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Stanley Garn

Year: October 17th, 2003
Location: Ann Arbor, Michigan, USA.
Interviewed by: Blackburn, Henry

Abstract

Stanley Garn is a physical anthropologist with deep curiosity about body build and function, who has made unique contributions to CVD epidemiology and prevention, beginning in Boston collaborations with Paul White on coronary disease in young people and extending to contributions about obesity and the metabolic syndrome.

This is the strangest of all our oral histories because of the wonderful pixilated character of Stanley, plus his conserving of breath and energy in a considerably disabled state in the infirmary of a retirement community. But it was nevertheless revealing of his curiosity, directness, and humor, and of those exciting times early in the study of coronary disease outside the clinic.

As he says, in those days: “We just went and did it. Everything was unknown. Everything was important. Everybody was welcoming.” The mood of the day was that of intellectual “fun” and being at the right place at the right time. The Young Coronary Project “led to everything,” for Stanley.

His conversation is remarkably short of conclusions, mechanisms, hypotheses, and other details, belying his profound thinking and scholarship. But his wit and intellect shine through. (Henry Blackburn)

Quotes

[ed. The reader will see, from this dialogue, how facts were frustratingly not forthcoming about Garn’s early studies of coronary disease in young people.]

HB: Old friend, we are compiling a history of the ideas, events, and people who developed research on the epidemiology and prevention of cardiovascular diseases (CVD). We will transcribe this conversation and you will have access to it. We do, nowadays, need a signed consent. Good. Done. The pioneers in CVD prevention started with curiosity about the phenomenon of heart attack and sudden death and went out from there to lab and field. That’s what happened to Ancel Keys.

G: Himself a very specific phenomenon.

HB: Right. I have a theory about Ancel that he was impressed with the constitutional factors that were modified so profoundly in the Minnesota Experiment among the conscientious objectors he starved and exercised. The whole concept of constitution and human variability changed for him in that period, which that led him to think that if blood pressure could change, if weight and body habitus could change, if blood cholesterol can change…..

G: What couldn’t?

HB: Exactly, what couldn’t? And that started him thinking out of the physiology box. And I think you have had the same sort of approach.

G: Remember, my background was zero.

HB: Well, it wasn’t zero; it was anthropology, which is a less formal……..

G: It was zero.

HB: OK it was zero.

G: I was a physical anthropologist. So all the things I was doing were completely new and different.

HB: How did you start thinking about nature – nurture and the origins of obesity and chronic diseases.

G: They just were. I mean, nobody had explored them. It was something new and different. You see, the tradition was that you learn what there was to learn, period. That was it.

HB: Almost dogma.

G: It wasn’t dogma whatever you learned; it became dogma. But the people were fun.

HB: Who were some of the people you thought were fun?

G: My background was by way of Paul Dudley White.

HB: How did you know Paul Dudley? You went on some expeditions with him?

G: No. He was my boss. I think he assumed I would do things. You see, we were the Coronary Research Project.

HB: With Menard Gertler?

G: Menard and I were the other half of it. And Menard was fun.

HB: As I recall, he challenged authority at every possible opportunity.

G: Yes, that was his way. And Paul Dudley White just tried to find out what was going on.

HB: A remarkable and direct and simple curiosity he had, yes.

G: That was allowed.

HB: That’s true. Because he was a Boston Brahmin, I suppose, he could do no wrong.

G: That is correct. We were the Coronary Research Project, a private project of Paul Dudley White.

HB: And what questions were you asking? Risk factors weren’t called risk factors back then.

G: All the questions. They weren’t called specific things, but you name it, we were going to turn to it.

HB: You thought about it all, with no a priori hypotheses?

G: Right

HB: An interesting pursuit.

G: Well, it was so in those early days.

HB: And your intent was to look at associations or to look at …….

G: We wanted to find what caused what.

HB: You wanted to predict. You were going to follow these people.

G: We wanted to find out what caused what.

HB: All right. What caused what. There are various ways of doing that. How did you do it?

G: By what we did. I know this sounds silly.

HB: This is almost Socratic here. You will explain a little bit, I hope.

G: We just went and did it.

HB: You went and did it. I like that kind of science.

G: I didn’t know there was any other kind.

HB: Oh, there are many other kinds, unfortunately.

G: I didn’t know that. And Menard was fun because although he had this background he had the same fluidity.

HB: Fluidity you call it? That’s a good word. So much fluidity that he dribbled off the edge of the universe from time to time.

G: Yes. Paul White took that for a given.

HB: Some are forgiven.

G: At the time I’m talking about.

HB: Yes, I know. Late Forties, early Fifties at the period just beginning to recognize the modern mass diseases and realize that all the information available was clinical or in the laboratory and not population-wide or species wide.

G: I had the fortune of working on the broader picture simply because I didn’t have a different picture in mind.

HB: Suggesting that we are in charge of our own fate. Well, too, you were with the right people at the right time.

G: That’s exactly it.

HB: And presumably asking the right questions.

G: To me, that’s how you did things.

HB: That sounds genetic to me.

G: You can use that term. But it was also being at the Mass. General with Paul Dudley White. You could work with him.

HB: True. I had the pleasure of traveling with him in Italy, the Greek islands and Yugoslavia during his early association with Ancel Keys. And he was always quite simple and direct in his questions and simple in his thinking. It turned out to be that the simple, obvious things were the important things and he saw them very clearly. Perhaps not as concerned with mechanisms as you were, but very ……..

G: The idea of people going out and spending their time doing research intrigued him.

HB: In the field, yeah. Going where it was. Well, he did a lot of that, including with us.

G: He had a good attitude.

HB: He walked around the wards in little clinics in Southern Italy and waited days until they could find a heart attack patient to show. Meanwhile, eating very well.

G: Well, that’s even better. I’m just going back mentally to the time, the date, and the people. And, of course, in the Mass. General you were mixed up with everything and everybody.

HB: I suppose.

G: So one wasn’t completely a heart man. Now you’ve got me facing the question of how do I define what I just said? But, you see, you got to know everybody on the faculty and they were nice to you. The point is you weren’t isolated.

HB: The problem for you probably was that there were so many problems, so many questions that ……..

G: And so many people who wanted you to come in and work with them.

HB: Exactly. But you focused enough to make your career.

G: I did what I did. That’s all I know.

HB: You won’t formalize this at all as a process? OK.

G: They were all quite wonderful, you see. They didn’t isolate me.

HB: But you did end up with a very strong thrust in your career and I’m trying to get to how it developed.

G: Well, don’t ask me. I mean I did what I did. I’m not being evasive.

HB: I understand that. But you began to ask questions about the origins of certain mass phenomena and ……

G: It was all about questions. And the people in cardiology were nice. Most of them were not awfully intellectual.

HB: That’s true, yeah. I’m not sure even Paul Dudley White would be called an intellectual.

G: Oh, no. But he asked questions.

HB: Curious and social, yeah.

G: And knew the right people.

HB: Well, I guess I would attribute my career to the same sort of relationship around Ancel Keys and Henry Taylor and Joseph Brozek and Paco Grande.

G: And then I took lots of EKGs in various ways in the Coronary Study.

HB: Right. Tell me a little bit more about the Coronary Study. These were young men and how did you recruit them? Was it a defined population or just hither and thither?

G: Beautifully put. The Coronary Group consisted of a number of males who developed coronaries under the age of 40.

HB: Ok, all right. So that defined them.

G: That was it.

HB: I now remember that. And the comparison group?

G: Whomever we could get our hands on.

HB: Ok. And then you published a book.

G: Yes. Because we wrote in those days.

HB: I have it somewhere. I haven’t looked at it in years. Is Dr. Gertler still with us?

G: I think so. Menard was an interesting person.

HB: Why?

G: Just to talk to, to think things through with.

HB: Tell me something about the populations you’ve studied and the comparative populations.

G: That’s them. There’s nothing mysterious about them. They were there, the coronary patients. We got our hands on them. Life was not as intellectual in those days.

HB: Or as statistical.

G: Well, I helped to make it somewhat more statistical.

HB: I’m sure.

G: Because I had to.

HB: Sure. Otherwise, how could you find associations? What did you think was the primary impact of that study? What was the thinking about coronary disease?

G: Everything.

HB: It led to clues of…….

G: It led to everything. Maybe not that directly. People often wondered how we had come to do the things we did. There it was, they were there to be done.

HB: They were there to be done. It’s not so obvious to many people.

G: You didn’t do things for a reason. You did them because you did them.

HB: I’m trying to trace back the intellectual origins of that strategy.

G: I understand that and I’m trying to give you an answer and I’m not good at it. So much of it was fortuitous.

HB: Fortuitous because it was fun, because it was ……

G: They were there.

HB: It was there, yeah. But that involves a certain awareness of what is there.

G: Such as the female coronaries.

HB: Exactly. Now the book didn’t include females, did it?

G: I think it included everything there was. I think I’m right.

HB: Couldn’t be many young females that you found with heart disease.

G: You see I wrote much of the book because I did that sort of thing. But it was fun doing it with Menard. I would write a section, he would write a section.

HB: I’ve done that occasionally. I wrote an article with Ancel Keys that way and I was very pleased as a young person when people said, “I couldn’t tell where he left off and you began.” At that time I thought it was a compliment.

G: Yes, Menard discovered he was writing like me.

HB: I wrote a book later with Geoffrey Rose. Did you ever meet him?

G: Only by name.

HB: The most precise, clear thinker I’ve ever been related to. And I found my language quickly getting briefer and much more to the point.

G: It made me think my way through writing various sections. Menard handled it by assigning a section to me and a section to him. He was naturally literate.

HB: I think that’s an oxymoron. Literacy doesn’t come by nature, it comes by nurture. But that’s all right, I like the term.

G: Well, what’s the difference?

HB: Ok, that’s even better.

G: See, most people can’t write.

HB: That is very true.

G: And Menard had it and it worked.

HB: So you provided that skill.

G: No, he had it naturally.

HB: He had it naturally while you acquired it.

G: That’s right. He was fun to be with.

HB: Who else was among your central collaborators over the years?

G: Read the introduction to the book.

HB: Ok, all right. I was talking subsequent to the book. Your Michigan days and……

G: That’s far too complicated. No criticism.

HB: Ok. Jim Neel, of course.

G: No. A great deal of pleasure, but we didn’t actually do anything together. All kinds of interesting relationships. I knew his wife when she was in the school of architecture and I knew her twin sister. See, everybody gets to know everybody in interesting, diverse, and odd ways. Jim and I had some overlapping interests.

HB: The thrifty gene idea goes on even though everybody knows there is not a gene. The concept goes on. I think the concept is interesting and important. What do you think?

G: I consider it to be a literary construct. No criticism.

HB: OK. I understand.

G: Now you’ve got me thinking of the people who became associated with that. But Jim made a great deal out of it.

HB: Yes, he did.

G: He sure did.

HB: I guess it’s really sort of the basis of evolutionary medicine that now we even look at phenomena such as jealousy and psychoses and diabetes and obesity and coronary disease as being modern maladaptations based on our evolutionary legacy as hunter-gatherers – the same idea is carried throughout.

G: It represents his kind of thinking.

HB: I think it opens interesting opportunities that take us to species-wide considerations that most doctors don’t have, but most of the ideas aren’t testable, I’m afraid.

G: Now you’ve got me thinking of various people. Free association. Now you’re going to make me think of what their actual contributions were.

HB: It would be nice.

G: See, I didn’t have that close of a relationship with Jim Neel. At Mass. General with Paul White we were having no evolutionary implications. Or at Harvard with Hooten. Those were my backgrounds.

HB: A mechanistic period.

G: That’s the way the world seemed to be. All the incredible numbers of people who got into the act.

HB: But eventually you have to …… You don’t flit from person to person. Eventually your environment changes and then you’re the leader, you’re on your own.

G: You find that out later.

HB: Anyway, if it isn’t fun, it isn’t anthropology. Or if it isn’t fun, it isn’t epidemiology, as far as I’m concerned.

G: That’s it. There I was living for years on Massachusetts Avenue – 1306. And everything was right there.

– – – – – – – – – –

HB: Ok. And what questions were you asking? Risk factors weren’t called risk factors back then.

G: All the questions. They weren’t called specific things, but you name it, we were going to turn to it.

HB: You thought about it all with no a priori hypotheses?

G: Right

HB: Ok. An interesting pursuit.

G: Well, it was so in those early days.

HB: And your intent was to look at associations or to look at…

G: We wanted to find at what caused what.

HB: You wanted to predict. You were going to follow these people.

G: We wanted to find out what caused what.

HB: What caused what, all right. There are various ways of doing that. How did you do it?

G: By what we did. I know this sounds silly.

HB: This is almost Socratic here.

G: Yes.

HB: Ok. You will explain a little bit, I hope.

G: We just went and did it.

HB: You went and did it. I like that kind of science.

G: I didn’t know there was any other kind.

HB: Oh, there are many other kinds, unfortunately.

G: I didn’t know that. And Menard [Gertler] was fun because although he had this background he had the same fluidity.

HB: Fluidity you call it? That’s a good word.

G: Yes.

HB: So much fluidity that he dribbled off the edge of the universe from time to time.

G: Yes. Paul White took that for a given.

HB: Some are forgiven.

G: At the time I’m talking about.

HB: Yes, I know. Late Forties, early Fifties at the period just beginning to recognize the modern mass diseases and realize that all the information available was clinical or in the laboratory and not population-wide or species wide.

G: I had the fortune of working on the broader picture simply because I didn’t have a different picture in mind.

HB: Suggesting that we are in charge of our own fate…Well, also you were with the right people at the right time.

G: That’s exactly it.

HB: And presumably asking the right questions. (8)

Garn continues in the same witty, frustrating way

HB: Tell me something about the populations you’ve studied and the comparative populations.

G: That’s them. There’s nothing mysterious about them. They were there, the coronary patients. We got our hands on them. Life was not as intellectual in those days.

HB: Or as statistical.

G: Well, I helped to make it somewhat more statistical.

HB: I’m sure.

G: Because I had to.

HB: Sure. Otherwise, how could you find associations? What did you think was the primary impact of that study? What was the thinking about coronary disease?

G: Everything.

HB: It led to clues of…

G: It led to everything. Maybe not that directly.

HB: Yeah.

G: People often wondered how we had come to do the things we did. There it was, they were there to be done.

HB: They were there to be done. It’s not so obvious to many people.

G: You didn’t do things for a reason. You did them because you did them.

HB: I’m trying to trace back the intellectual origins of that strategy.

G: I understand that and I’m trying to give you an answer and I’m not good at it. So much of it was fortuitous.

HB: Fortuitous because it was fun, because it was…

G: They were there.

HB: It was there, yeah. It involves a certain awareness of what is there.

 

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