Link between smoking and lung cancer

It seems obvious now that smoking is bad for you. But, back in the first half of the last century, things were different. Medical textbooks were largely empty on the subject, and smoking was often seen as part of growing up.

Alfred McTear, who died in 1993 of lung cancer at the age of 48, smoked 60 cigarettes a day. At the time of his death, he was in the process of suing Imperial Tobacco for £500, 000, arguing that he was unaware of the risks when he began smoking. His widow, Margaret, continued the case after her husband's death but, on Tuesday, the courts threw out their case.

Alfred McTear's objections are not as outlandish as they might seem. He started smoking in 1964 and, according to Jean King, director of tobacco control at Cancer Research UK, the seminal document that linked lung cancer to tobacco and demanded action from government was published only two years before by the Royal College of Physicians. And it took time before its effects were widely felt.

Evidence had been gathering for more than a decade beforehand. In 1949, Richard Doll, a researcher working for the Medical Research Council, and Bradford Hill, an epidemiologist at the London School of Hygiene, began looking at lung cancer patients in London hospitals. The patients were asked about family history, diet and previous diseases. In 649 cases of lung cancer, two were non-smokers. Doll immediately gave up his own five cigarettes a day habit.

Doll and Hill extended their research to Cambridge, Bristol and Leeds and, after speaking to some 5, 000 people, found the same results.

In 1951, the researchers wrote to 59, 600 doctors and asked about their smoking habits. They kept a watch on the doctors' health and published the results in 1954 in a paper now deemed so important that the British Medical Journal reprinted the first page last June, 50 years after the original report.

Doll and Hill followed up their work and, by 1956, the link was incontrovertible: more than 200 heavy smokers had died in a four-year period while the incidence among non-smokers was negligible.

After the Royal College's recommendations in 1962 - restriction of advertising; higher taxation; restrictions on sales to children and on smoking in public places; information on tar and nicotine content - cigarette sales fell for the first time in a decade.

King says the ruling in the McTears' case was disappointing. "It is time we stopped blaming smokers for becoming addicted to tobacco and started blaming the tobacco companies that actively promote their products. When young people start smoking they do not think about the risks associated with cigarettes. By the time they do realise, it's too late and they're hooked."