Change of Heart; Unraveling the Mysteries of Cardiovascular Disease
By Daniel Levy, M.D., Susan Brink
In preparation for the fiftieth anniversary celebration of the Framingham Heart Study, I scanned hundreds of yellowing newspaper clips and old photographs. I was often invited then to speak about the history of the Study, and I wanted to remind myself of that time and place, of just how far we had come in understanding cardiovascular disease. One photograph in my file featured two people whose names I knew well-Walter Sullivan and Victor Galvani. As voting men, they served as community leaders who helped and advised the Heart Study. Both remain active in the project to this day. Old pictures provide an especially stark reminder of the passage of time. These men, whom I know as patriarchs, as grandfathers, as community pillars-yes, and as white-haired, respected elderly gentlemen-were, in their prime, the promise of the future. They and their families were representative of a generation on the cusp of revolutionary lifestyle changes. They were typical of men returning from World War II to start families and share in the new prosperity.
In Framingham and across America it was a time of unbridled optimism, a time when a nation, long deprived, could let the good times roll. Fields that once grew potatoes, corn, and soybeans began to sprout duplex, Georgian, Cape Cod, and ranch-style homes, making way for a new generation that would conic to be called, collectively, the baby boomers. Bulldozers uprooted thickets of trees, creating stark landscapes that filled practically overnight with row upon row of cookie-cutter houses. Construction techniques that were perfected in the erection of prefabricated military buildings spread across the land. Houses for the newly discharged veterans went up assembly-line style. Crews of workers raised two-by-four frames and nailed sheetrock to one side, shingles to the other. They moved from one house to the next to create whole new communities of dwellings uniform in everything from bathroom faucets to kitchen cabinet hardware. Little more than the saplings that would eventually break the monotony of the barren yards held the promise of individuality. After the war, the federal government promised 2.7 million new houses by 1948, and loans granted by the Veterans Administration and the Federal Housing Authority made these houses available for little or no money down. The returning GIs needed this benefit. Housing costs had doubled since 1939.
Hundreds of thousands of men and women who had put off college to go to war returned to school, and hundreds of thousands more who had never dreamed of college-some who hadn't even finished high school-earned degrees and entered the middle class. They did it courtesy of the GI Bill of Rights, which provided $500 in yearly tuition and a living allowance of $90 a month for a married man. Walter Sullivan, a slight son of Irish immigrants, and Victor Galvani, the sturdy offspring of Italian immigrants, were two veterans from Framingham who practiced law in Framingham after the war. Where once, as children, they were members of rival ethnic "gangs" whose mischief was kept under control by a beat cop on foot patrol, they grew to be professional men who used their talents and spare time to serve together on a citizens' committee that helped enlist five thousand of their friends and neighbors in the Framingham Heart Study.
This long-term observational Study was aimed at sorting out the reasons behind the epidemic of heart disease and helping many millions beyond the handful of participants directly involved. Eventually, its accomplishments would be listed among cardiology's ten greatest achievements of the twentieth century in an editorial in the Texas Heart Institute Journal, in the company of many other remarkable breakthroughs: the electrocardiogram, coronary care units, open-heart surgery, implantable cardiac defibrillators, and coronary angiography. The Heart Study would also be listed in The Merck' Mannual's Centennial Edition as fourth among the one hundred most significant advances in all of medicine in the twentieth century, along with such accomplishments as the development of antibiotics, the use of mass imnumizations, and the discovery of vitamins. The Framingham Heart Study would invent a way to use epidemiology, or the study of diseases in the population, a discipline that had heretofore dealt with the simpler mysteries surrounding infectious diseases like cholera and tuberculosis. Framingham would push the envelope of epidemiology. Its researchers would learn and create ways to observe healthy people over the course of their lives, collect data, and come up with a list of factors contributing to disease. In the process, the study would help create a way of using the science of epidemiology to understand not only heart disease, but many other complex, multifaceted illnesses. "It is truly one of the great studies of this century," said cardiac surgeon Michael DeBakcy. "It has set the model."
But none of the researchers or volunteers involved in 1948 knew whether success or failure lay ahead when Sullivan, Galvani, and others asked their neighbors to participate in the fledgling project.
There was much that postwar Americans craved, and much more they didn't know. Pent-up consumer demand resulted in a nationwide buying spree as young families spent their savings on homes, furnishings, children, cars, and a cascading array of time-saving appliances. The modern world was in the process of engineering most of the physical work and exercise out of day-to-day lite.
Ironically, they were about to enter what would become for millions a life-threatening prosperity. Their fantasies of the good life, their collective yearnings and imaginings, would take many down a path toward ill health, disability, and even premature death. After the deprivation of the Great Depression and the rationing of World War II, men felt good about being able to provide for their families. And women, having been dismissed from wartime factory work, went home, donned aprons, and rustled up daily high-far feasts. A glimpse inside one of those postwar households reveals the extent of our misconceptions about what constituted healthy living.
A typical American breakfast was fried eggs with bacon or sausage and a side of toast slathered with butter. Housewives skimmed the cream from the top of milk bottles for coffee. Children washed down their after-school cookies with whole milk. Eggs and bologna, fried in butter, made a tasty lunch. Steak and mashed potatoes were seen as a hearty and healthy meal. Ethnic variations included corned beef and cabbage, chopped liver, and lasagna. Children would fight over who got to car the crispy tar trimmed from the fried pork chop or steak. Ice cream, once a rare treat, then a reward for being good, soon became a typical, often expected, way to end a summer day. Picnickers are franks and beans. Every housewife had a crock near the stove to hold bacon drippings, lard, and Crisco to use and reuse in deep-frying everything from potatoes to chicken. Americans believed these foods were good for them. Serving sizes grew from adequate to huge to gargantuan. After dinner, 70 percent of men sat back and lit up a cigarette.6 Women, who had begun smoking in the 1920s, would start to catch up with men over the next two decades. The whole family got into the habit of sitting around the living room, transfixed by the black-and-white television set. By 1949, Americans were buying 100,000 television sets a week, and by the mid-fifties, two-thirds of families owned one. The first generation of couch potatoes was born.