Thomas Royle Dawber

Abstract

Epidemiologist who led the Framingham Heart Study. He was born on Jan 18, 1913, in Duncan, BC, Canada. He died of complications of Alzheimer's disease in Naples, FL, USA, on Nov 23, 2005, aged 92 years. Thomas Dawber didn't start the Framingham Heart Study, the now iconic 57-year-old classic of heart disease epidemiology. The study's first director, beginning in 1948, was a young officer in the US Public Health Service named Gilcin Meadors. Dawber would take over from Meadors in 1949. Dawber, however, is credited with being the architect of the study. The study “had a confused mission when it was started”, said Daniel Levy, who now leads the Framingham Heart Study. “On the one hand, it wanted to be a surveillance project. On the other hand, it wanted to be a population demonstration project in which they would demonstrate the ability to reduce heart disease in that population.” To give the study focus and scientific rigor, Dawber completely abandoned the idea of a prevention demonstration project, arguing that not enough was known at the time about risk to be able to modify it. Framingham was one of several similar studies that got off the ground at the same time in the USA, but it “was probably the strongest, because Dawber was a very strong figure with a very strong clinical sense”, said Gerald Oppenheimer of Brooklyn College and Columbia University's Mailman School of Public Health, New York, USA. The Framingham study's results are some of the most well known in heart disease epidemiology. “Between 1957 and 1963 they wrote excellent articles which began to build a case for well known risk factors for heart disease”, Oppenheimer said. They were the first to apply the term risk factor to heart disease. Today, the study has published more than 1500 papers, some of which “corrected many misconceptions about cardiovascular disease, including the predisposing role of hypertension, of diabetes, cigarette smoking”, said William Kannel, whom Dawber recruited as a young resident and who would eventually take over the study from him in 1966. Dawber graduated from Haverford College in Haverford, PA, USA, in 1933, and from Harvard Medical School, Boston, MA, in 1937. Despite serving in the Public Health Service, he had no training in epidemiology when he began leading the Framingham study, so he and Kannel enrolled at the Harvard School of Public Health to earn their masters in public health. “People were always sceptical, calling him an epidemiologist with a little ‘e’. But he was really quite qualified”, Kannel told The Lancet. The study faced other challenges in its early days. Framingham had been the site of a tuberculosis intervention project between 1917 and 1923, but local physicians resisted having their patients enrol in the heart study. They feared that the study doctors were going to steal their patients, Levy said, and that it would be the start of socialised medicine, because President Truman was pushing universal health-care coverage at the time. The directors overcame these challenges and convinced patients to trust them as well. “Participants were treated like gold”, Levy said, and still are today. “They must never wait, must be thanked by everyone they interact with. That participant must appreciate by the time that the person leaves that they are doing us a favour, not the other way around.” In 1966, Dawber moved to Boston University. Soon after, the study faced another challenge, as the National Institutes of Health (NIH) threatened to cut its budget. The study survived, but only as a strictly observational study. Dawber, however, was determined “not to let the study lapse into obscurity”, Kannel said. “He raised funding to keep it going, and was able to sustain it.” Between 1968 and 1972, the study would publish 48 peer-reviewed reports. “It was recognised then even by NIH that this thing wasn't exactly exhausting its possibilities, and funding was completely restored”, Kannel said. Many of the lessons of Framingham were not lost on Dawber. “When they started the study, they actually ordered ash-trays for the staff”, said Susan Brink, who co-authored a book with Levy on the study, A Change of Heart. “Before they published the first study connecting smoking to heart disease, he saw it coming and made it a non-smoking environment.” He found his own stress reduction technique, knitting, thanks to a study participant who worked at a local store selling yarn. Dawber is survived by a daughter, Nancy, and a son, John; his wife Eleanor predeceased him.