Epidemiologist and anti-smoking campaigner Credit: AMERICAN HEALTH FOUNDATION

In the world of cancer researchers, a rather sober lot, Ernst Wynder stood out in brilliant colour. Wynder, who died earlier this year, was a pioneer who spent most of the past 50 years as a public-health crusader, preaching that cancer prevention would ultimately prove far more effective in reducing mortality than would new forms of treatment.

Wynder was born in Herford, Westphalia, Germany, but as the racial persecution of the late-1930s grew in intensity his family fled to the United States. After the war, he entered Washington University Medical School in St Louis, and, already very ambitious, laid out a plan for winning a coveted research prize for medical students. His idea came from an autopsy of a lung-cancer patient in which he happened to participate. He questioned the widow, discovered that the deceased had been a two-pack-a-day man for 30 years, and built on this clue by studying the histories of 20 other lung-cancer patients and 20 controls. By late 1948, he was able to assemble a preliminary report indicating that lung cancer was rife among smokers. And, of course, he won the research prize.

In fact, recognition of the connection between smoking and lung cancer was hardly new (as discussed, coincidentally, on page 425). Among its other admonitions, Nazi propaganda included a warning against the ill effects of smoking, and Hitler himself believed that tobacco was the root of almost all evil. A German study, published in 1939, indicated that non-smokers were more common in healthy populations than among lung-cancer patients.

But like much else that went on in Germany in the period 1933–45, this early epidemiological work was tainted by its Nazi associations and was ignored. For this reason, the connection between smoking and lung cancer remained a matter of intense debate long after the Second World War ended. Air pollution was at the top of the list of suspected causes.

Wynder's initial research was greeted by scepticism, even by the American Cancer Society. But by mid-1949, he and his mentor, Evarts Graham, had accumulated data on 648 cases of lung cancer and 600 normal controls. The study that they published in the Journal of the American Medical Association showed lung cancer to be as much as 40 times more common in heavy smokers than in non-smokers. Six months later, in Britain, Richard Doll published a more definitive prospective study on smoking and non-smoking groups of British physicians that reached the same conclusion.

By his own account, Wynder's work attracted little attention until he extended it through research at the Sloan-Kettering Institute in New York where he moved after his medical studies. In 1953, he showed that the condensate of cigarette smoke, when painted on the backs of mice, was a potent inducer of skin cancer. But not all were won over. In 1960, Wynder had a public debate with Clarence Cook Little, founder of the Jackson Laboratory in Bar Harbor, Maine, and a pioneer in the discovery of the mammary tumour virus of mice. Little, a pillar of the US cancer-research establishment, argued that viruses were the cause of human cancer, and that Wynder's epidemiology was at best correlative. The debate ended in a draw.

Wynder's time at Sloan-Kettering was not a tranquil one. The tobacco companies generously supported the institute's research work and wanted Frank Horsfall, its director, to muzzle Wynder. In the end, Wynder's freedom to continue proselytizing against smoking was ensured by Peyton Rous, virologist and soon-to-be Nobel laureate — Rous walked across the street from Sloan-Kettering's sister institution, the Rockefeller Institute, and told Horsfall to back off.

There were also tensions between Wynder and his colleagues, who viewed his frequent mass-media diatribes against the evils of tobacco as self-promotion and questioned the rigour of his science. Wynder also had a side that seemed overly flamboyant to them: he was a bon vivant, a ladies' man. Long a bachelor, he was often seen about town with one or another young starlet on his arm.

Wynder had not endeared himself to his colleagues. With the winds at Sloan-Kettering blowing against him, he left in 1969 and founded the American Health Foundation (AHF), located today in Valhalla north of New York City. He built it from the ground up to a staff size of 200.

The agenda of the AHF was clear from the beginning: Wynder believed strongly that the most significant reductions in cancer mortality would come from changes in lifestyle. These views were already spelled out in 1952 in the mammoth 28-page study, published in the New England Journal of Medicine, entitled “Medical Progress: Some Practical Aspects of Cancer Prevention”.

Research at the AHF centred on epidemiology and the use of animal models to follow up suspected connections between dietary intake and specific types of malignancies. In recent years, the foundation launched a programme in elementary schools that attempted to alter the life courses of young children by inculcating them with the virtues of healthy diet and smoke-free air. This was an exercise that Wynder felt would pay handsome dividends sometime in the mid-twenty-first century.

Wynder portrayed himself as being far removed from the mainstream of contemporary cancer research — the reductionist world of molecules and cells — and argued that it has far less to offer improvement of the human condition than epidemiology and public health measures. The world of science, he often said, had become too enraptured with the latest discovery in cancer genetics and had lost sight of its mandate to keep people healthy. He never retired, working unabated as head of the AHF until his death on 14 July this year, aged 77.

Ernst Wynder leaves behind an enormous, often unappreciated imprint on cancer research, and more than 750 papers on the epidemiology and aetiology of the disease. He is survived by his wife Sandra.