The Medical Research Council (MRC) and CVD Epidemiology in the UK

Like its American counterparts within the U.S. National Institutes of Health, the British Medical Research Council (MRC), established in 1919, did not become seriously involved with population health research in CVD until several decades after its founding. In 1948, the newly enacted National Heath Service Act “for the first time provided decent healthcare for all–and, at a stroke, transformed the lives of millions” (BBC 1998). More specific to our story, the Act provided major support for medical research through the rejuvenated MRC, which included the establishment of research units in social medicine, statistics, chronic diseases, and cardiovascular epidemiology.

The MRC came to embrace epidemiology more formally in the early 1950s with its support of a Doll-Hill project–the now-classic British Doctors Study–which greatly forwarded the design of case-control and prospective investigations and profoundly influenced understanding about tobacco smoking as a cause of both lung cancer and coronary disease (Doll and Hill 1954).

In addition to supporting a broad program in clinical medicine, the MRC of that period conducted what it termed a preventive medicine program, the major component of which was nutrition as it related to deficiency diseases, not to heart-disease prevention. Thomson’s definitive MRC history includes, in fact, no discussion of contributions to coronary disease except for the briefest mention of Morris’s studies of its possible reversal by “vigorous leisure exercise” (Thomson 1975, 185). Morris’s MRC Social Medicine Unit had from its inception in 1948 made cardiovascular diseases the prime subject of prospective studies, including studies of cardiac pathology as well as of the occupational and social epidemiology of coronary disease. His “epidemiology of needs” reflected a political focus on poverty and on the distribution of health and disease that characterized the discipline for which his unit was named–social medicine.

In an essay on Morris’s commitment to studying health as a means of bringing about social change, medical anthropologist Dorothy Porter described his contributions as integrating evidence from population studies, on which to base clinical decisions, with the analysis of needs in public health and medical services. Morris and many of his British colleagues at the time his Social Medicine Unit was formed shared “a belief in the analytical power of quantitative methods and the potential political power of epidemiological research to influence policy making.” Thus, Porter wrote, “for this generation of peers, social medicine and a needs-driven epidemiology were more or less inter-changeable descriptions of the quantitative, population-based scientific investigation of disease, health and socio-economic inequality aimed at instituting social change” (Porter 2007, 1181).

Jeremy Morris’s commitment to social justice endured throughout his life and encompassed issues beyond the public health. In a BBC Radio interview after Morris died in 2009 at age 99, public health historian Virginia Berridge recalled that, even into his 90s, Morris “had a research grant from the Department of Health to research the minimum income which was necessary for healthy living.” On the same program, Morris’s son David noted that his father “had an absolute passion that opera and theatre and music should be accessible to all” (Bannister 2009).

Morris’s unit moved from the central Middlesex Hospital to London Hospital in 1956, and thence to the LSHTM in 1966, with Morris the director throughout. Its members focused on chronic diseases and social medicine issues until the unit was dissolved upon Morris’s retirement in 1975, its functions continuing at a lesser pace through his personal enterprise as emeritus professor at the London School. He died in 2009.

A parallel MRC effort in Wales under Archie Cochrane

When Archie Cochrane, who also had trained at University College Hospital London, returned from long military and prisoner-of-war experience, he was invited to join the MRC Pneumoconiosis Research Unit at Cardiff by his former professor, Charles Fletcher, the pioneering pulmonologist. There they began to use whole communities as control and experimental units to test the role of treatment of tuberculosis on the progression of pulmonary fibrosis. In the late 1950s, the MRC Population Laboratory in the Rhonda Fach, an offspring of the Pneumoconiosis Unit and of wartime UK chest disease surveillance, Cochrane initiated studies in cardiovascular disease epidemiology. To these he recruited a bright young faculty of future leading epidemiologists, including William Miall and Ian Higgins, and conducted surveys in and around the Welsh Rhondda Fach River Valley.
[During this period, working on these survey issues, Ian Higgins made increasing connections with Minnesota, Framingham, and Pittsburgh researchers in CVD, which eventually influenced his decision to move to the U.S.]

In his autobiography, Cochrane spoke of this period of his epidemiological work in Cardiff: “as well as being the happiest, this was very likely the most productive period of my life. I think I showed that we could, very nearly, make measurements in communities with roughly the same known error that one can make in laboratories and use them to test hypotheses” (ibid.). He early saw the opportunities, developed the questions and methods, and then tested them in representative populations, which establish him as a pioneer and founder of CVD epidemiology. In 1960, Cochrane was named “honorary director” of the MRC Epidemiological Research Unit and encouraged a similarly-named MRC unit in Jamaica under Miall, which functioned until Miall returned to Wales in 1970 to lead the MRC Mild Hypertension Trial.

Thus, the MRC established strong units with effective leaders who were given carte blanche to conduct their researches. Several focused on CVD. With these units, the MRC attempted to identify salient issues of national public health and then to do something about them. (Henry Blackburn)

Sources:

BBC News. 1998. The NHS: ‘One of the greatest achievements in history.’ BBC Online Network July 1.

Berridge, Virginia, and David Morris. 2009. Interview by Matthew Bannister. BBC Radio program. Last Word. November 13.

Cochrane A.L. and Blythe, M 1989. One Man’s Medicine. An autobiography of Professor Archie Cochrane. Memoir Club, British Medical Journal.

Doll, R., and Hill, A. B. 1954. The mortality of doctors in relation to their smoking habits: A preliminary report. British Medical Journal 1:1451-55.

Porter, D. 2007. Calculating health and social change: An essay on Jerry Morris and late-modernist epidemiology. International Journal of Epidemiology 36 (6): 1180-84.

Thomson, A. L., ed. 1975. Half a century of medical research, Vol. II: Program of the Medical Research Council, UK. London: Her Majesty’s Stationery Office.