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|Oral History: Interview with
Dr. Henry Blackburn
Gerald Oppenheimer, a historian (with an MPH) at Columbia University is writing on Framingham and other epidemiological issues and interviewed Henry Blackburn in Minnesota. He focuses on the shifts in insights and paradigms, why and how a physiologist like Ancel Keys gets interested in causes and preventability of common diseases, how Keys came to ideas of public health?
A broad range of ideas is covered. The rejection is discussed, which occurs in some medical circles, of epidemiology and prevention concepts and interventions; as is the “different” outlook and personalities and eccentricities of Framingham versus other investigators in epidemiology; the definition of normal and abnormal and the search for variations; the use of statistics and math; leadership styles; the relation of personal political views to research choices and public health; informed consent.
Keywords: Framingham; dissemination of ideas; paradigm shifts; leadership style; political views and choice of specialty; Ancel Keys; Physiological Hygiene; Professional attitudes.
Then they sent me as a hospital corpsman to the U.S. Naval Hospital in Key West to wait to get into medical school, which I finally did. As corpsman I had to run a VD clinic before breakfast every morning on this little island with 20,000 sailors and 5,000 prostitutes. It was not a good way to begin the day. (Pg. 6)
Joossens, you know, correlated dietary intakes with [mortality from] stomach cancer, coronary disease, etc. Most people don’t regard that [ecologic correlations] a very effective way to get at underlying causes. But there is no better way to get at population impact if you have [individual] correlations established otherwise, plus plausible mechanisms. And Ancel just looked at it all. (pg. 25)
But [with] the British . . It’s not scientific, it’s emotional and anti-American. Anything that has to do with cholesterol and America they are agin’ it. Anything that has to do with diet they’re agin’ it. Anything that has to do with modifying lifestyle they are agin’ it. And as my friend Gerald Shaper describes it, ‘It’s not science, Henry. I cannot explain it. They hate anything American and if it’s an American idea they’ll have none of it.’ And that was true for many years. (pg. 45)
They would get up and leave, [saying things like]: “This is not science, people, this is drama and Dr. Blackburn is an entertainer here this morning.” (pg. 48)
An Offer from Keys
Keys’s activities sounded very attractive to me. Ancel was after a sort of Holy Grail, the cultural origins of heart attacks. I had seen the influence of culture in Cuba and among the displaced persons camps [in Austria]. Moreover, I had an international wife and enjoyed travel and exposures and adventures. Keys assigned me the project to develop the medical aspects of surveys methodologically, so that he could “count bodies.” So I developed all the forms and all the diagnostic criteria and developed what later came to be known as the Minnesota Code, which is still used 40 years later in classifying cardiograms for population studies and clinical trials. And so I got involved with methodology in my clinical function and gradually became an academic epidemiologist by osmosis and by responsibility and opportunity. Besides, I became a fixture in the international clique developing the methods and concepts of CVD epidemiology and prevention research. It was fun, and heady, and hard work. (pg. 5)
More About Ancel Keys
He’s an affirmative person, not a contemplative person. He uses all the processes, induction and deduction, and comes up with ideas and then he runs with them and he sweeps you off your feet with them and if you don’t follow him you’re stupid and don’t deserve to live. You make mistakes. He doesn’t (of course, he does).
I’ve never seen him sit around and talk about mechanisms like Henry Taylor. . . yet he will come out in a beautiful statement and a beautiful hypothesis and questiona for a new study.
His skills with regressions and with logic move too fast and are too tiresome [for him] to explain and they just put him way ahead of everybody. Then he can really write well. (pg. 21)
You know, he was a classically trained physiologist and yet he was interested in more than the cellular mechanisms and organ function. He was interested in human physiology and he was interested in the whole individual and he became interested in the individual in his environment. Of course, physiologists study stresses on systems. And the stresses they devised in their studies of human biology were heat and cold and physical activity and mental stress, psychological stress, dietary stress, and semi-starvation. And that was their interest, how the body functioned, how it functioned under stress. That was precipitated by the war- time interests. As you know, the government got involved in research for the first time in a big way and Ancel was right in the middle of it. So he really looked at the body’s capacity to adapt and respond to various stresses. And I think, I’m making an assumption, because Ancel has never formalized it, but I think the fact that they saw how these very fundamental aspects of lifestyle – over nutrition, under nutrition, over activity, heat and cold and so forth – changed physiology in the effort of the body to maintain its internal milieu, and it surprised him that things had been considered fixed constitutional variables weren’t really fixed or could be fixed at new levels of adaptation. And I think that’s what really got them involved in the next step, which came from there to the larger influence of environment and culture on health and then disease. I don’t know whether any of this was a conscious process. (pg.21)
[At Framingham] They were quite firm in pointing out that using my system there would be errors (they had a fine sense of validity, none of reproducibility), and I said, “Yes, we’ll make errors and they will be random and they will be on the side of under-diagnosis, under-estimates of cases. But we propose validated criteria and working on repeatability and accepting random, non-systematic error, and you might give it a try. (pg. 10)
The Need for ‘Proof’
The seventies was the generation of preventive trials in high risk in both this country and abroad, which had been sort of forced onto us by the reaction of the establishment and the practitioners to the diet recommendations. They weren’t prepared to recommend. They wanted “proof.” We hadn’t proved to them in clinical trials. So we were pushed into a lot of clinical trials that probably shouldn’t have been done, but were politically necessary. [Lipid Research Centers, etc] (pg. 52)
On “The Pause”
. . .they [NIH] impaneled various groups to demonstrate that it [The Diet-Heart Trial] wasn’t practical. There weren’t enough doctors, there weren’t enough patients, there weren’t enough nutritionists in the world, not to speak of enough money to do such a study. So they killed it. And then nothing happened for two or three years. Amidst all this political clamor by that time that they should do something about coronary prevention, and so they had to come up with something. That’s when they came up with the Multiple Risk Factor Trial and a whole generation of other risk factor trials in the seventies. (pg. 54)Click to listen to audio clips from a segment of this interview
Full transcripts of interviews may be made available to those engaged with original materials for scholarly studies by contacting Henry Blackburn at the CVD History Archive of the University of Minnesota School of Public Health. firstname.lastname@example.org.