Commentary: Social epidemiology? Way!

The central assertion contained in the essay by Zielhuis and Kiemeney is that epidemiology is a ‘part of medical sciences and rests on human-biological (scientific) background’.1 On the basis of this broad contention, the authors attempt to draw two corollaries. The first is that training ‘comparable to the training that medical practitioners need as a basis for medical practice’ is necessary for an individual to practice epidemiology. The second is that epidemiologists must eschew study of social factors because their narrow clinical training provides them with insufficient understanding of these quantities. Inarguably, ‘basic training in biomedicine’ is potentially useful for anyone engaged in the scientific study of health and disease. Nonetheless, people achieve intellectual development through varied means, of which formal progress through a degree programme in order to obtain a credential is but one. Ultimately, we do not judge scientific knowledge on the basis of the authors' credentials, but rather on the objective merit of the work. For example, we do not reject the biostatistical techniques developed by Jerry Cornfield and James Robins, simply because these individuals never obtained doctoral degrees in statistics. Similarly, Gertrude Elion was awarded the Nobel Prize in Medicine in 1988, although she possessed no degree in medicine, nor in fact, any doctoral degree at all. While not seeking to denigrate formal training programmes, I merely note that these are a means to an end; namely, knowledge and understanding. We must never become so obsessed with our little merit badges (MD, PhD, etc.) that we mistake these for the actual professional competence they are meant to portend.