Despite falling death rates, we must not be complacent about smoking


In this year’s Harveian Oration at the Royal College of Physicians, Professor Sir Richard Peto, co-director of the Clinical Trial Service Unit (CTSU) at the University of Oxford, said that despite falling death rates from smoking in the UK, we must not be complacent about current smoking rates and continue to press home the message ‘Smoking kills – stopping works’. In terms of saving lives, it is better to have a moderate reduction in a big cause of death than a major reduction in a small cause of death.

The Oration illustrated Sir Richard’s work in both UK and international epidemiology. His key message comes in the year of the 50th anniversary of the RCP’s first report on smoking and health, and the 100th anniversary of the birth of Sir Richard Doll, who with Sir Austin Bradford Hill, first published their studies on the link between smoking and lung cancer in the British Medical Journal in 1950. Sir Richard Peto was for decades a close collaborator with Sir Richard Doll.

Sir Richard said that the UK has gone from having the world’s worst death rate from smoking in 1970, when tobacco accounted for half of all premature deaths among men in the UK, to having the world’s biggest decrease in mortality from smoking by 2010. But, smoking still causes a fifth of all UK deaths in middle age (35-69), which is twice as many as overweight and obesity. Those killed in middle age lose, on average, more than 20 years of life.

However, the good news is that if people stop smoking before they are 40, they avoid more than 90% of their risk of being killed by tobacco. Although those who stop at 40 will always have an excess risk of premature death in comparison to never-smokers, that excess risk would have been ten times larger if they had continued smoking.  And, those who stop before age 30 avoid more than 97% of their risk of being killed by tobacco.

The four corpsemen of the apolcalypse…

In most countries, premature mortality from both communicable and non-communicable diseases is decreasing. The only four causes of death in peacetime that have increased substantially in some major population over the past few decades are smoking (e.g. in China), alcohol (e.g. in Russia), obesity (e.g. in America) and HIV (e.g. in Africa).