Injurywatch discovers secret payments for anti-smoking cancer-link Oxford academic Sir Richard Doll by asbestos and chemical industry

injurywatch has found a series of secret payments from environmental polluters to the leading Oxford University cancer researcher Sir Richard Doll may have compromised his integrity. By choosing the epidemiological evidence to seemingly omit higher risk groups, adequate health warnings may have failed to have been given. Doll's work certainly seems to have protected the interests of his now proven paymasters in the chemical and asbestos industries and may have led to inadequate protection or warnings for millions of people worldwide.

Cancer research hero Sir Richard Doll was lauded for being instrumental in discovering the connection between smoking and lung cancer. With a knighthood, an Oxford University building devoted to cancer research named after him within his lifetime, freedom of the city of Oxford, a seemingly unassailable reputation and international awards falling to him, Doll dominated the UK cancer epidemiology scene for more than 50 years.

But two scientific papers, “The Causes of Cancer: Quantitative Estimates of Avoidable Risks of Cancer in the United States Today,” (Journal of the National Cancer Institute 66 (1981) which he wrote with Professor Richard Peto and Effects of exposure to vinyl chloride. An assessment of the evidence. Scand J Work Environ Health 14(2):61-78. Doll R. 1988. which he wrote alone have long been regarded by leading scientists in Sir Richard Doll's field as using evidence which might be deemed to massively underplay the risks by using parameters which are seemingly obviously wrong.

Perversely the 1981 US study which was supposed to cover all environmental and work-related cancers, Doll specifically excluded African Americans and anyone aged over 60 from the statistics when exposure would be expected to be higher among blue collar workers and the poor where African Americans might be deemed to be over-represented because of insurance claims and the locations they live and work in. Similarly the cancer incidence would certainly be expected to be highest in the old.

In Doll's 1998 study into vinyl chloride the same policy was followed: Older workers (with heavy exposure) and plants regarded as particularly dangerous seem to have been excluded, while young workers (with little/no exposure) were included, leading to downplayment of the risk.

Now documents obtained by injurywatch from Doll's personal archive reveal that Doll personally, and Green College, the Oxford college he founded and where he installed his wife as warden, were receiving substantial payments from variously Turner and Newall, the notorious asbestos company, Monsanto the American chemicals giant, and from the industry body, the Chemical Manufacturers Association.


Asbestos scandal

Sir Richard Doll: the industry man?

•In 1976, in spite of well-documented concerns on the risks of fluoridation of drinking water with industrial wastes, Doll declared that it was "unethical" not to do so.
•In his 1981 report on causes of cancer mortality in the U.S, in the absence of any scientific evidence, Doll trivialized the role of environmental and occupational causes of cancer. He claimed that occupation was responsible for 4% of mortality rather than at least 20%, as previously admitted by consultants to the American Industrial Health Council of the Chemical Manufacturer's Association.
•In 1982, as a longstanding consultant to Turner & Newall (T&N), the leading U.K. asbestos corporation, Doll gave a speech to workers at one of their largest plants. This speech was in response to a TV exposé that forced the Government to reduce occupational exposure limits to an allegedly low level (1f/cc). Doll reassured the workers that the new exposure limit would reduce their lifetime risk of dying from cancer to "a pretty outside chance" of 1 in 40 (2.5%). This, however, is an extremely high risk. Doll also declined to testify on behalf of dying plaintiffs or their bereaved families in civil litigation against asbestos industries. Furthermore, Doll filed a sworn statement in U.S. courts in support of T & N
•In 1983, in support of U.S. and U.K. petrochemical companies, Doll claimed that lead in petroleum vehicle exhaust was not correlated with increased blood lead levels and learning disabilities in children. Doll's research had been generously funded by General Motors.
•In 1985, The U.K. Society for the Prevention of Asbestos and Industrial Disease (SPAID) criticized Doll for manipulating scientific information in order to assure us that only 1/100,000 people working in an office containing undamaged asbestos risked disease and death.

•In 1985, Doll wrote to the judge of an Australian Royal Commission, investigating claims of veterans who had developed cancer following exposure to the herbicide Agent Orange in Vietnam, in strong support of the defence claims of its major manufacturer, Monsanto. He stated that, "TCDD (dioxin), which has been postulated to be a dangerous contaminant of the herbicide, is at the most, only weakly and inconsistently carcinogenic in animal experiments". In fact, dioxin is the most potent known tested carcinogen, apart from confirmatory epidemiological evidence. Doll's defense, resulting in denial of the veterans' claims, was publicized by Monsanto in full-page advertisements in worldwide major newspapers. Injurywatch has established payments of $1000 a day (increased to $1500 a day in 1986) were made by Monsanto to Doll for more than thirty years.

•In 1987, Doll dismissed evidence of childhood leukemia clusters near 15 U.K. nuclear power plants. Faced with evidence of a 21% excess of lymphoid leukemia in children and young adults living within ten miles of these plants, Doll advanced the novel hypothesis that "over clean" homes of nuclear workers rendered their children susceptible to unidentified leukemia viruses.
•In 1988, Doll claimed that the excess mortality from leukemia and multiple myeloma among serviceman exposed to radiation from atom bomb tests was a "statistical quirk". Doll revisited this study in 1993 and eliminated the majority of cases which developed within two years of exposure, claiming that such short latency disproved any possible causal relation.
•In a 1988 review, on behalf of the U.S. Chemical Manufacturer's Association, Doll claimed that there was no significant evidence relating occupational exposure to vinyl chloride and brain cancer (62). However, this claim was based on an aggregation of several studies, in some of which the evidence for such association was statistically significant.
•In a 1992 letter to a major U.K. newspaper, Doll pleaded the public to trust industry and scientists and to ignore warnings by the "large and powerful anti-science mafia" of risks from dietary residues of carcinogenic pesticides.
•In a January 2000 deposition, Doll admitted to donations from the chemical industry to Green College, Oxford, where he had been the presidential "Warden". He also admitted that the largest "charitable" donation (£50,000) came from Turner & Newall, U.K.'s leading asbestos multinational corporation, "in recognition of all the work I had done for them."Documents obtained by injurywatch document a single payment from Turner and Newall to Green College of £50,000. Other documents show Doll enjoyed a personal financial relationship with Turner and Newall which lasted more than thirty years.

In 1982, following a television exposé which laid bare the dangers of asbestos, Doll was wheeled out by T&N at factory meetings with workers across the UK to reassure their staff that their asbestos exposure danger was what he termed "a pretty outside chance."

In fact using Turner and Newall/Doll's own figures at the time, the cancer risk incidence was 1 in 40 (2.5%) which is very high. But now the incidence has been shown to be much higher. In the UK, between 1900 and 2000 people die each year from mesothlioma, a cancer solely caused by exposure to asbestos fibre. The figure is doubled by other lung cancer deaths caused by asbestos. The annual incidence is expected to escalate with the yearly death rate rising until at least 2012.

Perhaps because of his financial relationship with Turner and Newall, Doll consistently refused to testify on behalf of dying asbestos plaintiffs or their bereaved families in civil litigation against asbestos industries and indeed filed a sworn statement in U.S. courts in support of T & N.

Indeed Doll expressed that the £50,000 payment was in "gratitude from Turner and Newall for work I had undertaken on their behalf."

A year after Sir Richard Doll's death and only after a five year delay in which many potential claimants died, a settlement was agreed on thousands of Turner and Newall claims earlier in 2006. Many people with a valid claim against the company will recieve as little as 10-20p in the pound.

Furthermore injurywatch has discovered that Sir Richard Doll was receiving $1000 a day from US chemical giant Monsanto from 1976 which was increased to $1500 a day (£1000 a day at the then exchange rates) in 1986. Other documents reveal that Doll was paid this fee by Monsanto until at least 2002.

The Health and Safety Executive still quotes the Doll/Peto 1981 study as the basis for their "current best estimate of the proportion of cancer deaths in Great Britain due to occupational exposures over the last few decades as 4%, with an associated uncertainty range of 2% to 8%1 and only now is work underway to seek to update it.

Doll/Peto was viewed as groundbreaking at the time in that it seemed to prove that environmental and occupational causes of cancer represented only 4% of total cancer mortality, when even consultants to the American Chemical Council (previously known as the Chemical Manufacturer's Association) had admitted that the incidence was probably 20%.

A further Doll article in 1988 Effects of Exposure to Vinyl Chloride, reported that there was no significant risk associated with vinyl chloride other than in the liver. It made no reference to payments he was receiving at the time from the Chemical companies but has since been frequently quoted in industry documentation. According to the ACC in 2001 in reference to the paper: "The world's leading researchers have studied vinyl chloride and brain cancer and concluded that the evidence does not support a link between brain cancer and vinyl chloride." They did not add that the article had been reviewed by Ted Torkelson, medical advisor to Dow and Geoffrey Paddle, another chemical industry funded medic.

"At the time many scientists were suspicious that the reports seemed to be too pro-Industry" says Swedish cancer expert Dr Lennart Hardell ". Many wondered if he had close links with Industry and were concerned with some of his findings. Because his conclusions formed the basis for health and safety guidelines and legislation many people have died unnecessarily in my opinion"

Maybe people like the workers at the Vinatex PVC plant in Derbyshire. A joint venture between US company Conoco and a now defunct British company called Staveley Chemicals Ltd it opened in 1969 and converted Vinyl Chloride Monomer to PVC.

By 1984 when the company went out of business dozens of Vinatex workers exposed to Vinyl Chloride were either dead or dying. While Doll concluded there was no significant risk associated with vinyl chloride the reality was quite different. Research by Trade Unions in Derbyshire estimate that about 40% of the 280 workers at the factory during its fifteen year history are now dead, many from rare forms of cancer.

It is now emerged that the cost of Doll's 1988 review into the effects of Vinyl Chloride had been paid by the Chemical Manufacturers Association, with a significant part of the fee coming from ICI, then the UK's largest vinyl chloride producer.

Significantly both Doll's 1981 research with Peto and his own work in 1988 continues to shape the cancer establishments' view: the now somewhat jaded advertising slogan "Let's cure cancer in the Eighties" was the ultimate embodiment of the Doll legacy which has seen millions of pounds of taxpayers money and charitable donations poured into seeking cancer "cures" when only minimal funding has been spent on raising awareness of the need to prevent environmental and workplace exposure.

Sir Richard Doll was closely connected with both the Imperial Cancer Research Fund and Cancer Rearch and indeed the two, now merged, have located their Cancer Research UK Epidemiology Unit (CEU) along side part of the Department of Public Health and the University’s Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU) in the Richard Doll Building.

On the basis of Doll/Peto's 4% figure the number of deaths attributable to occupational/environmental cancer in the UK would be around 6,000 - a significant number at double the number of annual deaths on the road and twenty times those killed in workpace accidents. But from the time of the release of the original paper the research appeared low to other researchers in the area.

Doll/Peto admitted their researches were only based on best guesses, noting that it was "impossible to make any precise attempt at the proportion of cancers that are attributable to hazards at work."

• Many cancers were missed entirely from their analysis or designated not work-related, including melanoma and breast cancer, the most common cancer among women.

• Overall risks to women would be under-estimated because of their relatively late entry to the industrial workforce in large numbers.

• Prostate cancer, the most prevalent cancer among men, was only considered a risk for cadmium-exposed workers. Studies have linked prostate cancer to exposure to pesticides, metalworking fluids and other occupational exposures.

• The study only included 16 substances or industries thought to be carcinogenic to humans, a small fraction the true number.

• The report only considered mortality (deaths) and not morbidity (number of cases), which is a considerably higher figure – in the UK even Doll/Peto’s 4 per cent figure would indicate around 11,000 cases a year.

• Excluding cancers in those over 65 years of age drastically top-sliced the number of cancers considered, this measure alone possibly reducing the work cancer toll to less than half the true figure.

• Cancers in those working in small industries were excluded.

• The analysis excluded African-Americans, a group over-represented in high risk jobs and with higher and increasing cancer rates.

• The analysis missed out those with indirect exposures to carcinogens, for example maintenance workers in contact with asbestos. These jobs are now among the highest risk for asbestos cancer in the UK.

• The study only considered human evidence – but for some substances and industries in the rapidly expanding job market the studies hadn’t be done, and for many newer exposures and industries conclusive human evidence just wasn’t yet available, but there was strong suggestive evidence from the more readily available toxicological and animal studies. As a result many cancers caused or related to workplace exposures would have switched columns to lifestyle, smoking or other causation categories.• The report acknowledged but failed to account for the interaction of exposures, for example the greatly increased risk of lung cancer in smokers who are also exposed to asbestos. Most cancers are likely to result from a combination of exposures or circumstances.

• Non-Hodgkin’s lymphoma, thought to be one of the most common work-related cancers, was classified as having only a slight risk association impacting on relatively few workers.

Excerpted from Stop Cancer Before It Starts: How to Win the War On Cancer by Samuel S. Epstein, Ph.D. 2003,
Professor emeritus, Environmental and Occupational Medicine UIC

But from the outset researchers expressed surprise at some of the methodology used in the study.

Researchers noted that the Doll/Peto estimates were based on mortality (deaths), rather than morbidity (diagnosis) and were limited to analysis of those under 65 when cancer is primarily a disease of the old (recent figures showing that cancer deaths under 60 amounted to only 26% of the total). The long latency of several environmental diseases - most notably the asbestos cancer mesothelioma - which can take 50 years to develop were thus largely excluded from the study. It currently kills 1,900 people a year in the UK - almost a third of Doll/Peto's estimate of likely total cancer deaths each year.

Furthermore Doll/Peto only took into account 16 carcinogenic substances when the International Agency on Research on Cancer classifies 89 substances as definite carcinogens, 64 as probable carcinogens and 264 as possible human carcinogens.

The study excluded African Americans from analysis, despite their being over-represented in hazardous trades, and women were excluded by concentrating on male career sectors, when increasingly women were present in the workplace.

Dr James Brophy, Executive Director of OHCOW, a Canadian occupational cancer clinic, sais of the study "Companies were ecstatic because it posed the whole cancer thing politically as a matter of lifestyle. That had consequences for prevention in that it effectively ended any chance of a structured and well resourced strategy to combat cancer worldwide."

Another major review of the environmental and occupational causes of cancer produced in 2005 concluded "it is difficult to estimate the difficulty of Doll and Peto's views but their 1981 article had been cited inover 440 other scientific articles by 2004. More importantly, it has been cited repeatedly by commentators who argue that 'cleaning up the environment' is not going to make much difference in cancer rates."2

The study, co-authored by Dr Richard Clapp of the University of Boston Medical School estimates that the occupational cancer incidence figure given by Doll/Peto probably underestimates the real figure by a factor of between 2 and 4, suggesting the real figure for occupational cancer is between 8% and 16%.

Occupational Cancer
(cases per year GB) HSE/ Doll-Peto

Other study estimates

% of all cancers
range 2-8%
range 8-16%

Lower/upper estimates

New cancer cases
Lower/upper estimates

Dr Clapp says “I believe occupational lung cancer is the leading work-related cancer followed by bladder cancer, non-Hodgkin's lymphoma, and leukaemia. Our review paper gives the scientific studies which back this up, along with the various exposures that cause these cancers.

“For example, for lung cancer, we review the evidence that metals, solvents, ionising radiation, reactive chemicals like BCME, environmental tobacco smoke, air pollution, polycyclic aromatic hydrocarbons, pesticides and fibres like asbestos and silica cause lung cancer. This adds up to a substantial burden, and some of these exposures - like asbestos and ionising radiation in underground miners - act synergistically with cigarette smoke and vastly increase lung cancer risk.”

He added “there is no way to put a precise number on this because cancer is such a ‘multifactorial’ disease and even small exposures can be a critical piece of the pie when lots of people are exposed. The reason we have so much cancer is because we are exposed to so many carcinogens; we need to turn that around both by producing and using fewer carcinogenic materials and not exposing workers and others to them.”

Dr Samuel Epstein, emeritus professor of environmental and occupational medicine at the University of Illinois at Chicago and Chairman of the US based Cancer Prevention Coalition, puts the occupational figure in the Clapp range, saying “based on minimal estimates” occupational carcinogenic exposures are responsible for 10 per cent of overall cancer mortality adding that for certain occupational exposures, mortality rates are much higher.

He said “lifestyle academics” including Sir Richard Doll “have consciously or unconsciously become the well-touted and enthusiastic mouthpiece for industry interests, urging regulatory inaction and public complacency”, adding the “puristic pretensions of ‘the lifestylers’ for critical objectivity are only exceeded by their apparent indifference to or rejection of a steadily accumulating body of information on the permeation of the environment and workplace with industrial carcinogens and the impact of such involuntary exposures on human health.”

According to Epstein, any adherence to the Doll/Peto figures is folly because their paper “excluded from analysis people over the age of 65 and blacks, just those groups with the highest and increasing cancer mortality rates. Not content with such manipulation, they claimed that occupation was only responsible for 4 per cent of all cancers, without apparent consideration of a wide range of recent studies dealing with the carcinogenic effects of such exposures… The wild 4 per cent guess was matched by ‘guesstimates’ that diet was determinant in some 35 per cent of all cancers.”

see: big academic guns rolled-out again

HSE's reaction

More than 35 years on, and despite a plethora of scientific studies showing the extent of hazardous environmental and chemical cancer risks, HSE still broadly accept the Doll/Peto findings and have failed to push the danger in the workplace message.

Occupational cancer remains a low priority, a position in the nation’s public health priorities that can be traced back to Doll/Peto. And it is a low priority also reflected in the approach of health organisations other than the Health and Safety Executive. Cancer Research UK notes on its website: “Most known occupational carcinogens are either banned or well regulated within the UK and the majority of occupation related cancers diagnosed in the UK today are the result of people being exposed more than ten years ago”.

In fact, regulation has not been a cancer cure. Unlike the case of infectious diseases, where a response is frequently swift and draconian, there are typically long delays between the identification of a carcinogenic agent and adoption of adequate measures of prevention. Even then, measures are usually late and incomplete, and will leave a generation to await their fate as a result of prior exposures. Asbestos and ionising radiation are two clear examples. Contrast the decades of occupational health inaction to the foot-and-mouth disease outbreak in 2001, where the army was deployed and a national campaign was mobilised to deal with a non-fatal animal disease because it posed a commercial but absolutely no human health risk.

Instead, the assumption that it is “the dose the makes the poison” has been behind a piecemeal and slow, incremental reduction in workplace exposure limits, for workplaces where carcinogens are handled, quite literally, in industrial quantities. For many substances this presumed dose-response relationship is dangerous flawed.

The asbestos related cancer mesothelioma is a case in point, occurring now in people who had only incidental exposure to asbestos. Only a handful of workplace substances have ever been banned on grounds of carcinogenicity. A UK ban on asbestos - the most prolific ever industrial killer which may claim 10 million lives before it is banned worldwide - only took effect in 1999. An early, precautionary move to safer alternatives would have saved millions. Commercial interests ensured that did not happen.

Injurywatch's reaction

• Occupational cancer prevention should be recognised by the government as a major public health priority and should be allocated resources accordingly.

• A national occupational cancer and carcinogens awareness campaign should be launched as a matter of urgency.

• The Health and Safety Executive should convene a tripartite working party, including representatives of unions, health and safety campaign organisations and occupational disease victims’ and advocacy organisations, to review its occupational cancer strategy.

• Wherever possible, IARC Group 1 and Group 2A carcinogens should be targeted for “sunsetting”, a phase out within a designated timeframe, to be replaced by safer alternatives.

• Toxics Use Reduction legislation, already used successful in some US jurisdictions, should be introduced to encourage the use of the safest suitable substances and processes. The precautionary principle should be applied to substances suspected of causing cancer in humans.

• A national system of occupational health records should be developed to ensure adequate recording of workplace exposures and other occupational cancer risk factors. Employers must have a duty to inform any workers of their exposures to known or suspected workplace cancer risks and carcinogens.

• A National Exposure Database should be created.

• The Health and Safety Executive should provide resources for training of union safety reps in “lay epidemiology”, techniques for the early recognition of work-related diseases, including cancer.

• The UK should implement properly the European Union law requiring workers to have access to occupational health services.

• The government Industrial Injuries Benefit Scheme should be revised and extended to include a wider range of occupational cancers in it scope. There should be a consideration of the introduction of a “rebuttal presumption” of work-causation for cancers with an established association with work.




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