Epidemiology Today: ‘A Thought-Tormented World’

Epidemiology has seen many theoretical advances over the past 20 years. Since the advances of one period often become the impediments of the next, it is timely to seek out disorders of thought that may beset our studies of disorders of health. In this undertaking, I speak as a premodern epidemiologist who has bent effort to promoting one kind of modern epidemiology. My intention is not to decry but to look forward. For epidemiology that is still to be, therefore, I shall venture some value-laden hopes. Premodem epidemiology was primarily an epidemiology of substance. It was epidemiology for problem solving and for the prevention or control of disease, subservient to this purpose and hence to its subject matter. At the same time, it was often epidemiology pursued intuitively, an avocation (excepting infectious disease epidemiologists) of gifted amateurs using primitive means. It engendered the excitement of the unexplored, and the frustration of technical incapacity. This kind of epidemiology was in decline by the 1950s and passe by, say, the early 1970s. Present day epidemiology, on the other hand, is primarily an epidemiology of technique, at risk of existing for its own sake regardless of subject matter. It is epidemiology pursued as a vocation by accomplished professionals who deploy refined and complex methods. In the absence of a central concern with subject matter, the satisfactions of technical command are held within narrow bounds; in the absence of broader purpose, an arsenal of methods might not necessarily be directed to the benefit of the public health. The transition from premodern to modern epidemiology was governed first by the historical shift in the substance of epidemiological studies from acute infectious diseases to chronic non-infectious diseases.