Towards A Better Appreciation Of Epidemiology As A Whole---An
Interview With Hopkins Epidemiologist Bryan Lau
To
obtain a sense of the highlights from different sessions at the recent
Hopkins Symposium celebrating the Epidemiology Department’s 100th
anniversary, we interviewed Bryan Lau, Associate Professor in
the Department and one of the organizers of the meeting along with
colleagues
Stephan Ehrhardt
and Priya Duggal.
The Symposium was to address contemporary issues in the field,
particularly those relating to the past and the future state of
epidemiology. Three themes—the nature of epidemiology, communication
in epidemiology, and the future of epidemiology were to be covered by
invited participants, including communication experts, journal
editors, and teachers of epidemiology.
EM:
What
were the highlights in your opinion of what the speakers had to say in
the communications session.
Lau:
The communications session was really about how to
communicate science on an individual level. Specifically, the Alan
Alda Center for as scientists need to pause and make Communicating
Science talked about making connections with the person or audience
that you are communicating with. It is having discussion in which
individuals as scientists need to pause and make sure that they are
understood. A takeaway point was to make the other person look good.
It was a take on the “Yes and …” approach to communicate rather than
“Yes but …”. That is, we need to accept the other
person’s viewpoint and add to it or modify it rather than be
confrontational in our communication.
The
field of epidemiology has had a significant impact on the health of
populations and I think it is time that we start communicating what
the field is about to the broader world. In doing so, I think there is
a message we can take from this session to try to keep in mind who we
are communicating with. Is it with a lay audience, policy makers,
funders, other scientists, or more specifically other epidemiologists?
Are they a receptive audience or more of a wary audience? The goals of
the messaging might be quite different in this latter case. With a
likeminded or sympathetic audience we might be trying to get the
overall scientific message across and the limitations of the field.
With a less likeminded or sympathetic audience, the goal may be just
to get them to acknowledge some aspect of the field overall that may
help make them more sympathetic.
EM:
What
were the highlights in your opinion of what the journal editors had to
say?
Lau:
We specifically asked the journal editors to speak
about why epidemiology is important to their journal, what role
epidemiology has had, what role do they see epidemiology playing in
the future, and what they would like to see more of from the field of
epidemiology. Overall, each of the journals represented, which were
Drs. Christine Laine from Annals of Internal Medicine,
Rebecca Cooney from Lancet, Sonja Schmid from
Nature Communications, and Brad Wibble from Science,
discussed why epidemiology has been important and continues to be
important for their journals. I think one of the take aways that the
journal editors had was that they didn’t realize epidemiology had so
much nuance to it. So in a way we may have altered their perceptions
of the field.
However, for Annals and the Lancet, epidemiology was
acknowledged as playing a large role in their journals and being able
to address questions that are important to their missions. For
Nature Communications and Science, it was that epidemiology
could provide the principles for analysis and interpretation of
observational data from “big data” since big data does not necessarily
mean better data. So overall, my takeaway from the session with
journal editors is that they viewed epidemiology as being an important
field that can answer important questions in a principled way in order
to reach appropriate inferences. Epidemiology will need to play a key
part in understanding and explaining new challenges in public health
such as big data or the effects of climate change on health.
EM:
What were the highlights in your opinion of what the
teachers of epidemiology had to say?
Lau:
One of the key themes that was in many of the talks
from teaching was that we need to focus on communication of
epidemiology results, that is, science communication. But also that
we need to focus on getting students to ask innovative and interesting
questions. That is, we need to perhaps focus on getting students to
ask good questions and a bit less on complex methodology. There is
nothing wrong with complex methodology, but if we as a field are going
to have impact, then we need to be able to ask good scientific and
public health relevant questions.
EM:
You and your colleagues recently wrote an
article in the IJE proposing a unifying framework under which
epidemiologists of all stripes could work productively to have public
health impact. Why or how does the framework help epidemiologists
address some of the key concerns you brought out in your opening
presentation at the Hopkins 100th
anniversary celebration?
Lau:
What Drs. Ehrhardt, Duggal, and I were trying to do
with the IJE paper was to bring people who have been involved in these
discussions in the field to focus on what the overall goal of
epidemiology is. The definition of epidemiology as the study of the
distribution and determinants of health related states and events in
populations and the use of this knowledge to control health problems,
is a broad definition. It covers all aspects of health and therefore
we need to acknowledge that we have a large field that covers the
mission of descriptive investigations including trends over time,
surveillance, and outbreak investigations. But it also covers causal
investigations as well as investigating how to implement in order to
control determinants that lead to health outcomes. We try to
acknowledge working at population levels down to individual levels.
Therefore, epidemiologists do not need to work in each domain of
descriptive, causal, and implementation investigations at both the
population and individual levels but rather recognize the need for
diversity between and across the various research areas and
methodology, including statistical as well as study design
methodology to support each of the domains.
With
this paper we hoped to start or maybe continue a discussion about what
our field is. We believe that this is a more holistic view of our
field and that from this we can start communicating out more
consciously about our field as a whole to other audiences and
potentially change the way our field may be perceived. Similarly, the
framework puts the scientific and public health question at issue in
the forefront. Therefore, just as was suggested by the Symposium
session on teaching, we need to be able to ask good public health
questions and make clear that the methods serve the research
question.
EM:
Where does the framework fall short if you
think it does in some respects?
Lau:
I am not sure yet where the framework falls short. I believe it will
become more apparent should the field open up to discuss where we are
and what messages we coalesce around to communicate to various
audiences.
EM:
You mentioned an interest in catalyzing a conversation in the
epidemiology community about the framework and the issues underlying
it. Can you say more about your plans to do this?
Lau:
Well I think that is up to the field to pick up the
discussion. We will certainly continue to foster dialogue. Certainly
having the Department Centennial Symposium focused on reflecting on
what epidemiology is, how we are perceived, how we are communicating,
and how what we teach shows our values. At the symposium were various
chairs of departments of epidemiology and other individuals in
positions of influence (*see below). So we are already engaging the
community beyond what we did with publication in IJE.
EM:
Sometimes it seems the epidemiology community is in a perpetual
conversation about who we are and why we exist without ever reaching
any widespread consensus about these issues. Is that right? Are these
questions really so intractable? Do you think that will change going
forward?
Lau:
I think that we are in a perpetual conversation about the field, but
that is healthy for our field that we keep having self-reflection
about who we are and who we want to be. It isn’t that the questions
are intractable, but that the definition of epidemiology is so broad
that we can cover a lot under this definition. Furthermore,
methodology and technology keeps evolving as well as societal
pressures and the way we communicate. Therefore, we keep revisiting
the questions of who we are and why we exist because we need to keep
evolving as a field to address the rising challenges and
opportunities.
So what I think is different about our vision from the JHU Department
of Epidemiology Centennial Symposium is that this discussion shifts
the focus towards communicating our message of epidemiology out to a
broader world about what we do, how we have impact, our strengths and
limitations. Indeed as pointed out by the recent editorial in
Nature Communications, the field of epidemiology is a science that
has had great impact by saving millions of lives from diseases both
infectious and non-communicable (see below). Therefore, we need to
get this message across and that what we do or accomplish as a field
is not reliant on any single study but comprises an accumulation or
whole body of evidence.
Notes: Invited or In
Attendance
Chairpersons of Department of Epidemiology: Drs. Albert Hoffman
(Harvard), Charlie Branas (Columbia), Stephen Hawes
(UW), Jiang He (Tulane), Albert Ko (Yale), Deborah
Levy (U of Nebraska Medical Center), Jay Magaziner (U of
MD), Til Sturmer (UNC, Chapel Hill), Martha Werler
(Boston University)
Others: Dean Javier Nieto (Oregon State), Associate Dean
Michael Lu (George Washington University), Deputy Director
Graham Colditz (Institute of Public Health at Washington
University, St. Louis), Barbara Mahon (Deputy Chief of Enteric
Diseases Epidemiology Branch, CDC), and Enrique Schisterman
(Branch chief at NICHD and SER President).
Editors. Epidemiology
is a science of high importance. Nature Communications 2018; 9:
1703
(https://go.nature.com/2K59k19)
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