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Agreement On The Field’s Purpose Still Elusive

Back in 2001 the new editors of the International Journal of Epidemiology (IJE) asked—“Epidemiology: Is it time to call it a day?” That was a direct question and their answer was no. At the recent IJE one day conference 16 years later, the editors launched their conference by asking another more ambiguous question --“ Is (publishing) epidemiology history?” and the answers were expected to be more nuanced, according to Shah Ebrahim, co-editor of the IJE.

He explained why to The Epidemiology Monitor. “This is a consequence of trends in methods of communicating scientific findings, our own experience of editing the IJE, a belief that knowing what went before is fundamental to doing better studies and gaining greater understanding, and the growth of modern epidemiological methods,” he said.

Conference Topics

Among the topics touched upon at the conference were aspects of the history and future of epidemiology, its relationships with other areas of science, funding, data access, and public understanding and media interest in epidemiological findings. The speakers and topics are listed at the end of this article.

Why Epidemiology Matters

According to Ebrahim and co-editor George Davey Smith, the talks provoked considerable discussion about the direction of epidemiology. For example, the talk given by Katherine Keyes of Columbia on why epidemiology matters laid out very clearly the ideas underlying what epidemiology was and what it is becoming. She stressed the importance of maintaining the broad scope of epidemiology (beyond causal inference). Her promotion of “population health sciences” as a means of teaching and practicing what seems to be getting pushed out in the USA (with strong emphasis on causal inference as the main purpose of epidemiology) is highly relevant, they said. 

Uses of Epidemiology

The authors added, “in the UK, causal inference in terms of the potential outcomes  approach is not taught in MSc Epidemiology courses so perhaps the need for a new discipline of “population health sciences” is less obvious.  What is very clear is that the original ideas about the uses of epidemiology, advanced by Jerry Morris, Mervyn Susser, and others need to be taught and understood by current and future generations of epidemiologists.”

Reaction To Presentations

Richard Smith, former editor of the British Medical Journal and a speaker at the conference, blogged that attending the conference was like a schadenfreude experience “…as an outsider to watch a professional group agonize over who they are, whether they matter, whether their methods are adequate, and whether they are missing something important."

 Smith described the presentation by geographer Danny Dorling who reported on both increases (bad news) and decreases (good news) in morbidity/mortality in different populations and asked why these events have not been given more attention by epidemiologists. The answer, at least for some in the room, according to Smith, was that  “epidemiologists had lost their way in ever cleverer mathematics, complex software programmes they barely understand, arcane debates over methods, and increasingly sophisticated studies of questions that hardly matter.”

Ben Goldacre, also a presenter at the conference on data transparency, called the meeting a “victory lap” for Ebrahim and Davey-Smith. He went on to describe the talks by each speaker in a phrase or two and encouraged  readers on his Bad Science blog to “settle in” and watch the videos of all the speakers. “Nothing on telly is worth the candle”, he added.

Luisa Zuccolo, also at Bristol University, in her recap of the conference on the IJE blog concluded that “ it left more questions than answers.”

Allegiances In Epidemiology

This conference was not the first to provoke epidemiologists to reflect on their core identity. At least one earlier conference in Birmingham Alabama in 1989 (See Epi Monitor June 1989) raised questions about the purposes of epidemiology. At that meeting, Albert Jonsen, a professor of ethics in medicine at the University of Washington, said “at the heart of efforts to develop a code of ethics for epidemiologists is the need to determine what are our allegiances. Do these allegiances have priorities? To the truth? To the social welfare? To the employers? What is epidemiology all about? When there is communal agreement about these issues, epidemiologists can develop a code of ethics.”

It appears those conversations are also needed for answering questions about the value of epidemiology and its uses in the larger society. The needed conversations have been lacking and the communal agreement appears to have eluded the profession.

Videos of the individual presentations at the conference can be accessed at the links below.

December Issue of IJE

Participants at the conference also heard about plans for the December issue of IJE on Causality in

Epidemiology. It will contain lengthy articles and commentaries from leading epidemiologists and book reviews of VanderWeele’s and Pearl’s new textbooks on causality, according to the editors. They told the Epidemiology Monitor “It will probably be the largest single issue we have published and will provide readers with an up to date and comprehensive review of schools of thought in causality. Perhaps the most important aspect are the commentaries of epidemiologists from different schools commenting on each others ideas.”

Entitled Causality in Epidemiology—The Last Frontier, some of the articles  have already been published online. Readers can access them from the links at the end of this article.
 

Topics and Speakers at IJE Conference

George Davey Smith: Epidemiology after 2017: methods or matter?
School of Social and Community Medicine, University of Bristol

Danny Dorling: Epidemiology: abandoning the social. How deaths in England and Wales rose in a year by 5%, in Scotland by 9%, but epidemiologists were too busy with the genome to notice the bills of mortality
School of Geography and the Environment, University of Oxford

Shah Ebrahim: IJE 2000-2016: what happened?
London School of Hygiene and Tropical Medicine; University of Bristol

Ben Goldacre: Data access and transparency
Nuffield Department of Primary Care Health Sciences, University of Oxford

Katherine Keyes: Why does epidemiology matter?
Mailman School of Public Health, Columbia University

Tom Koch: Mapping history into the future
Department of Geography, University of British Columbia

Martin McKee: Epidemiology in the age of austerity
London School of Hygiene and Tropical Medicine

Alex Mold: Placing the public in public health: epidemiology and the public in post-war public health
Centre for History in Public Health, London School of Hygiene and Tropical Medicine

Richard Smith: The death of journals can’t come soon enough
Chair, International Disease Research

Links to the videos for these talks can be found at:
https://tinyurl.com/gvvafc8

Articles Published Early Online From IJE December Issue On Causality

Krieger N and Davey Smith G. The tale wagged by the DAG: broadening the scope of causal inference and explanation for epidemiology

http://ije.oxfordjournals.org/content/early/2016/09/28/ije.dyw114.full

Vandenbroucke et al. Causality and causal inference in epidemiology: the need for a pluralistic approach

http://ije.oxfordjournals.org/content/early/2016/01/21/ije.dyv341.full

VanderWeele et al. Letter to the Editor: Re: Causality and causal inference in epidemiology: the need for a pluralistic approach

http://ije.oxfordjournals.org/content/early/2016/08/08/ije.dyw162.full

Chiolero A. Letter to the Editor: Counterfactual and interventionist approach to cure risk factor epidemiology

http://ije.oxfordjournals.org/content/early/2016/08/08/ije.dyw159.full

Schooling CM et al. Letter to the Editor: Causality and causal inference in epidemiology: we need also to address causes of effects

http://ije.oxfordjournals.org/content/early/2016/08/08/ije.dyw160.full

Broadbent A et al. Letter to the Editor: Authors’ Reply to: VanderWeele et al., Chiolero, and Schooling et al.

http://ije.oxfordjournals.org/content/early/2016/08/08/ije.dyw163.full  

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