American Journal of Epidemiology Advance Access originally published online on December 27, 2007
American Journal of Epidemiology 2008 167(3):375; doi:10.1093/aje/kwm379
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
LETTERS TO THE EDITOR |
RE: "THE GENERAL EPIDEMIOLOGIST: IS THERE A PLACE IN TODAY'S EPIDEMIOLOGY?"
RTI, International, 3040 Cornwallis Road, Research Triangle Park, NC 27517
(e-mail: slea{at}rti.org)
In his recent Journal article, David Lilienfeld posed an essential question regarding the future of epidemiology: "Is there a role for the generalist in epidemiology today?" (1, p. 3). It was reassuring to read that someone with such stature "was greeted with a mix of amazement and puzzlement" (1, p. 1) when describing himself as a "generalist," because it frees those of us other "generalists" to declare this fact.
Epidemiology is by its very essence a discipline constructed from pieces of other disciplines: demography (for population estimation), medicine (for disease endpoints), psychology (for understanding how to design questionnaires), statistics (for analysis of data), and, more recently, molecular biology, plus many other disciplines of course, depending on the "specialization." Through these disciplines, epidemiology provides a set of tools to generalize about disease outcomes in a population.
Like Dr. Lilienfeld, I became a general epidemiologist as a conscientious choice. I started my career in research-driven academic schools of public health involved in cancer and environmental epidemiology and then had the privilege to work in state and local public health departments, which rotated my view of epidemiology. I was proud to bring to public health practice technical training in a context where public health issues are not investigator initiated and are rarely static or clearly defined, and data are not always "clean."
Working in a public health department made me a better epidemiologist, because it expanded my contextual thinking and caused me to apply core epidemiologic principles in real-time problem solving (2). My colleagues in observational chronic disease epidemiology who are highly specialized (molecular, genetic, biomarkers, the "o-mics," etc.) have had difficulty intellectually relating to the role of an epidemiologist for a county or state public health department. The tools to conduct analytic epidemiology can be perceived to differ from the tools needed to conduct public health surveillance or disease investigations.
In reality, however, research questions, study design techniques, and analytic approaches may be generalized across specialized fields of epidemiology in cancer and infectious disease, where the context may differ. To conduct an outbreak investigation, for example, one must define the case (or disease endpoint), recognize the exposed and nonexposed, and decide whether the context of data collection lends itself to a cohort or case-control design. Molecular endpoints have added a layer of complexity to design and data analysis, but epidemiologic methods continue to evolve to keep pace with emerging science.
There is a shortage of epidemiologists in public health practice (3). Should epidemiology master of public health students be trained as "generalists"? Does one become a "generalist" by virtue of one's diverse professional path or research domains?
In modern epidemiology, it is the atypical student or professional who seeks to "specialize" in general public health methodologies that can be applied across specialization areas and professional contexts. Dr. Lilienfeld (1) has presented professional organizations and institutions that promote epidemiologic research and practice an opportunity to begin dialogue on these critical questions.
 |
ACKNOWLEDGMENTS |
|---|
Conflict of interest: none declared.
|
NOTES |
|---|
Editor's note: In accordance with Journal policy, Lilienfeld was asked whether he wanted to respond to this letter, but he chose not to do so.
|
References |
|---|
 TOP References |
|---|
- Lilienfeld DE. The generalist epidemiologist: is there a place in today's epidemiology? Am J Epidemiol (2007) 166:1–4.
[Abstract/Free Full Text] - Mausner JS, Kramer S. Mausner and Bahn epidemiology—an introductory text. 2nd ed. (1985) Philadelphia, PA: WB Saunders.
- Council of State and Territorial Epidemiologists. 2004 National assessment of epidemiologic capacity: findings and recommendations. (2004) Atlanta, GA: Council of State and Territorial Epidemiologists. (http://www.cste.org//Assessment/ECA/pdffiles/ECAfinal05.pdf). (Accessed December 17, 2007).
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||