like smoking and lung cancer.
00:03:54So this is where the smoking and lung cancer
00:03:57research came in.
00:04:01The research was carried out for the MRC by two
00:04:04researchers at the London School of Hygiene and Tropical Medicine,
00:04:08which is the institution where I'm based.
00:04:12These researchers were Sir Austin Bradford Hill, who was professor of statistics,
00:04:14and Dr Richard Doll, who was an epidemiologist,
00:04:20a scientist who specialises in disease, and it's incidents in society
00:04:24The Medical Research Council had been worried about
00:04:32the rise in cases of lung cancer.
00:04:35But smoking wasn't considered the prime factor at the time the research started.
00:04:37It was just included among a number of other issues which were being looked at
00:04:42and many years later, uh Dole, who became Sir Richard Doll,
00:04:49a very eminent scientist.
00:04:53He was interviewed about this research and this is what he said,
00:04:55he said. We began our study without any expectation
00:05:00that tobacco was likely to be an important cause of the disease.
00:05:04And we included questions about its use,
00:05:08primarily because the consumption had cigarette of cigarettes had increased at a
00:05:11possibly appropriate interval before the increase
00:05:16in mortality began to be recorded.
00:05:20For my part, he said, I suspected that if we could find a cause,
00:05:23it was most likely to be something to do with motor cars
00:05:27and the towering of the roads.
00:05:31So the scientists set out not expecting
00:05:33smoking to be associated very much at all.
00:05:36So it was quite a surprise when they found that it was
00:05:40and these results were published in the British Medical Journal in 1950
00:05:43and concluded there was what they called a real
00:05:49association between smoking and cancer of the lung.
00:05:51There have been similar work going on in the United
00:05:57States by two researchers over their window and Graham.
00:06:00And they published it just before Dahlin Hill.
00:06:05Um, and in fact, the connection had been identified even earlier,
00:06:07before World War Two by researchers in Nazi Germany who
00:06:12were very keen on these kind of public health issues,
00:06:17and also by an American statistician who was working for insurance companies.
00:06:21But its Doll and Hill's research, I think, which is most remembered today
00:06:26and later research went on for many, many years into smoking, Um, and lung cancer.
00:06:32A big study of British doctors began in the early 19 fifties
00:06:39and that continued for over 50 years till 2004.
00:06:44Um, it was only completed, uh, the year before Sir Richard Doll died,
00:06:49and it looked at the smoking habits of British doctors and showed how,
00:06:54as they gave up, uh, the mortality rate reduced.
00:06:58Um, so smoking was very much the key issue, Um, for this new style of public health,
00:07:03which came on the agenda in the post war years
00:07:10
Cite this Lecture
APA style
Berridge, V. (2021, September 08). Medicine Through Time – Smoking and Lung Cancer, 1945-2015 - Finding a connection between smoking and lung cancer [Video]. MASSOLIT. https://massolit.io/courses/medicine-through-time-smoking-and-lung-cancer
MLA style
Berridge, V. "Medicine Through Time – Smoking and Lung Cancer, 1945-2015 – Finding a connection between smoking and lung cancer." MASSOLIT, uploaded by MASSOLIT, 08 Sep 2021, https://massolit.io/courses/medicine-through-time-smoking-and-lung-cancer