Big Epidemiology for Big Problems is the attention-grabbing title
used by Jonathan Samet, USC epidemiologist, in delivering the 17th
annual Robert Gordon Lecture at NIH. Without being too specific
about the definition of big, he described big problems as those
with a heavy disease burden, a high percentage of the population
exposed, a high relative risk, extensive costs to society, or
posing a big future disease risk. On the Big Epidemiology side,
Samet included studies with large sample sizes, large amounts of
data, a large budget, and/or conducted by a multidisciplinary
team.
Main Purpose
Actually, Samet’s main purpose in the talk was to provide his
perspective on the future directions of epidemiology as the field
continues to change in pursuit of its overall goal to understand
what drives human health. An alternative title for Samet’s talk
could have been taken from one of his slides, “The Times They Are
A-changin”
Earlier Era
In the earlier era, according to Samet, “…epidemiologists carried
out small studies that answered big questions. They found that
smoking caused lung cancer and heart disease and that reproductive
patterns determined breast cancer risk. One investigator, driven
by curiosity, could start and end one study.”
The classic example of the successful lone investigator is the
story of John Snow and the London cholera outbreak. For
other triumphs in epidemiology such as smoking and lung cancer,
the number of investigators per study remained relatively small.
A New Era Now
According to Samet, “a new era dawned at the millennium. We
entered a time of technology-driven change, large data sets, and
genomics. The age of clinical/translation research began.” During
this period, the growth of multi-authored papers has been
significant with increases in papers written by 50, 100, and 200
authors. The most striking increase in recent years has involved
the rise in papers authored by more than 500 persons!
Other Trends
Among the other changes noted by Samet are 1) the growth of health
systems based research and electronic medical records, 2) the use
of systems approaches to tackle problems, 3) increased data
sharing and access, 4) a view of research as a public good with
its associated demand for greater accountability, 5) the emergence
of new disciplines like bioinformatics, and 6) an increase in the
creation of networks and networking to address problems.
Samet called these changes a paradigm shift and illustrated each
from his own career. For example, he admitted he was not keen on
data sharing when at the outset of his career after working hard
for ten years to collect data for his first study. However, he
stated he has changed his mind on this issue and now supports data
sharing.
Model of a Public Health Problem
Also, Samet described the use of a model depicting the stages from
experimentation to disease to assess the impact of menthol
cigarettes on public health. The model, recently described in the
NEJM was helpful in pointing out the actual places in the pathway
where epidemiology could be useful, while at the same time
illustrating that epidemiology was not by itself the whole answer
to solving this public health problem.
Impact on Epi Careers
According to Samet, these paradigm changes have implications for
the careers and training of epidemiologists. Right now, he said,
“…we are training epidemiologists the way we used to,” and he
believes that the time has come to rethink this training. Is it
necessary for students to carry out their own cohort study or is
best for them to learn to download data to be used as part of a
larger undertaking? How can young scientists become independent
scientists in this environment? Should they become team members or
team leaders? And how do scientists gain credit for their
contributions?
Samet noted that this latter point is becoming more of an issue in
academia where promotion letters highlighting team contributions
are being read by bench scientists on promotion committees who do
not share the same appreciation for “team science”. Such science
has not yet drilled down very deep into the way many scientists
think, according to Samet.
Optimism
Samet was careful in his talk to make sure that listeners did not
interpret his stance on epidemiology to be a pessimistic one. He
said he is optimistic about epidemiology and would not want any
young persons to change their mind about such a career path based
on his assessments. He brought up a favorite quote from former
Governor Richard Lamm of Colorado to buttress his point. He
stated in 1986 that “the major factors that brought health to
mankind were epidemiology, sanitation, vaccination,
refrigeration, and screen windows.”
Samet closed his talk by noting further that epidemiology’s appeal
is its potential to save lives, not one at a time, but millions at
a time. To view a videocast of Samet’s Gordon Lecture, visit
http://videocast.nih.gov/pastevents.asp?c=0&s=21
Join the discussion online at Talking Epidemiology (www.epimonitor.net)
about the implications and impact of these changes on the careers
of epidemiologists in academia and in other sectors.
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A printable PDF
version of this article is available for download by clicking
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"a new
era dawned at the millenium"
"the
major factors that brought health to mankind were
epidemiology, sanitation, vaccination, refrigeration, and
screen windows."
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