Commentary: The rise and rise of corporate epidemiology and the narrowing of epidemiology's vision

Epidemiology and the Covid-19 pandemic: opportunities to review trajectories and plan for the future

The Covid-19 pandemic has caused substantial changes in various spheres of academic life. Epidemiology can use the experiences accumulated in this period as an opportunity to plan for its future. Facing a pandemic requires the production of explanatory theories about the pandemic process and its unequal manifestation in the population. In this sense, Epidemiology needs to strengthen its scientific foundations and recognize the values and limits of its approaches. Thus, it is essential to strengthen the links with other disciplines. A new teaching model can be produced from pandemic experiences, including transversal contents, such as preparation for responses to natural and technological disasters, like epidemics and pandemics, and scientific communication. The teaching of Epidemiology needs to be contextualized with the bases of Collective Health, reinforcing its commitment to the translation and application of knowledge in order to improve people’s health and lives.

Epidemiologia e pandemia de Covid-19: oportunidades para rever trajetórias e planejar o futuro

A pandemia de Covid-19 provocou modificações substanciais em diversas esferas da vida acadêmica. A Epidemiologia pode utilizar as experiências acumuladas nesse período como oportunidade para planejar seu futuro. O enfrentamento de uma pandemia exige a produção de teorias explicativas sobre o processo pandêmico e sua expressão desigual na população. Nesse sentido, a Epidemiologia necessita fortalecer seus fundamentos científicos e reconhecer os valores e limites de suas abordagens. Nesse caminho, é essencial o fortalecimento dos elos com outras disciplinas. Um novo modelo de ensino pode ser produzido por meio das experiências ao longo da pandemia, integrando conteúdos transversais, como a preparação para a resposta a desastres naturais e de origem tecnológica, incluindo epidemias e pandemias e a comunicação científica. O ensino da Epidemiologia precisa ser contextualizado com as bases da Saúde Coletiva, reforçando seu compromisso com a tradução e a aplicação do conhecimento para a melhoria da saúde e da vida das pessoas.

Challenges of translating epidemiologic research: An application to rheumatic and musculoskeletal disorders

Translation of research into public health policy is featured in common definitions of epidemiology, as an end result of scientific discovery on disease occurrence and causes. This dual nature of epidemiology, which brings together discovery and its use, seems to imply two main dimensions by which to judge epidemiologic research: technical or field-specific quality and societal value. This paper uses our research on the epidemiology of rheumatic and musculoskeletal disorders as a starting point to discuss the interface between these dimensions, exploring a number of conceptual, practical and ethical challenges that epidemiologists increasingly need to address when aiming for research translation. Those include not only the appraisal of the technical quality of research, which is familiar to researchers, but also the judgement on the usefulness and actual use of knowledge, as well as the assessment of the legitimacy of research based on translation potential. Several challenges lie ahead, but interdisciplinary conceptual and technical developments have the potential to guide future epidemiologic research of consequence. Approaches that recognize complexity and formalize the involvement of stakeholders in the research process within transparent frameworks open promising avenues for an effective translation of epidemiologic research projected into the future.

Post-Modern Epidemiology: When Methods Meet Matter

In the last third of the 20th century, etiological epidemiology within academia in high-income countries shifted its primary concern from attempting to tackle the apparent epidemic of noncommunicable diseases to an increasing focus on developing statistical and causal inference methodologies. This move was mutually constitutive with the failure of applied epidemiology to make major progress, with many of the advances in understanding the causes of noncommunicable diseases coming from outside the discipline, while ironically revealing the infectious origins of several major conditions. Conversely, there were many examples of epidemiologic studies promoting ineffective interventions and little evident attempt to account for such failure. Major advances in concrete understanding of disease etiology have been driven by a willingness to learn about and incorporate into epidemiology developments in biology and cognate data science disciplines. If fundamental epidemiologic principles regarding the rooting of disease risk within populations are retained, recent methodological developments combined with increased biological understanding and data sciences capability should herald a fruitful post-Modern Epidemiology world.

Epidemiology in a changing world: implications for population-based research on mental disorders

Introduction and objectives. Population-based research on mental disorders needs to keep pace with trends in general epidemiology. At present, this requirement is complicated by uncertainty within the parent discipline about its future development. The present study examines proposals for new directions in strategy and methods and considers their significance for psychiatric epidemiology. Method. Narrative review, cross-checked by search of English-language journals of epidemiology for new trends and developments reported in the years from 2000 onwards. Results. The proposals reviewed here are divided into three groups: 1. A new research paradigm of 'eco-epidemiology', which includes both individual risk factors and macro-environmental systems that mediate population levels of health and sickness. 2. Improved 'translation' of research findings - i.e. more rapid and effective implementation of epidemiological evidence into health policy and practice. 3. Adaptation of epidemiology to a globalised economy, with firmer regulation of funding and resources. Conclusions. Each of these proposals has implications for psychiatric epidemiology. Workers in this field, however, are still preoccupied by relatively specific problems of definition, measurement and classification, and so far the current debates in general epidemiology are scarcely reflected. The proposals outlined above call for: • a working model of eco-epidemiology as it relates to psychiatric disorders; • implementation strategies to encourage more active participation in epidemiological research by community health services and caregiver organisations; • international collaborative projects that offer practical benefits in training and service facilities for the countries taking part.

Diagram-based Analysis of Causal Systems (DACS): elucidating inter-relationships between determinants of acute lower respiratory infections among children in sub-Saharan Africa

BACKGROUND

Effective interventions require evidence on how individual causal pathways jointly determine disease. Based on the concept of systems epidemiology, this paper develops Diagram-based Analysis of Causal Systems (DACS) as an approach to analyze complex systems, and applies it by examining the contributions of proximal and distal determinants of childhood acute lower respiratory infections (ALRI) in sub-Saharan Africa.

RESULTS

Diagram-based Analysis of Causal Systems combines the use of causal diagrams with multiple routinely available data sources, using a variety of statistical techniques. In a step-by-step process, the causal diagram evolves from conceptual based on a priori knowledge and assumptions, through operational informed by data availability which then undergoes empirical testing, to integrated which synthesizes information from multiple datasets. In our application, we apply different regression techniques to Demographic and Health Survey (DHS) datasets for Benin, Ethiopia, Kenya and Namibia and a pooled World Health Survey (WHS) dataset for sixteen African countries. Explicit strategies are employed to make decisions transparent about the inclusion/omission of arrows, the sign and strength of the relationships and homogeneity/heterogeneity across settings.Findings about the current state of evidence on the complex web of socio-economic, environmental, behavioral and healthcare factors influencing childhood ALRI, based on DHS and WHS data, are summarized in an integrated causal diagram. Notably, solid fuel use is structured by socio-economic factors and increases the risk of childhood ALRI mortality.

CONCLUSIONS

Diagram-based Analysis of Causal Systems is a means of organizing the current state of knowledge about a specific area of research, and a framework for integrating statistical analyses across a whole system. This partly a priori approach is explicit about causal assumptions guiding the analysis and about researcher judgment, and wrong assumptions can be reversed following empirical testing. This approach is well-suited to dealing with complex systems, in particular where data are scarce.

Pairomics, the omics way to mate choice

The core aspects of the biology and evolution of sexual reproduction are reviewed with a focus on the diploid, sexually reproducing, outbreeding, polymorphic, unspecialized, altricial and cultural human species. Human mate choice and pair bonding are viewed as central to individuals' lives and to the evolution of the species, and genetic assistance in reproduction is viewed as a universal human right. Pairomics is defined as an emerging branch of the omics science devoted to the study of mate choice at the genomic level and its consequences for present and future generations. In pairomics, comprehensive genetic information of individual genomes is stored in a database. Computational tools are employed to analyze the mating schemes and rules that govern mating among the members of the database. Mating models and algorithms simulate the outcomes of mating any given genome with each of a number of genomes represented in the database. The analyses and simulations may help to understand mating schemes and their outcomes, and also contribute a new cue to the multicued schemes of mate choice. The scientific, medical, evolutionary, ethical, legal and social implications of pairomics are far reaching. The use of genetic information as a search tool in mate choice may influence our health, lifestyle, behavior and culture. As knowledge on genomics, population genetics and gene-environment interactions, as well as the size of genomic databases expand, so does the ability of pairomics to investigate and predict the consequences of mate choice for the present and future generations.

Epidemiology and bioethics: a plea for reconnecting with the public

The author takes the position that both epidemiology and bioethics, as practiced within academic establishments, have largely although not entirely abstracted the public context of health and well-being from their respective disciplines. It is argued that by and large both disciplines have been highly successful at what they do. However, this success can in part be attributed to each limiting its ability to look beyond its respective academic niche and thus embrace challenges which are socially challenging, politically charged, and academically messy. This narrow focus has become self-serving and ultimately detracts from fundamental remits of both disciplines in protecting the public from harm. Furthermore, it may re-enforce the inequalities of research into health overall, whereby the greatest concentration of effort remains firmly focused upon those who already have the most. Currently marginalized approaches to each of these disciplines - such as social epidemiology, global bioethics, and critical bioethics - provide us with platforms that challenge mainstream academic epidemiologists and bioethicists to seek out and reconnect their expertise with questions that are more relevant to real-world situations.

Explanatory pluralism in the medical sciences: theory and practice

Explanatory pluralism is the view that the best form and level of explanation depends on the kind of question one seeks to answer by the explanation, and that in order to answer all questions in the best way possible, we need more than one form and level of explanation. In the first part of this article, we argue that explanatory pluralism holds for the medical sciences, at least in theory. However, in the second part of the article we show that medical research and practice is actually not fully and truly explanatory pluralist yet. Although the literature demonstrates a slowly growing interest in non-reductive explanations in medicine, the dominant approach in medicine is still methodologically reductionist. This implies that non-reductive explanations often do not get the attention they deserve. We argue that the field of medicine could benefit greatly by reconsidering its reductive tendencies and becoming fully and truly explanatory pluralist. Nonetheless, trying to achieve the right balance in the search for and application of reductive and non-reductive explanations will in any case be a difficult exercise.

Learning the Lessons of the BSE Crisis

By any standard, the BSE crisis was a most difficult period in the public health of the UK. This period saw a previously unknown TSE emerge in cattle and then transmit to humans, a scenario which by August 2009 had cost 164 people their lives in the UK and which has resulted in an unknown number of other people incubating variant CJD (vCJD). The economic damage caused by this disease has been considerable. In April 2000, the government estimated that by the end of the 2001/2002 financial year, the total net cost of the BSE crisis to the Exchequer would be £3.7 billion (BSE Inquiry Report, Volume 10: 1). Less quantifiable consequences have also stemmed from this crisis. Chief amongst them has been significant damage to the public’s ability to trust the pronouncements of government on matters of food safety and risk. The scientific community has suffered inestimable damage to its expertise and to its capacity to provide objective, consistent scientific advice to the public. With such serious consequences emanating from the BSE affair, it is incumbent on all those who were involved in this tragic episode to reflect on the events that took place and to consider how things could have been done better. Such a reflective exercise has, of course, been conducted by Lord Phillips and his inquiry team who examined all the events that took place during the BSE epidemic and drew a wide-ranging set of lessons from these events. A reflective purpose is also a central motivation of the current chapter. However, the focus of this reflection – scientific reasoning in contexts of uncertainty – is altogether narrower than that undertaken during the public inquiry into BSE. Moreover, the question of reasoning in contexts of uncertainty was omitted from Lord Phillips’ inquiry into BSE and has also been overlooked within the vast literature that has been written on the topic of BSE both before and after this inquiry was conducted.

Invited commentary: genes, environment, and hybrid vigor

In the 1950s, case-control studies of smoking and lung cancer established a paradigm for epidemiologic studies of risk factors for chronic diseases. Since then, thousands of case-control studies have examined possible associations of countless risk factors with numerous diseases, rarely finding associations as strong or consistent as that of smoking with lung cancer. Recently, researchers have applied advances in molecular genetics to conduct candidate gene and genome-wide association studies of lung cancer. Skeptics among both epidemiologists and geneticists have argued that genomic research adds little value when most cases of disease can be attributed to a preventable exposure; however, well-conducted studies of gene-environment interactions that draw on data from more than 50 years of research in toxicology, pathophysiology, and behavioral science offer important models for the development of more comprehensive approaches to understanding the etiology of chronic diseases.

Point-counterpoint. The triumph of the null hypothesis: epidemiology in an age of change

The recent confusion concerning the relation between hormone replacement therapy and cardiovascular disease has stirred a new wave of debate about the value and future of epidemiology. Opponents of epidemiology suggest an ever-diminishing role in an age of small risks and complex diseases, yet proponents are not in consensus about how to adapt their discipline to the challenges associated with ageing societies and changing disease patterns. While epidemiology is likely to be increasingly called upon to make sense of the risks involved with these changes, wading into this era with a mindset and tools that were derived from epidemiology's 'golden era' of tackling major risk factors, has created more confusion than understanding. Increasingly, we need to downsize epidemiology to what is testable, measurable, and relevant, based on robust methodology and public health rationale. Applying an evolutionary perspective, that views health problems of modernity as a manifestation of the mismatch between our ancient genes and hi-tech lifestyles, can provide guidance for a 21st century research agenda.