BOOK REVIEWS |
A History of Epidemiologic Methods and Concepts
Edited by Alfredo Morabia ISBN 3-7643-6818-7, Birkhäser Verlag, Basel, Switzerland (Website: www.birkhauser.ch), 2004, 405 pp., $119.00 (softcover)
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205
Surprisingly little has been written on the history of epidemiology. A 1980 volume edited by Abraham Lillienfeld presents a series of essays, Rosen's history of public health covers highlights, and biographies have been written on some key figures: Snow, Chadwick, Goldberger, and Frost, for example. Yet, there has not been a single volume that attempted to cover the topic, nor even a comprehensive review to recommend to students. Alfredo Morabia has taken a step toward addressing this gap by bringing together a set of papers that originated with a 1996 meeting on the history of epidemiology. The volume begins with his own lengthy synthesis of the individual contributions, which sweep broadly across the major themes of epidemiology—study design, bias, and causation. The essays that follow cover these and other topics; the authors are epidemiologists, including some of the field's most senior leaders, and historians.
Alfredo Morabia's lengthy contribution anchors the volume. He skillfully blends materials from across the individual chapters to offer a long-needed single paper on the evolution of epidemiologic methods. His approach is didactic, combining historical snippets with lessons on epidemiology. This approach will work for students of epidemiology but may frustrate those looking for a flowing, historical account, and of necessity, he cannot cover any individual topic in depth. He attempts to characterize the evolution of epidemiology, offering a four-phase sequence from "preformal" to "modern" and proposing that there have been qualitative leaps from phase to phase. Although necessarily arbitrary in its distinctions among these phases, Morabia's sequence indicates that epidemiology is probably at another point of transition.
The remaining 250 pages present essays, commentaries, and republication of an 1838 paper by William Farr. As with most multiauthored volumes, the chapters are mixed in style, approach, and quality. Readers will find a range of approaches to documenting the history of epidemiology: the detail-based styles of the historian; personal accounts; and more conventional reviews. The variety limits the volume, as readers cannot find equal depth of review across topics, and coverage of some topics would have benefited from the perspective of unrepresented disciplines, for example, philosophy, in the example of causality.
Some of the chapters sparkle. Richard Doll's paper on the cohort study blends the evolution and application of the design with a recounting of his own seminal contributions in remembrances that only he could provide. George Comstock reviews Frost's development of cohort analysis and carefully documents that Andvord had published a similar analysis of Norwegian data 6 years previously. Farr's paper, "On Prognosis," sets out an epidemiologic perspective on disease survival and its determinants with remarkable conceptual clarity, particularly considering its 1838 publication date. The four commentaries that follow guide the reader in understanding Farr's early contributions and document his prominence in setting the foundation for contemporary epidemiology. Many other papers are noteworthy: the evolution of the case-control study, an accounting of statistical methods in epidemiology, and perspectives on Snow. Eyler provides a fascinating comparison of the work of Farr and Snow on cholera, as viewed in the disease paradigms of their times. Vanderbroucke traces the evolution of "the image of John Snow," proposing that this image has been shaped over time as Snow has been transformed into the present "hero of epidemiology." Hardy and Magnello summarize the methodological work of Pearson, Ross, Greenwood, and Hill, whose analytical work set a foundation for modern epidemiology. Greenwood, at the London School of Hygiene and Tropical Medicine, appreciated the nexus of biology, epidemiology, and statistics and was Hill's mentor.
Some contributors took on difficult topics—bias, confounding, and causality. These papers draw on the epidemiologic literature to a large extent without an in-depth historical perspective. Nonetheless, they offer useful overviews and biographies for those seeking future insights. These chapters may be particularly useful for students and younger epidemiologists who have not witnessed the evolution of these concepts in recent decades. However, those of us who are not new to the field can also benefit: I learned, for example, from Vanderbroucke that historical uses of the term "confounding" are closely related to current epidemiologic concepts, as well as from Vineis's chronicle of the concept of bias. Causality is covered from an epidemiologic perspective, but the book would have benefited by a contribution from a philosopher or historian of science who has focused on this difficult, but central, topic. Stellman covers causation in occupational epidemiology, an area of inquiry where causal conclusions have had significant regulatory and legal implications.
This book will be my recommended starting point for reading about the history of epidemiology. Although patchy in its coverage, it introduces readers to key figures and the historical dimensions of central concepts. I hope that the work of Morabia and his colleagues will be extended into a long-needed, comprehensive accounting of epidemiology's evolution. To paraphrase, "More history is needed."
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