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• Obituary | Michael Russell  

Russell built on the belief that it was tar, not nicotine, that killed smokers

By the 1960s, the emerging evidence of the danger of cigarette smoking was clear, but there was very little understanding of why people smoked. Cigarette smoking was generally thought of as a habit, with pharmacological factors receiving little or no attention.

Michael Russell, who has died at the age of 77 from a heart attack, was the man who did most to revolutionise our understanding. His research led to the 1988 report of the US surgeon general, Nicotine Addiction, which finally brought recognition that cigarette smoking is a classic drug dependence.

Russell was a psychiatrist in training at the Maudsley hospital, in south London, when he chose the topic of cigarette smoking for his research thesis in 1967. Based on his review of what was then fragmentary research literature, he concluded in a 1971 paper that the drug nicotine was the motivating force underlying smoking behaviour. He made the study of the interacting pharmacological and psychological determinants of tobacco dependence his life's work. . . .

But Russell is probably best known in the cessation field for a non-pharmacological intervention. In 1979 he published a trial examining the effectiveness of brief advice to quit smoking given by GPs in the course of routine consultations. The one-year success rate was 5%, compared with less than 1% in controls. A successful trial of nicotine chewing gum combined with brief advice in primary care followed. Russell moved towards the concept of an integrated district smoking cessation service, in which routine delivery of advice and pharmacological therapy in primary care was combined with intensive clinic support. That vision has now been realised in the NHS.

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