Abstracts
The goal of this article is to present a snapshot of an ongoing debate within epidemiology, pitching opposing sides in the struggle to define the path it should follow in the years to come. The debate among epidemiologists in the mid-90s pitted those who defended the idea that epidemiology should necessarily deal with a wide context against those who believed that science and public health are better served by focusing on the individual level. Ian Hacking’s concept of styles of reasoning was used as a theoretical tool. The literature was reviewed using a core set of articles as an entry point, seeking articles that cited them, and then back-tracking the citations of the resulting set in the Scopus database. The main arguments are presented according to levels (ontological, epistemological, axiological and pragmatic), in order to show an even deeper disagreement, in the very conception of science and its relation to social issues and public policy.
Epidemiology; Public Health; Science; Knowledge; Review
O objetivo deste artigo é apresentar o debate em curso na epidemiologia, evidenciando lados opostos na luta para definir o caminho nos próximos anos. Discussão entre epidemiólogos em meados dos anos 1990, que defendem que a epidemiologia deve necessariamente tratar de contexto amplo contra aqueles que acreditam que a ciência e a saúde pública são mais bem servidas focalizando o nível individual. O conceito de estilos de raciocínio de Ian Hacking foi usado como ferramenta teórica. A literatura foi revisada usando um conjunto nuclear de artigos como ponto de entrada, buscando os artigos que os citaram, e então seguindo as citações do conjunto resultante na base Scopus. Os argumentos principais, de acordo com níveis (ontológico, epistemológico, axiológico e pragmático), foram apresentados a fim de mostrar uma discordância ainda mais profunda, na própria concepção de ciência e da sua relação com questões sociais e políticas públicas.
Epidemiologia; Saúde Pública; Ciência; Conhecimento; Revisão
El objetivo de este artículo es presentar el debate actual en epidemiología, evidenciando lados opuestos en la lucha para definir el camino en los próximos años. La discusión de los epidemiólogos en la mitad de los años 90, se dio entre quienes defienden que la epidemiología debe necesariamente tratar del contexto amplio contra aquellos que piensan que la ciencia y la salud pública son mejor atendidas enfocando el nivel individual. El concepto de estilos de raciocinio de Ian Hacking fue usado como herramienta teórica. La literatura fue revisada usando un conjunto nuclear de artículos como punto de entrada, buscando los artículos que los citaron, y posteriormente siguiendo las citaciones del conjunto resultante en la base Scopus. Los argumentos principales, de acuerdo con los niveles (ontológico, epistemológico, axiológico y pragmático), fueron presentados a fin de mostrar una discordancia mucho más profunda, en la propia concepción de ciencia y de su relación con aspectos sociales y políticas públicas.
Epidemiología; Salud Pública; Ciencia; Conocimiento; Revisión
INTRODUCTION
Epidemiologists have over time divided themselves, in general terms, into two camps. One
side concentrates on the proximal aspects of the health-disease process, whereas the other
emphasizes the broader context. Depending on how it is framed, this argument could be
retraced as far as the original contributions of Engels and Virchow to theories of social
determination of disease. However, our chronological framework is narrower. Since the formal
establishment of epidemiology as a discipline, with courses, departments, professors,
curricula and publications early in the 20th century, the proximal view became
increasingly dominant, though not uncontested. 66 . Cassel J. Social science theory as a source of hypotheses in
epidemiological research. Am J Public Health Nations Health .
1964;54:1482-8. From the 90s onwards, the articulation of a new version of the
broader contextual vision spearheaded a shift in the discipline which continues to this
date. This is the period we are dealing with in this article. However, within the proximal
view camp and during that time frame there has been a considerable amount of internal
dissension by smaller groups of epidemiologists who believed the discipline should be more
integrated with molecular biology, or who, to use Pierce’s expression, were “merely
disgruntled about epidemiological findings”. 4646 . Pearce N, McKinlay JB. Dissent: back to the future in epidemiology and
public health: response to Dr. Gori. J Clinl Epidemiol .
1998;51(8):643-6. DOI:10.1016/S0895-4356(98)00054-7
https://doi.org/10.1016/S0895-4356(98)00...
This, however, is not our main focus.
The context versus proximal debate involves more than theories, encompassing worldviews
that set the stage for the development of theories themselves, and the deployment of
techniques and methods as well. Resonating with Kuhn’s concept of paradigm 3131 . Kuhn TS. The structure of scientific revolutions. 3.ed. Chicago:
University of Chicago Press;1996. and Ludwik Fleck’s notion of ‘thought
style’, 1414 . Fleck L. Genesis and development of a scientific fact. Chicago: University
of Chicago Press; 1981. Ian Hacking’s ‘style of
reasoning’ seems appropriate to cast the context versus the proximal debate within
epidemiology, as the tension between two contrasting styles of reasoning. Styles of
reasoning represent particular ways of thinking, seeing and practicing and involve
formulating propositions that are intelligible within a particular style. Styles of
reasoning are “self-authenticating” 1818 . Hacking I. The self-vindication of the laboratory sciences. In: Pickering
A, editor. Science as practice and culture. Chicago: University of Chicago Press; 1992.
p.29-64.
,
2020 . Hacking I. Historical ontology. Cambridge (MA): Harvard University Press;
2004. ‘Style’ for historians and philosophers; p.178-99. since they establish the criteria of
evaluation by which they are judged as well as bring into being the objects they are
supposed to study. 1919 . Hacking I. Inaugural lecture: Chair of Philosophy and History of
Scientific Concepts at the Collège de France, 16 January 2001. Econ Soc .
2002;31(1):1-14. DOI:10.1080/03085140120109222
https://doi.org/10.1080/0308514012010922...
,
2020 . Hacking I. Historical ontology. Cambridge (MA): Harvard University Press;
2004. ‘Style’ for historians and philosophers; p.178-99.
This study aimed to present a snapshot of an ongoing debate within epidemiology, pitching opposing sides in a struggle to define the path it should follow in the years to come.
HOW TO APPROACH A DEBATE
Science thrives on debates; but not all debates take place at the same level. Arguments can be about specific findings, on whether an association between a given exposure and a given outcome can be considered a fact or an artifact. 3333 . Latour B, Woolgar S. Laboratory life: the construction of scientific facts. Princeton (NJ): Princeton University Press; 1986. This kind of debate frequently involves discussion of methods, in the sense of whether adequate methods were chosen and/or deployed. More rarely, the whole enterprise of inquiry is brought under critical examination; it is no longer a matter of discussing findings and methods but the general framework within which the latter operate to produce the former. When this kind of debate grows in importance it may signal a confrontation of different styles of reasoning.
Approaching this sort of discussion through the literature is not as straightforward a proposition as it may seem. Keywords do not always reflect the core issues in the argument, and the crossfire of a polemic does not always retain an orderly account of citations between participants of a debate. Dates of publication do not necessarily reflect the actual order of writing. Different journals have different periodicity. Much of the argument can happen in venues other than printed articles, such as meetings or symposia. In our references, there is indication that this was indeed the case in this debate.
We resorted to both bibliographic database searches and poring over citations in order to
arrive at a core set of articles that would reflect the overall tenor of the debate. We
chose a core set of articles 2424 . Krieger N. Epidemiology and the web of causation: has anyone seen the
spider? Soc Sci Med . 1994;39(7):887-903.
DOI:10.1016/0277-9536(94)90202-X
https://doi.org/10.1016/0277-9536(94)902...
,
4242 . McMichael AJ. The health of persons, populations, and planets:
epidemiology comes full circle. Epidemiology .
1995;6(6):633-6.
,
4343 . McMichael AJ. Prisoners of the proximate: loosening the constraints on
epidemiology in an age of change. Am J Epidemiol .
1999;149(10):887-97.
,
4545 . Pearce N. Traditional epidemiology, modern epidemiology, and public
health. Am J Public Health . 1996;86(5):678-83.
,
6363 . Susser M, Susser E. Choosing a future for epidemiology: I. Eras and
paradigms. Am J Public Health . 1996;86(5):668-73.
DOI:10.2105/AJPH.86.5.668
https://doi.org/10.2105/AJPH.86.5.668...
,
6464 . Susser M, Susser E. Choosing a future for epidemiology: II. From black box
to Chinese boxes and eco-epidemiology. Am J Public Health .
1996;86(5):674-7. DOI:10.2105/AJPH.86.5.674
https://doi.org/10.2105/AJPH.86.5.674...
,
6666 . Susser M. Should the epidemiologist be a social scientist or a molecular
biologist? Int J Epidemiol . 1999;28(5):S1019-22. that were published in the mid-to-late
90’s, which shared common traits of a wide critique of risk-factor epidemiology. We searched
the Scopus database for articles that cited them in roughly that same period. In order to
arrive at a set of articles that would allow at least an approximate view of the ongoing
discussion, we independently went over the whole list of articles produced from the database
query. We selected only those that actually engaged the main arguments, being theoretical
reflections on the role and development of epidemiology, arriving at a smaller number of
articles. We perused the cited references of that group, including those that matched the
same criteria, arriving at a final set of 47 articles. We analyzed the resulting set of
papers trying to elicit and synthesize the main positions and arguments in the debate.
THE RUN-UP TO THE DEBATE
A full account of the history of epidemiology as a discipline is beyond the scope and
purpose of this paper. Nevertheless, we would like to mention just one previous period in
the history of the discipline, characterized in similar terms by a number of authors: 2828 . Krieger N. Epidemiology and the people’s health: theory and context. New
York: Oxford University Press; 2011.
,
4444 . Morabia A, editor. A history of epidemiologic methods and concepts. Basel:
Birkhäuser; 2004.
,
6767 . Susser M, Stein Z. Eras in epidemiology: the evolution of ideas. New York:
Oxford University Press; 2009. The growth and eventual establishment
of risk factor epidemiology from the post-war period onwards, culminating with the so-called
“Modern Epidemiology” as the dominant version of the discipline in the 80’s. Following
changes in the prevalence of disease in the populations of industrialized countries, a
certain degree of hostility to progressive social thinking in the context of either the cold
war or the forced neoliberal “consensus”, and the growing availability of technical means
(computers), epidemiology concentrated on the search for risk factors associated with
chronic-degenerative diseases, developing an increasingly sophisticated set of methods that
relied heavily on complex statistics. A new generation of researchers, PhDs with
mathematical backgrounds, rose to prominence, in contrast to the preceding era, when MDs
committed to public health predominated. The publication of a group of very influential
books, like Miettinen’s, Kleinbaum’s and Rothman’s would mark the apogee of that epoch.
4444 . Morabia A, editor. A history of epidemiologic methods and concepts. Basel:
Birkhäuser; 2004.
,
6767 . Susser M, Stein Z. Eras in epidemiology: the evolution of ideas. New York:
Oxford University Press; 2009. Early examples of discontent with
mainstream epidemiology, however, can be found in the attempts by Carol Buck to shore
epidemiology up with popperian philosophy, 55 . Buck C. Popper’s philosophy for epidemiologists. Int J
Epidemiol . 1975;4(3):159-68. DOI:10.1093/ije/4.3.159
https://doi.org/10.1093/ije/4.3.159...
and in the reaction that followed, including Susser’s “Thought
Tormented World”. 6262 . Susser M. Epidemiology today: ‘a thought-tormented world’. Int J
Epidemiol . 1989;18(3):481-8.
However, the context had changed significantly a decade later. The effects of disastrous
economic policies based on neoliberal orthodoxy (“structural adjustment programs”) on human
lives became increasingly difficult to ignore, and parallel to that, paradoxically, the
success of modern epidemiology itself seemed to bring it closer to its limits. The latter
aspect is exemplified by an article published in 1995, 6868 . Taubes G. Epidemiology faces its limits. Science .
1995;269(5221):164-9. DOI:10.1126/science.7618077
https://doi.org/10.1126/science.7618077...
authored by a science writer who interviewed several prominent
epidemiologists, all associated with risk-factor epidemiology. As a group, the interviews
seemed to indicate that the discipline, as practiced then, was reaching its limits. The more
significant risk factors had already been identified, and the ones that were being uncovered
were weak enough to make it difficult to distinguish from spurious associations. Although
some of the interviewees tried later to distance themselves from the most radical
implications of Taubes’ article, or shift the blame to the press and how it reports
scientific findings, none went as far as to totally disavow the report. 7070 . Trichopoulos D. The discipline of epidemiology. Science .
1995;269(5229):1326. DOI:10.1126/science.7660107
https://doi.org/10.1126/science.7660107...
,
7171 . Trichopoulos D. The future of epidemiology. BMJ .
1996;313(7055):436-7. DOI:10.1136/bmj.313.7055.436
https://doi.org/10.1136/bmj.313.7055.436...
,
7777 . Willett W, Greenland S, MacMahon B, Trichopoulos D, Rothman K, Thomas D,
et al. The discipline of epidemiology [letter]. Science .
1995;269(5229):1325-6. DOI:10.1126/science.7660105
https://doi.org/10.1126/science.7660105...
THE DEBATE
We can divide the epidemiologists in the latter half of the 90s into two groups: one
arguing for a broader view of the objects and ideas that should be contemplated in
epidemiologic research, 2424 . Krieger N. Epidemiology and the web of causation: has anyone seen the
spider? Soc Sci Med . 1994;39(7):887-903.
DOI:10.1016/0277-9536(94)90202-X
https://doi.org/10.1016/0277-9536(94)902...
,
2525 . Krieger N, Ziegler S. What explains the public’s health? A call for
epidemiologic theory. Epidemiology. 1996;7(1):107-9.
,
4242 . McMichael AJ. The health of persons, populations, and planets:
epidemiology comes full circle. Epidemiology .
1995;6(6):633-6.
,
4343 . McMichael AJ. Prisoners of the proximate: loosening the constraints on
epidemiology in an age of change. Am J Epidemiol .
1999;149(10):887-97.
,
4545 . Pearce N. Traditional epidemiology, modern epidemiology, and public
health. Am J Public Health . 1996;86(5):678-83.
46 . Pearce N, McKinlay JB. Dissent: back to the future in epidemiology and
public health: response to Dr. Gori. J Clinl Epidemiol .
1998;51(8):643-6. DOI:10.1016/S0895-4356(98)00054-7
https://doi.org/10.1016/S0895-4356(98)00...
-
4747 . Pearce N. Epidemiology as a population science. Int J
Epidemiol . 1999;28(5):S1015-8.
,
6060 . Shy CM. The failure of academic epidemiology: witness for the prosecution.
Am J Epidemiol. 1997;145(6):479-84.
,
6363 . Susser M, Susser E. Choosing a future for epidemiology: I. Eras and
paradigms. Am J Public Health . 1996;86(5):668-73.
DOI:10.2105/AJPH.86.5.668
https://doi.org/10.2105/AJPH.86.5.668...
,
6464 . Susser M, Susser E. Choosing a future for epidemiology: II. From black box
to Chinese boxes and eco-epidemiology. Am J Public Health .
1996;86(5):674-7. DOI:10.2105/AJPH.86.5.674
https://doi.org/10.2105/AJPH.86.5.674...
,
7878 . Wing S. Limits of epidemiology. Med Glob Surviv .
1994;1(2):74-86.
,
7979 . Wing S. Whose epidemiology, whose health? Int J Health
Serv . 1998;28(2):241-52. the other emphasizing a strict
risk-factor approach, more concerned with putting Epidemiology on solid statistical grounds.
4848 . Poole C, Rothman KJ. Our conscientious objection to the epidemiology wars.
J Epidemiol Community Health . 1998;52(10):613-4.
DOI:10.1136/jech.52.10.613
https://doi.org/10.1136/jech.52.10.613...
,
5353 . Rothman K. Policy recommendations in epidemiology research papers.
Epidemiology . 1993;4(2):94-5.
54 . Rothman KJ, Adami H-O, Trichopoulos D. Should the mission of epidemiology
include the eradication of poverty? Lancet . 1998;352(9130):810-3.
DOI:10.1016/S0140-6736(98)01327-0
https://doi.org/10.1016/S0140-6736(98)01...
55 . Savitz DA. In defense of black box epidemiology.
Epidemiology . 1994;5(5):550-2.
56 . Savitz DA. The alternative to epidemiologic theory: whatever works.
Epidemiology . 1997;8(2):210-2.
-
5757 . Savitz DA, Poole C, Miller WC. Reassessing the role of epidemiology in
public health. Am J Public Health. 1999;89(8):1158-61.
DOI:10.2105/AJPH.89.8.1158
https://doi.org/10.2105/AJPH.89.8.1158...
,
7171 . Trichopoulos D. The future of epidemiology. BMJ .
1996;313(7055):436-7. DOI:10.1136/bmj.313.7055.436
https://doi.org/10.1136/bmj.313.7055.436...
,
7272 . Trichopoulos D. Accomplishments and prospects of epidemiology.
Prev Med . 1996;25(1):4-6. DOI:10.1006/pmed.1996.0003
https://doi.org/10.1006/pmed.1996.0003...
,
7676 . Wilcox AJ. From the Shy trial defense: a leak, or red herring?
Epidemiology . 1997;8(6):684-5. We can find a core set of similar
critiques (in the first group) and responses (in the second), albeit with important
individual variations within each group. Other authors were already seeking to
methodologically develop the approach proposed by the critics 88 . Diez-Roux AV. Bringing context back into epidemiology: variables and
fallacies in multilevel analysis. Am J Public Health . 1998;88(2):216-22.
DOI:10.2105/AJPH.88.2.216
https://doi.org/10.2105/AJPH.88.2.216...
9 . Diez-Roux AV. On genes, individuals, society, and epidemiology. Am
J Epidemiol . 1998;148(11):1027-32.
-
1010 . Diez-Roux AV. The study of group-level factors in epidemiology: rethinking
variables, study designs, and analytical approaches. Epidemiol Rev .
2004;26(1):104-11. DOI:10.1093/epirev/mxh006
https://doi.org/10.1093/epirev/mxh006...
,
2222 . Koopman JS, Longini Jr IM. The ecological effects of individual exposures
and nonlinear disease dynamics in populations. Am J Public Health .
1994;84(5):836-42. DOI:10.2105/AJPH.84.5.836
https://doi.org/10.2105/AJPH.84.5.836...
,
2323 . Koopman JS, Lynch JW. Individual causal models and population system
models in epidemiology. Am J Public Health. 1999;89(8):1170-4.
DOI:10.2105/AJPH.89.8.1170
https://doi.org/10.2105/AJPH.89.8.1170...
or elaborating its implications for
public health 22 . Beaglehole R, Bonita R. Public health at the crossroads: which way
forward? Lancet . 1998;351(9102):590-2.
DOI:10.1016/S0140-6736(97)09494-4
https://doi.org/10.1016/S0140-6736(97)09...
,
3939 . McKinlay JB. Paradigmatic obstacles to improving the health of
populations: implications for health policy. Salud Publica Mex .
1998;40(4):369-79. DOI:10.1590/S0036-36341998000400010
https://doi.org/10.1590/S0036-3634199800...
,
4040 . McKinlay JB, Marceau LD. A tale of 3 tails. Am J Public
Health . 1999;89(3):295-8. DOI:10.2105/AJPH.89.3.295
https://doi.org/10.2105/AJPH.89.3.295...
,
4949 . Putting public health back into epidemiology. Lancet .
1997;350(9073):229. DOI:10.1016/S0140-6736(97)21030-5
https://doi.org/10.1016/S0140-6736(97)21...
but not necessarily engaging in that
specific debate.
One of the problems in reconstructing the discussion is that arguments operate on different levels, that, although inter-related, have their specificities as well, and it is not uncommon to see the authors sliding between those levels in their discourse. In the articles we selected, we found arguments that could be classified, for didactic purposes, as (a) ontological, dealing with non-testable assumptions of how the world is; (b) epistemological, which discussed how to produce reliable knowledge in epidemiology; (c) axiological, concerning whether research should be “neutral” or valued-oriented; and (d) pragmatic/utilitarian, about the utility and application of the produced knowledge (or not) ( Table ).
The overall argument of the critique can be summarized as follows: risk factor epidemiology operates under an atomistic metaphysics, implying that the universe can be understood as a vast mechanism composed of elementary parts. This leads to an epistemological approach to the objects of inquiry that disassembles them into elementary components and studies their articulations in isolation. Its practitioners believe in a science that is objective and neutral, that should not be “contaminated” with political considerations, and whatever use the knowledge they produce may have, it is separated from the research enterprise, which is an end in itself. Methods are emphasized to the detriment of theories, and are reified as means to achieve reliable knowledge. The narrow focus on the individual level of the processes underlying health and disease leads to the exclusion of important determinants at the population level, and consequently misses the opportunity to propose measures at that level, which would be inherently more efficient. The Table shows a summary of their critique and alternative propositions.
In addition to this generic, shared kernel, different authors emphasized specific aspects
in their articles. Wing states that some of the confounders in risk factor epidemiology
could become essential aspects of the context. 7878 . Wing S. Limits of epidemiology. Med Glob Surviv .
1994;1(2):74-86. Krieger emphasizes what she considers a lack of theory in that kind
of research, and states that it would be important to have new guiding metaphors that could
replace the venerable web, proposing a combination of a fractal structure to represent
biological processes, from the molecular to the ecological, with a scaffolding standing for
the social processes. 2424 . Krieger N. Epidemiology and the web of causation: has anyone seen the
spider? Soc Sci Med . 1994;39(7):887-903.
DOI:10.1016/0277-9536(94)90202-X
https://doi.org/10.1016/0277-9536(94)902...
Susser &
Susser make use of the kuhnian framework to describe the history of the discipline, and cast
both the critique and alternative view as competing paradigms. 6363 . Susser M, Susser E. Choosing a future for epidemiology: I. Eras and
paradigms. Am J Public Health . 1996;86(5):668-73.
DOI:10.2105/AJPH.86.5.668
https://doi.org/10.2105/AJPH.86.5.668...
,
6464 . Susser M, Susser E. Choosing a future for epidemiology: II. From black box
to Chinese boxes and eco-epidemiology. Am J Public Health .
1996;86(5):674-7. DOI:10.2105/AJPH.86.5.674
https://doi.org/10.2105/AJPH.86.5.674...
They propose the metaphor of the
Chinese boxes as a guiding principle for the new paradigm, acknowledging that it would
require new techniques and methods to be fully achieved. Despite the idea of nested
hierarchies represented as “boxes”, Susser & Susser emphasize the importance of systems
and multilevel approaches (“multiple interactions between and within levels”. 6464 . Susser M, Susser E. Choosing a future for epidemiology: II. From black box
to Chinese boxes and eco-epidemiology. Am J Public Health .
1996;86(5):674-7. DOI:10.2105/AJPH.86.5.674
https://doi.org/10.2105/AJPH.86.5.674...
Pearce adds that risk factor epidemiology
leads to “blaming the victim”, i.e., placing the responsibility of living under higher risks
exclusively at the feet of the affected individuals. He makes the strongest criticism on the
distancing of epidemiology from public health; he states that an epidemiologist cannot be
“too political” – a decision not to study socioeconomic factors is a political decision to
focus on what is politically acceptable, adding that epidemiology was being reduced to a set
of methods for measurement of health and disease-related issues. 4545 . Pearce N. Traditional epidemiology, modern epidemiology, and public
health. Am J Public Health . 1996;86(5):678-83. McMichael emphasizes the temporal dimension, stating that
modern epidemiology has become a “prisoner of the proximal”, not only in terms of the
overall model but in terms of focusing only on short-term processes. 4343 . McMichael AJ. Prisoners of the proximate: loosening the constraints on
epidemiology in an age of change. Am J Epidemiol .
1999;149(10):887-97. Of all the critics, he most clearly makes the case that the
problem of modern epidemiology is not doing risk factor research, but doing
only that. Finally, he also makes a clear case for the application of a
systems theory based approach: “How epidemiologists relate to that upstream category of
question is influenced by whether we perceive the distal determination of disease as being
part of either a linear causal chain or a systems-based causal web. (…) Causal processes
within this web are not necessarily linear and sequential, but may involve interactions and
feedbacks”. 4343 . McMichael AJ. Prisoners of the proximate: loosening the constraints on
epidemiology in an age of change. Am J Epidemiol .
1999;149(10):887-97.
On the other side of the debate, which defended a narrow risk-factor approach, the authors
seem to agree with the critics’ characterization of risk factor epidemiology, but disagree
that this represents a problem: “there is no denying that epidemiologists have progressively
concentrated on the details of causal mechanisms. The only surprise to us is that anyone
would regard this preoccupation with causal mechanisms as a problem”. 5454 . Rothman KJ, Adami H-O, Trichopoulos D. Should the mission of epidemiology
include the eradication of poverty? Lancet . 1998;352(9130):810-3.
DOI:10.1016/S0140-6736(98)01327-0
https://doi.org/10.1016/S0140-6736(98)01...
They defend that empiric “atheoretical” data gathering and
interpretation, with emphasis on methods , is (a) scientific; (b) what can
provide answers when other disciplines cannot. Even without knowing biological mechanisms
that would explain links, risk factor epidemiology has provided evidence that led to actions
which decreased disease (e.g., tobacco): “even without a clear understanding of mechanism,
such observations provide the basis to modify exposures in order to prevent disease”; 5555 . Savitz DA. In defense of black box epidemiology.
Epidemiology . 1994;5(5):550-2. “In fact, the value of epidemiologic
evidence for decision-making may be the greatest when other biomedical disciplines have the
least to offer”. 5555 . Savitz DA. In defense of black box epidemiology.
Epidemiology . 1994;5(5):550-2. They state that
epidemiologists should not be “activists”. This would compromise the objectivity/neutrality
of science: “we maintain that epidemiology best contributes to public health goals through
rigor and by striving for the ever-elusive goal of objectivity, Mixing scientific and
activist roles not only threatens the validity of epidemiologic science but reduces its
benefit to public health”. 5757 . Savitz DA, Poole C, Miller WC. Reassessing the role of epidemiology in
public health. Am J Public Health. 1999;89(8):1158-61.
DOI:10.2105/AJPH.89.8.1158
https://doi.org/10.2105/AJPH.89.8.1158...
They believe
that science is not bound by a requirement of applicability; as scientists, epidemiologists
should not be burdened by this kind of demand. “If an astrophysicist can study the origin of
the universe without apology, should an epidemiologist have to apologize for work that is so
practical?”. 5454 . Rothman KJ, Adami H-O, Trichopoulos D. Should the mission of epidemiology
include the eradication of poverty? Lancet . 1998;352(9130):810-3.
DOI:10.1016/S0140-6736(98)01327-0
https://doi.org/10.1016/S0140-6736(98)01...
There are also some specific variations among this group. Rothman is particularly keen in
affirming that policy considerations do not belong in epidemiologic articles: “we want
readers (...) to be able to focus on a critical examination of the science without confusing
the issue with policy questions”. 5353 . Rothman K. Policy recommendations in epidemiology research papers.
Epidemiology . 1993;4(2):94-5.
Reacting to a Lancet editorial, 4949 . Putting public health back into epidemiology. Lancet .
1997;350(9073):229. DOI:10.1016/S0140-6736(97)21030-5
https://doi.org/10.1016/S0140-6736(97)21...
he and
his collaborators state that “accusations have been mounting that epidemiologists have
abandoned their public health mission of being ‘physician-scientist’ to society in favor of
studying the scientific arcana of disease causation”. 5454 . Rothman KJ, Adami H-O, Trichopoulos D. Should the mission of epidemiology
include the eradication of poverty? Lancet . 1998;352(9130):810-3.
DOI:10.1016/S0140-6736(98)01327-0
https://doi.org/10.1016/S0140-6736(98)01...
They consider that two “accusations” were being made:
“epidemiology is too individualistic” and “epidemiologists need moral and political fiber”;
and respond to those stating that upstream inference is less secure and intervention at that
level “may be” less efficient than closer to disease occurrence. Poole & Rothman, 4848 . Poole C, Rothman KJ. Our conscientious objection to the epidemiology wars.
J Epidemiol Community Health . 1998;52(10):613-4.
DOI:10.1136/jech.52.10.613
https://doi.org/10.1136/jech.52.10.613...
commenting on a later article, 6565 . Susser M. Does risk factor epidemiology put epidemiology at risk? Peering
into the future. J Epidemiol Community Health . 1998;52(10):608-11.
DOI:10.1136/jech.52.10.608
https://doi.org/10.1136/jech.52.10.608...
tone down considerably the
counter-critique, proposing an armistice with Susser et al stating that while they are right
in their demand for a more comprehensive epidemiology, in their proposal there is room for
risk factor epidemiologists to proceed as they always had. They reserve the harsher
criticism for Krieger 2424 . Krieger N. Epidemiology and the web of causation: has anyone seen the
spider? Soc Sci Med . 1994;39(7):887-903.
DOI:10.1016/0277-9536(94)90202-X
https://doi.org/10.1016/0277-9536(94)902...
and Pearce 4545 . Pearce N. Traditional epidemiology, modern epidemiology, and public
health. Am J Public Health . 1996;86(5):678-83. and others; Krieger & Ziegler 2525 . Krieger N, Ziegler S. What explains the public’s health? A call for
epidemiologic theory. Epidemiology. 1996;7(1):107-9. and Shy 6060 . Shy CM. The failure of academic epidemiology: witness for the prosecution.
Am J Epidemiol. 1997;145(6):479-84. are characterized as defending a macro-only approach (“social
production of disease theories”) and Vanderbrouke as defending a micro-only approach, 7474 . Vandenbroucke JP. Is ‘the causes of cancer’ a miasma theory for the end of
the twentieth century? Int J Epidemiol . 1988;17(4):708-9.
DOI:10.1093/ije/17.4.708
https://doi.org/10.1093/ije/17.4.708...
implying that their position would be the
reasonable middle.
There is some disagreement on whether epidemiology is 7272 . Trichopoulos D. Accomplishments and prospects of epidemiology.
Prev Med . 1996;25(1):4-6. DOI:10.1006/pmed.1996.0003
https://doi.org/10.1006/pmed.1996.0003...
or not 5757 . Savitz DA, Poole C, Miller WC. Reassessing the role of epidemiology in
public health. Am J Public Health. 1999;89(8):1158-61.
DOI:10.2105/AJPH.89.8.1158
https://doi.org/10.2105/AJPH.89.8.1158...
a
basic science for public health, as well. Savitz et al deny that epidemiology is a basic
science of public health, 5757 . Savitz DA, Poole C, Miller WC. Reassessing the role of epidemiology in
public health. Am J Public Health. 1999;89(8):1158-61.
DOI:10.2105/AJPH.89.8.1158
https://doi.org/10.2105/AJPH.89.8.1158...
and affirm
that the latter is better served by the former when epidemiologic research focuses on
producing evidence of specific (i.e., at the individual level) associations between risk
factors and diseases. They propose a clear division of labor between epidemiologists and
public health workers, who would use the evidence to advocate for adequate public policy.
They stress the importance of accurate measuring as a means to reduce uncertainty in the
evidence, which would better serve the design of policy interventions.
While there are some Braudelian, longue durée , threads in this debate, it
signals some important changes and its originality should not be underestimated. The marked
differences in various approaches that place the emphasis on context as a common denominator
is clearly depicted in Krieger’s book. 2828 . Krieger N. Epidemiology and the people’s health: theory and context. New
York: Oxford University Press; 2011.
It would not be possible for the latter to propose a fractal-based analogy before a body of
knowledge and a rich imagery about fractals became available in scientific discourse; the
references to “complex systems” 2323 . Koopman JS, Lynch JW. Individual causal models and population system
models in epidemiology. Am J Public Health. 1999;89(8):1170-4.
DOI:10.2105/AJPH.89.8.1170
https://doi.org/10.2105/AJPH.89.8.1170...
rely on
more recent work on complex adaptive systems; invocations of functionalist or behavioral
thinking in the social sciences is radically different from a dialectic vision, 4545 . Pearce N. Traditional epidemiology, modern epidemiology, and public
health. Am J Public Health . 1996;86(5):678-83. and, more obviously, the critique of risk
factor epidemiology once it becomes dominant can point to its limits in a way that was not
possible in earlier conjunctures. It is the triumph of that approach that made its
shortcomings more clear. The systematic ensemble of those criticisms,
couched in a significantly different conception of science (itself based on philosophical
developments available only in the late sixties and previously not mentioned in similar
debates), marks a singular and relevant moment in the recent history of epidemiology.
A DEEPER DISAGREEMENT
Participants sometimes talked past each other as often happens in scientific controversies. The critique that advocated a new theory, metaphor or paradigm was understood as an either/or proposition with regards to the techniques patiently developed under the aegis of risk-factor epidemiology. More often than not the call to embrace a wider worldview was misunderstood as an invalidation of methods and findings .
Taking aside the obvious differences visible in the articles discussed, there seems to be a deeper, more fundamental level of disagreement between the two sides, in their conception of what science is and how it should work. Deep divergences in the ontological, epistemological, axiological and pragmatic dimensions seem to indicate an incommensurability 3232 . Kuhn TS. The road since structure: philosophical essays, 1970-1993, with an autobiographical interview . Chicago: University of Chicago Press; 2002. Commensurability, comparability, communicability; p. 33-57. of competing styles of reasoning. 2020 . Hacking I. Historical ontology. Cambridge (MA): Harvard University Press; 2004. ‘Style’ for historians and philosophers; p.178-99.
The critics of the status quo explicitly subscribe to a more contemporary philosophy of science that does not assume an absolute separation of facts and values, that relies on history instead of prescription of how science should be and that embraces political positions as part of any research that involves human populations. 77 . Daston LJ, Galison P. Objectivity. New York: Zone Books; 2007. , 3333 . Latour B, Woolgar S. Laboratory life: the construction of scientific facts. Princeton (NJ): Princeton University Press; 1986. , 5959 . Shapin S, Schaffer S. Leviathan and the air-pump: Hobbes, Boyle, and the experimental life. Princeton (NJ): Princeton University Press; 1989. The traditional view embraced by the risk factor epidemiology camp, however, seems to assume a pre-20th century view of science as a mirror image of “reality” that considers objectivity as an absolute, and that for this reason, concentrates on methods and eschews social and political “contamination”. 5151 . Rorty R. Objectivity, relativism, and truth: philosophical papers. Cambridge (MA): Cambridge University Press; 1991. , 5252 . Rorty R. Philosophy and the mirror of nature. Princeton (NJ): Princeton University Press; 2009. One would be hard pressed to find a contemporary philosopher of science who would underwrite any proposition of “atheoretical” research, for instance.
If we consider those positions as derived from different styles of reasoning and take into
account the self-vindicating aspect of such styles, 2020 . Hacking I. Historical ontology. Cambridge (MA): Harvard University Press;
2004. ‘Style’ for historians and philosophers; p.178-99. the apparent impermeability of each side to each other’s arguments
is hardly surprising. This raises an issue, pointed out in a critique of Hacking’s point of
view: 5050 . Ritchie J. Styles for philosophers of science. Stud Hist Philos
Sci Part A . 2012;43(4):649-56.
DOI:10.1016/j.shpsa.2012.07.007
https://doi.org/10.1016/j.shpsa.2012.07....
if styles of reasoning were
indeed impervious to change, how to explain their demonstrable evolution over time? First of
all, as Hacking 1818 . Hacking I. The self-vindication of the laboratory sciences. In: Pickering
A, editor. Science as practice and culture. Chicago: University of Chicago Press; 1992.
p.29-64. explains elsewhere, his
concern when he began writing about styles was not so much with the changes in scientific
disciplines, as explored by authors like Kuhn and Popper, but their large areas of
stability. Secondly, resistance to change does not mean success in resisting as implied in
the argument. As Fleck (another important reference in Hacking’s work) discussed, resistance
to new thoughts is an active process that nevertheless progressively recedes from finding
such ideas unthinkable to attempts to describe them within the framework of the prevailing
conceptions. 1414 . Fleck L. Genesis and development of a scientific fact. Chicago: University
of Chicago Press; 1981. The next step in this
process would be finally having a change or replacement in the style of reasoning, even if
complete substitution might only happen after a generational change, as Kuhn remarked with
regard to paradigms. 3030 . Kuhn TS. The essential tension: selected studies in scientific tradition
change. Chicago: University of Chicago Press; 1977. The function of measurement in modern
physical science; p.178-224 .
THE AFTERMATH
New versions of the larger debate have erupted occasionally since the 90’s, 1616 . Greenland S, Gago-Dominguez M, Castelao JE. The value of risk-factor
(“black-box”) epidemiology. Epidemiology . 2004;15(5);529-35.
DOI:10.1097/01.ede.0000134867.12896.23
https://doi.org/10.1097/01.ede.000013486...
,
1717 . Greenland S, Gago-Dominguez M, Castelao JE. Authors’ response.
Epidemiology . 2004;15(5):527-8.
DOI:10.1097/01.ede.0000136364.97719.ba
https://doi.org/10.1097/01.ede.000013636...
,
3838 . Mawson AR. On not taking the world as you find it – epidemiology in its
place. J Clin Epidemiol. 2002;55(1):1-4.
DOI:10.1016/S0895-4356(01)00428-0
https://doi.org/10.1016/S0895-4356(01)00...
,
4141 . McKinlay JB, Marceau LD. To boldly go.... Am J Public
Health. 2000;90(1):25-33.
,
6161 . Susser E. Eco-epidemiology: thinking outside the black box.
Epidemiology . 2004;15(5):519-20.
DOI:10.1097/01.ede.0000135911l.42282.b4
https://doi.org/10.1097/01.ede.000013591...
,
7373 . Trichopoulos D, Lagiou P. Are epidemiologists becoming victims of the
success of their discipline? Soz Praventivmed . 2001;46(6):347-8.
DOI:10.1007/BF01321657
https://doi.org/10.1007/BF01321657...
,
7575 . Weiss NS. Presents can come in black boxes, too.
Epidemiology . 2004;15(5):525-6.
DOI:10.1097/01.ede.0000135175.11460.27
https://doi.org/10.1097/01.ede.000013517...
and it would be incorrect, even
irresponsible, to claim that it has been settled. That is one of the risks of dealing with a
historical reconstruction of the recent past.
The first decades of the 21st century also witnessed a flourishing literature
that took up the critics’ propositions and developed them further, both theoretically and
methodologically. 44 . Bingenheimer JB. Multilevel models and scientific progress in social
epidemiology. J Epidemiol Community Health . 2005;59(6):438-9.
DOI:10.1136/jech.2004.028456
https://doi.org/10.1136/jech.2004.028456...
,
1010 . Diez-Roux AV. The study of group-level factors in epidemiology: rethinking
variables, study designs, and analytical approaches. Epidemiol Rev .
2004;26(1):104-11. DOI:10.1093/epirev/mxh006
https://doi.org/10.1093/epirev/mxh006...
11 . Diez-Roux AV. Integrating social and biologic factors in health research:
a systems view. Ann Epidemiol . 2007;17(7):569-74.
DOI:10.1016/j.annepidem.2007.03.001
https://doi.org/10.1016/j.annepidem.2007...
12 . Diez-Roux AV. Next steps in understanding the multilevel determinants of
health. J Epidemiol Community Health . 2008;62(11):957-9.
DOI:10.1136/jech.2007.064311
https://doi.org/10.1136/jech.2007.064311...
-
1313 . Duell EJ. The future of epidemiology: methodological challenges and
multilevel inference. Bundesgesundheitsblatt Gesundheitsforschung
Gesundheitsschutz. 2006;49(7):622-7.
DOI:10.1007/s00103-006-1293-9
https://doi.org/10.1007/s00103-006-1293-...
,
2626 . Krieger N. Epidemiology and social sciences: towards a critical
reengagement in the 21st century. Epidemiol Rev .
2000;22(1):155-63.
,
2727 . Krieger N. Theories for social epidemiology in the 21st century: an
ecosocial perspective. Int J Epidemiol . 2001;30(4):668-77.
DOI:10.1093/ije/30.4.668
https://doi.org/10.1093/ije/30.4.668...
,
6969 . Tong S, Neale RE, Shen X, Olsen J. Challenges for epidemiologic research
on the verge of a new era. Eur J Epidemiol ; 2011;26(9);689-94.
DOI:10.1007/s10654-011-9615-0
https://doi.org/10.1007/s10654-011-9615-...
Two articles, in particular, seem to
characterize the growth of the critical point of view within the epidemiologic community.
The first comments on (then) recent changes at the NIH, stressing how it was displaying an
increasing commitment to multilevel studies of health. 11 . Bachrach CA, Abeles RP. Social science and health research: growth at the
National Institutes of Health. Am J Public Health . 2004;94(1):22-8.
DOI:10.2105/AJPH.94.1.22
https://doi.org/10.2105/AJPH.94.1.22...
The second is a 2005 article that resulted from a discussion that
took place in the 2002 APHA meeting, involving 12 leaders of epidemiology associations, who
discussed the future and challenges of epidemiology in this century. 1515 . Foxman B. Challenges of epidemiology in the 21st century: comments from
the leaders of several epidemiology associations. Ann Epidemiol.
2005;15(1):1-4. DOI:10.1016/j.annepidem.2004.09.006
https://doi.org/10.1016/j.annepidem.2004...
Despite its conciseness, it is a very comprehensive
document; among the many statements it makes, three have direct bearing in our discussion:
(a) that the advancement in other fields, especially molecular biology and genetics at one
extreme and ecology, social science and public policy at the other, offer the chance to open
the “black box”; (b) that a systems approach should be increasingly adopted, given the
importance of both context and ecology, and this is tied to “the ultimate goal of all
epidemiologic research: planning interventions to reduce the occurrence of disease and
enhance the public’s health.”; and (c) that epidemiologists, as researchers and public
health professionals, have a duty to assist the development and implementation of policy
based on sound information. This could be read as an endorsement, across the board, of the
theses defended by the critics of the status quo .
The historical development of Epidemiology cannot be entirely attributed to the internal dynamics of the discipline. Kuhn 2929 . Kuhn TS. The essential tension: selected studies in scientific tradition change. Chicago: University of Chicago Press; 1977. Preface; p.IX-XXIII. references en passant certain domains of knowledge that would be less likely to achieve a certain degree of “insulation” from the general societal environment, among them, medicine. If we extend “medicine” to include the health sciences, epidemiology included, this would be a reason why the crisis-revolution pattern might not directly apply. Given the constant pressures from society at large, the kind of transition driven mainly by the internal dynamics of a discipline would be less likely to take place, or at least, clearly perceived. Still according to Kuhn, 3030 . Kuhn TS. The essential tension: selected studies in scientific tradition change. Chicago: University of Chicago Press; 1977. The function of measurement in modern physical science; p.178-224 . , 3131 . Kuhn TS. The structure of scientific revolutions. 3.ed. Chicago: University of Chicago Press;1996. the social sciences do not fit the single paradigm model, and possibly never will; 3030 . Kuhn TS. The essential tension: selected studies in scientific tradition change. Chicago: University of Chicago Press; 1977. The function of measurement in modern physical science; p.178-224 . , 3131 . Kuhn TS. The structure of scientific revolutions. 3.ed. Chicago: University of Chicago Press;1996. given the proximity of epidemiology and the social sciences, this characterization could also apply to the former.
Epidemiology has gone through some important changes as a discipline in recent years. The
new social epidemiology grew considerably in importance, with an increasing number of
publications, both in article and book format. 2828 . Krieger N. Epidemiology and the people’s health: theory and context. New
York: Oxford University Press; 2011. It would be presumptuous to propose that the mid-90’s debate decided
a controversy that in a sense is still being played out. There were also important
developments in the interface of genetics and epidemiology in the same period, 33 . Beaty TH, Khoury MJ. Interface of genetics and epidemiology.
Epidemiol Rev . 2000;22(1):120-5.
,
2121 . Khoury MJ, Millikan R, Little J, Gwinn M. The emergence of epidemiology in
the genomics age. Int J Epidemiol . 2004;33(5):936-44.
DOI:10.1093/ije/dyh278
https://doi.org/10.1093/ije/dyh278...
,
5858 . Seminara D, Khoury MJ, O’Brien TR, Manolio T, Gwinn ML, Little J, et al.
The emergence of networks in human genome epidemiology: challenges and opportunities.
Epidemiology . 2007;18(1):1-8.
DOI:10.1097/01.ede.0000249540.17855.b7
https://doi.org/10.1097/01.ede.000024954...
and even critics of risk factor
epidemiology admit that it is still dominant; 3737 . March D, Susser E. The eco- in eco-epidemiology. Int J
Epidemiol . 2006;35(6):1379-83. DOI:10.1093/ije/dyl249
https://doi.org/10.1093/ije/dyl249...
despite the growing number of articles and books dedicated to social
epidemiology, their methodological approaches are still dominated by that model. The new
methods that would be more in line with the critical style of reasoning are still in their
infancy, their contribution yet to mature. 3636 . Luke DA, Stamatakis KA. Systems science methods in public health:
dynamics, networks, and agents. Annu Rev Public Health . 2012;33:357-76.
DOI:10.1146/annurev-publhealth-031210-101222
https://doi.org/10.1146/annurev-publheal...
The relevance of the critique formulated in the mid-90’s seems clear to us. As Lillienfeld & Lillienfeld wrote, 3535 . Lilienfeld AM, Lilienfeld DE. Epidemiology and the public health movement: a historical perspective. J Public Health Policy . 1982;3(2):140-9. public health and epidemiology need to constantly nourish each other. A conception of epidemiology disconnected from social and political demands will not be able to face the challenges of a global public health, which include issues ranging from new health risks posed by recently developed technologies to claims for social justice.
REFERENCES
-
1Bachrach CA, Abeles RP. Social science and health research: growth at the National Institutes of Health. Am J Public Health . 2004;94(1):22-8. DOI:10.2105/AJPH.94.1.22
» https://doi.org/10.2105/AJPH.94.1.22 -
2Beaglehole R, Bonita R. Public health at the crossroads: which way forward? Lancet . 1998;351(9102):590-2. DOI:10.1016/S0140-6736(97)09494-4
» https://doi.org/10.1016/S0140-6736(97)09494-4 -
3Beaty TH, Khoury MJ. Interface of genetics and epidemiology. Epidemiol Rev . 2000;22(1):120-5.
-
4Bingenheimer JB. Multilevel models and scientific progress in social epidemiology. J Epidemiol Community Health . 2005;59(6):438-9. DOI:10.1136/jech.2004.028456
» https://doi.org/10.1136/jech.2004.028456 -
5Buck C. Popper’s philosophy for epidemiologists. Int J Epidemiol . 1975;4(3):159-68. DOI:10.1093/ije/4.3.159
» https://doi.org/10.1093/ije/4.3.159 -
6Cassel J. Social science theory as a source of hypotheses in epidemiological research. Am J Public Health Nations Health . 1964;54:1482-8.
-
7Daston LJ, Galison P. Objectivity. New York: Zone Books; 2007.
-
8Diez-Roux AV. Bringing context back into epidemiology: variables and fallacies in multilevel analysis. Am J Public Health . 1998;88(2):216-22. DOI:10.2105/AJPH.88.2.216
» https://doi.org/10.2105/AJPH.88.2.216 -
9Diez-Roux AV. On genes, individuals, society, and epidemiology. Am J Epidemiol . 1998;148(11):1027-32.
-
10Diez-Roux AV. The study of group-level factors in epidemiology: rethinking variables, study designs, and analytical approaches. Epidemiol Rev . 2004;26(1):104-11. DOI:10.1093/epirev/mxh006
» https://doi.org/10.1093/epirev/mxh006 -
11Diez-Roux AV. Integrating social and biologic factors in health research: a systems view. Ann Epidemiol . 2007;17(7):569-74. DOI:10.1016/j.annepidem.2007.03.001
» https://doi.org/10.1016/j.annepidem.2007.03.001 -
12Diez-Roux AV. Next steps in understanding the multilevel determinants of health. J Epidemiol Community Health . 2008;62(11):957-9. DOI:10.1136/jech.2007.064311
» https://doi.org/10.1136/jech.2007.064311 -
13Duell EJ. The future of epidemiology: methodological challenges and multilevel inference. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2006;49(7):622-7. DOI:10.1007/s00103-006-1293-9
» https://doi.org/10.1007/s00103-006-1293-9 -
14Fleck L. Genesis and development of a scientific fact. Chicago: University of Chicago Press; 1981.
-
15Foxman B. Challenges of epidemiology in the 21st century: comments from the leaders of several epidemiology associations. Ann Epidemiol. 2005;15(1):1-4. DOI:10.1016/j.annepidem.2004.09.006
» https://doi.org/10.1016/j.annepidem.2004.09.006 -
16Greenland S, Gago-Dominguez M, Castelao JE. The value of risk-factor (“black-box”) epidemiology. Epidemiology . 2004;15(5);529-35. DOI:10.1097/01.ede.0000134867.12896.23
» https://doi.org/10.1097/01.ede.0000134867.12896.23 -
17Greenland S, Gago-Dominguez M, Castelao JE. Authors’ response. Epidemiology . 2004;15(5):527-8. DOI:10.1097/01.ede.0000136364.97719.ba
» https://doi.org/10.1097/01.ede.0000136364.97719.ba -
18Hacking I. The self-vindication of the laboratory sciences. In: Pickering A, editor. Science as practice and culture. Chicago: University of Chicago Press; 1992. p.29-64.
-
19Hacking I. Inaugural lecture: Chair of Philosophy and History of Scientific Concepts at the Collège de France, 16 January 2001. Econ Soc . 2002;31(1):1-14. DOI:10.1080/03085140120109222
» https://doi.org/10.1080/03085140120109222 -
20Hacking I. Historical ontology. Cambridge (MA): Harvard University Press; 2004. ‘Style’ for historians and philosophers; p.178-99.
-
21Khoury MJ, Millikan R, Little J, Gwinn M. The emergence of epidemiology in the genomics age. Int J Epidemiol . 2004;33(5):936-44. DOI:10.1093/ije/dyh278
» https://doi.org/10.1093/ije/dyh278 -
22Koopman JS, Longini Jr IM. The ecological effects of individual exposures and nonlinear disease dynamics in populations. Am J Public Health . 1994;84(5):836-42. DOI:10.2105/AJPH.84.5.836
» https://doi.org/10.2105/AJPH.84.5.836 -
23Koopman JS, Lynch JW. Individual causal models and population system models in epidemiology. Am J Public Health. 1999;89(8):1170-4. DOI:10.2105/AJPH.89.8.1170
» https://doi.org/10.2105/AJPH.89.8.1170 -
24Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med . 1994;39(7):887-903. DOI:10.1016/0277-9536(94)90202-X
» https://doi.org/10.1016/0277-9536(94)90202-X -
25Krieger N, Ziegler S. What explains the public’s health? A call for epidemiologic theory. Epidemiology. 1996;7(1):107-9.
-
26Krieger N. Epidemiology and social sciences: towards a critical reengagement in the 21st century. Epidemiol Rev . 2000;22(1):155-63.
-
27Krieger N. Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol . 2001;30(4):668-77. DOI:10.1093/ije/30.4.668
» https://doi.org/10.1093/ije/30.4.668 -
28Krieger N. Epidemiology and the people’s health: theory and context. New York: Oxford University Press; 2011.
-
29Kuhn TS. The essential tension: selected studies in scientific tradition change. Chicago: University of Chicago Press; 1977. Preface; p.IX-XXIII.
-
30Kuhn TS. The essential tension: selected studies in scientific tradition change. Chicago: University of Chicago Press; 1977. The function of measurement in modern physical science; p.178-224 .
-
31Kuhn TS. The structure of scientific revolutions. 3.ed. Chicago: University of Chicago Press;1996.
-
32Kuhn TS. The road since structure: philosophical essays, 1970-1993, with an autobiographical interview . Chicago: University of Chicago Press; 2002. Commensurability, comparability, communicability; p. 33-57.
-
33Latour B, Woolgar S. Laboratory life: the construction of scientific facts. Princeton (NJ): Princeton University Press; 1986.
-
34Latour B. Science in action: how to follow scientists and engineers through society. Cambridge (MA): Harvard University Press; 1987.
-
35Lilienfeld AM, Lilienfeld DE. Epidemiology and the public health movement: a historical perspective. J Public Health Policy . 1982;3(2):140-9.
-
36Luke DA, Stamatakis KA. Systems science methods in public health: dynamics, networks, and agents. Annu Rev Public Health . 2012;33:357-76. DOI:10.1146/annurev-publhealth-031210-101222
» https://doi.org/10.1146/annurev-publhealth-031210-101222 -
37March D, Susser E. The eco- in eco-epidemiology. Int J Epidemiol . 2006;35(6):1379-83. DOI:10.1093/ije/dyl249
» https://doi.org/10.1093/ije/dyl249 -
38Mawson AR. On not taking the world as you find it – epidemiology in its place. J Clin Epidemiol. 2002;55(1):1-4. DOI:10.1016/S0895-4356(01)00428-0
» https://doi.org/10.1016/S0895-4356(01)00428-0 -
39McKinlay JB. Paradigmatic obstacles to improving the health of populations: implications for health policy. Salud Publica Mex . 1998;40(4):369-79. DOI:10.1590/S0036-36341998000400010
» https://doi.org/10.1590/S0036-36341998000400010 -
40McKinlay JB, Marceau LD. A tale of 3 tails. Am J Public Health . 1999;89(3):295-8. DOI:10.2105/AJPH.89.3.295
» https://doi.org/10.2105/AJPH.89.3.295 -
41McKinlay JB, Marceau LD. To boldly go.... Am J Public Health. 2000;90(1):25-33.
-
42McMichael AJ. The health of persons, populations, and planets: epidemiology comes full circle. Epidemiology . 1995;6(6):633-6.
-
43McMichael AJ. Prisoners of the proximate: loosening the constraints on epidemiology in an age of change. Am J Epidemiol . 1999;149(10):887-97.
-
44Morabia A, editor. A history of epidemiologic methods and concepts. Basel: Birkhäuser; 2004.
-
45Pearce N. Traditional epidemiology, modern epidemiology, and public health. Am J Public Health . 1996;86(5):678-83.
-
46Pearce N, McKinlay JB. Dissent: back to the future in epidemiology and public health: response to Dr. Gori. J Clinl Epidemiol . 1998;51(8):643-6. DOI:10.1016/S0895-4356(98)00054-7
» https://doi.org/10.1016/S0895-4356(98)00054-7 -
47Pearce N. Epidemiology as a population science. Int J Epidemiol . 1999;28(5):S1015-8.
-
48Poole C, Rothman KJ. Our conscientious objection to the epidemiology wars. J Epidemiol Community Health . 1998;52(10):613-4. DOI:10.1136/jech.52.10.613
» https://doi.org/10.1136/jech.52.10.613 -
49Putting public health back into epidemiology. Lancet . 1997;350(9073):229. DOI:10.1016/S0140-6736(97)21030-5
» https://doi.org/10.1016/S0140-6736(97)21030-5 -
50Ritchie J. Styles for philosophers of science. Stud Hist Philos Sci Part A . 2012;43(4):649-56. DOI:10.1016/j.shpsa.2012.07.007
» https://doi.org/10.1016/j.shpsa.2012.07.007 -
51Rorty R. Objectivity, relativism, and truth: philosophical papers. Cambridge (MA): Cambridge University Press; 1991.
-
52Rorty R. Philosophy and the mirror of nature. Princeton (NJ): Princeton University Press; 2009.
-
53Rothman K. Policy recommendations in epidemiology research papers. Epidemiology . 1993;4(2):94-5.
-
54Rothman KJ, Adami H-O, Trichopoulos D. Should the mission of epidemiology include the eradication of poverty? Lancet . 1998;352(9130):810-3. DOI:10.1016/S0140-6736(98)01327-0
» https://doi.org/10.1016/S0140-6736(98)01327-0 -
55Savitz DA. In defense of black box epidemiology. Epidemiology . 1994;5(5):550-2.
-
56Savitz DA. The alternative to epidemiologic theory: whatever works. Epidemiology . 1997;8(2):210-2.
-
57Savitz DA, Poole C, Miller WC. Reassessing the role of epidemiology in public health. Am J Public Health. 1999;89(8):1158-61. DOI:10.2105/AJPH.89.8.1158
» https://doi.org/10.2105/AJPH.89.8.1158 -
58Seminara D, Khoury MJ, O’Brien TR, Manolio T, Gwinn ML, Little J, et al. The emergence of networks in human genome epidemiology: challenges and opportunities. Epidemiology . 2007;18(1):1-8. DOI:10.1097/01.ede.0000249540.17855.b7
» https://doi.org/10.1097/01.ede.0000249540.17855.b7 -
59Shapin S, Schaffer S. Leviathan and the air-pump: Hobbes, Boyle, and the experimental life. Princeton (NJ): Princeton University Press; 1989.
-
60Shy CM. The failure of academic epidemiology: witness for the prosecution. Am J Epidemiol. 1997;145(6):479-84.
-
61Susser E. Eco-epidemiology: thinking outside the black box. Epidemiology . 2004;15(5):519-20. DOI:10.1097/01.ede.0000135911l.42282.b4
» https://doi.org/10.1097/01.ede.0000135911l.42282.b4 -
62Susser M. Epidemiology today: ‘a thought-tormented world’. Int J Epidemiol . 1989;18(3):481-8.
-
63Susser M, Susser E. Choosing a future for epidemiology: I. Eras and paradigms. Am J Public Health . 1996;86(5):668-73. DOI:10.2105/AJPH.86.5.668
» https://doi.org/10.2105/AJPH.86.5.668 -
64Susser M, Susser E. Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology. Am J Public Health . 1996;86(5):674-7. DOI:10.2105/AJPH.86.5.674
» https://doi.org/10.2105/AJPH.86.5.674 -
65Susser M. Does risk factor epidemiology put epidemiology at risk? Peering into the future. J Epidemiol Community Health . 1998;52(10):608-11. DOI:10.1136/jech.52.10.608
» https://doi.org/10.1136/jech.52.10.608 -
66Susser M. Should the epidemiologist be a social scientist or a molecular biologist? Int J Epidemiol . 1999;28(5):S1019-22.
-
67Susser M, Stein Z. Eras in epidemiology: the evolution of ideas. New York: Oxford University Press; 2009.
-
68Taubes G. Epidemiology faces its limits. Science . 1995;269(5221):164-9. DOI:10.1126/science.7618077
» https://doi.org/10.1126/science.7618077 -
69Tong S, Neale RE, Shen X, Olsen J. Challenges for epidemiologic research on the verge of a new era. Eur J Epidemiol ; 2011;26(9);689-94. DOI:10.1007/s10654-011-9615-0
» https://doi.org/10.1007/s10654-011-9615-0 -
70Trichopoulos D. The discipline of epidemiology. Science . 1995;269(5229):1326. DOI:10.1126/science.7660107
» https://doi.org/10.1126/science.7660107 -
71Trichopoulos D. The future of epidemiology. BMJ . 1996;313(7055):436-7. DOI:10.1136/bmj.313.7055.436
» https://doi.org/10.1136/bmj.313.7055.436 -
72Trichopoulos D. Accomplishments and prospects of epidemiology. Prev Med . 1996;25(1):4-6. DOI:10.1006/pmed.1996.0003
» https://doi.org/10.1006/pmed.1996.0003 -
73Trichopoulos D, Lagiou P. Are epidemiologists becoming victims of the success of their discipline? Soz Praventivmed . 2001;46(6):347-8. DOI:10.1007/BF01321657
» https://doi.org/10.1007/BF01321657 -
74Vandenbroucke JP. Is ‘the causes of cancer’ a miasma theory for the end of the twentieth century? Int J Epidemiol . 1988;17(4):708-9. DOI:10.1093/ije/17.4.708
» https://doi.org/10.1093/ije/17.4.708 -
75Weiss NS. Presents can come in black boxes, too. Epidemiology . 2004;15(5):525-6. DOI:10.1097/01.ede.0000135175.11460.27
» https://doi.org/10.1097/01.ede.0000135175.11460.27 -
76Wilcox AJ. From the Shy trial defense: a leak, or red herring? Epidemiology . 1997;8(6):684-5.
-
77Willett W, Greenland S, MacMahon B, Trichopoulos D, Rothman K, Thomas D, et al. The discipline of epidemiology [letter]. Science . 1995;269(5229):1325-6. DOI:10.1126/science.7660105
» https://doi.org/10.1126/science.7660105 -
78Wing S. Limits of epidemiology. Med Glob Surviv . 1994;1(2):74-86.
-
79Wing S. Whose epidemiology, whose health? Int J Health Serv . 1998;28(2):241-52.
Publication Dates
-
Publication in this collection
Oct 2013
History
-
Received
2 Nov 2013 -
Accepted
24 June 2013