Um toque de otimismo sobre a epidemiologia contemporânea: comentários sobre as reflexões de Maria Lúcia Penna

Faerstein, Eduardo

doi:10.1590/S0103-73311997000100007

Resumos

Neste artigo, registram-se exemplos de vitalidade teórica e metodológica da produção epidemiológica recente. Menciona-se que a sofisticação computacional e analítica não está condenada a usos politicamente conservadores, e vem permitindo a elucidação de perguntas científicas complexas, desde efeitos de contexto aos mecanismos de ação de exposições ambientais. Ressalta-se, entretanto, que métodos de produção de dados merecem esforços semelhantes de aperfeiçoamento. Avanços no plano teórico são ilustrados com as concepções de Geoffrey Rose e com as teorias sobre influências intrauterinas na etiologia de doenças do adulto. A relativa inocuidade das prescrições epistemológicas é exemplificada com diversas vias existentes para a formulação de teorias. Finalmente, alerta-se para o compromisso da disciplina com os esforços coletivos de redução do sofrimento humano desnecessário, que podem exigir conhecimentos abrangentes da realidade, dos níveis subcelular ao social.

Epidemiologia; estatística; métodos epidemiológicos; métodos e procedimentos estatísticos

This paper discusses theoretical and methodological advances in recent epidemiological work. It is mentioned that analytical sophistication is not bound to politically conservative use, and that it allows answers to complex scientific questions, from the understanding of contextual effects to mechanistic aspects of environmental exposures. However, data collection methods deserve similar improvement efforts. Theoretical advances are exemplified by Geoffrey Rose's ideas and by hypotheses on intrauterine influences on adult disease. The diversity of situations related to theory building is commented, which may be the reason why scientists generally ignore epistemological prescriptions. Finally, the commitment of epidemiology to the collective efforts to reduce unnecessary human suffering is emphasized, which may require comprehensive knowledge from different levels of reality, from the subcelular to the social level.

Epidemiology; statistics; epidemiologic methods; statistical methods and procedures

Cet article présent des exemples d'une sorte de vitalité théorique et méthodologique de la production scientifique récente en epidémiologie. On mentionne que la sophistication au niveau analytique nést pas condamnée à des usages politiquement conservateurs, et que cette sophistication permet même l' éclaircissement de questions scientifiques complexes, des celles referés aux effets du contextjusqu'à celles sur les méchanismes d'action d'éxpositions environnementales. On rémarque, cependant, que des méthodes de production des données meritent des efforts semblables de perfectionnement. Des avancements sur le plan theórique sont ilustrés à travers des idées de Geoffrey Rose e des théories sur l'influence de l'ambiance intrautérine dans l' éthiologie des maladies de l' adulte. L'inocuité des prescriptions epistémologiques est demontrée par des exemples sur les differentes voies possibles ménant à la formulation de théories. Enfin, on previent sur l'engagement de la discipline avec les efforts collectifs pour la diminuition de la souffrance humaine non nécessaire, lesquels peuveut exiger des connaissances élargies de la realité, des le niveau souscellulaire au niveau social.

Épidérniologie; statistique; méthodes épidémiologiques; méthodes statistiques

Um toque de otimismo sobre a epidemiologia contemporânea. Comentários sobre as reflexões de Maria Lúcia Penna^* * Agradeço a Dóra Chor por várias sugestões preciosas, incorporadas ao texto original, e a Michael Reichenheim por seus comentários.

A touch or optimism about contemporary epidemiology. Comments on Maria Lúcia Penna's ref1ections

Une goutte d'optimisme sur l'épidémiologie contemporaine. Quelques commentaires sur les pensées de Maria Lúcia Penna

Eduardo Faerstein

PhD em Epidemiologia pela Johns Hopkins University, EUA, professor adjunto do Departamento de Epidemiologia do Instituto de Medicina Social da UERJ

RESUMO

Neste artigo, registram-se exemplos de vitalidade teórica e metodológica da produção epidemiológica recente. Menciona-se que a sofisticação computacional e analítica não está condenada a usos politicamente conservadores, e vem permitindo a elucidação de perguntas científicas complexas, desde efeitos de contexto aos mecanismos de ação de exposições ambientais. Ressalta-se, entretanto, que métodos de produção de dados merecem esforços semelhantes de aperfeiçoamento. Avanços no plano teórico são ilustrados com as concepções de Geoffrey Rose e com as teorias sobre influências intrauterinas na etiologia de doenças do adulto. A relativa inocuidade das prescrições epistemológicas é exemplificada com diversas vias existentes para a formulação de teorias. Finalmente, alerta-se para o compromisso da disciplina com os esforços coletivos de redução do sofrimento humano desnecessário, que podem exigir conhecimentos abrangentes da realidade, dos níveis subcelular ao social.

Palavras-chave: Epidemiologia; estatística; métodos epidemiológicos; métodos e procedimentos estatísticos.

ABSTRACT

This paper discusses theoretical and methodological advances in recent epidemiological work. It is mentioned that analytical sophistication is not bound to politically conservative use, and that it allows answers to complex scientific questions, from the understanding of contextual effects to mechanistic aspects of environmental exposures. However, data collection methods deserve similar improvement efforts. Theoretical advances are exemplified by Geoffrey Rose's ideas and by hypotheses on intrauterine influences on adult disease. The diversity of situations related to theory building is commented, which may be the reason why scientists generally ignore epistemological prescriptions. Finally, the commitment of epidemiology to the collective efforts to reduce unnecessary human suffering is emphasized, which may require comprehensive knowledge from different levels of reality, from the subcelular to the social level.

Keywords: Epidemiology; statistics; epidemiologic methods; statistical methods and procedures.

RÉSUMÉ

Cet article présent des exemples d'une sorte de vitalité théorique et méthodologique de la production scientifique récente en epidémiologie. On mentionne que la sophistication au niveau analytique nést pas condamnée à des usages politiquement conservateurs, et que cette sophistication permet même l' éclaircissement de questions scientifiques complexes, des celles referés aux effets du contextjusqu'à celles sur les méchanismes d'action d'éxpositions environnementales. On rémarque, cependant, que des méthodes de production des données meritent des efforts semblables de perfectionnement. Des avancements sur le plan theórique sont ilustrés à travers des idées de Geoffrey Rose e des théories sur l'influence de l'ambiance intrautérine dans l' éthiologie des maladies de l' adulte. L'inocuité des prescriptions epistémologiques est demontrée par des exemples sur les differentes voies possibles ménant à la formulation de théories. Enfin, on previent sur l'engagement de la discipline avec les efforts collectifs pour la diminuition de la souffrance humaine non nécessaire, lesquels peuveut exiger des connaissances élargies de la realité, des le niveau souscellulaire au niveau social.

Mots-clé: Épidérniologie; statistique; méthodes épidémiologiques; méthodes statistiques.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Bibliografia

Recebido em 16/10/97.

Aprovado em 29/10/97.

ARMENIAN, H. K. Case investigation in epidemiology. AJE, v. 134, n.10, p. 1067 1072, novembro, 1991.
AUVINEN, A; KARJALAINEM, S. e PUKKALA, E. Social class and cancer patient survival in Finland. AJE, v. 142, n. 10, p.1089-1102, 1995.
BARKER, D. J. P. Mothers, babies, and disease in later life London: BMJ Publishing Group, 1994.
CZEJZEJ , A E. Congenital abnormalities are preventable. Epidemiology, v. 6, n. 3, p. 205-207, maio, 1995.
DIFZ-ROUX, A N.; NIETO, F. J.; MUNTANER, C.; TYROLER,H. A.; COMSTOCK, G. W.; SHAHAR, E.; COOPER, L. S.; WATSON, R. L. e SZKLO, M. Neighborhood environments and coronary heart disease: a multilevel analysis. AJE, v. 146, n. 1, p. 48-63, 1997.
DOLL, R. e HlLL, A. B. El habito de fumar y el carcinoma de pulmon: informe preliminar. BMJ 30/91/950, p. 739-748. In: BUCK, C. et alii (eds.). El Desafio de la Epidemiologia PAHO, Publ. Cient. n. 505, 1988.
EDITORIAL. Male reproductive health and environmental oestrogens. The Lancet, v. 345, n. 8955, p.933-935, 1995.
FAERSTEIN, E. Ideologia, normas médicas e racionalidade epidemiológica: o caso do câncer genital feminino. Cadernos do Instituto de Medicina Social, v. 3, n. 2, p. 173-186, mar.labr. 1989.
FEYERABEND, P. Against method London: Verso, 1988.
GRAHAM, D. Y. Campylobacter and peptic ulcer disease. Gastroenterology, v. 96, p. 615, 1989.
GRAYSON, J. T; KUO, C. C. e CAMPBELL, L. A. Chlamydia pneumoniae, strain TWAR and atherosclerosis. Eur. Heart J., v. 14 (suppl K), p. 66-71, 1993.
GREENLAND, S. Modeling and variable selection in epidemiologic analyses. Am. J. Public Health, v. 79, n. 3, p. 340-349, 1989.
HALLORAN, M. E. e STRUCHINER, C. J. Causal inference in infectious diseases. Epidemiology, v. 6, n. 2, p. 142-151, march 1995.
HlLL, A. B. The environment and disease: association or causation? Proc. Royal Soe. Med., v. 58, p. 295-300, 1965.
HOAGLIN, D. C. e MOORE, D. S. Perspectives on contemporary statistics. USA: Mathematical Association of America Notes Number 21.
ICKOVICS, J. R.; VISCOLI, C. M. e HORWITZ, R. I. Functional recovery after myocardial infarction in men: the independent effects of social class. Ann. Intern. Med, v. 127, p. 518-525, October 1997.
IMREY, R. H. Sexual factors and cancer risk: a normative bias in cancer epidemiology. 1983 (fotocópia).
KALDOR, J. The role of epidemiologic observation in elucidating the mechanisms of carcinogenesis. In: VAINO, H. et alii (eds.), Mechanism of carcinogenesis in risk identification. IARC Scientific Publication No. 116. Lyon: Intemational Agency for Research on Cancer, 1992.
KARASEK, R. e THEORELL, T. HeaHhy Work - Stress, productivity and the reconstruction of working life. New York: Basic Books, 1990.
KIELY, J. L. Some conceptual problems in multivariate analyses of perinatal mortality. Pediatric & Perin Epidemiol, v. 5, p. 243-25, 1991.
KRIEGER, N. Women and social class: a methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history. J. Epidemiol Community Health, v. 45, p. 35-42, 1991.
KRIEGER, N; ROWLEY, D. L. e HERMAN, A. A. et alii Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am. J. Prev. Med, v. 9, (suppl. 6), p. 982-122, 1993.
LAKATOS, I. Falsification and the methodology of scientific research programmes. In: LAKATOS, I. e MUSGRAVE, A. (eds.), Criticism and the growth of knowledge Cambridge: Cambridge University Press, 1970.
LIBOFF, A. R.; WILLIAMS, T.; STRONG, D. M. e WISTAR, R. Time-varying magnetic fields: effect on DNA synthesis. Science, v. 223, p. 818-820, 1984.
MACKENZIE, D. Eugenics and the rise of mathematical statistics in Britain. In: IRVINE, J., MILES, I. e EVANS, J. (eds.), Demystifying Social Statistics London: Pluto Press, 1979. p. 39-50.
O'CAMPO, P.; XUE, X.; WANG, M. e CAUGHY, M. O. Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis. Am. J. Public Health, v. 87, n. 7, p.1113-1118, 1997.
OAKES, M. Statistical inference Chestnut Hill: Epidemiologic Resources Inc., 1990.
PANETH, N.; SUSSER, M. Early origin of coronary heart disease (the "Barker hypothesis"). BMJ, v. 310, p. 411-412.
PARSONNET, J.; FRIEDMAN, G. D.; VANDERSTEEN, D. P. Helicobacter pylori infection and the risk of gastric carcinoma. N. Engl. J. Med., v. 325, p. 1127 31, 1991.
PEARCE, N. Traditional epidemiology, modem epidemiology, and public health. Am. J. Public Health, v. 86, n. 5, p. 678-683.
ROSE, G. The strategy of preventive medicine. Oxford: Oxford University Press, 1992.
ROTHMAN, K. Modern epidemiology Boston: Little, Brown & Co, 1986.
SACKS, O. A ilha dos daltônicos. São Paulo: Companhia das Letras, 1997.
SCHRIJVERS, C. T. M; MACKENBACH, J. P.; LUTZ, J. M.; QUINN, M. J. e COLEMAN, M. P. Deprivation, stage at diagnosis and cancer survival. /nt. J. Cancer, v. 63, p. 324-329, 1995.
SCRIMSHAW, N. S. The relation between fetal malnutrition and chronic disease in later life. BMJ, v. 315, n. 7112, October 1997.
SORLIE, P. D; ADAM, E.; MELNICK, S. L. et alii, Cytomegalovirus/herpesvirus and carotid atherosclerosis: the ARIC study. J. Med. Virol., v. 42, p. 33-37, 1994.
SUSSER, M. Choosing a future for epidemiology: I. Eras and paradigms. Am. J. Public Health, v. 86, n. 5, p. 668-673, 1996a.
SUSSER, M. Choosing a future for epidemiology: 11. From black box to Chinese boxes and eco-epidemiology. Am. l. Public Health, v. 86, n. 5, p. 674-677, 1996b.
SUSSER, M. The logic in ecological: I. The logic of analysis. Am. l. Public Health, v. 84, n. 5, p. 825-829, 1994a.
SUSSER, M. The logic in ecological: II. The logic of designo Am. l. Public Health, v. 84, n.5, p. 830-835, 1994b.
SWALES, J. D. (ed.). Platt versus Pickering - An episode in recent medical history Cambridge: Cambridge University Press, 1985.
TAUBES, G. Epidemiology faces its limits. Science, v. 269, p.164-169, July 1995.
TOMATIS, L. (ed). Cancer: causes, occurrence and control. IARC Sei. Publ., n.100. Lyon: Intemational Agency for Research on Cancer, 1990.
TRICHOPOULOS, D.; LIPWORTH, L. Is cancer causation simpler than we thought, but more intractable? Epidemiology, v.6, n. 4, p. 347-349, 1995.
UNICEF. The State of the World's Children 1995 Oxford: Oxford University Press, 1995
WERTHEIMER, N. e LEPPER, E. Electrical wiring configurations and childhood cancer. AJE, v. 109, p. 273-284, 1979.
WYNGAARDEN, J. B.; SMITH, L. H. e BENNETT, J; C. Cecil Textbook of Medieine Philadelphia: W.B. Saunders Co, 1992.

*

Agradeço a Dóra Chor por várias sugestões preciosas, incorporadas ao texto original, e a Michael Reichenheim por seus comentários.

Datas de Publicação

Publicação nesta coleção
04 Fev 2009
Data do Fascículo
Jun 1997

Histórico

Recebido
16 Out 1997
Aceito
29 Out 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] ARMENIAN, H. K. Case investigation in epidemiology. AJE, v. 134, n.10, p. 1067 1072, novembro, 1991.

[2] AUVINEN, A; KARJALAINEM, S. e PUKKALA, E. Social class and cancer patient survival in Finland. AJE, v. 142, n. 10, p.1089-1102, 1995.

[3] BARKER, D. J. P. Mothers, babies, and disease in later life London: BMJ Publishing Group, 1994.

[4] CZEJZEJ , A E. Congenital abnormalities are preventable. Epidemiology, v. 6, n. 3, p. 205-207, maio, 1995.

[5] DIFZ-ROUX, A N.; NIETO, F. J.; MUNTANER, C.; TYROLER,H. A.; COMSTOCK, G. W.; SHAHAR, E.; COOPER, L. S.; WATSON, R. L. e SZKLO, M. Neighborhood environments and coronary heart disease: a multilevel analysis. AJE, v. 146, n. 1, p. 48-63, 1997.

[6] DOLL, R. e HlLL, A. B. El habito de fumar y el carcinoma de pulmon: informe preliminar. BMJ 30/91/950, p. 739-748. In: BUCK, C. et alii (eds.). El Desafio de la Epidemiologia PAHO, Publ. Cient. n. 505, 1988.

[7] EDITORIAL. Male reproductive health and environmental oestrogens. The Lancet, v. 345, n. 8955, p.933-935, 1995.

[8] FAERSTEIN, E. Ideologia, normas médicas e racionalidade epidemiológica: o caso do câncer genital feminino. Cadernos do Instituto de Medicina Social, v. 3, n. 2, p. 173-186, mar.labr. 1989.

[9] FEYERABEND, P. Against method London: Verso, 1988.

[10] GRAHAM, D. Y. Campylobacter and peptic ulcer disease. Gastroenterology, v. 96, p. 615, 1989.

[11] GRAYSON, J. T; KUO, C. C. e CAMPBELL, L. A. Chlamydia pneumoniae, strain TWAR and atherosclerosis. Eur. Heart J., v. 14 (suppl K), p. 66-71, 1993.

[12] GREENLAND, S. Modeling and variable selection in epidemiologic analyses. Am. J. Public Health, v. 79, n. 3, p. 340-349, 1989.

[13] HALLORAN, M. E. e STRUCHINER, C. J. Causal inference in infectious diseases. Epidemiology, v. 6, n. 2, p. 142-151, march 1995.

[14] HlLL, A. B. The environment and disease: association or causation? Proc. Royal Soe. Med., v. 58, p. 295-300, 1965.

[15] HOAGLIN, D. C. e MOORE, D. S. Perspectives on contemporary statistics. USA: Mathematical Association of America Notes Number 21.

[16] ICKOVICS, J. R.; VISCOLI, C. M. e HORWITZ, R. I. Functional recovery after myocardial infarction in men: the independent effects of social class. Ann. Intern. Med, v. 127, p. 518-525, October 1997.

[17] IMREY, R. H. Sexual factors and cancer risk: a normative bias in cancer epidemiology. 1983 (fotocópia).

[18] KALDOR, J. The role of epidemiologic observation in elucidating the mechanisms of carcinogenesis. In: VAINO, H. et alii (eds.), Mechanism of carcinogenesis in risk identification. IARC Scientific Publication No. 116. Lyon: Intemational Agency for Research on Cancer, 1992.

[19] KARASEK, R. e THEORELL, T. HeaHhy Work - Stress, productivity and the reconstruction of working life. New York: Basic Books, 1990.

[20] KIELY, J. L. Some conceptual problems in multivariate analyses of perinatal mortality. Pediatric & Perin Epidemiol, v. 5, p. 243-25, 1991.

[21] KRIEGER, N. Women and social class: a methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history. J. Epidemiol Community Health, v. 45, p. 35-42, 1991.

[22] KRIEGER, N; ROWLEY, D. L. e HERMAN, A. A. et alii Racism, sexism, and social class: implications for studies of health, disease, and well-being. Am. J. Prev. Med, v. 9, (suppl. 6), p. 982-122, 1993.

[23] LAKATOS, I. Falsification and the methodology of scientific research programmes. In: LAKATOS, I. e MUSGRAVE, A. (eds.), Criticism and the growth of knowledge Cambridge: Cambridge University Press, 1970.

[24] LIBOFF, A. R.; WILLIAMS, T.; STRONG, D. M. e WISTAR, R. Time-varying magnetic fields: effect on DNA synthesis. Science, v. 223, p. 818-820, 1984.

[25] MACKENZIE, D. Eugenics and the rise of mathematical statistics in Britain. In: IRVINE, J., MILES, I. e EVANS, J. (eds.), Demystifying Social Statistics London: Pluto Press, 1979. p. 39-50.

[26] O'CAMPO, P.; XUE, X.; WANG, M. e CAUGHY, M. O. Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis. Am. J. Public Health, v. 87, n. 7, p.1113-1118, 1997.

[27] OAKES, M. Statistical inference Chestnut Hill: Epidemiologic Resources Inc., 1990.

[28] PANETH, N.; SUSSER, M. Early origin of coronary heart disease (the "Barker hypothesis"). BMJ, v. 310, p. 411-412.

[29] PARSONNET, J.; FRIEDMAN, G. D.; VANDERSTEEN, D. P. Helicobacter pylori infection and the risk of gastric carcinoma. N. Engl. J. Med., v. 325, p. 1127 31, 1991.

[30] PEARCE, N. Traditional epidemiology, modem epidemiology, and public health. Am. J. Public Health, v. 86, n. 5, p. 678-683.

[31] ROSE, G. The strategy of preventive medicine. Oxford: Oxford University Press, 1992.

[32] ROTHMAN, K. Modern epidemiology Boston: Little, Brown & Co, 1986.

[33] SACKS, O. A ilha dos daltônicos. São Paulo: Companhia das Letras, 1997.

[34] SCHRIJVERS, C. T. M; MACKENBACH, J. P.; LUTZ, J. M.; QUINN, M. J. e COLEMAN, M. P. Deprivation, stage at diagnosis and cancer survival. /nt. J. Cancer, v. 63, p. 324-329, 1995.

[35] SCRIMSHAW, N. S. The relation between fetal malnutrition and chronic disease in later life. BMJ, v. 315, n. 7112, October 1997.

[36] SORLIE, P. D; ADAM, E.; MELNICK, S. L. et alii, Cytomegalovirus/herpesvirus and carotid atherosclerosis: the ARIC study. J. Med. Virol., v. 42, p. 33-37, 1994.

[37] SUSSER, M. Choosing a future for epidemiology: I. Eras and paradigms. Am. J. Public Health, v. 86, n. 5, p. 668-673, 1996a.

[38] SUSSER, M. Choosing a future for epidemiology: 11. From black box to Chinese boxes and eco-epidemiology. Am. l. Public Health, v. 86, n. 5, p. 674-677, 1996b.

[39] SUSSER, M. The logic in ecological: I. The logic of analysis. Am. l. Public Health, v. 84, n. 5, p. 825-829, 1994a.

[40] SUSSER, M. The logic in ecological: II. The logic of designo Am. l. Public Health, v. 84, n.5, p. 830-835, 1994b.

[41] SWALES, J. D. (ed.). Platt versus Pickering - An episode in recent medical history Cambridge: Cambridge University Press, 1985.

[42] TAUBES, G. Epidemiology faces its limits. Science, v. 269, p.164-169, July 1995.

[43] TOMATIS, L. (ed). Cancer: causes, occurrence and control. IARC Sei. Publ., n.100. Lyon: Intemational Agency for Research on Cancer, 1990.

[44] TRICHOPOULOS, D.; LIPWORTH, L. Is cancer causation simpler than we thought, but more intractable? Epidemiology, v.6, n. 4, p. 347-349, 1995.

[45] UNICEF. The State of the World's Children 1995 Oxford: Oxford University Press, 1995

[46] WERTHEIMER, N. e LEPPER, E. Electrical wiring configurations and childhood cancer. AJE, v. 109, p. 273-284, 1979.

[47] WYNGAARDEN, J. B.; SMITH, L. H. e BENNETT, J; C. Cecil Textbook of Medieine Philadelphia: W.B. Saunders Co, 1992.

Brasil

Brasil

Um toque de otimismo sobre a epidemiologia contemporânea: comentários sobre as reflexões de Maria Lúcia Penna

A touch or optimism about contemporary epidemiology: comments on Maria Lúcia Penna's reflections

Une goutte d'optimisme sur l'épidémiologie contemporaine: quelques commentaires sur les pensées de Maria Lúcia Penna

Resumos

Datas de Publicação

Histórico