The Michael Russell Oration has been established as an annual event, delivered to honour the work and memory of Professor Michael Russell, one of the pioneers in the study of smoking behaviour, clinical interventions and public policy action, who died in 2009. The oration will be given by a leading researcher, practitioner or commentator in the field of nicotine use.
Michael Russell, a psychiatrist and research scientist, was a pioneer in the study of tobacco dependence and the development of treatments to help smokers quit. The enduring impact of his work is likely to place him among the foremost clinical public health scientists of the twentieth century.
Working in London at the Maudsley, Institiute of Psychiatry between 1969 and 1998 he conducted a number of highly original studies that revolutionized our understanding of both the pharmacological and psychological basis of tobacco smoking. For public health the interventions and treatments he developed have had an enormous impact throughout the world in reducing the morbidity and mortality caused by tobacco. In the UK his work formed much of the evidence base that inspired the new NHS Stop Smoking services, launched in the year after his retirement.
Born in Cape Town, South Africa, after studying medicine at Oxford and Guys Hospital he returned to South Africa in 1959, where he developed a strong interest in psychiatry. He became a psychiatry registrar at the Maudsley in 1965 and in 1969 took a research post at the Addiction Research Unit of the Institute of Psychiatry, at a time when the main focus was on opiates and alcohol. Although at this time the appalling health effects of tobacco were being fully revealed in the work of Doll and others, the behaviour of smoking was still believed to be no more than a “habit”. The insight Russell gained while trying to help smokers in the outpatient clinic he set up at the Maudsley quickly developed into a belief that rather than being defined by social and psychological factors and habituation, smoking was instead a form of drug addiction, maintained in most cases by the nicotine inhaled from cigarettes. Such an idea was first proposed in the early 1940s, but had then been quickly dismissed. It was again strongly resisted by the new generation of scientists and politicians and Russell began a protracted and frustrating battle for the acceptance of nicotine addiction as the underlying cause of more than 100,000 premature deaths in the UK and millions around the world. Establishing the truth would require all his powers of insight, tenacity and intellectual rigour.
Following a series of promising studies in the early 1970s the UK Medical Research Council took notice and offered long-term financial support - as they had previously to Doll and Hill in the 1950s - to study the health effects of smoking. He established a strong team of psychologists, biochemists and statisticians to broaden and expedite his research. In the late 1970s he helped develop a nicotine-containing chewing gum with the Swedish scientist, Dr Ove Ferno. In experimental studies at his now established Maudsley clinic the gum demonstrated that nicotine was indeed heavily implicated in tobacco dependence. Despite overwhelming evidence for the gum as an effective treatment, it was not until 2001 that it became available on NHS prescriptions. In the intervening years he helped develop other Nicotine Replacement preparations; these are now seen as common-place in pharmacies and supermarkets around the world.
This work was accompanied by numerous other research lines, the findings from which are now fully accepted. From nicotine pharmacokinetics to fear-arousing anti-smoking media campaigns, there were few areas of tobacco dependence that remained unexplored. Development of the first nicotine assay allowed the precise measurement of nicotine levels in blood and studies of nicotine tolerance and self-regulation elucidated how the drug was used by smokers. Using ambitious statistical techniques he presented a first typology of smoking motives in a Royal Statistical Society lecture. He first demonstrated that brief advice by GPs could be effective in helping their patients stop smoking, that workplace interventions were effective, and that there were measurable dangers associated with second-hand smoke. Children and adolescent smokers were also found to exhibit characteristics of early dependence. During the 1980s Russell developed and tested a model for a National smoking cessation service in which primary care was effectively supported by specialist clinics. This was eventually translated into clinical practice through the 1998 UK Government White Paper, “Smoking Kills”, which for the first time acknowledged the addictive nature of smoking underpinned by nicotine and provided NHS funding for nation-wide treatment services using his “Maudsley Model”.
He argued that while the tobacco industry remained free to market cigarettes, millions of lives would be prematurely ended, especially in the growing markets in developing countries, before sufficient numbers of smokers could quit. Based on the knowledge that pure nicotine carries little health risk, but is the main reason why people smoke, he advocated the development and promotion of safer nicotine products to the exclusion of cigarettes, to reduce the majority of harm caused by ingesting the non-nicotine toxins in burning tobacco. Russell is the person who did most to lay the foundations for tobacco harm reduction that drive much research in the field today.
To date, opponents with greater government influence have held sway arguing that people should not be allowed safer nicotine products that continued nicotine dependence. Since the mid-1970s when Russell first proposed safer nicotine use in the BMJ, the WHO estimates that 115 million people have died prematurely worldwide by smoking cigarettes, losing on average 16 years of life each.
Those attending the Global Forum on Nicotine have much to learn from Michael Russell and the organisers are grateful to his family for their support in the establishment of this oration as a fitting memorial to him.
An archive of his working papers is maintained by the library at Kings College, London.