Opinion » John Rember

Framingham Idyll

New disease from old data


Boston. Brigham and Women's Hospital. 1982. I was there to interview Dr. William Castelli, director of the Framingham Heart Study. I was writing a book on heart attacks for people who were recovering from one. My job was to put scientific language into ordinary English so people could at least know what questions to ask their doctors.

Dr. Castelli didn't use scientific language. He mostly talked about the Framingham Study, which began in 1948 and is still going. It has tracked thousands of residents of Framingham, Mass., for more than six decades, giving them detailed physical examinations every two years. Because of Dr. Castelli and his colleagues, we have good evidence that smoking, obesity and lack of exercise cause heart attacks. We know that genes play a role in heart disease, and so does cholesterol, and that blood pressure once considered normal is now considered lethally high. We know that going through life charging over every obstacle and stressing over every detail is hard on your heart. We know that the people you hang out with can influence whether you live to 100 or fall over in your 40s.

Dr. Castelli didn't talk about certainty during our interview. Instead, he said how difficult it was to interpret hard data. In medical school, he had been told that cholesterol in the diet went straight to artery walls. Cardiologists—thinking they were in the know—had swallowed teaspoons of margarine before going out for steak and potatoes, preloading their blood with hydrogenated vegetable fats. "Now," he said, "I'd recommend you and your readers cut out margarine. Yesterday."

"We have an enormous amount of data from the Framingham Study," he said. "What it means changes every time we ask a new question."

My readers weren't going to like this idea. They'd had heart attacks and wanted to know how to get their lives back. Castelli told me that getting a life back wasn't a scientific question.

The interview changed my book. It put me in the shoes of my intended audience. I structured my chapters not around the data, but around the questions heart attack victims would ask if they dared: "Can I enjoy eating anything ever again? Can I have sex without dying? How much weight do I have to lose? Is my life over? Will anyone love me if I'm not a strong, uncomplaining silent-type?"

The Framingham Study didn't address such questions. If taken seriously, they would change the tone of all those two-year physicals and complicate the jobs of the doctors. Whatever answers they generated would be scientifically suspect.

I tried to answer those all-too-human questions as best I could. But the company I worked for went out of business before my manuscript was published and before I got my first royalty check. My first book no doubt resides in the archives of a firm specializing in bankruptcy law.

Was it worth writing? Probably. I haven't eaten margarine since 1982, don't smoke, try to get some exercise every day and have stopped pouring tablespoons of sugar on my morning Rice Krispies. Then again, I've since realized there are far worse ways to go than having your heart suddenly stop.

When I looked up Castelli on Wikepedia this morning, I couldn't find an obituary. He's an old man now, but a living one, probably with as strong a heart as a lifetime of state-of-the-art medical science can deliver. I hope he's still got his wits about him. All the questions I have for him now are human, non-scientific, imprecise ones and it occurs to me that the ability to answer those is probably the first thing to go.

Still, the Framingham Study continues to accumulate terabytes of data about who dies and from what. New connections are becoming apparent between how people live and how they die. A study focused on heart disease has now broadened to include data about cancer, genetic-based obesity, dementia, stress and contagious disease.

Framingham data have grown to become a kind of mirror-world of human existence. It's a world that can be explored. Something that looks like certainty can result. The scientific method avoids final answers, but over time it gets close.

Which brings up some difficult human questions. I'd like some solid answers, given that generations of Framingham data can probably answer them:

• What happens, over decades, to people who get concussions and joint injuries in high-school football? (The disease of entertainment?)

• What sort of diseases do combat veterans get, 30 years after combat? (The disease of war?)

• What other foods besides trans-fats kill? (The disease of eating whatever we want?)

• Do high-stress family lifestyles constitute child abuse? (The disease of unselfconscious parenting?)

• Is plastic killing us? (The disease of the miracle of chemistry?)

• Does poverty kill? Does a career in middle-management? How about teaching? Being a CEO? (The disease of hierarchy?)

These are questions that require individual and cultural self-awareness. Thanks to the Framingham study, they can be quantified and subjected to scientific analysis. They only await people with the courage to work on them.