The hazards of epidemiology, continued.

Abstract

Professor Holland's May 1995 editorial1 on the hazards of epidemiology has stirred up something of a hornets' nest on EPIDEMIO-L, an electronic mailing list for epidemiologists (subscribe to Listproc@CC.UMontreal.CA). Following an extensive discussion on this list, I have been deputed to respond. Leaving aside the dearth of references to support some very sweeping condemnations, the editorial presents, in some respects, a caricature of epidemiology. Holland's suggestion that nonmedical epidemiologists are unaware of temporal drift in diagnoses and interobserver variation in measurement is simply incorrect. Much basic work on these two issues has been done by nonmedical people, including people who have worked with Holland. Indeed, the problem of measurement error is one of the many reasons why epidemiologists need a wide variety of skills and often come from divergent professional backgrounds. No one would dispute that all epidemiology should include detailed consideration of biological and clinical evidence. It should also include consideration of social, anthropological, chemical, toxicological, and physical evidence. This is usually beyond the competence of any one person, no matter how talented. Serious epidemiologists, regardless of their professional background, will have to become familiar with much of the detail of the biology and statistics of their chosen topic. Clearly, clinicians have a head start on pathophysiology, and statisticians have a head start on mathematics. This does not invalidate the contributions of either. The composition of research teams will vary widely depending on contingency, personal interactions, and funding. There is no magic formula for establishing a winning team. Few if any teams will contain all of the possible contributors, but we believe that successful teams, regardless of composition, will be those that not merely listen to others but actively solicit their views. Modern epidemiology needs clinicians, but it also needs a host of other skills. All of us should perhaps stop thinking ofourselves as physician-epidemiologists, statistician-epidemiologists, or whatever. Of interest is the substantive scientific or policy question and the use of sensible methods to answer interesting questions. The primary degree of the person investigating is surely irrelevant. O Anthony Staines, MRCP, MFPHM, MSc