WEBVTT - How the Framingham Heart Study Works 0:00:00.760 --> 0:00:06.439 Hello, Colorado. The States so nice. We're playing there twice, 0:00:06.680 --> 0:00:08.680 two days in a row. Chuck, we added a second 0:00:08.680 --> 0:00:11.520 show to our Gothic Theater tour. That's right, we're gonna 0:00:11.560 --> 0:00:15.680 be there June seventh and June now sold out, but 0:00:16.120 --> 0:00:17.880 one of those weird cases where you go see the 0:00:17.920 --> 0:00:21.200 first show you were actually late buying tickets. Right. We're 0:00:21.239 --> 0:00:23.480 also going to be in Boston April four, d C 0:00:23.720 --> 0:00:26.680 April five. We're gonna be in St. Louis on May, 0:00:27.720 --> 0:00:31.120 in Cleveland one, and then of course we're gonna wrap 0:00:31.200 --> 0:00:36.040 this summer up on June at the Gothic Theater in Colorado. 0:00:36.120 --> 0:00:38.080 So go to s Y s K live dot com 0:00:38.320 --> 0:00:43.040 for all of your information and ticket needs. Welcome to 0:00:43.440 --> 0:00:52.840 Stuff you Should Know from how Stuff Works dot com. Hey, 0:00:52.920 --> 0:00:56.440 and welcome to the podcast. I'm Josh Clark. There's Charles W. 0:00:56.720 --> 0:01:00.960 Chuck Bryant, There's guest producer Noel all of Nature, Wild 0:01:01.040 --> 0:01:04.440 and Free. This is where you long to be. Stuff 0:01:04.480 --> 0:01:07.920 you should know. So let's go ahead and admit that 0:01:07.959 --> 0:01:11.080 we just did a rare retake of like the first 0:01:11.120 --> 0:01:14.160 four minutes of the show. Yeah, and I still reused 0:01:14.160 --> 0:01:17.319 the Madonna lyric joke. That's fine, but we have to 0:01:17.319 --> 0:01:20.120 recreate the rest of the previous four minutes. No, I 0:01:20.160 --> 0:01:21.720 don't think so. I think we should just kind of 0:01:21.800 --> 0:01:24.200 let it flow. I was just I was saying to myself, 0:01:24.200 --> 0:01:27.400 By God, that Madonna jokes getting in there. All right, Well, 0:01:27.440 --> 0:01:30.200 maybe just a quick recap. Noel's dressed up and looks great. 0:01:30.520 --> 0:01:34.560 He's it's because he's a snappy dresser. Uh. We mispronounced 0:01:34.600 --> 0:01:38.160 words in the UK and got laughed at. And now 0:01:38.200 --> 0:01:42.440 we're talking about the Framing Him heart Study. That's right, 0:01:42.480 --> 0:01:44.600 which we h. I don't know what podcast it was on, 0:01:44.640 --> 0:01:48.880 but years ago we called it the Farmington hard Study. Um, 0:01:48.920 --> 0:01:53.320 every time we said it, we said Farmington's did we really? Yeah, 0:01:53.360 --> 0:01:56.280 you don't remember that. No, I mean that definitely sounds 0:01:56.320 --> 0:01:58.240 like us, but I don't remember it. Yeah. Yeah, that's 0:01:58.240 --> 0:01:59.960 why I made that joke when you first came in 0:02:00.160 --> 0:02:04.240 about the Farmington Heart Study. Okay, yeah, we said it 0:02:04.320 --> 0:02:06.880 was years ago. It was one of our earlier couple 0:02:06.880 --> 0:02:11.320 of years and we said the Farmingtons Hearts Study probably 0:02:11.360 --> 0:02:14.760 twelve times. Yeah. Back in the day, the standards used 0:02:14.800 --> 0:02:17.440 to be its head lower. Yeah, because we were low 0:02:17.480 --> 0:02:22.440 hanging Fruit podcast. It was us Zyberglass was Ricky Gervais 0:02:22.480 --> 0:02:25.120 and Jesse Thorn, and then Adam Curry was out there 0:02:25.200 --> 0:02:30.560 somewhere and probably Adam Corolla. Sure, yeah no, but no 0:02:30.560 --> 0:02:33.040 one else we had. There were eight podcasts. That was it. 0:02:33.320 --> 0:02:34.959 That was all you had to choose from, So you 0:02:35.080 --> 0:02:36.720 better like at least one of them. Do you know 0:02:36.720 --> 0:02:39.960 how many there are? Now? I just saw today? Uh no, 0:02:40.200 --> 0:02:42.120 do you like you have an actual number? Well, I 0:02:42.120 --> 0:02:45.200 mean it's a it's an even number, so it's probably 0:02:45.200 --> 0:02:49.480 not exact. But the latest hot pod newsletter said that 0:02:49.520 --> 0:02:54.239 there are roughly three podcasts. Oh my god, that's nuts. 0:02:55.240 --> 0:02:59.359 I know, man alive. That's pretty impressive, and probably only 0:02:59.440 --> 0:03:03.519 like five of those are good. Well, we we went 0:03:03.560 --> 0:03:07.600 from that was mean, we went from eight to three 0:03:08.040 --> 0:03:11.680 fifty thousand and how many years? Ten? We're still hanging strong, 0:03:12.040 --> 0:03:15.560 we are. That's great. That's what happens when you say 0:03:15.600 --> 0:03:22.560 things like Farmington ten twelve times. He's long gone. Yeah, 0:03:22.680 --> 0:03:26.000 he pronounced everything perfectly like guys washed up now yea, 0:03:27.720 --> 0:03:30.400 So the reason we're talking about framing him, which, by 0:03:30.440 --> 0:03:34.160 the way, yeah, yeah, it's gonna be tough to say 0:03:34.200 --> 0:03:39.160 it the same way every time, but it's framing Ham 0:03:39.360 --> 0:03:43.040 is the city of Massachusetts. I don't get the Framingham 0:03:43.120 --> 0:03:46.960 as opposed to framing him Yeah, ok, yeah, the h 0:03:47.080 --> 0:03:52.520 is a hard age or soft aged like, Whereas if 0:03:52.520 --> 0:03:56.360 this were in Scotland they would just say you're right, 0:03:57.080 --> 0:03:59.640 which is again why we were laughed at Manchester that 0:04:01.080 --> 0:04:08.680 it's Germany sorry, right, which is landlocked. So again we're 0:04:08.720 --> 0:04:12.920 talking about Framingham, Massachusetts, a very small town these days. 0:04:13.160 --> 0:04:16.560 In two thousand and seventeen, I think the census, well 0:04:16.600 --> 0:04:20.839 that the population estimate was something like seventy residents, not 0:04:20.960 --> 0:04:23.480 a not a huge town. I think that qualifies as 0:04:23.480 --> 0:04:26.680 a small, dinky town. Still. Yeah, but it's a suburb 0:04:26.720 --> 0:04:31.080 of Boston, which is a huge metropolis. Sure it is, um, 0:04:31.240 --> 0:04:34.560 but it is aside from being a suburb of Boston, 0:04:34.839 --> 0:04:38.520 it is in its own right, uh, an internationally renowned 0:04:39.080 --> 0:04:43.159 tiny town. Not because it's like a place where the 0:04:43.160 --> 0:04:47.359 circus used to hang out during the winter, or because um, 0:04:47.400 --> 0:04:53.160 they have some amazing kind of fudge. Right, Farmingham, Massachusetts 0:04:53.240 --> 0:04:57.200 is on the map because that town back in the day, 0:04:57.240 --> 0:05:00.599 actually two times over that town. Just I did that 0:05:00.680 --> 0:05:06.760 they were going to present themselves as as test subjects, 0:05:07.520 --> 0:05:12.640 study participants, for some of the most important studies ever 0:05:12.760 --> 0:05:15.920 carried out in the history of medicine. Yeah. What one 0:05:15.960 --> 0:05:21.360 of the largest and certainly most influential longitudinal studies ever 0:05:21.440 --> 0:05:24.440 performed in medicine. Yeah, it's called the Farming hum Or 0:05:24.480 --> 0:05:29.760 farming Ham Heart Study, the Framingham Oh my god, was 0:05:29.800 --> 0:05:35.159 that an accident? Yes, Oh boy, The Framing hum Heart Study. Yeah, 0:05:35.160 --> 0:05:39.159 which you know, we've we've had challenges, as has the 0:05:39.200 --> 0:05:44.960 medical community in research community throughout study history, of being 0:05:44.960 --> 0:05:48.560 frustrated with like bad studies and poor sample sizes. This 0:05:48.640 --> 0:05:52.039 one is really set the standard. Yeah, it's it's the 0:05:52.120 --> 0:05:54.680 gold standard for anything that has anything to do is 0:05:54.920 --> 0:05:58.200 studying cardiovascular disease. And as we'll see it basically is 0:05:59.200 --> 0:06:02.599 everything we you and I, just Joe Schmo walking around 0:06:02.600 --> 0:06:06.800 on the street know about cardiovascular disease basically came out 0:06:06.839 --> 0:06:10.680 of this study. Um. And even before that, there was 0:06:10.720 --> 0:06:14.839 another study that the town participated in that helped lick tuberculosis, 0:06:15.880 --> 0:06:21.240 which was which was appropriate because you know, framing framing him. Yeah, 0:06:21.279 --> 0:06:24.200 I got it right. Is in Massachusetts, which is part 0:06:24.240 --> 0:06:27.920 of New England, which was part of the vampire panic area, which, 0:06:27.920 --> 0:06:30.640 as you remember, was the result of tuberculosis. So it's 0:06:31.279 --> 0:06:35.520 it was appropriate that that little town contributed to humanity 0:06:35.560 --> 0:06:38.080 in that way as well. Yes, so should we hop 0:06:38.080 --> 0:06:40.840 in the way back machine? Oh yes, all right, let's 0:06:40.880 --> 0:06:44.760 set the dial. Let's load up the flux capacitor with 0:06:45.720 --> 0:06:50.880 Miller heavy beer and banana peals. Miller heavy. Yeah that's 0:06:50.880 --> 0:06:56.680 what he used, nice, I think so, yeah, okay, that's 0:06:57.120 --> 0:07:00.200 that's at the end with the more modern version right 0:07:00.279 --> 0:07:03.400 right of the Dolorean. Yeah. I think he used some 0:07:03.480 --> 0:07:10.040 sort of plasma waist incenterator. Yeah. Uh so, let's let's 0:07:10.040 --> 0:07:13.720 set the dials for um, the World War two era. 0:07:14.240 --> 0:07:23.280 We're not gonna be super specific here, No, sometimes we 0:07:23.440 --> 0:07:25.560 rolled the dice in the way back machine. Let's see 0:07:25.600 --> 0:07:28.280 what happened. Just say, spit us out anytime in the 0:07:28.400 --> 0:07:32.440 nineteen forties, not in Europe or the South Pacific, that's right. 0:07:32.520 --> 0:07:36.320 So in the nineteen UM here was a scene in 0:07:36.320 --> 0:07:38.400 the USA, and I guess all over the world is 0:07:38.480 --> 0:07:41.240 we did not know a lot about and all this 0:07:41.240 --> 0:07:45.200 stuff seems so second nature now and like duh about 0:07:45.240 --> 0:07:48.600 heart disease, But we didn't know a lot about heart 0:07:48.640 --> 0:07:51.360 disease back then, and it was sort of just accepted 0:07:52.240 --> 0:07:55.120 that once you reach a certain age, like, yeah, your 0:07:55.160 --> 0:07:57.320 heart just may take you out. Nothing we can do 0:07:57.360 --> 0:07:59.920 about it. Might as well not research it. And there's 0:08:00.000 --> 0:08:05.040 certainly no preventative medicines for your to ensure that health. No, 0:08:05.200 --> 0:08:08.120 certainly not like they could try to treat it or whatever. 0:08:08.160 --> 0:08:11.040 But most of the time, once you came down with UM, 0:08:11.120 --> 0:08:15.679 one of the cardiovascular diseases, you UM, you were a goner. 0:08:16.360 --> 0:08:24.120 YEA of us deaths we're due to CBD, right, And 0:08:24.240 --> 0:08:26.960 so there was a confounding factor that led to this 0:08:27.360 --> 0:08:30.720 huge increase. There are actually two of them. One is 0:08:31.760 --> 0:08:37.640 as far as percentages go. The cardiovascular disease deaths lurched 0:08:37.760 --> 0:08:42.400 forward in the mid early mid twentieth century because what 0:08:42.640 --> 0:08:45.480 used to be the big killers, which were infectious diseases 0:08:45.520 --> 0:08:50.000 which we now consider highly treatable. They used to kill everybody, right, 0:08:50.480 --> 0:08:52.440 And as we started to treat them thanks to the 0:08:52.480 --> 0:08:56.720 discovery and use of penicillin and antibiotics, those things fell 0:08:56.760 --> 0:09:00.720 into the background and and by by extend mention or 0:09:00.760 --> 0:09:08.000 by proxy, cardiovascular disease was basically bear naked out there 0:09:08.080 --> 0:09:11.160 statistics wise. Suddenly something that was just kind of like 0:09:11.559 --> 0:09:14.320 a secondary problem was now that the leading cause of 0:09:14.360 --> 0:09:17.280 death in the United States and in the West. I believe, yeah, 0:09:17.280 --> 0:09:21.480 because I guess people were living routinely, living into their 0:09:21.480 --> 0:09:26.240 fifties and sixties, maybe for the first time, I don't know, Yeah, 0:09:26.320 --> 0:09:28.679 and they were saying, my god, I'm so glad I 0:09:28.760 --> 0:09:31.600 get these extra couple of decades of eating raw steak 0:09:31.679 --> 0:09:36.720 and smoking cigarettes at the dinner table. Grass. That is 0:09:36.720 --> 0:09:39.360 so nasty. It's a it's a true story, though. I 0:09:39.400 --> 0:09:42.440 saw my grandpa do it with my own eyes, smoke 0:09:42.679 --> 0:09:45.240 at the table. Now. Actually, my grandpa was one of 0:09:45.240 --> 0:09:48.040 the He went the other way. He was like like 0:09:48.120 --> 0:09:52.760 subscriber number three to Prevention magazine and yeah, into like 0:09:52.840 --> 0:09:55.480 coffee animas and all sorts of weird st He was 0:09:55.559 --> 0:09:58.840 big time healthy guy. Is that what led your dad 0:09:58.840 --> 0:10:01.800 to become the herbal Elviots? I think that that had 0:10:01.960 --> 0:10:04.719 some had to have had something to do with it, 0:10:04.840 --> 0:10:08.000 for sure. Luckily my dad didn't carry on the family 0:10:08.040 --> 0:10:12.720 tradition of coffee animos down to me. So um alright, 0:10:12.760 --> 0:10:18.240 So by of death or cardiovascular everyone's dying now from 0:10:18.280 --> 0:10:20.520 their heart because they're living longer because they're not dying 0:10:20.520 --> 0:10:23.480 of TV and their thirties and forties and then the 0:10:23.520 --> 0:10:27.680 second big thing that happened that you teased was President Roosevelt. 0:10:28.920 --> 0:10:33.160 Uh started to get really he got cardiovascular disease. He 0:10:33.200 --> 0:10:36.160 started to get really high blood pressure. Uh. This was 0:10:36.240 --> 0:10:40.600 compounded by UM. Now we understand that stress and anxiety 0:10:40.640 --> 0:10:43.360 can compound these things, and he certainly had no shortage 0:10:43.360 --> 0:10:47.840 of that UM as president. And you know Winston Churchill 0:10:47.880 --> 0:10:50.520 of all people, when he says he seems to be 0:10:50.600 --> 0:10:54.040 a very tired man. If Winston Churchill was saying that, 0:10:54.040 --> 0:10:56.840 then you're in trouble. Yeah, because he wasn't the picture 0:10:56.840 --> 0:10:59.800 of health. No, he certainly wasn't. But apparently f D 0:11:00.200 --> 0:11:03.559 made him look like he was fresh as a daisy. 0:11:03.760 --> 0:11:06.400 So FDR had high blood pressure when he went into 0:11:06.400 --> 0:11:09.520 the White House to begin with. But by the time 0:11:10.720 --> 0:11:15.040 rolls around right after the Yalta UM conference where they 0:11:15.080 --> 0:11:19.800 divided Europe up between what Great Britain, the United States 0:11:19.800 --> 0:11:24.960 in UM, Russia the Soviet Union, right. Um. He died 0:11:25.000 --> 0:11:27.960 a couple of weeks after that, at age sixty three. 0:11:28.000 --> 0:11:31.880 He had a stroke from hypertension, which is another word 0:11:31.920 --> 0:11:35.640 for high blood pressure. And boy, oh boy, did he 0:11:35.840 --> 0:11:40.120 have high blood pressure like off the charts. Chuck, Yeah, 0:11:40.200 --> 0:11:43.280 three hundred, when when he died he had three hundred 0:11:43.320 --> 0:11:49.200 over one. One more time, three hundred over one. So 0:11:49.240 --> 0:11:51.200 I went and look that up. I'm like, even without 0:11:51.240 --> 0:11:53.800 looking it up, I know that's high, but how high 0:11:53.840 --> 0:11:58.160 is it? So? Ideal is between ninety over sixty and 0:11:58.200 --> 0:12:02.400 one over eighty. That's how deal blood pressure. Anything over 0:12:02.559 --> 0:12:06.840 one eighty over one twenty is what's called a hypertensive crisis. 0:12:07.360 --> 0:12:09.880 And the chart tells you to go to your doctor 0:12:09.960 --> 0:12:14.000 immediately for that if you have anything over one eight over. 0:12:14.800 --> 0:12:18.120 FDR had three over one. Yeah, and I mean his 0:12:18.200 --> 0:12:20.880 doctor said, I predict he's a very sick man. I 0:12:21.000 --> 0:12:22.680 predicted will be dead within a few months. And he 0:12:22.720 --> 0:12:27.040 was running the money, right Churchill's doctor. Yeah, FDR Zone 0:12:27.080 --> 0:12:29.599 doctor was like, here, take this digitalis You'll love that. 0:12:29.720 --> 0:12:33.480 Churchill's guy, Yeah, okay, yeah. At the y'all take conference. 0:12:33.679 --> 0:12:36.800 I guess he just travels with I would think, so, 0:12:36.880 --> 0:12:39.240 I thought, I mean, I would imagine all those guys 0:12:39.280 --> 0:12:42.000 would travel with their doctors, you know, just just for fun, 0:12:42.080 --> 0:12:44.080 like what kind of pills you got today? Yeah, and 0:12:44.120 --> 0:12:46.280 again I'm watching The Crown now. I talked about that 0:12:46.320 --> 0:12:49.319 in the TV h well, in the episode but when 0:12:49.320 --> 0:12:52.880 we talked about it and John listcal As Winston, Churchill 0:12:53.160 --> 0:12:58.520 is grow great. What he's awesome? When he and FDR 0:12:58.679 --> 0:13:00.959 like half two part ways after the y'all to conference, 0:13:01.000 --> 0:13:03.000 does he punch FDR in the face and say O, 0:13:03.880 --> 0:13:07.160 FDR hasn't actually he hasn't been in it. Okay, well 0:13:07.320 --> 0:13:09.720 look for that scene coming up. Yeah, but it's crazy. 0:13:09.800 --> 0:13:11.839 Churchill's all over the place. He had the Gary Oldman 0:13:11.920 --> 0:13:15.280 movie and then there were dual Churchill movies. Brian Cox 0:13:15.320 --> 0:13:18.360 was on another one. Oh, he's in it's quality. He's great, 0:13:18.600 --> 0:13:23.160 although his Hannibal lecture was it was fine until Anthony 0:13:23.200 --> 0:13:25.920 Hopkins got his hands on that role. Yeah. The rare 0:13:26.000 --> 0:13:31.400 case where the second actor totally owns the role usually 0:13:31.400 --> 0:13:34.600 like the first actor. Will you know, just probably by 0:13:34.679 --> 0:13:38.400 the fact that the first Although I liked Um, What's 0:13:38.440 --> 0:13:41.680 the to Live In Diane l A's guy's name who 0:13:41.720 --> 0:13:45.320 was the lead guy in Manhunter? William Peterson. Yeah, I 0:13:45.360 --> 0:13:50.360 liked William Peterson's character. That's a great movie more than 0:13:50.800 --> 0:13:55.319 Um Edward Norton's version. Oh, in Red Dragon, because Red 0:13:55.360 --> 0:13:57.880 Dragon and Manhunter they're based on the same book. Yeah, yeah, 0:13:57.880 --> 0:14:01.160 it's the same thing. Yeah, yeah, you're really right. William 0:14:01.160 --> 0:14:03.400 Peterson a way better than Edward Norton in that role, 0:14:03.640 --> 0:14:06.880 but Jodie Foster better than all of them, is closed, Yes, yeah, 0:14:06.960 --> 0:14:09.400 all of them put together. Man. I just watched the 0:14:09.440 --> 0:14:11.360 end of that again the other day, and oh, you're 0:14:11.360 --> 0:14:16.400 gonna appreciate this. Uh. Emily was in the other room, um, 0:14:16.400 --> 0:14:18.240 in the bathroom or something, I can't remember, and she 0:14:18.320 --> 0:14:20.520 didn't know what. I turned it on and I passed 0:14:20.640 --> 0:14:25.280 it right at the moment of the Penis Tuck Buffalo 0:14:25.360 --> 0:14:28.200 Bill when he had his arms out in the Jesus 0:14:28.240 --> 0:14:30.800 Christ post and Emily came in and just got in 0:14:30.840 --> 0:14:32.640 bed and looked up and was like, oh my god, 0:14:34.720 --> 0:14:37.640 what a great movie that was. Had everything, the perfect 0:14:37.720 --> 0:14:42.080 race Rain did everything, had Jodie Foster, Anthony Hopkins, and 0:14:42.120 --> 0:14:45.920 a Penis Tuck scene. We should probably take a break, 0:14:46.520 --> 0:14:49.560 all right, We're off the rails here, are you ready? Yes? 0:14:50.000 --> 0:15:23.240 Break starting now? Okay, Chuck. So we were talking about 0:15:23.360 --> 0:15:29.320 Penis tux right. FDR famously did that at the Yalta conference. 0:15:30.360 --> 0:15:34.040 Oh my god, so he you know the reason the 0:15:34.080 --> 0:15:37.920 reason FDR's death from hypertension really factors into the stories 0:15:37.960 --> 0:15:43.120 because it was extremely public, okay, And what FDR basically 0:15:43.160 --> 0:15:48.000 did without using these last words, he basically said he 0:15:48.120 --> 0:15:52.600 pointed at at modern medicine and said, I beseech you, 0:15:52.880 --> 0:15:56.160 and then keeled over right, So modern medicine was like, 0:15:56.320 --> 0:15:58.520 who us, we don't know what we're doing when it 0:15:58.520 --> 0:16:04.040 comes to cardiovascular disease ease. And shortly thereafter, the framing 0:16:04.080 --> 0:16:09.160 him heart study was born. No, you can almost coming. 0:16:09.560 --> 0:16:12.920 The framing of heart study was born because Harry Truman 0:16:13.040 --> 0:16:18.160 signed the National Heart Act, which is probably the thing 0:16:18.240 --> 0:16:20.960 that he's most famous for. Its president. Yeah, and that 0:16:21.000 --> 0:16:25.400 included and that included five thousand dollars in the form 0:16:25.400 --> 0:16:28.960 of a grant for this study for twenty years to 0:16:29.000 --> 0:16:32.720 cover twenty years for the study. And um, I think 0:16:32.760 --> 0:16:38.400 initially Public Health service physician Uh Gilson or Gilkin Metters 0:16:39.960 --> 0:16:43.360 uh said, it sounds like you messed that up, but 0:16:43.440 --> 0:16:45.280 you didn't. I think you hit it right on the head. 0:16:45.360 --> 0:16:48.800 Gilson Metters. It matters sounds like a weird you think 0:16:48.840 --> 0:16:51.240 it'd be meadows or something. It sounds like you're drunk 0:16:51.280 --> 0:16:55.400 and saying meadows. Uh. And this was the original quote, 0:16:55.400 --> 0:16:57.760 which is actually a pretty good mission statement for the study. 0:16:58.320 --> 0:17:01.280 Their mission was to study the express and of coronary 0:17:01.400 --> 0:17:05.840 artery disease and a normal or unselected population, and to 0:17:06.000 --> 0:17:10.359 determine the factors predisposing to the development of the disease 0:17:10.359 --> 0:17:13.600 through clinical and laboratory examined long term follow up. So 0:17:13.640 --> 0:17:16.760 there you have it. Not bad, it's got a clinical ring, 0:17:16.840 --> 0:17:20.720 it's got a it's concise. You can dance to it. Yeah, exactly. 0:17:21.160 --> 0:17:25.080 So this this framing Him heart study was a heart 0:17:25.080 --> 0:17:28.280 study before it was set in framing him. And they 0:17:28.680 --> 0:17:31.160 went to framing him for a number of reasons. One 0:17:31.200 --> 0:17:34.480 they said, well, this is a pretty pretty standard UM 0:17:34.640 --> 0:17:40.399 middle America, middle class UM community, at least of the 0:17:40.480 --> 0:17:43.360 kind that we pay attention to in this day and age, right, 0:17:43.680 --> 0:17:46.800 meaning it was almost entirely white people, which will see 0:17:46.800 --> 0:17:49.480 as a huge criticism of this study that UM the 0:17:49.800 --> 0:17:53.840 study directors over time have tried to work on. But um, 0:17:53.880 --> 0:17:58.920 they said, aside from the the the complete and almost 0:17:58.920 --> 0:18:04.879 complete and utter of UM diversity. Yes, in this study, 0:18:04.920 --> 0:18:08.560 it's a pretty good slice of America. It's a small town, 0:18:08.960 --> 0:18:12.400 most of the people their middle income. It's it's got 0:18:12.400 --> 0:18:14.720 a big enough population. At the time, this is the 0:18:14.800 --> 0:18:17.600 nineteen forties or something like twenty eight thousand people that 0:18:17.680 --> 0:18:20.080 we could get a pretty decent, like random sample of 0:18:20.080 --> 0:18:23.640 the population going. But the town itself is small enough. 0:18:23.960 --> 0:18:26.440 There's only like two hospitals and in time there would 0:18:26.440 --> 0:18:29.240 only be one hospital that we can actually easily keep 0:18:29.320 --> 0:18:32.840 track of the people in this town. And it's not 0:18:32.920 --> 0:18:35.680 too far from Boston University, which would win the contrast 0:18:35.720 --> 0:18:38.840 to UM carrying out the study on behalf of the 0:18:38.920 --> 0:18:42.199 National Heart Institute. Well, yeah, and they had also, like 0:18:42.240 --> 0:18:45.600 you said, earlier, proven that their game for this kind 0:18:45.600 --> 0:18:49.000 of thing by participating in that uh to what was 0:18:49.040 --> 0:18:53.440 called tuberculosis how down or something. Ye had a name. 0:18:53.920 --> 0:18:56.280 It did have a name. It was called the Framing 0:18:56.359 --> 0:19:02.560 Him Tuberculosis Demonstration. There would be like watch this, no, 0:19:02.760 --> 0:19:05.800 but it could be on a Saturday night. It was 0:19:05.880 --> 0:19:08.160 the hold Down. So that, yeah, the whole town had 0:19:08.440 --> 0:19:10.160 was not the whole town, but the town had gotten 0:19:10.200 --> 0:19:15.359 behind being UM test subjects or study participants for a 0:19:15.400 --> 0:19:19.720 whole other study about thirty years before the Heart study began. 0:19:20.240 --> 0:19:23.520 So they were already kind of like there. Their healthcare 0:19:23.560 --> 0:19:27.160 providers were already like aware that this stuff was going on. 0:19:27.480 --> 0:19:31.280 And at the time, apparently healthcare providers like your general practitioner. 0:19:31.920 --> 0:19:34.560 That was like the end all be all of your health. 0:19:35.200 --> 0:19:38.320 That person was meant to know everything about you and 0:19:38.400 --> 0:19:42.280 everything about disease and how to treat you. And that 0:19:42.480 --> 0:19:45.840 was that. There weren't any longitudinal studies, There wasn't any 0:19:45.880 --> 0:19:49.760 preventative medicine, There wasn't any national hard institute, there was 0:19:49.840 --> 0:19:52.680 nothing like that. It all came down to your general practitioner. 0:19:53.040 --> 0:19:56.359 So it was really important that the general practitioners and 0:19:56.359 --> 0:19:59.200 the healthcare providers in the town of Framing Them were 0:19:59.280 --> 0:20:02.240 on board this kind of thing, because they could very 0:20:02.320 --> 0:20:06.119 easily have seen this as encroaching on their turf, but 0:20:06.200 --> 0:20:09.800 they didn't. And I think the Framing Him study directors 0:20:09.840 --> 0:20:13.400 and the people who carried this actual study out deferred 0:20:13.440 --> 0:20:17.360 to the general practitioners in the town as far as 0:20:17.359 --> 0:20:21.159 like giving advice from the findings and and keeping up 0:20:21.160 --> 0:20:24.520 with the the like outside medical findings or even the 0:20:24.520 --> 0:20:27.080 stuff they were finding from the study. They didn't directly 0:20:27.119 --> 0:20:30.800 give it to the study participants. They gave it to 0:20:30.840 --> 0:20:33.000 their doctors, and then the doctors would tell the study 0:20:33.000 --> 0:20:35.639 parts participants, so they were kept in the loop. So 0:20:35.680 --> 0:20:39.919 there was a there was a a symbiotic relationship that 0:20:40.000 --> 0:20:42.520 was forged. Yeah. I thought that was interesting that they 0:20:42.600 --> 0:20:45.320 just kept the research like they weren't there to offer 0:20:45.400 --> 0:20:48.760 medical advice. They were literally just collecting research. But I 0:20:48.800 --> 0:20:53.560 do wonder if some of the times they would say, hey, uh, 0:20:53.800 --> 0:20:57.840 gp of Mr Donaldson, you really need to get him 0:20:58.040 --> 0:21:02.960 in like next week. Yeah, like really yeah, like he 0:21:03.080 --> 0:21:09.480 It's kind of like I guess how Churchill's doctor saw Roosevelt, right, Like, 0:21:09.520 --> 0:21:11.159 I know we're not supposed to give advice, but my 0:21:11.240 --> 0:21:14.359 advice to you is to call this guy up and say, 0:21:14.480 --> 0:21:17.080 maybe you should come in a little earlier than next spring, right, 0:21:17.600 --> 0:21:22.000 or go up your malpractice insurance. So we did say 0:21:22.000 --> 0:21:28.119 that it wasn't super ethnically diverse, which um didn't phase 0:21:28.200 --> 0:21:29.920 them too much at the time, And it really hit 0:21:29.960 --> 0:21:33.960 home to me just how like just how white probably 0:21:34.040 --> 0:21:39.640 every major study had been up until this point without 0:21:39.680 --> 0:21:42.399 even like thinking it was a problem, which is being like, 0:21:42.520 --> 0:21:44.520 I don't know, there's a great study. They're like, well, 0:21:44.560 --> 0:21:47.360 you know, he didn't include any black people, and they 0:21:47.520 --> 0:21:49.119 just it probably just didn't even occur to them at 0:21:49.119 --> 0:21:51.600 the time. I don't know if it didn't occur to him. 0:21:51.600 --> 0:21:56.920 I I think that it was mostly that's who their 0:21:57.000 --> 0:22:01.320 clientele was. I think that that's probably who was being 0:22:01.359 --> 0:22:04.720 studied because that's what America catered to at the time, 0:22:04.800 --> 0:22:07.720 or who America catered to, I should say at the time. 0:22:08.480 --> 0:22:11.520 I don't know that that much has changed these days, unfortunately, 0:22:11.560 --> 0:22:15.320 but I think it was vastly more pronounced back then. 0:22:15.800 --> 0:22:18.720 Well I think they I think they're way more inclusive 0:22:18.760 --> 0:22:21.560 now and and probably have to be to get research 0:22:21.680 --> 0:22:24.840 grants these days. I would think, oh, yeah, yeah, yeah, yeah, yeah, 0:22:24.880 --> 0:22:27.600 for sure. No, I'm saying America as a whole being 0:22:27.680 --> 0:22:31.080 like catering to Yeah, hear you, But that did change 0:22:31.160 --> 0:22:34.400 in and framing him after World War Two. Apparently there 0:22:34.480 --> 0:22:37.439 was an influx of a more diverse population after the 0:22:37.440 --> 0:22:41.440 war at least, right, and I think by the Good 0:22:41.480 --> 0:22:44.480 Lord was that the nineties when they added the new cohort. 0:22:45.000 --> 0:22:47.879 Well we'll get to the cohorts, Okay, well, anyway, sure 0:22:48.359 --> 0:22:52.000 we'll spoiler alert. They added they made the study population 0:22:52.040 --> 0:22:55.320 more diverse. One thing that is in the credit of 0:22:55.359 --> 0:22:59.919 the study designers is that they included women at a 0:23:00.000 --> 0:23:04.000 about which was totally unheard of it's in any kind 0:23:04.040 --> 0:23:07.120 of medical study at the time. Because again, not only 0:23:07.119 --> 0:23:10.760 did they cater to almost exclusively white people in America 0:23:10.760 --> 0:23:13.960 at the time. They catered almost exclusively to white men 0:23:14.000 --> 0:23:19.240 at the time. Yeah, and I think also women. I 0:23:19.280 --> 0:23:22.880 think heart disease probably still has a stigma of like, yeah, 0:23:22.920 --> 0:23:28.159 men have heart disease, uh more than women do, right, Like, 0:23:28.200 --> 0:23:29.840 what are you a trucker lady? How do you have 0:23:29.880 --> 0:23:33.040 heart disease? Go back, go back home, get out of 0:23:33.080 --> 0:23:36.080 my doctor's office. Yeah, you dummy. Yeah, which is not 0:23:36.160 --> 0:23:40.240 the case, right, No. But the weird thing is is 0:23:40.280 --> 0:23:44.520 what they found from the study. Just overall, they found 0:23:44.520 --> 0:23:47.000 that the stuff that they've come up with, which we'll 0:23:47.040 --> 0:23:50.200 talk about in a second, is really good at predicting 0:23:50.280 --> 0:23:55.119 things for like white guys, for cardio vascular disease for 0:23:55.160 --> 0:23:59.280 white guys. But even though women were very um clearly 0:23:59.320 --> 0:24:01.960 represented in the study, they've actually found that the same 0:24:02.000 --> 0:24:04.400 predictors don't work for women. So it's kind of led 0:24:04.480 --> 0:24:09.040 to a separate study of women and how they suffer 0:24:09.119 --> 0:24:13.000 from cardiovascular disease, because they definitely do, it's just under 0:24:13.040 --> 0:24:17.400 different circumstances it appears than men. Yeah, it's pretty interesting. 0:24:17.600 --> 0:24:21.000 So let's talk about the beginning of the study, right, Yeah, 0:24:21.040 --> 0:24:23.479 So they recruited people between the ages of thirty and 0:24:23.480 --> 0:24:26.879 fifty nine initially because that is the window where you 0:24:26.960 --> 0:24:30.720 might develop c D d UM and they they thought 0:24:30.800 --> 0:24:33.120 by recruiting people in this range, they would also get 0:24:33.480 --> 0:24:36.560 a certain amount of people that are already have this 0:24:36.800 --> 0:24:41.040 uh appearing like these symptoms appearing right. They didn't though. 0:24:41.080 --> 0:24:43.439 Actually it turned out that they had to actually go 0:24:43.600 --> 0:24:48.160 recruit people who had cardiovascular disease already and put them 0:24:48.240 --> 0:24:51.040 into this study themselves, I think, because people probably that 0:24:52.320 --> 0:24:56.440 maybe we're on that track, don't volunteer for studies like this. Well. 0:24:56.480 --> 0:25:00.359 They also it wasn't a very random sample, especial at 0:25:00.400 --> 0:25:05.600 first because they initially got participants through um word of 0:25:05.680 --> 0:25:10.280 mouth at like civic groups and clubs. So so the 0:25:10.320 --> 0:25:12.520 presence of a social network or a certain type of 0:25:12.560 --> 0:25:16.680 social network, we just kind of does away with randomness 0:25:16.760 --> 0:25:20.080 right out of the gate. And they ended up recruiting 0:25:20.080 --> 0:25:23.240 other people outside of like these groups and civic civic 0:25:23.240 --> 0:25:26.280