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

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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

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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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Seated —Eva Salber, Kathleen Shreeve, Maureen Molloy. Standing —Ascher Segall, Theodor Abelin, Brian MacMahon, George Hutchison, Manning Feinleib, Thomas Pugh. health or disease without a consideration of the environment in which he operates, whether that be biological or physical or social environment . . . Of course, one of the fascinating things about study¬ ing disease under the various conditions it occurs is serendipity . . . We had spent several months studying an epidemic of measles. And there was this August morning, a goodly reason for a certain amount of scientific satisfaction. We were inter¬ ested in diarrheal diseases and found that it was an important contribution to a death rate from mea¬ sles which, in this village, amounted to better than eight per cent compared with the minor fraction to which one is accustomed in Boston, for exam¬ ple. Also, I had a certain amount of satisfaction be¬ cause we had been working on a procedure which I had long practiced. Namely, that if one really wants to know about health in an underdeveloped country, there is one pretty sure way to find out and that’s to go into medical history and look into what happened in the present-day developed coun¬ tries a hundred years ago... John E. Gordon After the epidemiology exam. Museum of Fine Arts, Boston 21