Society for
Epidemiologic Research (SER) Presidential Addresses
SER President
Stresses Value of Teamwork at 25th Annual Meeting
Epidemiologists should strive to
work closely with a variety of groups and disciplines to maximize
their effectiveness and promote advancements in knowledge, said
Charles H. Hennekens, president of the Society for
Epidemiologic Research (SER), at the 25th annual meeting in
Minneapolis recently.
“Within our discipline, we must
remain cognizant that epidemiology is not an individual effort like
tennis or squash, but a team effort like baseball, basketball, or
football,” Hennekens said. He applied this metaphor to the research
team which he said is likely to include not only epidemiologists, but
statisticians, clinicians, other public health professionals, project
directors, coordinators, administrators, systems analysts,
programmers, research assistants, medical editors and the secretarial
staff, but the metaphor applies to his address in general. He said
other groups epidemiologists should work with as a team include
colleagues from other disciplines, the media, and he called for more
collaboration between the epidemiology societies.
Working With Other
Disciplines
According to Hennekens, while
different disciplines may sometimes seem adversarial, they are
actually crucial for achieving advancement in knowledge. Each
discipline addresses a different set of issues, and it is the sum of
the findings which expands our body of information, he said. Each
component provides relevant and complimentary information to the
totality of evidence upon which rational clinical decision making, as
well as public health policy, can be based, said Hennekens.
Communicating With the
Press
Because epidemiology has such
direct relevance to the lives of human beings, Hennekens said he feels
epidemiologists have a special responsibility to communicate their
findings to the public. He said teamwork with the lay press is one
good way to do this, and he provided some advice:
• Don’t contribute to existing
misperceptions. Hennekens said each finding must be viewed “in the
context of the totality of evidence,” and epidemiologists must be
vigilant in their efforts to avoid giving the impression that their
field is prone to contradictory findings. To do this, he said, “we
must first ourselves believe firmly in the principle that no one
epidemiological study, whether case control, observational cohort or
randomized trial can definitively answer a given research question.”
He said to stress to the media representatives that they need to try
to see the “big picture.”
• Seek headlines for the right
reasons. He said epidemiologists need to avoid collusion with the
media and remain focused on the primary issue—the health of the
general public—instead of using the media as a mechanism to try to
secure further research dollars. Avoid self-defeating sensationalism
in the short run. Sincere and whole-hearted efforts to educate the
media and the public should be the aim of the epidemiologist who is
called upon by the press to elaborate on research findings, according
to Hennekens. “This type of teamwork will only serve to enhance our
profession in the long run,” he said.
Teamwork and Epi
Societies
Hennekens said it is the common
dedication to excellence in epidemiology that needs to be stressed
among the large number of epidemiological societies in existence now.
As an example of teamwork among the groups, Hennekens mentioned the
activities regarding a set of common ethical guidelines. He said
efforts in this direction will establish an important precedent for
other issues of common concern.
In closing Hennekens remarked:
“I strongly believe we must all hang together, or else we run the risk
of all hanging separately.”
Published July 1992
Postscript 2000
It seems like only yesterday but
over eight years have passed since I delivered my l992 SER
Presidential Address at the 25th Annual Meeting in June l992.
In May 1991, I had an experience
that crystallized my thoughts about my Presidential Address. Dr.
Robert Bazell, the chief medical correspondent for
NBC News invited me to appear on the Today show to comment upon
statements by several prominent epidemiologists about whether drinking
coffee did or did not cause myocardial infarction or pancreatic
cancer.
I looked forward to this
opportunity to comment upon the crucial role epidemiology plays in
advancing medical knowledge. Specifically, I believe that advances in
medical knowledge proceed upon several fronts, optimally
simultaneously. Basic researchers provide biologic mechanisms to
answer the crucial question of why an exposure causes or prevents
premature death. Health care providers are conferring enormous
benefits to their patients by their applications of advances in
diagnosis and treatment and are formulating hypotheses from their own
clinical experience, that is, their case reports and case series.
Clinical investigators are testing the potential relevance of basic
research findings to healthy individuals and individual patients.
Epidemiologists and biostatisticians are formulating hypotheses from
descriptive studies and testing hypotheses in appropriate analytic
studies, whether case-control, observational cohort, or where
necessary to detect reliably small to moderate effects, randomized
trials. Thus, epidemiologists answer the crucial, unique, and
complementary question of whether an exposure causes or prevents
premature death. In my view, all these disciplines and, indeed, each
strategy within a discipline, contributes importantly relevant and
complementary information to a totality of evidence. Reliance on the
totality of evidence allows for the most rational individual clinical
decisions for patients and policy decisions for the health of the
general public.
On the Today show, Dr. Bazell
asked me why one day epidemiologists say that coffee drinking causes
myocardial infarction or pancreatic cancer and another day equally
reputable epidemiologists say that coffee drinking has no adverse
health effects. I replied that we, the academic researchers, and they,
the media, often seem to be in collusion to confuse the general
public. He then asked me how this situation occurs and I replied that
researchers often overstate the findings from their single study and
that the media likewise exaggerates the conclusions. I added that the
simple solution is to never rely on the results of any single study
but instead, rely on the totality of evidence.
If so, no single study ever
changes our minds completely about a relationship between an exposure
and disease but merely may shift our thinking in one or the other
direction. Dr. Bazell was a most gracious host and thanked me for my
valuable public service.
My subsequent uncontrolled
clinical observation was that I was not invited back for seven years.
On a more serious note, however, I stated in my 1992 SER Presidential
Address that I believed the words of Benjamin Franklin
on July 4, 1776 at his signing of the Declaration of Independence,
were as relevant to epidemiologists today. He stated “We must all hang
together or assuredly we shall all hang separately.” Unfortunately,
during the last eight years my uncontrolled clinical observations are
that epidemiologists seem to prefer to hang separately than together.
But as I would also caution, such descriptive studies are useful only
to formulate not test hypotheses. Thus, I eagerly and anxiously await
the analytic studies that would provide the reassuring data necessary
to forecast a brighter future for our crucial discipline that has
provided so much satisfaction and joy to me during the last 31 years.
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