Uri Goldbourt

Quotes

I researched to an extent the origins of cardiovascular epidemiology in Israel and I think that almost certainly the first two observations of a variability – at that time it was limited to hospitalization rate in Israel – was a paper by Fritz Dreyfus in 1953-54… It pointed out that the Yemenite-born Jews were very rarely seen in most hospitalized cases. The second sort of pillar of knowledge, if I’m not exaggerating, has to go to, I think, Professor Toor from Bellingston [ed. unsure of place name]. He was director of cardiology there, but he took great interest in ethnic origin of differences between atherosclerosis and coronary disease and he looked at risk factors among different geographic and ethnic groups in Israel not so much in terms of a prospective study, but he also collected them in a crude manner, of course, that was the time when computers were only beginning to evolve and methods of analysis were very slow. He correlated them in a manner with a national cause of death, mortality data, which were already available since the very beginning of Israel in the early 1950s. And at the same time Kalneil [ed. unsure of name]and Groen, G-r-o-e-n – we know about him – wrote a number of either papers or publications in the form of booklets. I think Kalneil was the major, I think she was the main statistician or maybe her job was different than otherwise defined. And in 1958 if I remember correctly; it can all be checked in our 1982 paper, they really printed a good material in the form of a government document or something like this, showing over a number of years how the rate of mortality from different causes of death including cardiovascular disease were distributed among recent migrants and all migrants from Asia, from Africa, from Eastern Europe, other parts of Europe. Then came a really benchmark undertaking … Eric Parents was an excellent statistician, but he was also a demographer and he had a major interest in epidemiology of coronary disease. While that publication appeared in late 1973, namely after the initiation and examination of the Israel’s coronary disease and stroke, but it related to mortality in Israel between 1950 and 1967. And for the first time they really laid out the entire bizarre patterns whereby the ethnic differences in cardiovascular mortality behaved in a certain manner among the males and another one among the females and it pointed out the strange phenomenon of a low coronary heart disease and mortality apparently on the basis of low incidence among African-born Jewish males it was completely different among the African-born Jewish females. That’s a phenomenon we are still seeing and we don’t understand yet. (2)

Progress

I think that Israel fairly quickly, you know for a country which existed only 14 years with all the economic problems at that time, emerging to the world scene of cardiovascular epidemiology. Mortality data was collected; almost immediately we provided WHO with the data. For long years there was a MONICA Project component here. Unfortunately that did not work too well. There was an LRC Prevalence Study of course in Jerusalem, but came together with LRC in the USA. There was in all this a very intimate, if I can say so, on-going contact between epidemiologists here and cardiovascular epidemiological community in the USA in general and in NIH and NHLBI later in particular all the time.

One of the causes of the slow pace here, perhaps, was the fact that it took time here to develop statisticians into knowledgeable epidemiologists in that area. And I remember myself studying and teaching during the same week at the Hebrew University when the so-called then Department of Social Medicine and something was active and there was no call for the epidemiology of coronary heart disease at that time. I started it 10 years ago when the master’s study of epidemiology was approved and at the same time there was the Public Health School in Jerusalem.

I think that we did a lot considering the size and the resources of our country. But I think we could have done much more and I think that we can still do much more because the talent is rife here and young people with a capacity to contribute to cardiovascular epidemiology are legion. It is a matter of raising or increasing the framework and raising interest and recruiting good people to do this. Because there is no paucity of talent or capability here. (10)

Past and Future

Obviously there was this move initiated by the NIH from studies on the individuals like Framingham, Albany to the Family Heart Study. In the early 1990s I was involved with it in a small way when I was on a sabbatical at DECA with Millicent Higgins so that permits obtaining family data. And then, of course, all the new measurements that became possible like the IMT and all the other things that ARIC implemented in the USA. We were talking here about starting a new large study, but unfortunately, so far it did not go beyond just talk.

The goal would be to recharacterize risk factors for a number of diseases in Israel using all the new tools and to the extent possible also genetic measurement. I think that the new cardiovascular epidemiology to the extent that it can be an answer would want to fall in line with an ideal of eventually finding all or most of the candidate genes and trying to characterize, … individuals… reacting in an unfavorable manner to the risk factors that we know…like hypertension, cigarette smoking, physical activity, I don’t think I see definite patterns of this happening.

If I look at the recent meetings of the Council on Epidemiology of the American Heart Association or the working group of the European [Society] and so on . . I think we are still pretty much presenting survival databased on the now not very new methods or approaches. It is somewhat of a puzzle where this is all going.

I think we all would want to know much, much more about the role of nutrition in determining the risk of many diseases and I don’t think until today have found a very good way to characterize the nutritional habits with all the correction with biomarkers and with everything else.

So the question is how do we learn more about the way of life and more about how way of life with all its components is related to cardiovascular risk and then, of course, the particular question is how you influence the public to do this, to do that, not only in the USA, but also in Israel? And in particular the women are beginning to put on weight recently in a frightening manner. (12)