Commentary: Medical aspects of the Framingham Community Health and Tuberculosis Demonstration

摘要

The Framingham Community Health and Tuberculosis Demonstration Study1 not only showed that community control of disease-producing factors is feasible and effective for combating tuberculosis but also that this approach was likely to be the foundation for the investigation of the causes and control of other chronic diseases that impact the population. The US Public Health Service, recognizing a growing epidemic of coronary heart disease (CHD), funded the Pramingham Heart Study to explore the causes of heart disease in 1948. It was not clear how best to go about doing this. Like the population Tuberculosis Study initiated in 1916, it was initially decided to do a community disease control demonstration programme, but later, under the auspices of the newly established National Heart Institute, it was directed at seeking.out correctable predisposing causes and clues to its pathogenesis.2 This change in the Framingham Heart Study objectives was initiated by Felix Moore at the National Heart Institute and byThomas Royal Dawber, the chief architect of the Framingham Heart Study, owing to the lack of information about causation and no handle on practical means of prevention. CHD was thought at that time to be an inevitable consequence of age and genetic makeup. The Framingham site for the study was promoted by Professor David-Rutstein, newly appointed to chair a department of preventive medicine at the Harvard Medical College. Equally persuasive was Paul Dudley White, a leading cardiologist of the day, who had just been named executive director of the National Advisory Heart Council and chief medical advisor to the National Heart Institute.