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This is exactly what happened to the American Heart Association (AHA). Originally formed in the 1920s by heart specialists to exchange ideas about their fi eld, by 1945 it was raising a modest $100,000 a year to subsidize conferences and fund some research. Meanwhile, the March of Dimes, founded in 1938 to combat polio, was collecting $20 million annually. This could not have been far from the minds of the new leaders who took over the AHA and set out to arouse public concern about the
“coronary plague.” They hired Rome Bett s, a former fund-raiser for the American Bible Society, to create a professional fund-raising apparatus.
He recruited a star-studded cast of laypeople, including the Hollywood movie mogul Sam Goldwyn and the author Clare Booth Luce, wife of the powerful Time-Life publisher Henry Luce, to sit on a new board of gover-nors. In the ensuing years, they helped recruit a host of celebrities to par-ticipate in the AHA’s annual “Heart Week” drives, which raised money to fi ght “the greatest epidemic in the twentieth century,” “the nation’s most serious medical and public health problem.”⁵ The organization also ben-efi ted from President Eisenhower’s heart att ack and a campaign to send him “get well” lett ers accompanied by donations to the AHA.⁶
At the outset, those running the reconstituted organization realized that successful fund-raising would have to involve more than just pleas to support research. Only about one-quarter of its budget went for that, and there was litt le hope that there would be much to show for it in the near future. Instead, its new president said its goal was educating the public about “the signifi cance of blood pressure, infections, overweight, rheumatic fever and other factors which contribute to various forms of heart disease.” It especially targeted businessmen, sending specialists to speak at their meetings. (A Cleveland cardiologist told one group that they could head off high blood pressure, “the No. 1 killer of the average business executive,” by taking naps at noon.) It tried to combat prejudice against businessmen who returned to work aft er heart att acks, something it said was just as important as supporting research. In 1954 Vice Presi-dent Richard Nixon, speaking to the international Congress of Cardiolo-gists, praised their success at this. He told of how eight months earlier the brilliant forty-four-year-old general who was President Eisenhower’s liaison with the Pentagon had been stricken with heart disease and had now returned to work “as good as new.” (Unfortunately, fi ve days later the poor man succumbed to a fatal heart att ack.)⁷
However, the philanthropist Mary Lasker, who was a major contribu-tor to the American Heart Association, was interested mainly in fund-ing research. This dovetailed with the interest that Paul Dudley White, a
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leading fi gure in the organization, was taking in Ancel Keys’s research.
As a result, in the mid-1950s support for research began to outdistance the organization’s public health eff orts.⁸ The New York Times, whose con-trolling Sulzberger family were major contributors to the AHA, helped drum up support for this. The paper’s science reporter Howard Rusk wrote enthusiastically about Keys’s and White’s work on the “coronary plague” and received one of the annual awards that the AHA began giv-ing to journalists for coverage of heart research. In 1959 the AHA’s presi-dent att ributed his organization’s success in raising a record $25 million to growing public awareness of the need for research.⁹
The association’s success in arousing support for research soon proved to be a double-edged sword, for it also helped stimulate a spectac-ular increase in government funding for heart research at the National Heart Institute (NHI), the heart research arm of the National Institute of Health (NIH). In 1948 the two organizations each had budgets of around
$1.5 million. In late 1961 AHA leaders were nonplussed by the fact that although their budget had risen to $26 million, the heart institute’s now totaled $88 million. Worse, the NHI’s budget was slated to rise to an as-tounding $132 million the next year. The AHA leadership now began worrying about being “squeezed out” by the federal government: that is, they feared that people would think that because their tax dollars were going for research into heart disease, there was no more need to con-tribute to the heart association.¹⁰ If the AHA hoped to maintain its high profi le and justify its money-raising eff orts, it would have to return to emphasizing public health. This meant recommending lifestyle changes, something for which Keys’s ideas provided the perfect springboard.
As we have seen, the AHA took a large step in this direction in 1960, when it backed Keys’s theory that lowering dietary fat reduced the risk of heart att acks. However, it had only recommended low-fat diets for people with a greater than normal risk for heart att acks. In June 1964 it threw off these restraints and warned all Americans to reduce their to-tal fat intake and to substitute vegetable oils containing polyunsaturated fats for saturated animal fats. It admitt ed that there was no proof that this would lower the risk of heart disease, but its spokeswoman said that heart disease had become “such a pressing public health problem” that it
“just can’t be left until the last ‘i’ is dott ed and last ‘t’ is crossed.”¹¹ Yet it was already apparent that dott ing the i’s and crossing the t’s was going to be a lot more diffi cult than Keys had anticipated. Even as the Seven Countries study was gett ing under way, there were serious doubts about whether this kind of study could provide convincing evidence
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that dietary cholesterol caused heart disease. The obstacles to accurately measuring and comparing the food intakes and health outcomes of such disparate groups of people were simply insurmountable. Only “prospec-tive” studies, using strictly supervised control groups who were fed on diff erent diets and followed over many years, could hope to achieve this.
However, a large NIH-funded study aiming to do this foundered, mainly because only about one-quarter of the men on low-fat diets could stick to them for more than a year.¹²