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'''Austin Bradford HILL'''

b. 8 July 1897 - d. 18 April
1991 

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'''Summary'''.  Bradford Hill was the leading proponent of 
randomized clinical
trials during the mid-20th century, and conducted important epidemiogic
surveys especially for the health effects of smoking. His writings were very
influential.

By the end of the 1930's Bradford Hill had achieved distinction as
a respected medical statistician who had written an influential
introductory book on the subject.  During the next 25 years he
occupied an undisputed place as the leading medical statistician, a
position justified by the important developments he initiated in
epidemiology and clinical trials and the consequent contributions
to medical knowledge.

Hill was born in London and died in Cumbria, England. He was 
always known as `Tony', and adopted the double
surname `Bradford Hill' later in life, and he came from a family of
considerable distinction.  His father, Sir Leonard Hill, was an
eminent physiologist and Fellow of the Royal Society.  His 19th
century forebears included Sir Rowland Hill, who introduced the
penny post in Great Britain.  Hill had expected to follow his
father in medicine, but, during wartime service with the Royal
Naval Air Service, he contracted tuberculosis which led to a long
period of convalescence.  The prospect of a medical career having
disappeared, he took a London University degree in economics, and
obtained a post in a research group in industrial medicine under
Major Greenwood, the leading medical statistician at that time.

Hill liked to tell people that he was trained in neither medicine
nor statistics.  He had attended lectures by Karl Pearson (q.v.), who
greatly impressed him, but he never developed a liking for
mathematical theory and in later life preferred to describe himself
as an epidemiologist.  During the inter-war period his research
covered a wide range of epidemiological work, but centered on
occupational health.  He moved, with Greenwood, to the London
School of Hygiene and Tropical Medicine, where he became a Reader
in 1933.  His lectures to postgraduate medical students were
inspiring, and helped to persuade a generation of future public
health workers of the central importance of the statistical
approach.  This vein of incisive exposition continued in a series
of articles in the ''Lancet'', which were published in book form
in as ''Principles of Medical Statistics'' (Hill, 1937; Hill and
Hill, 1991).  This book, which was immensely successful, had
minimal technical content, but explained clearly the general
principles of the subject and the problems of interpretation of
statistical data.

After the war, during which he worked for the Royal Air Force, Hill
succeeded Greenwood as Professor of Medical Statistics and directed
the Statistical Research Unit of the Medical Research Council
(MRC).  Between 1945 and his retirement in 1961 he directed
research in a number of major projects, many of which were funded
by the MRC.

In 1946 he persuaded two MRC committees to launch randomized
controlled trials, one in preventive medicine to test a pertussis
(whooping cough) vaccine, the other in clinical medicine to assess
the effect of streptomycin in the treatment of pulmonary
tuberculosis.  The report on the latter (Medical Research Council,
1948) is generally regarded as marking the first randomized trial
(Armitage, 1992).  Hill had advocated randomization in his book,
although he had not initially distinguished clearly between
strictly random allocation and the more suspect method of
alternation.  The streptomycin trial was an opportunity to clarify
his thoughts, and there followed a remarkable stream of writing on
the principles of clinical trials including practical and ethical
problems, exemplified by further trials supported by the MRC and
other bodies.  Many of these accounts are included in a volume of
selected papers (Hill, 1962).

Meanwhile he launched, with Richard Doll, a major case-control
study (Doll and Hill, 1950), comparing lung cancer patients with
matched controls, which showed conclusively that smoking was the
predominant risk factor.  This was followed by other case-control
studies, and, again with Doll, a long-term prospective study of
smoking and health which demonstrated that lung cancer was not the
only disease to be caused by smoking.  This cohort study, which
continued for several decades, was conducted on British doctors, an
ideal population whose cooperation was testimony to the respect
with which Hill's work was regarded by his medical colleagues.  As
with clinical trials, Hill accompanied his work on specific
epidemiological projects with expositions of the principles to be
followed in this field of research (Hill, 1962).  In particular, in
Hill (1965) he proposed nine criteria which should be satisfied
before one could confidently claim that an association between a
disease and a risk factor was causative.  Hill was by nature a
cautious man, and he had been careful initially to claim that a
causal effect of smoking on lung cancer was only one of a number of
possible explanations for the association.  As the evidence mounted
he accpeted the causal link as being overwhelmingly the most likely
explanation, and was disturbed by sceptical remarks occasionally
expressed by eminent scientists unwilling to take a commonsense
view of the matter.

Hill was elected Fellow of the Royal Society in 1954 and knighted
in 1961.  He was President of the Royal Statistical Society in
1950-52 and was honoured by many other learned institutions.  After
retirement he became one of the first members of the UK committee
set up to regulate the safety of drugs, later known as the
Committee on Safety of Medicines.

Hill made, during his career, little use of any but the simplest
mathematical techniques, but gave strong support to colleagues
whose inclination lay in that direction.  His success was due to a
combination of factors: enormous ability as a research strategist,
able to see the right way to tackle a difficult problem and to
develop the means of doing so; a remarkable facility with numerical
data, which enabled him to see the essential features of data
summaries without technical analysis; a very sharp intellect,
highly effective in committee discussions; and a charming and witty
personality engendering confidence amongst medical colleagues who
might otherwise have resented the interventions of an `outsider'.
His influence on younger colleagues was considerable, and his
standing as a pioneer in the continued advance of quantitative
medical research is unchallenged.


====References====
{|
|-
|valign="top"|{{Ref|1}}||valign="top"|   Armitage, P. (1992). Bradford Hill and the randomized controlled trial. ''Pharmaceutical Medicine'' '''6''', 23-37. 
|-
|valign="top"|{{Ref|2}}||valign="top"|   Doll, R. and Hill, A. Bradford (1950). Smoking and carcinoma of the lung.  Preliminary report.  ''British Medical Journal'' '''2''', 739-748. 
|-
|valign="top"|{{Ref|3}}||valign="top"|   Hill, A. Bradford (1937). ''Principles of Medical Statistics''. London: Lancet. 
|-
|valign="top"|{{Ref|4}}||valign="top"|   Hill, A. Bradford (1962). ''Statistical Methods in Clinical and Preventive Medicine''. Edinburgh and London: Livingstone. 
|-
|valign="top"|{{Ref|5}}||valign="top"|   Hill, A. Bradford (1965).  The environment and disease: association or causation? ''Proceedings of the Royal Society of Medicine'' '''58''', 295-300. 
|-
|valign="top"|{{Ref|6}}||valign="top"|   Hill, A. Bradford and Hill, I.D. (1991). ''Bradford Hill's Principles of Medical Statistics'', 12th ed. London: Arnold. 
|-
|valign="top"|{{Ref|7}}||valign="top"|   Medical Research Council (1948). Streptomycin treatment of pulmonary tuberculosis: a report of the Streptomycin in Tuberculosis Trials Committee. ''British Medical Journal'' '''2''', 769-782. 
|-
|valign="top"|{{Ref|8}}||valign="top"|  '''Further Bibliography''' 
|-
|valign="top"|{{Ref|9}}||valign="top"|   Doll, R. (1993). Sir Austin Bradford Hill, 1897-1991. ''Statistics in Medicine'' {\bf12}, 795-808 [includes a bibliography of Bradford Hill's writings]. 
|-
|valign="top"|{{Ref|10}}||valign="top"|   Doll, R. (1994). Austin Bradford Hill. ''Biographical Memoirs of Fellows of the Royal Society'' '''40''', 129-140. 
|-
|valign="top"|{{Ref|11}}||valign="top"|   Hill, I.D. (1982). Austin Bradford hill - ancestry and early life. ''Statistics in Medicine'' '''1''', 297-300.
|-
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Peter Armitage

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