Theodore Cooper Announces Giant Leap in CVD Research Policy, 1972
In fall 1971, after a long, simmering pause during which there was absent national research policy on the nation’s greatest killer, the pot came to a boil. Ted Cooper, NHI Director-chef, cooked up a policy.
In the Lyman Duff Lecture at the annual meeting of AHA, he speaks, at first hemming and hawing with self-deprecatory humor, then coming to the point: “I believe . . . that the time is now eminent for the development of a national policy in arteriosclerosis.”
Cooper proposes a change in how the NIH deals with the health and social problem of arteriosclerosis, coupling morphological research with clinical physiology and biochemistry, linking pathologic data with clinical laboratory data, and working across traditional disciplinary boundaries.
The need for a national policy for research should depend, he states, on: “the magnitude of the problem, the importance that the public attaches to the problem, and the scientific, social and necessarily political possibilities of significant change in the acquisition of new knowledge and the application of it.”
He then defines the magnitude of the problem and for the first time calls attention to a decline in the number of U.S. deaths from all cardiovascular-renal disease from 1940-1970, but indicates that heart disease has actually been the #1 killer in the United States since 1910.
He deals colorfully with public attitudes toward coronary disease as an appropriate way to die but he chides professional attitudes that claim the situation is a long way from a breakthrough and so attention should be directed elsewhere.
He challenges that idea, saying: “it does not seem to me to be profitable to pit one disease against another,” arteriosclerosis should have consideration as a health problem, and “allocation of national resources determined on a simple, factual basis, namely, its magnitude and the high likelihood that something can be done about it.” These, the NHI director states, were major determinants of the Heart Institute’s new Program in Arteriosclerosis.
Particularly important for the prevention community, Cooper endorses prevention as a prime objective, but not just so-called “premature disease,” the target on most tongues. “I am unwilling to view the appearance of disease after the age of 65 years as inevitable, and I believe, in the present state of ignorance of aging processes, to say that something is ‘inevitable’ is akin to describing etiology as ‘idiopathic.’”
The new policy derives from any- and everywhere: “These data and ideas can be found in test tubes, in experimental animals, in individual patients, and in populations.” [Music to the epidemiologists ear] The next breakthrough, he suggests, might come from any discipline.
The new national policy for research in atherosclerosis has these recommended undertakings, as outlined by the Director:
- Prevention should be a prime objective of a program in arteriosclerosis.
- Progress in understanding and conquest of the disease lies in basic research, with new concepts and new data from each of the major medical research methodologies, clinical, laboratory, and epidemiological.
- Coordinated systems or groups of scientists interested in working on arteriosclerosis are required (SCORS, or specialized centers of research).
- Major trials of lowering blood lipids are slated in the prevention of arteriosclerotic vascular disease.
- Measuring the prevalence and distribution of blood lipid abnormalities in the population is needed.
- A specific test of the lipid hypothesis is proposed through a large-scale trial in patients at high risk because of their lipid characteristics.
- A trial to assess the role of blood pressure control on the prevention of myocardial infarction would include the young, black, and female as well as the middle-aged white male.
- A trial of multiple risk factor lowering is in the plan.
In the last goal, Cooper made the first official mention of a multiple risk factor trial, following up on the Makarska Report, the “Jumbo” Multifactor Trial proposal, and other recommendations brought so vigorously to his attention by activists during “The Pause.” He states: “It seemed reasonable to extrapolate the observations to practical prevention by advocating a program which includes the elimination of cigarette smoking along with the reduction of serum cholesterol and control of blood pressure” in which the study would not be to disclose mechanisms, but to test the prevention concept overall. Thus, a multifactor trial would be a pragmatic test of the application of knowledge rather than a clinical trial as an explanatory test of a hypothesis.
“It is my opinion,” he states, “that the study of the lipid factor, the study of the hypertension factor, and the test of the multiple risk factor concept can and should be done concurrently.” That opinion boiled his meal down to the essentials that made up most of the nourishment for the next decade of CVD prevention researches.
In a final plea for program, Cooper opines winsomely, beginning to serve the primary prevention message: “Children must learn to take care of their hearts as well as their teeth.”
The new CVD statesman-chef closes with an argument that we not make these health decisions as a scientific elite: “We must take our plans to the people, for in the final analysis it is the people, and their representatives, who make the priority decisions upon which the dollars and the programs depend.”
“The Pause” had ended.
U.S. pioneers and their many scientific colleagues around the world, now had a policy going forward. Direction and major projects and funding followed promptly.
It is not certain that Ted Cooper, who had taken much heat from prevention activists for some years, then received the credit deserved for facing up to the epidemic problem of ailing arteries and moving things out from the center in Bethesda.
At any rate, we signify this moment in history as the beginning of the Modern Era of CVD Epidemiology and Prevention. (Henry Blackburn)
Cooper, T. 1972. Lyman Duff Lecture to the Council on Arteriosclerosis of the American Heart Association, Anaheim, California, November 9, 1971. Circulation 35:433-440.