Invited commentary: Learning from our past to build on our future-lessons learned from MRFIT and JUMBO

We propose that Blackburn (Am J Epidemiol. 2020;189(6):491-498) ignores several important issues that need to be considered in the context of a historical reflection of the National Heart Institute's landmark study, the Multiple Risk Factor Intervention Trial (MRFIT), and the alternative proposal, the “JUMBO” trial, submitted to the National Heart Institute by an experienced team of extramural investigators but never funded. A key focus of this commentary is to offer an alternative perspective on both studies using our current understanding of the impact of social and structural determinants of health; evidence that policy, systems, and environmental interventions are needed to support behavior change at the individual level; and the significance of examining research from a racial/socioeconomic equity lens. While we strongly agree with Blackburn's conclusion urging the National Institutes of Health to invest in prevention research at a level consistent with its social and economic impact, we encourage the author to move beyond simply underscoring the methodological limitations and failure of the findings of MRFIT compared with the potential of the proposed JUMBO trial to consider the contribution of MRFIT to our current understanding of chronic disease prevention and treatment.