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Shackles of Power Three Jeffersonian Dec
A Change of Heart" is a detailed account of the revolutionary Framingham Heart study -- which, over the years, has provided conclusive evidence that cardiovascular disease is largely the result of measurable and modifiable risk factors. First begun in 1948, not long after Franklin Delano Roosevelt succumbed to a massive stroke, the study of over 5,000 citizens of Framingham, Massachusetts, changed the course of medical history. The lessons learned in Framingham allow each of us to control our risk of heart disease and stroke, two of the leading causes of death in the United States. Here is a clear-eyed and intriguing assessment of the achievements of this study and of its continuing importance to our health today. "From the Trade Paperback edition.
- GenresNonfictionScienceHealth
Hardcover
First published February 1, 2005
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January 6, 2021
Disclaimer: I think the author writes about the participants of the study with a very kind tone and I feel kind of guilty for how hard I’m about to go in on this book but it was so so so boring and problematic. Also I had to read this for a cardiology elective, and I notoriously hate books I’m forced to read. Below are basically a list of my rants and complaints:
...
POTATOES ARE NOT INHERENTLY BAD!!!
It’s not their fault people always fry them.
A LOT of fat shaming. There was an entire chapter about “lifestyle” that didn’t once touch on the fact that people do not choose these things, they are a product of their financial status and environment and billions of dollars of marketing. So infuriating. People are not just “lazy and fat.”
Also, the authors state (paraphrasing) that back in the day people knew that if they were overweight, but not fat, they were probably fine. So you are unknowingly giving a history of the way doctor’s mistreat fat people.
Loved the chapter about the man who considered obese people “disgusting.”
You can’t blame CVD on the affluence that came in the wake of the GI bill which allowed families to build houses and simultaneously ignore the fact that black people were not given the GI bill and yet now have higher CVD rates.
They say they didn’t include minorities because “it did not reflect the US population at the time.” So you’re telling me there weren’t minorities in the 60’s.......They didn’t include minorities because they were too busy killing them with syphilis (both Framington and Tuskegee were originally US public health studies going on at roughly the same time in the 1900’s). ALSO THE STUDY WAS ORIGINALLY MANAGED BY A CONFEDERATE SOLDIER SO MAYBE IT WASN’T A COINCIDENCE ugh
It also bothered me that even if you were purely interested in the science of epidemiology and clinical trials, the history of those were not handled well either. Mentioned the Women’s Health Initiative without going into the problems that have been debunked within the original study. Someone reading this book would walk away from it thinking HRT is inherently bad.
It’s clear that the author isn’t interested in nuance when it comes to obesity, race, or the medical establishment as a whole. He repeated trite statements so often that it was like dude what’s the word count on this mf but couldn’t be bothered with reflection on the true history of our current medical climate.
...
POTATOES ARE NOT INHERENTLY BAD!!!
It’s not their fault people always fry them.
A LOT of fat shaming. There was an entire chapter about “lifestyle” that didn’t once touch on the fact that people do not choose these things, they are a product of their financial status and environment and billions of dollars of marketing. So infuriating. People are not just “lazy and fat.”
Also, the authors state (paraphrasing) that back in the day people knew that if they were overweight, but not fat, they were probably fine. So you are unknowingly giving a history of the way doctor’s mistreat fat people.
Loved the chapter about the man who considered obese people “disgusting.”
You can’t blame CVD on the affluence that came in the wake of the GI bill which allowed families to build houses and simultaneously ignore the fact that black people were not given the GI bill and yet now have higher CVD rates.
They say they didn’t include minorities because “it did not reflect the US population at the time.” So you’re telling me there weren’t minorities in the 60’s.......They didn’t include minorities because they were too busy killing them with syphilis (both Framington and Tuskegee were originally US public health studies going on at roughly the same time in the 1900’s). ALSO THE STUDY WAS ORIGINALLY MANAGED BY A CONFEDERATE SOLDIER SO MAYBE IT WASN’T A COINCIDENCE ugh
It also bothered me that even if you were purely interested in the science of epidemiology and clinical trials, the history of those were not handled well either. Mentioned the Women’s Health Initiative without going into the problems that have been debunked within the original study. Someone reading this book would walk away from it thinking HRT is inherently bad.
It’s clear that the author isn’t interested in nuance when it comes to obesity, race, or the medical establishment as a whole. He repeated trite statements so often that it was like dude what’s the word count on this mf but couldn’t be bothered with reflection on the true history of our current medical climate.
November 18, 2020
When US President Franklin Delano Roosevelt died from complications of high blood pressure in 1945, the medical community sought to discover the nature and causes of heart disease. Thus was born a multi-generational, decades-long research study into people’s health in Framingham, Massachusetts. This study found scientific evidence about heart disease and changed treatment, research, and culture. This book chronicles this history and preserves this inspiring story for future generations.
At the time of writing, Levy serves as the director of the Framingham study, and Brink is a medical journalist. Together, they divide the Framingham narrative into 17 smaller stories that communicate how these people – researchers and community – changed the world. They capture these dynamic events in a series of before-and-after scenes. Varied and interesting topics include: technology and research, the culture of risk factors, high blood pressure, the challenges of entrenched pro-smoking habits, and the sedentary, high-fat lifestyle.
The authors relate about the hardships and victories shared amongst the participants and workers. They talk frankly about times where the study was jeopardized by external threats. They tell how the town of Framingham changed for the better by tracking their families’ health. They tell individual stories about how the study united the community across generational and ethnic barriers.
Published in 2005, this book could use some updating. Written soon after the completion of the Human Genome Project, it concludes with a chapter on how Framingham has encountered the era of genetics. I’d like to hear how that particular story has progressed over the past 15 years. To my ears as a researcher, it’s refreshing to hear how steady data collection and analysis has changed and continues to change human lives. This study has impacted the lifestyle of almost every living adult worldwide – whether through modifying diet, embedding the value of exercise, or exposing the vice of smoking. This book provides an accessible and friendly way of learning about this study’s history and the people of Framingham behind the study. Now, after learning so much about healthy hearts, I need to get back to my treadmill…
At the time of writing, Levy serves as the director of the Framingham study, and Brink is a medical journalist. Together, they divide the Framingham narrative into 17 smaller stories that communicate how these people – researchers and community – changed the world. They capture these dynamic events in a series of before-and-after scenes. Varied and interesting topics include: technology and research, the culture of risk factors, high blood pressure, the challenges of entrenched pro-smoking habits, and the sedentary, high-fat lifestyle.
The authors relate about the hardships and victories shared amongst the participants and workers. They talk frankly about times where the study was jeopardized by external threats. They tell how the town of Framingham changed for the better by tracking their families’ health. They tell individual stories about how the study united the community across generational and ethnic barriers.
Published in 2005, this book could use some updating. Written soon after the completion of the Human Genome Project, it concludes with a chapter on how Framingham has encountered the era of genetics. I’d like to hear how that particular story has progressed over the past 15 years. To my ears as a researcher, it’s refreshing to hear how steady data collection and analysis has changed and continues to change human lives. This study has impacted the lifestyle of almost every living adult worldwide – whether through modifying diet, embedding the value of exercise, or exposing the vice of smoking. This book provides an accessible and friendly way of learning about this study’s history and the people of Framingham behind the study. Now, after learning so much about healthy hearts, I need to get back to my treadmill…
July 29, 2008
I heard this book mentioned during a discussion of the Framingham Heart Study on NPR. Unfortunately, this was no more than a superficial review.
There was little discussion of the details of the data collection and analysis that's at the heart of this project. Instead, fifty years of data from more than ten thousand participants were boiled down to the same pithy phrases we've all heard many times over: dietary fat is bad. Exercise is good. Stop smoking. The reader is told over and over again that it was the data collected in Framingham that provided the foundation for these conclusions, but that's as far as it goes: we're told, not shown.
The controversies surrounding this sort of (now-standard) medical advice is addressed with equal superficiality: they're touched upon, but ultimately dismissed. Dr. Levy mentions many times over that despite the information gleaned from Farmingham, the health of the average American hasn't improved in terms of blood pressure (when not regulated by medication), weight, or diet. But instead of discussing the limitations of this advice, he just seems vaguely perplexed and frustrated, as if it's merely laziness and gluttony that's keeping heart disease prevalent in America. There's a brief mention of how the medical establishment's message to fear all fat led to an increase in the amount of carbohydrates and sugar in the average American's diet -- and thus an increase in obesity. But this failure is, for the most part glossed over; instead, Levy finishes the book by praising the abundance of fat-free dairy products (high in sweeteners!) and out-of-season produce (imported thousands of miles, burning fuel and lacking flavor) available in modern supermarkets.
There's doubtless a fascinating book to be written on the Framingham Heart Study, but this isn't it.
There was little discussion of the details of the data collection and analysis that's at the heart of this project. Instead, fifty years of data from more than ten thousand participants were boiled down to the same pithy phrases we've all heard many times over: dietary fat is bad. Exercise is good. Stop smoking. The reader is told over and over again that it was the data collected in Framingham that provided the foundation for these conclusions, but that's as far as it goes: we're told, not shown.
The controversies surrounding this sort of (now-standard) medical advice is addressed with equal superficiality: they're touched upon, but ultimately dismissed. Dr. Levy mentions many times over that despite the information gleaned from Farmingham, the health of the average American hasn't improved in terms of blood pressure (when not regulated by medication), weight, or diet. But instead of discussing the limitations of this advice, he just seems vaguely perplexed and frustrated, as if it's merely laziness and gluttony that's keeping heart disease prevalent in America. There's a brief mention of how the medical establishment's message to fear all fat led to an increase in the amount of carbohydrates and sugar in the average American's diet -- and thus an increase in obesity. But this failure is, for the most part glossed over; instead, Levy finishes the book by praising the abundance of fat-free dairy products (high in sweeteners!) and out-of-season produce (imported thousands of miles, burning fuel and lacking flavor) available in modern supermarkets.
There's doubtless a fascinating book to be written on the Framingham Heart Study, but this isn't it.
April 30, 2008
This is the “biography” of the Framingham Heart Study. This is a longitudinal study of citizens from Framingham Mass. The study and how it grew and developed since the late 40’s is an incredible story about a public health problem that had not really been recognized as such. The story starts with FDR’s blood pressure at Yalta or one of those conferences. The point is if he had the reading he did today, he would have been rushed to the hospital. The end of the story is how the people of Framingham revolted when they learned that all the data that had been collected was going to be given to a private company formed out of Boston University. Folks said that they would never have participated if they had known the data was going to be used this way. Over the years, the study collected tons of data that could not be analyzed. The author thinks some kind of private interest should work with the data, but that any sales of the data should go to the Study or to Framingham or the participants.
December 22, 2020
This was a fascinating, enjoyable, and informative book. The authors—one of whom ran the Framingham Heart Study—describe the development of epidemiology methods, protocols, and scientific foundations needed for the Study. We like to think that, gosh, we've always known that dietary fat was bad, hypertension was bad, and physical exercise was a necessary part of health. We can also be found guilty of thinking that epidemiology studies like this are the norm, when really it was a first of its kind.
I had no idea that annual physicals didn't become a thing until after the Framingham Heart Study. Likewise, I didn't know that people—men in particular—just expected to drop dead from a fatal cardiac event. Or that "essential hypertension" was just thought to be a normal and necessary part of aging.
We've learned so much about our health from this study. While our health has dramatically improved since 1948, we still have a long way to go.
I had no idea that annual physicals didn't become a thing until after the Framingham Heart Study. Likewise, I didn't know that people—men in particular—just expected to drop dead from a fatal cardiac event. Or that "essential hypertension" was just thought to be a normal and necessary part of aging.
We've learned so much about our health from this study. While our health has dramatically improved since 1948, we still have a long way to go.
March 9, 2025
We all know that cholesterol is bad. We all know that high blood pressure is bad. We all know we should watch our diet and exercise. But where, exactly, did those insights come from? They largely came from the Framingham Heart Study, which followed approximately 5000 people from the small town of Framingham in Massachusetts, USA, for decades to evaluate their risk of cardiovascular disease. Extensive questionnaires and regular physical exams, later expanded to include ECG, echocardiography and X-rays, were analyzed to identify risk factors for sudden death, angina pectoris, myocardial infarction and stroke. Begun in 1948, the study later included the Offspring Study, and in 2002 the Third Generation study was begun.
I found it fascinating to dig a little deeper into the origin of this epidemiological survey, which every medical student hears about. It had humble beginnings in the post-WWII years, when steak, mashed potatoes and gravy were considered a hearty, nutritious meal and most men smoked, courtesy of the cigarettes that had been provided as part of their rations during WWII - but also a time when the idea of serving the greater good was appealing and natural to most folks. A serious effort to reassure the local doctors that the Heart Study would just evaluate, not treat or "steal" their patients was absolutely necessary, as was the work of grassroots volunteers who would walk around Framingham convincing individuals to sign up.
From the technical point of view, the data from the Heart Study was kept on punch cards for decades, until the 1980s. And according to the author, the statistical technique called multivariate analysis was developed at the National Institutes of Health specifically to help untangle the multiple variables of cardiovascular health that the Study uncovered. In the course of its lifetime (or at least until 2005, when this book was written), the Study survived two major threats to its existence. The first was an effort in 1968 to shut it down, partially because certain influential cardiologists felt that over the 20 years of its existence, the study had yielded all the data it was ever going to produce, and partially because funding was being driven into the War on Cancer. And around 2000, Boston University came up with an ill-conceived plan to form a for-profit company to use and sell the study data. As expected, the participants rose up in arms against this violation of the original premise (and promise) of the Study, and the project was shut down.
Some of the most interesting chapters were about how the insights about cholesterol, hypertension and smoking came about. The Framingham Study certainly played an important role, as did epidemiological studies of countries where cardiovascular disease was infrequent, in determining what foods to select and avoid. The chapter on homocysteine as risk factor for cardiovascular disease was informative as well.
Overall, an interesting book that allows a peek behind the curtain of the study whose recommendations now widely known (if not always implemented, specifically the warnings about sedentarism and obesity).
I found it fascinating to dig a little deeper into the origin of this epidemiological survey, which every medical student hears about. It had humble beginnings in the post-WWII years, when steak, mashed potatoes and gravy were considered a hearty, nutritious meal and most men smoked, courtesy of the cigarettes that had been provided as part of their rations during WWII - but also a time when the idea of serving the greater good was appealing and natural to most folks. A serious effort to reassure the local doctors that the Heart Study would just evaluate, not treat or "steal" their patients was absolutely necessary, as was the work of grassroots volunteers who would walk around Framingham convincing individuals to sign up.
From the technical point of view, the data from the Heart Study was kept on punch cards for decades, until the 1980s. And according to the author, the statistical technique called multivariate analysis was developed at the National Institutes of Health specifically to help untangle the multiple variables of cardiovascular health that the Study uncovered. In the course of its lifetime (or at least until 2005, when this book was written), the Study survived two major threats to its existence. The first was an effort in 1968 to shut it down, partially because certain influential cardiologists felt that over the 20 years of its existence, the study had yielded all the data it was ever going to produce, and partially because funding was being driven into the War on Cancer. And around 2000, Boston University came up with an ill-conceived plan to form a for-profit company to use and sell the study data. As expected, the participants rose up in arms against this violation of the original premise (and promise) of the Study, and the project was shut down.
Some of the most interesting chapters were about how the insights about cholesterol, hypertension and smoking came about. The Framingham Study certainly played an important role, as did epidemiological studies of countries where cardiovascular disease was infrequent, in determining what foods to select and avoid. The chapter on homocysteine as risk factor for cardiovascular disease was informative as well.
Overall, an interesting book that allows a peek behind the curtain of the study whose recommendations now widely known (if not always implemented, specifically the warnings about sedentarism and obesity).
April 14, 2018
A good intro to the project, but poor writing.
Read
August 9, 2011Loved this book while I was on my flight from DC to Beijing. I actually didn't finish the whole thing though since I left it on the plane! But, from what I did read, it's fascinating finding out the history of what my family has been doing for the last three generations. how it started, why it started, and most importantly, why the Heart Study has continued for decades beyond it's original plan, and looks like it will continue you for many more. At some points, it gets a little technical and medical, so it's not exactly a light read, and if you're not in the Heart Study, or know someone who is, this book may not be that interesting for you. It's a bit of a fan fodder book, if you can call something about a medical study fan fodder. But still, an interesting read if you are a history buff, or a medical buff.
Displaying 1 - 8 of 8 reviews