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Epi Wit & Wisdom Articles
REFLECTIONS: Epidemiology—The
State of the Discipline
The beginning of a new decade
occasions ruminations on a wide variety of topics. The meaning of the
70’s and the outlook for the 80’s have been common themes in numerous
newspapers, magazines and journals. Now two epidemiologists, Reuel
Stallones of the University of Texas School of Public Health, in a
more or less retrospective look, and Kenneth Rothman, Harvard School
of Public Health, in a satirical prospective look (actually a
non-concurrent prospective look since he situates himself in the year
2,000 or thereabouts) have provided “decennial” reflections on the
state of our discipline.
In his essay entitled “To
Advance Epidemiology” in the first volume of the new Annual Review of
Public Health (1980; 1:69-82), Stallones provides the most engaging
definition of epidemiology encountered in some time. It is worth
quoting--“Epidemiology represents the recognition that the patterns of
occurrence and disability in human communities are determined by
forces that can be identified and measured, that these forces include
but are not limited to medical concepts of etiology, and that
modification of these forces is the most effective way to prevent
disease.” This definition is actually presented as part of the summary
of his essay, and to fully appreciate the definition one must read
Stallones’ comments on four sets of concerns which he attributes to
epidemiology in the 70’s--what is the real territory of epidemiology,
what concepts of causation are adequate models of reality, how can
disease entities be profitably classified, and what is unique about
epidemiology. For example, on the territory of epidemiology, he
embraces “as a matter of faith that only one epidemiology exists.”
What varies is the application of the tool. On concepts of causation,
he admonishes against seeking truth through mathematical analysis,
reminding us with a borrowed quote that “the product of an
arithmetical computation is the answer to an equation; it is not the
solution to a problem.”
Those who have learned with
delightful anticipation to expect the unexpected from Stallones will
not be disappointed with this essay. One small sample--in commenting
on a recent outpouring of definitions of epidemiology, he states, “The
plainest conclusion to be drawn from them is that the length of the
definition is inversely related to the age of the epidemiologist.”
Dr. Stallones may disagree, but
the brief summary of his essay seems to qualify as a lengthy
definition of epidemiology. We liked it, but it does make Dr.
Stallones a young man indeed!
In a more recent article in the
NEJM (03/05/81), Dr. Rothman takes a sympathetic look at the history
of epidemiology, particularly the period 1950 - 1980, and makes a
decidedly more pessimistic forecast for the next twenty years.
Imagining himself in the year 2000 or thereabouts he traces the
decline of epidemiology from 1980 - 2000. Bureaucratic obstacles faced
in implementing protection of human subjects, increased regulation of
epidemiologic research, and decreased attractiveness of academic
positions contributed to the decline. Many undoubtedly will take issue
with the accuracy of some of Rothman’s interpretations or omissions of
epidemiologic history (what happended to Goldberger?). However, the
specific observations of this article are not, in our view, its main
contribution. Rather it is a provocative piece on the forces
influencing epidemiologic research in the 1980s, and deserves
consideration by epidemiologists who wish to maximize the potential
contributions of epidemiology in the foreseeable future.
Published March 1981 v
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