Becoming the Framingham Study 1947-1950

Abstract

In the epidemiological imagination, the Framingham Heart Study has attained iconic status, both as the prototype of the cohort study and as a result of its scientific success. When the Public Health Service launched the study in 1947, epidemiological knowledge of coronary heart disease was poor, and epidemiology primarily involved the study of infectious disease. In constructing their investigation, Framingham's initiators had to invent new approaches to epidemiological research. These scientific goals were heavily influenced by the contending institutional and personal interests buffeting the study. The study passed through vicissitudes and stages during its earliest years as its organizers grappled to define its relationship to medicine, epidemiology, and the local community.

Figure 1

Framingham in the 1950s. At the time of its selection, Framingham, 20 miles west of Boston, was a politically autonomous, overwhelmingly White industrial and commercial community. It had already been the site of a famous public health tuberculosis intervention project conducted between 1917 and 1923.…Phot courtesy of National Heart, Lung, and Blood Institute.

Figure 2

Joseph Mountin (1891–1952) of the US Public Health Service, an innovative public health planner and administrator, began advocating for programs to control noninfectious disorders a decade before he proposed an epidemiological study of coronary heart disease in 1947. Well known for launching the Office of Malaria Control in War Areas (later the Centers for Disease Control), he strongly supported population screening and intervention efforts to prevent and control diabetes, hypertension, cancer, and accidents.

Figure 3

After transfer of the Framingham Study to the newly formed National Heart Institute in 1949, its director asked Thomas Dawber to head the investigation, replacing Gilcin Meadors, the original organizer. A board-certified internist, Dawber, like most of those pioneering similar cardiovascular studies in the 1940s and 1950s, lacked formal training in epidemiology. In their early articles, Dawber, Jeremiah Stamler, Joseph Doyle, and other researchers had to justify to skeptical scientific and medical audiences the application of epidemiology to chronic disease.

Figure 4

The “Framingham Heart Program” stationery of the 1950s, in addition to its whimsical logo, stressed the support of local physicians and community leaders. Some of those listed, including Walter Sullivan, chairman of the Executive Board and an attorney, were also study participants.

Figure 4

The “Framingham Heart Program” stationery of the 1950s, in addition to its whimsical logo, stressed the support of local physicians and community leaders. Some of those listed, including Walter Sullivan, chairman of the Executive Board and an attorney, were also study participants.