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In the early 1900's, when the habit of smoking was gaining popularity in England, it was not known that smoking caused lung cancer. Lung cancer was so widespread in 1930's, that it was the second most frequent cause of death, exceeded only by death in military action, because of World Wars 1 and 2.
Richard Doll, and Bradford Hill were epidemiologists for the Medical Research Council (MRC). The MRC was concerned about lung cancer rates, so they asked Doll and Hill to perform an epidemiological study.
Doll and Hill went to multiple hospitals in London and visited patients, who had been diagnosed with or suspected of having lung cancer, giving them a questionnaire (asking about family history, diet, previous diseases, and if they had worked on roads). Doll had a suspicion that lung cancer was caused by tarring of roads, but the most believed cause at time was atmospheric pollution. The results showed that if a patient was a heavy smoker, their diagnosis would not change. If a patient was a nonsmoker, the diagnosis almost always changed. The numbers were astonishing: in the 649 cases of lung cancer that they studied, there were only two non-smokers. They were sure that smoking was not just related to lung cancer - it was the cause of lung cancer.
Even though the results were clear, nobody paid much attention to their study. The MRC suggested that their results might have only applied to London, so Doll and Hill conducted the same type of survey in 4 other neighboring cities, in a bigger, wider survey. The results were the same, but they still did not get much attention.
Doll and Hill decided to do a new study, but this time they studied lung cancer in doctors. They wrote to more than 40,000 doctors, asking about their smoking habits. Their health was monitored over the next few following years (1951-1954). The results were still the same (smoking caused lung cancer), and this time, attention was given to the study, because they had studied doctors, who conveyed the results of the study to their patients.
