Framing the Framingham Heart Disease Study

Professor Gerald Oppenheimer

(City University of New York and Mailman School of Public Health, Columbia University)

11th November 2010

Following World War II, the search for the causes of coronary heart disease (CHD), the leading cause of death in the United States and Great Britain profoundly changed the purview of epidemiology, shifting its primary focus from infectious disease to chronic disorders. When CHD epidemiology is presented historically in the U.S., it often becomes the story of the successful, long-running Framingham Heart Disease Study, initiated in 1947. Framingham becomes a kind of “founding myth,” a New England town in which altruistic, white, ethnically diverse citizens, forward-looking local doctors, and a group of intensely curious physician-scientists cooperate to tease out the causes of epidemic CHD. This act of historical simplification leaves in Framingham’s shadow the other significant cohort studies begun in the 1940s and 1950s, and the generation of CHD studies and clinical trials that followed. It misrepresents the missteps and contestations that are part of any scientific endeavour, especially the debates over the role of risk factors (a term coined by Framingham) and whether any actually caused heart disease and were therefore vital to its prevention. At least as important, it masks the central role of federal public health policy which created and funded Framingham and without which a CHD epidemiology of cohort studies and multi-centre clinical trials would not have existed.