IJE Advance Access originally published online on April 15, 2005
International Journal of Epidemiology 2005 34(4):729-731; doi:10.1093/ije/dyi076
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Commentary |
Commentary: On the article by Lester Breslow on the origins and development of the IEA
Iona, Cannon Fields, Hathersage, Hope Valley, S32 1AG, UK
Lester Breslow attended the first meeting of the International Corresponding Club (ICC), later named the International Epidemiological Association (IEA), which was held in Noordwijk, Netherlands, in September 1957 (Figure 1).
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He has played a key role in the development of the Association ever since, becoming Chairman for the years 1964–68 (Figure 2).
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In his paper in this issue of the IJE1 he gives a clear and accurate description of the origins of the Association and the ideas and activities on which it was based and he makes an important suggestion for a possible future role.
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The international role of the IEA |
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The international role of...
Early yearsHe emphasizes the international role of the IEA as repeatedly expressed in the words of our first chairman, Robert Cruickshank, ‘We must spread the Gospel of Epidemiology’. He describes how this has been done by the organization of regional meetings in various countries and by affiliations with other international organizations such as the WHO. It has also been done to a remarkable extent by the development of our modest cyclostyled ‘Bulletin of the ICC’ started in 1955, into the influential International Journal of Epidemiology of today.
The journal has played a very important part in spreading the knowledge of epidemiology worldwide.
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Early years |
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In the early days our efforts to obtain members from as many countries as possible were not always successful. The Soviet Union presented an unusual problem. When I wrote to the only epidemiologist I knew of in that country asking him if he knew of any suitable epidemiologists who might like to join the IEA he replied ‘yes of course, we have 20,000 epidemiologists in the USSR’.
Another little difficulty arose at a meeting held later in Prague when the Soviet representative, a professor of public health, insisted that for a problem to be epidemiological it must involve a disease transmitted by a living chain of organisms. An international confrontation was avoided when Donald Reid from the London School of Hygiene, in his inimitable way, asked the professor how he would classify the dancing mania of the Middle Ages.
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New concepts contributing to the creating of the IEA |
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Several influences contributed to the creation of the IEA. Probably the most important, referred to by Breslow, was the demonstration that the methods of epidemiology used in the study and control of infectious disease could be used with success when applied to some non-communicable diseases such as the work of Doll and Hill on lung cancer.2
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Relationships to clinical medicine |
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Another influence was a growing realization among a minority of clinicians in the 1940s that the social conditions of patients could play an important part in the cause of their diseases and affect their aftercare, especially among poorer people.
This change in attitude was included under the general term of social medicine. In the UK James Spence, a professor of child health in Newcastle, and John Ryle, the first professor of Social Medicine in the UK (1942), were leading clinicians who contributed to this movement.3,4
The interest of leading physicians like these who were also involved in medical education helped to get social medicine included in the medical curriculum and, as Lester Breslow points out, epidemiology is now recognized as a basic health science.
A number of leading professors of clinical medicine became members of the IEA and came to our early meetings including Jack Ustvedt (Norway), George Pickering and Melville Arnott (UK), Gunnar Biorck (Sweden), and Eric Cruickshank (Jamaica). This close contact with clinicians and clinical problems was of great value and a fruitful stimulus to the Association in its early years.
I think that more needs to be done to interest clinicians in epidemiological research today.
It would, I believe, be of mutual value and interest to epidemiologists and clinicians if joint meetings were held on a regular basis to discuss current disease problems such as obesity, depression, and diabetes and the role that epidemiology might play in their solution.
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Other disciplines which have contributed a great deal to the development of the IEA |
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Statisticians, social scientists, and psychologists have made very important contributions to the IEA and to epidemiology, and indeed to the whole field of medicine, over the last half century.
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The role of epidemiology |
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Lester Breslow comments on the achievements of the IEA in advancing ‘the scientific methodology of epidemiology’ but questions whether this may have lured some epidemiologists away from ‘the application of knowledge to improve health’.
There is a serious shortage of epidemiologists so it is important that those who are available should be used as effectively as possible. Many, I think, would agree that the most valuable function that epidemiologists can perform in the community is to discover the causes of disease and to suggest methods of prevention. It is important that as many as possible should be available to work in this field.
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Health services research |
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There has been a great expansion in health services research in recent years to which members of the IEA have made a big contribution. The recognition of its importance was largely due to the inspiration and work of a founder member of the IEA, Archie Cochrane.5
The work of Cochrane and many others in the field has done a great deal to make health services more efficient and cost-effective. It is however possible that it has deflected a good many epidemiologists from tackling the more important problems of the causation and prevention of disease.
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A new role for epidemiology: optimum health |
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At the end of his article Lester Breslow turns our attention to what he calls a ‘third epidemiological revolution’ to follow the successes of epidemiology in the partial control of communicable and non-communicable diseases. The challenge for the health professions now, he says, is not only combating disease but also in attaining and maintaining optimum health.
The idea of optimum health, as a condition far superior to the mere absence of disease, has been around for a long time. It has never been clearly defined or planned for on a big scale. Lester Breslow argues that it would be necessary to define optimum values for human physiological, anatomical, sensory, mental, and social characteristics and to identify a state of optimum health.
He provides some guidance on how these aspects could be approached. To establish optimum values of the characteristics listed would require much study and epidemiological research. He also refers to ‘health practices’, presumably meaning healthy behaviour, this would require a manual describing both healthy and unhealthy practices on a world scale.
Lester Breslow's vision for future work in epidemiology is exciting in its scope and possibilities. Although the task is immense and difficult it is one the IEA might well consider as a grand design for future research.
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References |
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1 Breslow L. Origins and development of the International Epidemiological Association. Int J Epidemiol 2005;34:725–9.
2 Doll R, Hill AB. A study of the aetiology of cancer of the lung. BMJ 1952;2:1271–86.[ISI][Medline]
3 Spence JA, Charles JC. Investigation into the health and nutrition of the children of Newcastle upon Tyne between the ages of one and five. City and Council of Newcastle upon Tyne. 1934.
4 Ryle JA. Aetiology: a plea for new concepts and new study. Lancet 1942;2:29–31.
5 Cochrane AL. Effectiveness and Efficiency. Random Reflections on Health Services. The Nuffield Provincial Hospitals Trust. 1972.
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