Bradford Hill Biographical Outline
Born in London, 8 July 1897, third son of distinguished medical physiologist, Sir Leonard Erskine Hill FRS, Professor of Physiology at The London Hospital.
Attended Chigwell Grammar School (crest above), which was founded in 1629.
During World War I, he enlisted as a pilot in the Royal Naval Air Service (which had been formed in January 1914), but his wartime experiences in Greece came to an end when he became seriously ill with pulmonary tuberculosis whilst travelling to the Dardenelles. In June 1917, he was posted to the Aegean. He journeyed overland via Paris and Rome in crowded wartime trains and arrived for patrol duty a few miles from the Dardanelles. Contracting pulmonary tuberculosis en route he was sent home - to all intents, to die.
However, after two years in hospital, he managed to recover, much to the surprise of his doctors, but his illness prevented him taking up a career in medicine as he had hoped - instead he used his convalescence to take an external, correspondence degree in economics. He graduated in 1922 with a BSc from the University of London.
Supported and encouraged by Major Greenwood (1880-1949), a friend of his father at the London Hospital, who was a medical officer in charge of the statistical division of the MRC’s National Institute for Medical Research at Hampstead. Hill obtained a grant from the Medical Research Council (MRC) to investigate the relatively high mortality rate of young adults in rural Essex. (1) He collected and analysed data on occupational illnesses, an interest in occupational health which was to shape his future career.
Hill carved out a career in medical statistics at the MRC in its Industrial Fatigue Research Board as a statistician. He enrolled on a part-time course in statistics and statistical analysis at University College, London, led by Karl Pearson (1857-1936).
Awarded PhD from University College, London.
Major Greenwood moved to the newly-formed London School of Hygiene and Tropical Medicine (LSHTM) together with his MRC staff. In 1929 they moved to new premises in Keppel Street and here Bradford Hill took on responsibilities which included teaching statistics to medical postgraduates.
Awarded DSc (London).
Major Greenwood appointed Chairman of the University Board of Studies in Hygiene and University Professor of Epidemiology and Vital Statistics at LSHTM. Bradford Hill became Reader in Epidemiology and Vital Statistics at the LSHTM and he taught at the Postgraduate Medical School at Hammersmith in London.
Bradford Hill’s lectures were published as a series of articles in the Lancet and then in book form, Principles of Medical Statistics. (2) The book went through 11 editions during his life-time. He wrote of his lectures, "I deliberately left out the words ‘randomisation’ and ‘random sampling numbers’ at that time, because I was trying to persuade doctors to come into controlled trials in the very simplest form and I might have scared them off. I think the concepts of ‘randomisation’ and ‘random sampling numbers’ are slightly odd to the layman, or for that matter, to the lay doctor, when it comes to statistics. I thought it would be better to get the doctors to walk first, before I tried to get them to run. So I had been thinking about controlled trials for all of those 10 years and hoping for an opportunity that might arise." (3)
1940 - 1942
During these war years he was seconded to the Research and Experiments Departments at the Ministry of Home Security and later to the Medical Directorate of the Royal Air Force.
Succeeded Major Greenwood at the LSHTM as Professor of Medical Statistics, and Honorary Director of the MRC’s Statistical Research Unit, positions he held until 1961.
During the immediate post-war years, the opportunity he sought to conduct controlled trials arose. He conducted two RCTs, one to test the merits of vaccination against whooping cough and the second, to test the value of streptomycin in treating pulmonary tuberculosis.
An MRC Streptomycin in Tuberculosis Trials Committee, chaired by Sir Geoffrey Marshall, began to plan large scale clinical trials of streptomycin in treating tuberculosis. Hill and his research group were able to perform the first randomized clinical trial, in collaboration with Philip D’Arcy Hart and Marc Daniels of the MRC Tuberculosis Research Unit, testing the efficacy of streptomycin in the treatment of pulmonary tuberculosis. (4) The use of randomisation in agricultural experiments had been pioneered by Ronald Aylmer Fisher (1870-1962), a talented evolutionary biologist, geneticist and statistician.
Because Hill's supply of the new antibiotic was extremely limited, and as funding was scarce, only a handful of patients could be given streptomycin. "In that situation I said it would be unethical not to make a randomized clinical trial - the first of its kind." argued Hill. (5)
His partnership with Sir Richard Doll (1912-2005), who was at the time a young doctor working for the MRC, led to pioneering case control studies which established a link between cigarette smoking and lung cancer. First paper published by Sir Richard Doll and Bradford Hill showed lung cancer to be closely related to smoking. (6) Initial response was lukewarm - medical scientists were doubtful and sceptical of the results. One critic of the conclusions and procedures of the smoking/cancer work was Ronald Aylmer Fisher whose criticism appeared in the press and in academic publications.
Bradford Hill’s response was to suggest a prospective study to determine the frequency with which the disease appeared in the future among groups who were already known to be smokers. Bradford Hill designed the prospective study (British Doctors Study) which involved collecting data on the smoking habits and health of over 30,000 British doctors, with Richard Doll providing the clinical knowledge. The resulting studies silenced the earlier criticism. (7,8)
President of the Royal Statistical Society.
Awarded the Gold Medal of the Royal Statistical Society.
Hill made a Fellow of the Royal Society.
Member of Council of the Medical Research Council.
Served as ‘Acting’ Dean, then Dean, of the LSHTM. Bradford Hill later set up a Department of Occupational Health at the LSHTM, which was directed by Richard Schilling.
Awarded the Galen Medal of the Society of Apothecaries.
Retires and is knighted.
Awarded Honorary FRCP and an Honorary Degree from the University of Oxford.
Fellowships of University College London and the London School of Hygiene and Tropical Medicine.
Honorary Fellowships of the Royal College of Physicians, the Faculties of Community Medicine and Occupational Medicine, the Royal Society of Medicine, the American Public Health Association, and the Faculty of Medicine at the University of Chile.
Awarded an Honorary Degree from the University of Edinburgh.
Interviewed by Max Blythe, on 26 March in Ambleside, Cumbria, for the Medical Science Video Archive of the Royal College of Physicians and Oxford Brookes University.
Dies on April 18, 1991. Up until the time of his death he continued to collect a 100%, war-related, disability pension from the British Government.
On Hill’s death, Peter Armitage, who succeeded him at the LSHTM, wrote, " to anyone involved in medical statistics, epidemiology or public health, Bradford Hill was quite simply the world’s leading medical statistician." (9)
(The prospective trial has continued with the initial respondents in 1951, followed-up with further questionnaires in 1957, 1966, 1971, 1978, 1991 and finally in 2001.)
A number of papers were published by the Imperial Cancer Research Foundations’ Cancer Studies Unit at Oxford, with Sir Richard Doll still acting as senior author, working with Richard Peto, Professor of Medical Statistics and Epidemiology at Oxford (10,11)
Response rates were high and, in the follow-up reports, statistical analyses revealed that both lung cancer and coronary thrombosis occurred more markedly in smokers. Final follow-up report in 2004 (12) concluded that smoking decreases life span by up to 10 years and that more than 50% of smokers die of a smoking-related disease.
The first Bradford Hill Medal is awarded to Professor M.J. Gardner (posthumously). The Medal is established in Austin Bradford Hill’s memory and is awarded every three years to a Fellow of the Royal Statistical Society who is considered to have made outstanding or influential contributions to the development of medical statistics.
(1) Hill A.B. Internal migration and its effects upon the death rates, with special reference to the county of Essex. Medical Research Council Special Report. Series No. 95. London: HMSO, 1925.
(2) Hill A.B. Principles of Medical Statistics. London: Lancet, 1937.
(3) Hill A.B. Suspended judgement, memories of the British streptomycin trial, the first randomised clinical trial. Controlled Clinical Trials 1990;1:77-79.
(4) Medical Research Council. Streptomycin in Tuberculosis Trials Committee. Streptomycin treatment of pulmonary tuberculosis. British Medical Journal 1948;2:769-783.
(5) Hill, A.B. The start and early years of my career. MSS LSHTM, p1.
(6) Doll R., Hill A B. Smoking and carcinoma of the lung. Preliminary report. British Medical Journal 1950;ii:739-748.
(7) Doll R., Hill A.B. The mortality of doctors in relation to their smoking habits. A preliminary report. British Medical Journal 1954;ii:1451-1455. (Reproduced in British Medical Journal 2004;328:1529-1533.)
(8) Doll R., Hill A.B. Lung cancer and other causes of death in relation to smoking. A second report on the mortality of British doctors. British Medical Journal 1956;233:1071-1081.
(9) Armitage P. Obituary: Sir Austin Bradford Hill 1897-1991. Journal of the Royal Statistical Society. Series A (Statistics in Society) 1991;154:482-484.
(10) Peto R., Hall E., Wheatley K., Gray R. Mortality in relation to consumption of alcohol, 13 years observations on male British doctors. British Medical Journal 1994;309:911-913.
(11) Doll R., Peto R., Hall E., Wheatle K., Gray R., Sutherland J. Mortality in relation to smoking, 40 years observations on male British doctors. British Medical Journal 1994;309:910-911.
(12) Doll R., Peto R., Boreham J., Sutherland I. Mortality in relation to smoking: 50 years' observation on male British doctors. British Medical Journal 2004;32:1519-1533.