I served as Project Officer in the early years, while Henry Taylor directed the Railroad Study, the U.S. component of the Seven Countries Study. A few years into the study, central coordination of data was shifted to Alessandro Menotti at the University of Rome. All field studies were carried out under the aegis of a National Heart Institute grant. Both public and private sources, as well as the World Health Organization, provided direct and logistic support. These days, the configuration of populations for such internal and international comparisons is strengthened by the random selection of greater numbers of units.
Ecologic correlations are relatively weak in arriving at causal inference about disease.
However, they are crucial indicators of population causes of disease, and of public health preventive strategies, where the epidemiologic evidence is congruent with that from the laboratory and the clinic. The Seven Countries Study, more than any other cardiovascular disease study, has directed attention to the causes of population rates of disease, while confirming the importance of an individual's risk within populations. The predictive equations derived from the population correlations provide the general rule, while departure from prediction points up important exceptions, such as the excess of coronary heart disease in East Finland and its rarity in Crete. These exceptions, in turn, have provided impetus to further research into causal factors other than dietary saturated fatty acids and cholesterol. The concept of the Seven Countries Study arose independently in the minds of innovative physicians and investigators who were interested in heart diseases beyond the clinic, and at the same time, were capable of synthesizing evidence from clinic, laboratory, and the population.