|
|
|
|
|
From our Archives: March 2015
Calls Policy at
Epidemiology “A Formidable Barrier To Addressing Public Health
Improvement” |
|
Author:
Roger Bernier, PhD, MPH For the Common Good Weighing in on the side of social welfare as the primary concern of epidemiologists, and quoting Woodrow Wilson that ‘to work for the common good is the greatest creed’, the University of Washington’s Howard Frumkin writes in the March issue of Epidemiology, that there is a need for a more consequential environmental epidemiology. He quotes from Sandro Galea’s efforts during a presidential address at SER and in the pages of the American Journal of Epidemiology to focus on epidemiologic work that matters for public health, i.e., consequential epidemiology. Frumkin is critical of the policy at Epidemiology which states that “Policy implications of research results many not be included in research reports." The journal reportedly gives highest priority to publishing etiologic research and its methods and not to potential uses of that information. Key Features To counter this “separatist” view of the role of epidemiologists, Frumkin identifies 9 features of consequential work in environmental epidemiology, including 6 that are applicable to all areas of epidemiologic work. These are: 1. Prioritizing for study widespread causes of suffering or premature death for which there are plausible environmental contributors. 2. Going beyond etiologic studies to investigate potential interventions. 3. Selecting for study questions that users of the data (decision makers) need to have answered. 4. Using varied and flexible study methods to get at the questions of interest. 5. Avoiding unnecessary replication research as it creates lost opportunities to study more pressing issues. 6. Being proactive about communicating research results. 7. Studying exposures which are potential environmental threats on a large scale. 8. Making increased use of the research design and other skill sets possessed by environmental epidemiologists which give them a comparative advantage in studying certain topics. 9. Exploring and documenting the additional non-health benefits associated with doing consequential environmental epidemiology. On Truth As Paramount Weighing in on the side of the pursuit of truth as the paramount value in epidemiology, Timothy Lash, the new editor of Epidemiology, asserts that “the utility of research results can only be validly measured retrospectively, once they are put to use” (2). He likens Frumkin’s ideas to frameworks for moral decision making such as utilitarianism and consequentialism and opposes their use for prioritizing work in epidemiology. For Lash, such guides are too likely to be misused to be trusted. He adds, the journal’s “…firewall between research and its policy implications, which has been in effect for 25 years, is one way in which we try to keep the pursuit of knowledge separate from the consideration of its consequences.” Epidemiology does not reject commentary articles focused on policy but simply does not accept such commentary within the body of research articles. There is support for the separatist position in scientific and even in policy circles because of the need for scientists to be perceived as objective about generating data. It’s their very detachment, what you might call the cold-bloodedness of science, that makes science the killer app according to an article in National Geographic (3). However, there is irony in that the report is about why people doubt.science the killer app according to an article in National Geographic (3). However, there is irony in that the report is about why people doubt science, and it makes clear that the facts do not speak for themselves, no matter how objective they may be. Not Advocacy Frumkin in his commentary does not go so far as to urge that environmental epidemiologists should be advocates, and he recognizes the importance of research not directed specifically at improving health outcomes. He acknowledges that research consequentiality is difficult to measure. He ends by urging that his 9 features should not be used to disqualify certain types of work, but rather should be used as a set of questions to help epidemiologists set priorities in how they invest their time and skills. His view is echoed in a quote he uses from Bill Foege who asserted that epidemiology is a tool to change the world, not merely to study the world. In Frumkin’s view, the policy at Epidemiology is in sharp contrast and a formidable barrier to addressing public health improvement. (1 & 2) http://tinyurl.com/k4oqmca (3) http://tinyurl.com/njvvkag ■ Observers Speak Out On Frumkin and Lash Commentaries The Epidemiology Monitor invited members of the International Joint Policy Committee of the Societies of Epidemiology to review and comment on the articles by Frumkin and Lash. Two representatives, Raymond Neutra, and Fiona Sim offered the following reactions to these two pieces. To The Epidemiology Monitor: As joint editor-in-chief of Public Health, I ask what is the value of epidemiology that is not ‘consequential’? De facto, it surely becomes ‘inconsequential’, which seems no way to encourage the best emerging scientific brains to participate in this essential pursuit of a core public health science. Epidemiology that is relevant to the promotion or protection of human or planetary health is central to the promotion or protection of population health. It is standard practice at Public Health to question the potential value to public health policy or practice of epidemiological research manuscripts submitted to the journal: those manuscripts that appear to be ‘inconsequential’ in that they have intentionally not addressed the potential utility of their findings, are unlikely to pass initial editorial review. Fiona Sim To The Epidemiology Monitor Since I spent my career doing environmental epidemiology, I am of course sympathetic to Howard Frumkin’s sentiments. I would also add some thoughts: 1) There are other drivers of research priorities than the utilitarian aim of maximizing the nation's quality adjusted DALY's. When a small environment or work place conveys unfair and unacceptable risks, its research and abatement is a priority even though there is little impact on the national DALY count. 2) The tendencies that Howard wants to reverse are caused more by the way research is funded and less by misguided education and defective attitudes of individual epidemiologists. How could CDC and NIH frame their funding to achieve these worthy goals? 3) That being said, if I were king, I would make epidemiologists study quantitative decision analysis, cognitive psychology and political science so that they had the intellectual tools to understand the policy processes to which they hope to contribute. They need to understand the culture of the other disciplines with which they will be working and how to translate the probabilistic inconvenient truths that they produce so that they are intelligible to others.
Raymond
Neutra
■ |
|
|
|
|
|
|
|
|
