Character and Traits of Pioneers in CVD Epidemiology

We mark here the tendency to shared characteristics among originators of the new field of CVD epidemiology and prevention research, acknowledging defects in all such generalizations:

1. Keen observation and ready hypothesis formulation: Clearly these are primary traits. Pioneers and innovators tended to see form, ask questions, and sniff the potential import among observations that remained obscure to the many. They successfully unified scatterings and simplified complexity.
2. Breadth of view, understanding, and disciplinary skill: A characteristic of early pioneers was their comfort to think and work across disciplines and in new fields. Jerry Morris, for example, assembled vital statistics on causes of death and then made a thoroughgoing review of cardiac autopsy data before tackling field surveys and occupational cohort studies. Ancel Keys correlated international vital statistics on causes of death and food consumption, tested diet effects on blood lipids in tightly controlled laboratory experiments, and initiated field surveys and prospective studies across cultures, all in seemingly seamless transitions. William Connor started systematic field studies in the young and then in hunter-gatherers, while he also carried out feeding experiments in the laboratory and led clinical trials. Jerry Stamler tested hormonal effects in experimental chicken atherosclerosis, assembled the first formal look at U.S. trends in CVD, initiated among the earliest cohort studies of risk, and directed the most far-flung international observations and multi-center preventive trials. The works of these pioneers were emblematic of unusual accomplishments due to the successful incorporation of multiple skills, methods, and strategies.
3. Clinical curiosity about the individual patient and mechanisms. Interest vested in the individual case and focus on uniqueness of manifestations is the mark of the exceptional clinician. The pioneers of CVD epidemiology often had this trait but were unusual in that it existed within a larger context, an experience and curiosity in the culture.
4. Curiosity about metabolic phenomena and disease mechanisms. The good academician is primarily focused on causal pathways and mechanisms. Many of “our” pioneers had this trait, complemented by experimental and observational skills and broader curiosity.
5. Vision beyond the laboratory and clinic to the socio-cultural influences on disease and health. A particular characteristic of the originators of CVD epidemiology, most of whom were clinical and laboratory scientists by training, was this trait of looking beyond the unique case and relevant biologic mechanisms to the family, social, and cultural influences on the individual and the collectivity. They then went further, to exploration and synthesis of the mass phenomena causing epidemic disease.

In sum, we find in the pioneers of CVD prevention research a certain competence and comfort to shift among disciplines and methods, between observation and experiment. Often there was competence in algebra and regressions and statistics or the early recognition of their need. Several of the early pioneers were competent in biochemistry, metabolism, physiology, and mechanisms. All were capable at facile integration of divergent facts.

All the leaders at the origins of the discipline were characterized by curiosity, energy, determination, intensity, persistence, and savvy. Most were endowed with confidence, a strong sense of self-worth, and both personal and scientific ambition.

All were imbued with vision beyond risk and disease to the prevention of risk in the first place and to the enhancement of health. All had vision beyond the individual to the population, and beyond the population to the species and the ecology. (Henry Blackburn)