British Doctors Study

The British Doctors' Study was a prospective cohort study which ran from 1951 to 2001, and in 1956 provided convincing statistical proof that tobacco smoking increased the risk of lung cancer. Although there had been suspicions of a link between smoking and various diseases, the evidence for this link had been largely circumstantial. In fact, smoking had been advertised as "healthy" for many years, and there had been no clear explanation why rates of lung cancer had soared. To further investigate the link, the Medical Research Council (MRC) instructed its Statistical Research Unit (later the Oxford-based Clinical Trial Service Unit) to conduct a prospective study into the link. This approach to medical questions was fairly new: in the 1954 "Preliminary report", the researchers felt it necessary to offer a definition of the prospective principle. The study, when it was published in 1956, heralded a new type of scientific research, showed the relevance of epidemiology and medical statistics in questions of public health, and vitally linked tobacco smoking to a number of serious diseases. In October 1951, the researchers wrote to all registered physicians in the United Kingdom, and obtained responses in two-thirds, 40,701 of them. No further cohorts were recruited. Because of the limited sample size females were excluded from most analyses and publications focused on the male physicians. The respondents were stratified into decade of birth, sex and their cause-specific mortality, as well as general physical health and current smoking habits, followed up in further questionnaires in 1957, 1966, 1971, 1978, 1991 and finally in 2001. Response rates were quite high, making appropriate statistical analyses possible. The result was, that both lung cancer and "coronary thrombosis" (the then-prevalent term for myocardial infarction, now commonly referred to as "heart attack") occurred markedly more often in smokers. In the follow-up reports, published every ten years, more information became available.