[EQ] The rise and fall of epidemiology, 1950-2000 A.D

         The rise and fall of epidemiology, 1950–2000 A.D.

Kenneth J Rothman  - Harvard School of Public Health, Boston, MA USA
International Journal of Epidemiology 2007 36(4):708-710; doi:10.1093/ije/dym150

[Extract] [Full Text] [PDF] 

"....In 1662 John Graunt, a London haberdasher, published his magnum opus, Natural and Political Observations ...
Made upon the Bills of Mortality, and thereby established the field of epidemiology.¹ Graunt brought to light a
diversity of facts about human life and disease that had not previously been appreciated. He was the first to notice
that the number of births and deaths of males exceeded those of females (by the ratio of 14 to 13); he noticed, too,
that despite their greater mortality, men had less morbidity than women. Graunt quantified for the first time the high
mortality in children, noting that one-third died by the age of five. He documented that plague actually claimed many
more deaths than had been ascribed to it, and he demonstrated that the frequency of rickets increased over the span
of a few years from zero fatal cases to a level that indicated a serious epidemic.  ^..."

Commentary: Epidemiology still ascendant
Kenneth J Rothman - Harvard School of Public Health, Boston, MA USA

Int. J. Epidemiol. 2007 36: 710-711; doi:10.1093/ije/dym151 [Extract] [Full Text] [PDF]

".....Though published in 1981, the footnote on the first page of ‘The Rise and Fall of Epidemiology’¹ indicates that it was
a preprint of a talk ‘to be presented December 10, 2004, at the annual meeting of the John Graunt Literary Society,
Harvard School of Public Health, Boston.’ Back in the 1970s, the facetiously named John Graunt Literary Society,
or JGLS, met each Friday in the late afternoon at the Harvard epidemiology department to celebrate Graunt's legacy
with brewed beverages. Although the December date 23 years in the future at the time of publication was in fact a
Friday, the ‘preprint’ implied that the JGLS was destined to evolve from a weekly beerfest into a yearly gathering of
sober, serious speeches. In an essay that many readers took to be a cynical rant laden with gloomy predictions,
this forecast for the JGLS was the gloomiest of all.

In fact the essay was not intended to predict the future of epidemiology, which I have always held to be bright.
It was meant to be a warning about the growth of research bureaucracy and its effect on epidemiologic research...."

Commentary: Epidemiology and futurology—why did Rothman get it wrong?
Cesar G Victora - Universidade Federal de Pelotas, CP 464-96001-970 Pelotas, RS, Brazil.
Int. J. Epidemiol. 2007 36: 712-713; doi:10.1093/ije/dym153 [Extract] [Full Text] [PDF] 

".....Ken Rothman is a household name for epidemiologists all over the world. The appearance of his book
‘Modern Epidemiology’¹ in the mid-1980s consolidated his reputation as a major thinker in our discipline.
I remember finding his book truly inspirational when I first read it as a junior epidemiologist.

Rothman's commentary on ‘The rise and fall of Epidemiology, 1950–2000 A.D.’,² however, made many
epidemiologists worry. This paper, published in 1981, reads as if it had been written in the beginning of the
21st century, for presentation at the ‘John Graunt Literary Society’ at Harvard in 2004, pretending to look
back at the downfall of our discipline ..."

Commentary: The rise and rise of corporate epidemiology and the narrowing of epidemiology's vision
Neil Pearce - Centre for Public Health Research, Massey University Wellington Campus, Wellington, New Zealand.
Int. J. Epidemiol. 2007 36: 713-717; doi:10.1093/ije/dym152 [Extract] [Full Text] [PDF]

 

"......with regards to the corporate influences on epidemiology, there is no simple solution. However, for the last
two decades there has been substantial discussion on ethics in epidemiology,^49–52 partly in response to the
unethical conduct of many industry-funded consultants.
A number of websites (e.g. http://www.ucsusa.org/scientific_integrity/ and http://www.cspinet.org/integrity/)
are now devoted to fostering integrity in science. Recently there have been renewed calls for scientists to
‘engage in processes to assert positive principles of ... how science should work, and how it should be
applied to public policy decisions’ rather than simply having a list of what not to do.³⁰ This will require
‘strong pressure from within the scientific community for codes of ethics conduct and financial conflict
of interest’³⁰ with the goal, not of restricting what people can do, but to ensure complete transparency
‘through full declaration of potential sources of conflicts of interest’.¹⁴ Ultimately, perhaps what is
needed is to create some sort of licensure in which epidemiologists would ‘sign up’ to not take funding
from any vested interests (corporate or otherwise)..."

Commentary: Epidemiology needs the patients to survive
J W W Coebergh - Professor of Cancer Surveillance, Erasmus MC Rotterdam
Department of Public Health,  The Netherlands
Int. J. Epidemiol. 2007 36: 717-719; doi:10.1093/ije/dym163 [Extract] [Full Text] [PDF]

".....According to Pubmed, the pessimistic and rather emotional paper of Ken Rothman on the presumed rise and
fall of epidemiology in 1980¹ was his 59th after being in the ‘business’ for almost 10 years. He was undoubtedly
speaking on behalf of many of his colleagues at the time in expressing the threatened demise of his profession.
By 2007, having become an influential teacher, he has been involved in 209 articles on a wide range of subjects,
often in the domain of congenital defects, early life exposures, pharmaco-epidemiology and disease aetiology. I
n 1981, he was still optimistic enough to found the New England Epidemiology Institute which was to successfully
train a large number of post-graduate students in the subsequent 20 years, and he became the first editor of
Epidemiology in 1990. Today, he is still actively teaching and advising all over the world and co-authoring articles.
So, if he did not live up to his own prediction or sought to refute it, were his alarming early warnings appropriate? ^..."

 

Commentary: Is epidemiology really dead, anyway?
• A look back at Kenneth Rothman's ‘The rise and fall of epidemiology, 1950–2000 AD’
Michel P Coleman - Cancer Research UK Cancer Survival Group, Non-Communicable Disease
Epidemiology Unit, London School of Hygiene and Tropical Medicine
Int. J. Epidemiol. 2007 36: 719-723; doi:10.1093/ije/dym160 [Extract] [Full Text] [PDF]

".....Epidemiologists are in increasing demand to provide answers to new problems of health and the causes of disease,
of disease prevention and of health care, and to refine the methods used to monitor or predict trends in disease control.
The public health applications of epidemiology continue to expand, from malaria control in Malawi to the eradication of
onchocerciasis in sub-Saharan Africa; from reducing the toll of road traffic accidents to designing cancer control programmes;
from health services research to defusing the obesity timebomb; and from racial or socio-economic inequalities in the outcome
of health care to projections of the tobacco-related disease epidemic in China.

Rothman's terrible gloom in 1981 overlooked the inherent strength of epidemiology. It is a science that tells us what we
want to know about the human condition and, often, how it might be improved, in a way which no other science can offer.
It is the science that underpins public health.

Less than 10 years ago, tongue firmly in cheek, Rothman co-wrote: ‘Should the mission of epidemiology include the
eradication of poverty?’⁴² Mission impossible, even for a science that can contribute hugely, but Rothman the
epidemiologist seems to have recovered his panache.

A science lives by the strength of its precepts, the intellectual vigour of those who practise it and the benefits it
brings to mankind. By those standards, epidemiology is still very much alive, and looking good. ^...."

 

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