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

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... Infiltration of the medical curriculum ... TTYith respect to subject matter, the following ’ are responses to the Yearbook editors’ ques¬ tion— What would you like your field to accom¬ plish in the next decade or two?”: 1. Clarification of the roles of exercise, diet and heredity and their inter-relationship in the etiology of coronary heart disease. 2. Elucidation of the etiology of the common malignant neoplasms of the digestive tract and reproductive organs, and, in particular, under¬ standing of the reasons for the remarkable international variation in rates of these dis¬ orders. 3. Explanation of the racial and international dif¬ ferences in prevalence of hypertension and cerebro-vascular accidents. 4. Development of operational diagnostic defini¬ tions of mental illness that lend themselves to analytic epidemiologic investigation. 5. Identification of other microbiologic, chemical and physical agents associated with fetal mal- development. Methodologically, the greatest need seems to be the improvement of data collection procedures— the automation of data retrieval from vital and other medical records, development of the tech¬ nology of record linkage (family and individual), and improvement of the facilities for long-term follow-up studies. Administratively, I would like to see continued infiltration of the medical curriculum and of clini¬ cal practice so that the insights of the clinician and the technology of the epidemiologist can be brought to bear simultaneously on problems of common concern. Brian MacMahon Brian MacMahon, M.D., Ph.D., D.P.H., S.M. in Hyg. 19

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...A Constitutional Stroll T iostatistics has arrived! One of its members, sig- nificance testing, has been added to the list of necessities. Everyone talks about significance, the journals insist on it and even doctors are taught tests of it. Every observation is soon challenged by the question, Are you significant?” The only dis¬ senters are the extremely cautious who insist that a real difference must be obvious without a test, an argument that accepts the basic skepticism of sig¬ nificance testing although it rejects the techniques. Acceptance has been accompanied by excessive enthusiasm and significance tests have appeared where they never ought to have. The null hypothe¬ sis that could not be rejected has been offered as proof of equivalence. Elsewhere significance tests have been taken too literally by the gullible who regard them as essential distillates, while the sub¬ stance of the data is relegated to insignificance.” Moreover, respectability imposed a canon of pro¬ priety. Editorial policy in some cases has rigidly prescribed a familiar format rather than one tai¬ lored to the needs of the problem and thereby robbed the techniques of their versatility. Regard¬ less of these imperfections, the utility of analysis of data according to mathematical models has been demonstrated. With computers as draft animals, biostatistics can turn to the revival of relative likelihood argu¬ ments, the development of non-parametric meth¬ ods and, possibly, enjoyment of the fruits of multi- David Heer solving a problem. variate analysis. Will these find their way into Biostatistics lab in the years to come? My guess is probably not. At least not in the sense that 6, t and p or q are found there today. As techniques of analysis become more varied and more demand¬ ing on the user, it becomes less and less justified to present a survey of their rudiments. Putting the £-test in the hands of everyone did not eliminate illogical or otherwise improper comparisons; rather it permitted these errors to be dressed up. The in¬ clusion of new techniques would only enlarge the wardrobe. Statistics is not for everyone, but logical observation is . Therefore the biostatistics course of the future may not be very different from the pres¬ ent one. The emphasis will still be on approach rather than techniques, but it will continue to be coupled with a constitutional stroll through a sig¬ nificance test. James Warram 18

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... The relevant variables ... npwo years of experience in the control of tuber- ■ - culosis has directed my attention to the widen¬ ing gap between the development of epidemiologic knowledge and its employment to yield health benefit. Responsibility for the formulation and ex¬ ecution of control programs usually lies outside the province of epidemiology. But, I believe, epide¬ miologists of the future may play a useful role in the transformation of new knowledge into more effective methods of control. The formulation of effective methods will re¬ quire the participation of various professionals— administrators, sociologists, economists, and epide¬ miologists. To resolve a particular problem, these professionals will need to develop and share a com¬ mon language, a language which describes the in¬ teractions of the total system under study. Relevant variables will include factors such as patients’ pref¬ erences and community resources in addition to time-honored age, sex, and occupation. Hence, those epidemiologists who participate in the for¬ mulation of strategies for disease control will find useful a broad conceptual framework that will ac¬ commodate these many variables. Thus far, this framework has not been developed. I believe that within the next two decades men will begin to use sys tematically a science of values, that is, an empirically-determined system of weigh¬ ing preferences for alternative acts. Epidemiologists who participate in developing strategies for disease control may find knowledge of this science of values useful. There will be a need for a new kind of epidemiology, one that deals with problems of synthesis as well as those of analysis. Frederic Bass Frederic Bass ... You get down to basic considerations... On January 12th, Dr. John E. Gordon, Professor Emeri¬ tus of Preventive Medicine and Epidemiology at the Harvard School of Public Health, spoke informally about a lifetime of work in epidemiology. Excerpts from his talk are printed below. W e speak oftentimes of the epidemiologic method. I don’t know much about what the epidemiologic method is. It has no particular indi¬ viduality. I think it is nothing but the scientific method turned to a special purpose: the study of disease and injury in groups of people in its natu¬ ral environment. It is based, like scientific method in general, on Baconian principles as they were refined by Claude Bernard, and little else. What it is, of course, is the attempt to develop a sophisti¬ cated understanding of disease under a variety of conditions. But it is more than geographic pathol¬ ogy ... It is more than provincialism in approach to disease, based so many times on the idea that most great secrets about disease are found in mod¬ ern metropolitan cities. I have a great liking—I have for all my life— for the study of disease in rural populations. I like particularly the studies we made in the Arctic be¬ cause the flora is simple, the fauna is simple, and the people are simple. You get down to basic con¬ siderations. I also believe that a goodly part of the advantage of epidemiology is in the fact that there is a futility to studying the behavior of man in 20