The Bleeding Obvious

In the early years after the second world war, health researchers in Britain noticed a curious epidemic: people had begun dying of heart attacks in unprecedented numbers.

Nobody knew why, and so a scientist in London named Jerry Morris set up a vast study to examine the heart-attack rates in people of different occupations – schoolteachers, postmen, transport workers and more.

“The very first results we got were from the London busmen,” says Morris.

“And there was a striking difference in the heart-attack rate. The drivers of these double-decker buses had substantially more, age for age, than the conductors.”

The data were so telling because drivers and conductors were men of much the same social class. There was only one obvious difference between them.

“The drivers were prototypically sedentary,” explains Morris, “and the conductors were unavoidably active. We spent many hours sitting on the buses watching the number of stairs they climbed.”

The conductors ascended and descended 500 to 750 steps per working day.

And they were half as likely as the drivers to drop dead of a sudden heart attack. Today, almost everyone understands that physical exercise can help prevent heart disease, as well as cancer, diabetes, depression and much else besides.

But on that day in 1949 when Morris looked at the bus data, he was the first person to see the link. He had inadvertently – “mainly luck!” – stumbled on a great truth about health: exercise helps you live longer. Morris’s own mission of the late 1940s was heart disease. He spent “interminable hours” reading the postmortem folios of the London Hospital in the East End for 1907 to 1949. But he still couldn’t understand why heart attacks were increasing.

“We were in the fortunate situation,” he says, “that very ­little research had been done on it. It might be hard for you to imagine a time when heart attack wasn’t a major preoccupation of everybody.” Today, heart disease is the most common cause of death in western countries.

“The only hunch I had was that this might be related to occupation. It was commoner in men than women, it was commoner as middle age advanced, and there were some hints in the national statistics of mortality that it might be connected in some way to occupation.” The busmen’s data were fascinating, and the sample size was thousands of men.

But Morris didn’t treat it as proof of anything. In what he has called “one of the tensest moments of my professional life”, he had to wait for data to arrive for other occupations. Finally, he got the figures for postal workers.

“It was strikingly similar!” he says. The postmen who delivered the mail by bike or on foot had fewer heart attacks than sedentary men who served behind counters or as telephonists and clerks.

It was true: exercise prevented heart disease.

And yet Morris sat on his data for years. If there were flaws in his theory, he was determined to find them before anyone else could. “We set about destroying this observation,” he says. “We brought in outside people with no blood in their veins, no interest, to destroy it.”

But they couldn’t.

His paper (“Coronary heart-disease and physical activity of work”) finally appeared in The Lancet in 1953.

His hypothesis, as he still called it, was greeted with general disbelief.

What could exercise possibly have to do with heart attacks?

True, there had always been a vague belief that exercise was good for the soul. Even he had no idea how exactly the mechanism worked.

Only after his paper appeared did the physiologist Henry Taylor sit him down for a solid day in a Washington hotel room and, in Morris’s words, “schoolboy-taught me the physiology of exercise”.

Morris thinks the essential story is simple: “Exercise normalises the workings of the body.”

Humans were meant to keep active.

With hindsight, his London bus drivers inhabited one of the first societies on earth where exercise was ceasing to be part of daily life.

Technology was letting people grow slothful. Even in the 1950s, Morris foresaw that when poor countries developed, they would have the same problems.

He remembers warning then: “Their time will come to develop these diseases, and not to make the mistakes that we made, eg a lack of exercise, eg smoking, eg our lousy diets. Of course, nobody paid any attention.”

**

Upon reading about the man that discovered exercise, it got McLeod Governance thinking.

What is it that is plain for all to notice but no one can see?

What is that the practitioners of internal audit, risk management and corporate governance are missing that will make eternal and fundamental sense of the world in which we ply our trade?

McLeod Governance is going to start the ball rolling on this one.

Our nomination for the Bleeding Obvious That Has Yet to Be Found is something (well we would be more precise but by definition we cant because we actually wont know it until we see it) to do with the importance of communication within an organisation in improving its internal control culture.

We all seem to know that that is the case in the same way that we now accept that exercise is good for a healthy heart.

But we have no way of measuring it to prove it.

Indeed when it comes down to it – internal audit, risk management and corporate governance have little in the way of measurements to prove their hypotheses (and some of its harsher critics say, worth).

And therein perhaps lays our equivalent of riding a London bus observing the world.

What is the one measure that proves our worth?

And who amongst us will find it.

Post based in part on “The Man Who Invented Exercise”. The Financial Times by Simon Kuper. September 11, 2009

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