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Is The Field In The Midst Of An “Identity Crisis”?

Led by Associate Professor Bryan Lau who gave a welcome address, the Epidemiology Department at the Hopkins School of Public Health celebrated its 100^th birthday (1919-2019) by offering faculty, students and invited guests a chance to pause from their busy lives in mid-November to think about the state of epidemiology--- past and future.

Goals

 According to Lau, the goals of the day and a half symposium were fourfold:

·       to reflect on what epidemiology has contributed to public health and what it will continue to contribute,

·       how the field of epidemiology is perceived,

·       how are we communicating what the field of epidemiology is about, and

·       what do the skills we are teaching say about our field now?

The symposium on November 8 and 9 was composed of several sessions to address these themes, including how to communicate science presented by the Alan Alda communications team, how epidemiology is viewed by journal editors of the broader scientific community, and what the teaching of epidemiology reveals about the field today. (Read the interview with Lau following this article to learn about the highlights from these sessions.)

What is epidemiology?

Lau spent considerable time in his opening presentation seeking to describe what epidemiology is. He began with some of the well-known definitions but also pointed out the emergence of population health and wondered what is the difference between epidemiology and population health. Since the term first arose, it has grown in use and Lau wanted to know if this represents a rebranding of epidemiology triggered by the perception outsiders have about epidemiology. He wondered if population health has emerged because of the increased focus on causal inference and complex methods in epidemiology. He quoted from a 2013 paper by Sandro Galea stating “…interest in causes takes the field far away from relevance and into obsolescence.” 

Other Trends

Others have expressed concern that epidemiology is leaving little room for working across disciplines or that it is producing results useful only at the individual level and not at the population level. New terms such as precision medicine and even precision public health have arisen. Some have called for epidemiology to renew its focus on public health. Since epidemiologists can work across the spectrum from the cellular and even sub-cellular level to the population level, Lau asked where do epidemiologists fit into these different ways of thinking about the work health researchers do.

Hints

Perhaps a part of the answer to the question of where epidemiologists fit might come from how epidemiologists are perceived by persons from outside the field. This is important according to Lau because how epidemiologists are perceived impacts how results are believed, how epidemiologists stay relevant, and how epidemiologists find funding. Lau commented on worrisome observations that there is a shift away from epidemiology in many NIH strategic plans. Anecdotal evidence suggests a decline in the use of epidemiology terms in providing course titles and even in describing methods. For example, one individual in a conversation discouraged the use of the term “cohort” and suggested instead “following a group of people over time” to avoid using a term that has been a well-recognized part of epidemiology.

What Do We Think

Another theme or question posed by Lau was to ask how epidemiologists think they are perceived. He cited limited findings that concerns about the field are substantial even among insiders in epidemiology with 30% in one survey disagreeing with the idea that epidemiology is held in high regard.  Attacks on nutritional epidemiology have occurred recently and epidemiology has been described as a weak science and the least reliable. In contrast, in other forums, papers have been published stating that epidemiology is very useful and deserves to be taught in secondary schools. A recent editorial in Nature Communications has called epidemiology “a science of high importance” (see below).

Bottom Line

According to Lau, how insiders and outsiders of the epidemiology field perceive epidemiology boils down to what epidemiologists are saying the field is all about. Some observers have noted that all fields debate these matters to some extent and that this debate is a healthy sign. Others point out that epidemiologists are known for being skeptical and critical of their own methods. The observation has been made that epidemiologists are so critical they eat their young. Epidemiologists diminish themselves, the thinking goes.

A final point raised by Lau near the end of his presentation was to ask—How do epidemiologists go from communicating about individual study results to communicating about the field itself? The opening session closed by leaving the audience with multiple questions in three broad theme areas.

Reflection

How did epidemiology arise?
Who are we?
Who do we need to become?

Communication

How do we communicate science better?
How do we communicate about our field?
What is our brand?

Future

How do we shape the field?
What should we be teaching?

Highlights from how these themes were covered in sessions with communication experts, journal editors, and teachers of epidemiology can be found in the interview with Bryan Lau published below or in this issue.

And video of some of the sessions are available online at:

https://bit.ly/2Tcy8bY

** Editors. Epidemiology is a science of high importance. Nature Communications 2018; 9: 1703

 (https://go.nature.com/2K59k19) ■

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