Society for
Epidemiologic Research (SER) Presidential Addresses
Petitti Gives
SER Address
Outgoing President
Stresses the Value of Interaction for Epidemiologists of Different
Sub-Specialties
As the molecular basis of
disease becomes clearer for many illnesses and as subspecialties in
epidemiology continue to proliferate, is it worthwhile for
epidemiologists of different kinds to continue to meet as one
discipline at a general meeting such as SER? Are we one or are we
many? These were the key questions posed by outgoing SER president
Diana Petitti in her address to the SER membership at
the recent meeting in Snowbird Utah in mid-June.
Petitti further noted that the
identification of epidemiologists as specialists in a subject specific
area such as breast cancer or AIDS often overshadows their
identification as epidemiologists. In an environment with increasing
specialization, what is the role of a generalist society such as SER?
To help set up her personal
answer to these questions, Petitti discussed Alzheimer’s disease and
illustrated how different branches of science including the basic
sciences, clinical medicine and epidemiology have contributed and will
continue to contribute to our growing understanding of this disease.
In her view, science advances as a partnership between the different
branches of science and progress with Alzheimer’s disease makes that
point very well.
According to Petitti, molecular
epidemiology, traditional risk factor epidemiology, and more applied
epidemiology all have a place at center stage in advancing scientific
knowledge. Even if we could define completely the molecular basis of
disease, she stated, that would not eliminate the need for risk factor
and public health epidemiology to bring more rationality to health
decisions.
Admittedly, risk factor
epidemiologists and applied epidemiologists cannot escape the
consequences of our rapidly increasing knowledge about the molecular
basis of disease and what this means for what epidemiologists do and
what they need to know. However, meetings such as SER are valuable,
according to Petitti, because they provide a forum for specialists
from one “tribe” to give other specialists who speak a different
“dialect” an understanding of what they are doing and what they are
interested in.
Why is this worthwhile? To
Petitti, this generalist forum is needed to create the kind of
balanced and broad understanding of the universe of science that is
needed by functioning scientists. She gave as examples the
opportunities epidemiologists have at SER to learn about methods they
never expect to use and to be exposed to topics they know very little
about. This helps epidemiologists realize, Petitti said, what they do
not know and gives them ideas about what they may need to know
tomorrow or what they should have known yesterday! It allows
epidemiologists to look for things in a “strange” universe that can
help them in their own more “familiar” universe.
Are we one or are we many? We
are both, according to Petitti, and there is a need for a generalist
society such as SER where epidemiologists from different specialty
areas can learn to talk to one another.
Published July 1995
Postscript 2000
My 1995 SER Presidential address
was about the increasing subspecialization of epidemiology and the
role of the generalist meeting in a subspecialized world. Speaking of
subspecialization, I asked: “Are we one or are we many?” Then, I
answered, “both.” I highlighted the many benefits of generalist
meetings. The generalist meeting is a forum in which scientists can
broaden their understanding of advancements in basic science and
balance knowledge about these advances with an appreciation for the
applications of that knowledge and issues that affect these
applications. The generalist meeting is a setting in which scientists
in one subspecialty learn something of the language of other
subspeciaties, which is essential to communication among
subspecialists and to the understanding of the work of others. The
generalist meeting facilitates interactions on a personal-level, and
personal interactions foster cross-fertilization of ideas, to the
benefit of subspecialties and subspecialists.
Since my 1995 SER
Presidential address, the increase in knowledge about the genetic
basis of disease has been breathtaking. I could not have predicted
that the Human Genome Project (and its collaborators and competitors)
would sequence the human genome by 2000 nor that entire new fields of
inquiry would be arise as a consequence. The role of epidemiology in
genetic research has expanded tremendously with the recognition that
most genes interact with environmental factors to influence disease
risk. Epidemiologists with interests in cancer, cardiovascular
disease, dementia, mental health--virtually any condition that can be
named--are involved in genetic research.
Since 1995,
evidence-based medicine has taken hold with a firmness that I not only
could not, but would not, have predicted. With this change,
epidemiologic thinking and epidemiologic methods have moved to the
forefront of clinical thinking and clinical policy development, and
epidemiologists have moved to center stage along with the thinking and
the methods.
Finally, since 1995,
measurement, monitoring, and accountability in the delivery of health
care services, called a revolution in the late 1980’s but still a
skirmish in 1995, have become a day-to-reality for systems of health
care and for those who work in them. Principles of epidemiology and
public health are being applied in settings that I would not have
thought possible in 1995.
But these wonderful
changes have accelerated subspecialization in epidemiology. Because of
the rapidity of advances in all fields of knowledge, the need for
subspecialists to talk among themselves seems to overshadow the need
to talk to others. The “dialects” of epidemiologic subspecialities
have become different from the mother tongue more extensively than I
envisioned, often putting great distance between epidemiologists
working in different fields. Sub- specialists are themselves
challenged to maintain mastery of their own dialect. “Rubbing
shoulders” with those whose interests duplicate ones own has become
more important in 2000 than it was in 1995, leaving little time for
shoulder rubbing to foster cross-fertilization of ideas.
In 2000, the
question, “Are we one, or are we many?” is the same. I am no longer so
sure of the answer. My 1995 answer may have been wishful. The
Renaissance epidemiologist has probably, of necessity, gone the way of
the Renaissance man.
“Is there a future
for the Society of Epidemiologic Research?” is a question I did not
ask in 1995. The need for common understanding, a common language and
interaction among scientists working in different fields is, if
anything, more acute now than in 1995. Who is going to translate
advances in genetics into clinical policy if the scientists at the
forefront of these advances do not understand how systems of care are
organized? How are populations to benefit from advances in knowledge
if those who manage health care for these populations do not
understand these advances? Where are subspecialists going to learn
about the work of others if there are no places where they meet with
others? My answer to the unasked question...the future is in meeting
the challenge.
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