Harvard School of Public Health - Yearbook (Cambridge, MA)

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Lastly, the political, administrative, or demographic characteristics of certain areas may favor carrying out in these areas epidemiologic studies which would be difficult or entirely impossible in other areas. An example of this is the existence in Lebanon of two population groups of similar social circumstances and living conditions, one circumcised and one not. This makes Lebanon an ideal place for a study of cancer of the uterine cervix. Although this is really a national rather than an international study, it is international in the sense that the study was designed here by one of the depart¬ mental seminar participants and the department hopes to keep close contact with it as it develops. The latter situation is frequent. The school, because of the international origins of its student body, has an excellent opportunity to keep in touch with developments in health research throughout the world. Through the influence that we have on students while in the school, and by keeping in contact with alumni, the department has unusual opportunities for imparting an international flavor to many studies which are pre¬ dominantly national in character. The basic problems of design of epidemiologic research are universal. The problem of making a study practicable by translating concepts into operational definitions recurs in every setting. To the extent that any course in epidemiology given to the student body at this school provides experience in coping with such problems, it is a course in international epidemiologic research. 18

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I N the investigation of both infectious and non-infectious diseases international epidemiologic studies have been and will continue to be of great value. This is recognized in the recent change in policy of the World Health Organization whereby this organization now accepts as one of its functions the sponsorship and support of international epidemiologic research, in addition to its traditional service and advisory functions. So far as the current program of the Department of Epidemiology is concerned, the main interest in international studies is in their usefulness in investigating problems in the malignant diseases. Teaching in the department, however, acquires a much greater variety of international flavors through the combined Epidemiology and Biostatistics departmental seminar. The wide range of experience of the participants in this course brings a group of research problems as variegated as the world’s health. Some of these activities can be mentioned in the context of a discussion of the reasons why inter¬ national studies are desirable. International cooperative studies may be required because the number of cases or persons exposed may be insufficient in any one country to test a particular hypothesis. For example, to study the incidence of leukemia in women treated for cancer of the uterine cervix with ionizing radiation requires at least 60,000 person years of observa¬ tion of such patients. To do such a study we have organized with two American col¬ leagues and the support of WHO, a study now in progress in 27 large cancer centers, 21 in Europe and 6 in America. This has required individual visits to the participating centers as well as a joint meeting in Geneva. The problems encountered in seeking not only cooperation but also financial assistance from governmental or other agencies in nine different countries have provided an interesting experience which can prove useful in any future endeavors of this nature. International studies may be required because exposures or other circumstances that need to be investigated are present only, or predominantly, in certain areas of the world. High background radioactivity levels in certain parts of India and Brazil, for example, make these areas prime targets for epidemiologic studies, but no studies have been started in these areas, although preliminary discussions have been held. A related type of epidemiological problem arises when a disease is localized to certain areas so that one can presume that the causal agents are similarly limited. We heard in our seminar, for example, a design for the investigation of Bangu ngut, or fatal night¬ mare syndrome, a cause of death almost completely confined to the Philippines. International studies may be prompted by the observation of striking international variations in disease frequency. It seems reasonable to ask whether the circumstances associated with very low disease frequencies in certain countries can be identified, and, if so, whether this information has practical application in high incidence countries. Concurrent studies in both high and low incidence countries offer a better chance of identifying the relevant circumstances than do studies in either high or low incidence countries alone. To this end, the department is currently trying to organize an inter¬ national cooperative study of breast cancer with six or seven participating institutions in several parts of the world. 17

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Dr. Leslie Silverman Professor of Engineering in Environmental Hygiene and Head of the Department INDUSTRIAL HYGIENE 1