Sir Richard Doll (1912–2005) was a trailblazing British epidemiologist whose research transformed our understanding of occupational health risks. Renowned for proving the link between smoking and lung cancer, Doll also conducted the first major statistical study connecting asbestos exposure to lung cancer. His 1955 study became a cornerstone for asbestos litigation, public health policies, and workplace safety regulations, shaping how we address industrial hazards.
In the early 20th century, industrial health risks were often ignored or hidden by companies. By the 1950s, evidence was mounting that asbestos, widely used in manufacturing, could cause lung cancer. Reports from England, Germany, and the United States had noted cases among asbestos workers, and a 1943 German consensus declared the link causal. However, industry-sponsored studies showing lung tumors in asbestos-exposed mice were kept secret, as were worker mortality records.
In 1953, Turner Brothers Asbestos (TBA), a subsidiary of Turner & Newall (T&N), approached Richard Doll to analyze mortality data from their Rochdale factory. T&N hoped Doll would confirm that the 1931 (updated in 1932) asbestos regulations had eliminated health risks. Instead, Doll’s findings, published in 1955 in the British Journal of Industrial Medicine, provided undeniable evidence that asbestos exposure significantly increased lung cancer risk, marking a pivotal moment in occupational health research.
Doll’s 1955 study examined mortality records of male workers at TBA’s Rochdale factory who had worked in high-exposure “scheduled” areas for 20 or more years. Among 113 such workers, 11 died of lung cancer—a rate 10 times higher than the general population. The study also found that the average time from first exposure to death from lung cancer was over 29 years, underscoring the disease’s long latency period.
Doll initially concluded that while dust control measures introduced in 1932 had likely reduced risks, there was not enough data to confirm the risk was fully eliminated. In the published version, he softened this stance, stating:
“The risk has become progressively less as the duration of employment under the old dusty conditions has decreased. It is unlikely that the risk is now large, but insufficient data are available to determine whether it has been completely eliminated.”
This change suggested that post-1932 conditions were safer, though the limited follow-up period (less than 22 years) made it hard to assess the regulations’ true impact.
T&N was alarmed by Doll’s findings and tried to block the study’s publication. Internal documents show they consulted lawyers about legal action against Doll but decided against it. They sent their medical officer, Dr. John Knox, who had co-authored the draft, to persuade Doll not to publish. T&N executives also invited Doll to dinner, arguing that the study could harm a “major industry.”
Despite this pressure, Doll published the study, though he agreed to tone down some conclusions. For example, he replaced a sentence noting the lack of evidence for eliminated risk with one suggesting the risk had likely decreased. One of these revised sentences was even used verbatim in a British Medical Journal editorial.
Years later, in sworn statements for T&N and Johns-Manville (another asbestos firm), Doll claimed the publication delay was due to efforts to reinstate Knox as co-author, a claim contradicted by internal correspondence showing T&N’s suppression attempts.
Doll’s study was a game-changer, providing the first large-scale epidemiological evidence of asbestos’s cancer-causing potential. It became a key reference in lawsuits, regulatory reviews, and labor inquiries, shifting the burden of proof for asbestos-related illnesses from speculation to science.
However, Doll maintained ties with the asbestos industry. In 1965 and 1968, he co-authored studies with Knox suggesting the 1931 regulations might have “completely eliminated” the cancer risk. Later data through 1974, showing continued excess lung cancer among long-term workers, challenged this view. In the 1980s, when colleague Julian Peto raised concerns about asbestos exposure limits, Doll downplayed the risks, comparing the chance of occupational cancer to a 40-to-1 longshot bet at the races.
Doll’s 1955 study is a landmark in occupational health, showing how epidemiology can hold industries accountable for hidden harms. Yet, its impact was slowed by systemic issues. Media coverage was limited, with journals like The Lancet and British Medical Journal noting the findings but not pushing for urgent action. Legislation to control asbestos-related lung cancer took 20 years, and compensation for affected workers took 25 years, often with strict limits.
Today, the study is a case study in public health education, illustrating both scientific courage and the challenges of industry influence. It highlights the need for transparency, advocacy, and the use of imperfect data to protect public health, lessons that resonate in debates over corporate accountability.
Doll’s 1955 paper analyzed 113 long-term asbestos workers and found a significant excess of lung cancer. Key points include:
It confirmed asbestos as a major lung cancer risk, supporting global scientific consensus.
It provided critical evidence for legal and regulatory reforms.
It faced strong industry resistance, with T&N attempting to suppress or weaken its findings.
This case remains a powerful example of the tension between scientific integrity and corporate interests.
Aspect | Lesson |
|---|---|
Scientific Courage | Doll’s persistence in publishing despite pressure shows the value of integrity. |
Industry Influence | T&N’s actions highlight how companies can try to shape scientific narratives. |
Slow Response | Delayed legislation reflects economic and political barriers to health reforms. |
Data Advocacy | Using imperfect data, as Doll did, can drive meaningful public health action. |
Richard Doll’s 1955 study was a groundbreaking achievement that exposed the dangers of asbestos and paved the way for safer workplaces. However, his later industry ties and softened statements complicate his legacy, raising questions about scientific independence. The study’s story is a reminder of the power of evidence-based research and the ongoing need to balance public health with corporate interests.
Doll, Richard. Mortality from lung cancer in asbestos workers. British Journal of Industrial Medicine, 1955, 12(2), 81–86. https://doi.org/10.1136/oem.12.2.81
Castleman, Barry I. Re: Doll’s 1955 Study on Cancer from Asbestos. American Journal of Industrial Medicine, 2001, 39(3), 237–240. https://doi.org/10.1002/1097-0274(200103)39:3<237::AID-AJIM1023>3.0.CO;2-8
Greenberg, Morris. A Study of Lung Cancer Mortality in Asbestos Workers: Doll, 1955. American Journal of Industrial Medicine, 1999, 36(3), 331–347. https://doi.org/10.1002/(SICI)1097-0274(199909)36:3<331::AID-AJIM12>3.0.CO;2-1
