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Historical Keynote
Addresses
Terris Gives Thoughtful,
Provocative Address at SER
It was an appropriate topic for
the 25th Annual Meeting of the Society for Epidemiologic Research
(SER): “SER and the Future of Epidemiology.” The speaker was equally
fitting; Milton Terris, an SER founding member.
After describing the history of
the formation of the SER from his firsthand experience, and after
tracing the shift in the focal point of epidemiologic research after
World War II from health departments to Schools of Public Health,
Terris went on to address issues about the future of epidemiology. The
future, he noted, depends not only on such things as the economy,
financial support from legislators and the public at large, but also
on the orientation of epidemiologists themselves.
Pitfalls of Epidemiology
Terris labeled the shift in the
focal point of epidemiologic research from non-academic settings to
academic centers as a “setback.” Why? Some of the major tendencies of
academic life have come to the fore to the detriment of epidemiology.
Among such tendencies, he pointed to the increased focus on the
methods of data manipulation rather than on the solution of disease
problems, the withdrawal from communities and the accompanying
decreased familiarity with the data collected, the increased use of
other people’s data without regard to its value, the increased focus
on “publish or perish” at the expense of focusing on the prevention of
disease, the adoption of arrogant and elitist attitudes towards health
officers and others working in the field, and finally the widespread
emphasis on biostatistical techniques at the expense of a more
biological orientation.
Suggestion
To counteract some of the
negative consequences of this shift to academia, Terris suggested
revamping epidemiology training programs to focus more time on
teaching students how to develop productive hypotheses and less time
on learning how to test hypotheses. He suggested a case-study method
to learn how to creatively synthesize knowledge into creative
hypotheses.
Research Frontiers
Finally, Terris gave his views
about the most pressing items on the research agenda for
epidemiologists. He included diseases which need more study if society
is to take the correct preventive measures (e.g. Cholera, STD’s), new
diseases such as HIV, occupational and environmental hazards, chronic
diseases of still unknown etiology such as diabetes, the whole topic
of evaluation of health services, and the epidemiology of health
itself. These challenges he called the “frontiers” of epidemiology and
said that success in addressing these would determine the future of
epidemiology and the extent to which it contributes to improving the
health of the public.
Fostering Epidemiology
He reminded epidemiologists that
the future depends on the degree of support received by legislators
and the public at large. He warned against standing idly by while
budgets are cut and against tolerating chronically inadequate funding
for prevention. He called for SER to reexamine the implications of its
mission statement to “foster epidemiologic research.” Terris appeared
to call for a redefinition of “fostering” epidemiology which would
continue to include improving methodology and sharing research
findings, but in addition, would include more efforts in helping to
convince the public and legislators that prevention is more important
than treatment, that the epidemiologic research agenda needs full
support, and that the application of epidemiologic findings deserves
to be granted the highest priority in shaping health policy in the
United States.
“We cannot remain
indefinitely in our ivory towers,” said Terris, “they may crumble
around us.”
Published July 1992
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