Michael Russell was a psychiatrist and research scientist who led the study of tobacco dependence and the development of treatments to help smokers to kick their habit. From 1997 to 2002 he was head of the tobacco research section at the National Addiction Centre in the Institute of Psychiatry at the University of London.
Working in London at the Maudsley Institute of Psychiatry between 1969 and 1998, he conducted a number of original studies that changed understanding of the pharmacological and psychological basis of smoking while interventions and treatments he developed have reduced morbidity and mortality. At home, his work formed much of the evidence base that inspired the new UK NHS Stop Smoking services, launched in the year after his retirement.
Michael Anthony Hamilton Russell was born in Cape Town, South Africa. After studying medicine at Oxford and Guy’s Hospital he returned to South Africa in 1959 where he developed a strong interest in psychiatry. After brief spells at the Hammersmith Hospital, London, and in Hong Kong he became a psychiatry registrar at the Maudsley in 1965. In 1969 he 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.
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Although the health effects of tobacco were being fully revealed in the work of Sir Richard Doll and others at this time, 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 smoking was a form of drug addiction maintained in most cases by the nicotine inhaled from cigarettes rather than being defined by social and psychological factors and habituation. Such ideas were first proposed in the early 1940s, but had been dismissed. The theories encountered resistance by the subsequent generation of scientists and politicians: 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 Britain and millions worldwide.
Establishing the truth would require all his powers of insight, tenacity and intellectual rigour. After a series of promising studies in the early 1970s, the UK Medical Research Council offered long-term financial support, as it had to Doll and Sir Austin Bradford Hill in the 1950s. Russell was thus able to gather a team of psychologists, biochemists and statisticians to broaden and expedite his research.
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A breakthrough came in the late 1970s when he helped to develop a nicotine-containing chewing gum with the Swedish scientist Dr Ove Ferno. In experimental studies at his Maudsley clinic, it was demonstrated that nicotine was heavily implicated in tobacco dependence. Yet despite overwhelming evidence supporting the notion that gum was an effective treatment, it was not until 2001 that it became available on NHS prescriptions. In the intervening years Russell helped to develop other nicotine replacement preparations; these are now seen as common-place in pharmacies and supermarkets around the world. This work was accompanied by other research lines: 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 Russell presented a first typology of smoking motives in a Royal Statistical Society lecture. He demonstrated that brief advice by GPs could be effective in helping their patients to 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 government White Paper Smoking Kills, which acknowledged the addictive nature of smoking underpinned by nicotine and provided NHS funding for nationwide treatment services using his “Maudsley Model”.
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Although most of Russell’s ideas and methods are now recognised, his proposal of safer modes of nicotine delivery and safer cigarettes remains controversial. He argued that while the tobacco industry remained free to market cigarettes, millions of lives would be prematurely ended, especially in the growing Third World markets.
Based on the assumption 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. To date, opponents with government influence have held sway, arguing that people should not be given enhanced access to products that continued nicotine dependence.
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An archive of his working papers is maintained by the library of King’s College London.
Russell is survived by his wife, Audrey, and two sons.
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Professor Michael Russell, research psychiatirst, was born on March 9, 1932. He died of a heart attack on July 16, 2009, aged 77