Dawber, Thomas Royle

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Dawber, Thomas Royle

(b. 18 January 1913 in Duncan, British Columbia, Canada; d. 23 November 2005 in Naples, Florida), epidemiologist and architect of the famed Framingham Heart Study, the research that identified the major risk factors for heart disease.

Dawber was born to Mark Alton Dawber, a Methodist minister, and Mary Dawber. His parents had immigrated to Canada from Cheshire, England, two years before his birth. When Dawber was about three years old, the family moved again, this time to Philadelphia, Pennsylvania. Dawber grew up in Philadelphia and eventually became an American citizen. He attended Haverford College in Haverford, Pennsylvania, earning a BA in 1933. That year Dawber entered Harvard Medical School, from which he received an MD in 1937. He immediately joined the U.S. Public Health Service and, from 1937 to 1938, completed his internship at the United States Marine Hospitals in Virginia. He was a medical resident there from 1938 to 1940. Dawber married Eleanor Ronimus in 1937, and the couple had two children.

Dawber left Virginia to serve on the medical staff of a U.S. Coast Guard cutter. During World War II he became a commissioned officer, eventually attaining the rank of captain. From 1941 to 1942 Dawber was affiliated with Brighton Marine Hospital near Boston, Massachusetts. Later in 1942 he worked for the Marine Hospital in Staten Island, New York. In 1944 Dawber was appointed chief of medicine at Brighton Marine Hospital, a position he retained until 1949.

By the end of World War II cardiovascular disease had emerged as the leading cause of death in the United States. In 1948 the federal government, through the U.S. Public Health Service, set up a study to identify the causes of heart disease and ways to prevent it. The town of Framingham, Massachusetts, was selected as the study site. Dr. Gilcin F. Meadors, a young Public Health Service officer, was charged with organizing the Framingham study. He began by accepting volunteers from the town, but Framingham residents were skeptical of the unprecedented epidemiological study, and few were interested in participating.

In 1949 the National Heart Institute (now the National Heart, Lung, and Blood Institute) was established, and the Framingham Study was placed under its jurisdiction. The decision was made to accept volunteers but also to target an appropriate random sample population of Framingham residents and invite them to participate in the study. In late 1949 Dawber was asked to direct the program. His clout as a physician gave the study credibility, and his persistence and understanding with the townspeople persuaded them to join and, eventually, become committed to the study. By 1950, 5,127 healthy Framing-ham men and women between the ages of thirty and fifty-nine were included as the first cohort for the anticipated twenty-year study.

Initially, a detailed history and physical examination were completed for each study participant. The population was then followed by biennial examination for the appearance of signs of coronary artery disease. Over the course of the study, Dawber authored or coauthored more than one hundred scientific papers. He also coauthored a book, Diseases of the Chest, published in 1952. Dawber had no training in epidemiology when he began leading the Framingham Study, so he returned to Harvard and earned a master’s in public health in 1958. By 1960 Dawber and his team had accumulated substantial evidence that cardiovascular disease was a result of lifestyle factors, including fatty diet, weight gain, and cigarette smoking. In 1961 a landmark paper in the Annals of Internal Medicine introduced the concept of “risk factors” for coronary artery disease and identified high blood pressure, high cholesterol levels, and left ventricular hypertrophy (enlargement of the left pumping chamber of the heart) as three major factors.

Dawber directed the Framingham Study until 1966, when he became head of the Section of Preventive Medicine and Epidemiology at Boston University. In 1968 the federal government discontinued funding for the study, stating that it had fulfilled its twenty-year mission. Dawber believed that there was more to be learned, and he led a campaign to finance an additional five years of follow-up and evaluation of the Framingham population. The study did continue without interruption for another four years. When this phase was completed, in 1975, the National Heart, Lung, and Blood Institute reconsidered its decision and supported continuing the study in partnership with Boston University. Since then, the study has continued long enough to include the children and grandchildren of the original cohort. Many significant findings, including the connection between high blood pressure and stroke and the benefits of high-density lipoprotein, or “good” cholesterol, were produced after the first twenty years.

In December 1972 the American Health Foundation honored Dawber and William B. Kannel, who succeeded Dawber as director of the Framingham Study, with the first Eleanor Naylor Dana Award for preventive medicine for their work in identifying the risk factors that lead to heart disease. Throughout his career Dawber received many other awards and was nominated three times for a Nobel Prize. Dawber was a member of the American College of Chest Physicians, the American College of Physicians, and the American Heart Association.

In 1980 Dawber published his book The Framingham Study: The Epidemiology of Atherosclerotic Disease. He retired that same year from Boston University and moved to Naples, Florida. Dawber, or “Roy,” as he was called, was described as tall, gray, and distinguished looking, with a twinkle in his eye. He had a passion for boating, was a skilled carpenter, and played piano and wind instruments. He also enjoyed knitting, an interest he developed thanks to a study participant who sold yarn at a local store. Dawber, who was described by his daughter as “very self-effacing,” was always modest about his accomplishments.

On 6 June 2003 Dawber received the Harvard School of Public Health Alumni Award of Merit, the highest honor the school confers upon its graduates. Dawber cared for his wife, who had Parkinson’s disease, until her death in 1995. He died in his sleep at age ninety-two after a two-year struggle with Alzheimer’s disease. As the architect of the Framingham Heart Study, Dawber transformed the medical world’s understanding of heart disease. Framingham became the benchmark for cardiovascular epidemiological studies. “If it wasn’t for Dawber, you wouldn’t have heard about the Framingham Heart Study,” said William Castelli, who directed the project from 1979 to 1995. “His contribution is so enormous; you would have to place him with the most outstanding physicians in the history of the United States.”

Obituaries are in the New York Times (1 Dec. 2005), Boston Globe (2 Dec. 2005), Washington Post (3 Dec. 2005), and BMJ and Lancet (both 14 Jan. 2006).

Victoria Tamborrino