Effect Measure

Alice Stewart

If you aren’t an epidemiologist of a certain age — or even if you are — you’ve probably not heard of Alice Stewart. Alice was one of England’s premier epidemiologists in the mid to late 20th century, but I didn’t meet her until she was in her 80s. At the time she could still bound up the two flights of stairs to my office like a teen in good shape. I’m not exaggerating. She literally took it at top speed and without becoming breathless. When she died at age 95 in 2002, obituaries frequently described her as “indefatigable,” and she was certainly that. “Boundless energy” might be another phrase, along with “sharp as a tack.” I thought about her again when I ran across a short bio of her on the British Medical Journal’s YouTube channel, which I’ve embedded below, and realized how little known she is despite having had such a great impact on modern life.

While you may not have heard of Alice Stewart, chances are she has affected your life. To take just one small example, when I was a kid it was pretty common to have full on fluoroscopes in shoe stores. You’d stand on a little platform in front of this console that had a slot for your feet at the bottom and a view visor atop looking down on your feet. What you saw when you looked down was your little feet inside the shoes, bones and all. You could wiggle your toes and seem them move. Needless to say there was a lot of radiation exposure with these machines. Most people today would be aghast at this unregulated and profligate radiation exposure of children and the general public. Pregnant women today don’t even get medically indicated x-rays unless absolutely necessary and when you get dental x-rays they put a lead shield across your torso. You can thank Alice Stewart for that.

From her obit in The Independent in 2002:

The incidence of child leukaemias was increasing and no one knew why. She suspected that the mothers might remember something the doctors did not, so she interviewed them and rapidly saw the correlation with X-rays, which she demonstrated statistically. X-rays were medicine’s new toy and were being used for everything from examining the position of the foetus to treating acne; even shoe shops had X-ray machines where customers could see how their footwear fitted. This was at the height of the arms race, when the British and US governments were trying to build up public trust in the friendly atom and did not want people to get the idea that low-dose radiation could kill their children.

The leukaemia-pregnancy link was briefly resisted by the medical establishment but soon led to a ban on X-rays on pregnant women. It was, however, fiercely opposed by many physicists and radiobiologists, the UK National Radiation Protection Board, the International Commission for Radiation Protection, and by the powerful nuclear lobbies, within and outside government, that ICRP seemed to serve. Stewart’s findings implied that low-level radiation, which had become an everyday part of life for nuclear workers, the armed forces and sometimes even the public, could be far more harmful than had been thought or admitted. (The Independent)

Alice was not only full of energy but full of determination. After she retired from Oxford at 68 she just kept going, like the Energizer Bunny. Indeed her most controversial study was yet to come, when she teamed up with another eminent epidemiologist of a by-gone era, Thomas Mancuso (whom I also knew) in a study of the nuclear workers at Hanford, Washington. Their results showed an increased cancer risk in workers considered to have “low level” exposure. For their trouble Alice, Tom and their biostatistician collaborator, George Kneale were reviled by the nuclear industry and the medical establishment. If it bothered Alice she didn’t make a big deal about it. She laughed about it on one of her visits, but I know she suffered professionally, first as a woman (never being named a professor at Oxford), then as a notorious thorn in the side of the nuclear industry and medical establishment.

With that preamble, here’s the BMJ vignette. It’s quite nice, although it would have been even nicer if there were clips of Alice speaking, exhibiting all of her boundless energy and determination. It’s not long (under 10 minutes) but there are judicious and appreciative assessments of her work from colleagues and her biographer. If you never heard of Alice Stewart (quite likely), now’s your chance to find out about a remarkable person who should be better known:


  1. #1 mistah charley, ph.d.
    April 7, 2010

    I remember using one of those shoe x-ray machines as a child in the early 1950s.

    There ARE people who are dedicated to the pursuit of truth, justice, and the potentially sentient way, even when it’s not convenient, and we should praise them and attempt to imitate them as much as we can.

  2. #2 Farmer
    April 8, 2010

    Extraordinary achievement under such adverse circumstances. Thank you for the introduction Revere.

  3. #3 Karen
    April 8, 2010

    Remember another Alice epidemiologist from the late 19th and early 20th centuries – Alice Hamilton. She brought awareness of the harm from ubiquitous lead exposures, especially to children of workers in lead industries.

    I wonder if there is an association of the name Alice with curiosity, high-energy and tenaciousness?

  4. #4 ejay
    April 8, 2010

    Immediate association of the name Alice with curiosity, high-energy and tenaciousness? Alice Liddell.

  5. #5 Paula
    April 9, 2010

    And the signage can be hard to see. Is the next cautioner an Alice or a “crank”? Can we speak dismissively of “anti-vaxers” and forget how the Alices were regarded by detractors? I am reminded of a Lois Gibbs biography (re Love Canal) I recently edited, or of the controversy re industrial-strength wind turbine noise or infranoise that rages between the wind industry association’s own supported research and that of the independents (Drs. Pierpont, Harry, etc.) treated by the industry as cranks. Is it possible that removing the pressures from big industry (including the nuclear industry) could allow research controversy to function less competively and, perhaps, more fruitfully?

  6. #6 vickie
    February 23, 2014

    Alice Stewart was my great aunt. I never really understood the importance of her work when I was younger – indeed, when she was still alive.
    Now I do on so many levels – and most importantly in the approach she took to data sourcing and collation, and her steadfastness in the face of both politicised rejection of her results and sexism.
    And now, as the mother of a child who developed autism at age 6, immediately after having a cocktail of vaccinations, I wish that she were still here to mentor those who are investigating the link between vaccines and autism. I object to the two divided sides of the commentary – and the reluctance to gather data in ways that Alice did, thereby ignoring evidence.
    I trust that I never forget her absolute attention to science in anything I say about autism: I never say vaccinations are a cause but possibly a catalyst, and I only ever advocate for more analysis of data that has been gathered using techiques like Alice used.
    No scientist has ever interviewed me about what external events happened directly prior to my son developing what I term as late-onset autism (autism symptoms are generally recognised by age 2, not witnessed in a period of regression at age 6) – this is not a technique used in data collation, therefore there is no real science on the matter.
    Anyone who has defined opinions about autism and vaccinations (from either side of the unfortunately polarised debate), I advise to read The Woman Who Knew to Much. My opinion on the matter is not formed yet, due to the lacuna of intelligently gathered data for analysis.
    But truth is the daughter of time, so maybe one day I’ll have a view that extends beyond ‘we don’t know enough and must use techniques that have previously uncovered uncomfortable truths to gather data for rigorous analysis’.
    I am a very proud great-niece, and privileged to have known such a force of life and integrity as aunt Alice!