Thomas Royle Dawber

BMJ 2006; 332 doi: (Published 12 January 2006) Cite this as: BMJ 2006;332:122

Founder epidemiologist of the Framingham heart study

In 1945 the Western world emerged from the second world war, only to be confronted by an epidemic of heart disease. The US government responded by setting up a study to identify the causes and to diagnose and treat early disease, though the latter aim was dropped as there was no treatment available. The town of Framingham in Massachusetts was chosen as the site for this study because it had a stable population of 28 000 and was close to Harvard University.

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The Framingham study, as it was known, became world famous. “Along with Ancel Keys's seven country study, this was the work on which all other epidemiology of heart disease stands. There isn't a study that doesn't owe its origin to Framingham,” Gerry Shaper, emeritus professor of clinical epidemiology at the Royal Free Hospital School of Medicine, told the BMJ. Sir Michael Marmot, professor of epidemiology and public health at University College London, said that Framingham was the benchmark for cardiovascular epidemiological studies.

Earlier research had tended to look only at heart patients with a view to finding a common thread in their lives, but Framingham was different. The study recruited 5209 healthy men and women aged 30 to 60 and followed their lifestyles and medical histories. The study was started in 1948 by the US public health service. It did badly in its first year. Epidemiology on this scale was unprecedented, and other medical scientists looked on the project as a fool's errand.

To overcome the resistance, Thomas Dawber, the young chief of medicine at the US coastguard service, was appointed to the new post of director. It was his clout as a physician that motivated the townspeople to participate and gave the study credibility with physicians. The newly established US National Heart Institute rapidly took over the funding.

Dawber published, with colleagues, more than 100 papers, including a landmark study in the Annals of Internal Medicine in 1961 that put forward the concept of risk factors in coronary heart disease, and identified the major ones. These were high blood pressure, high cholesterol levels, defects in the heart beat rhythm, and possibly smoking. In 1988, Dawber's team reported the association between “type A behaviour”—ambition, tension, and aggression—and heart disease.

Thomas Dawber, known as Roy, was born in Duncan, British Columbia. His father was a Methodist minister; his parents had emigrated from Cheshire two years earlier. A few years later they migrated again, to Philadelphia. Roy entered Harvard Medical School in 1933, graduating in 1937.

He spent the next 12 years with the coastguard service, based at Brighton Marine Hospital, near Boston, ending as chief of medicine. He then spent two decades at the Heart Institute, working on Framingham. The study was initially planned to last 20 years and the US government wanted to close it down when the time expired.

Dawber moved to Boston University as chairman of preventive medicine in 1966, and took Framingham with him, though he stood down as director. He raised $500 000 (£283 000; €415 000) from private sources to keep the study going. As the work, and the publications, continued, the US government relented and resumed funding, though the research team stayed at Boston. The ensuing research led to many more significant findings, including the connection between high blood pressure and stroke, and the benefits of high density cholesterol. Nowadays the study includes the children and grandchildren of the original participants.

Dawber received numerous awards and was nominated for a Nobel prize three times. He was tall, grey, and distinguished, with a twinkle in his eye. Modest and unassuming, he felt that it was wrong to boast about his accomplishments. He was a skilled carpenter, an Elvis fan, and played the piano and wind instruments.

After retiring aged 67 he moved to Naples, Florida, to a house facing the bay and spent much of his time sailing. He cared for his wife until she died, in 1995, from Parkinson's disease. When he was 90 he developed Alzheimer's disease and went into a care home, where he died. He leaves two children and two grandchildren.

Thomas Royle Dawber, former director Framingham study, US National Heart Institute, 1949-66, and chairman of preventive medicine Boston University 1966-80 (b 1913; q Harvard 1937), d 23 November 2005.

[Caroline Richmond]