IJE Advance Access originally published online on February 14, 2008
International Journal of Epidemiology 2008 37(5):1193; doi:10.1093/ije/dyn004
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Letters to the Editor |
Author's response
* Director, Centre for Public Health Research, Massey University Wellington Campus, Private Box 756, Wellington, New Zealand. E-mail: n.e.pearce{at}massey.ac.nz
I thank Professor MacMahon for his comments. I was asked to write my commentary1 as part of a series of commentaries on a reprint of a paper by Ken Rothman.2 This is why I specifically refer to Ken's work several times in my commentary. I had expected that all of these papers would be published together and that therefore any subsequent correspondence would relate to the whole set. Instead, my piece was finished and posted first, and MacMahon's letter refers just to this piece. In fact, Cesar Victora's commentary,3 which was posted a week later, makes essentially the same points as mine.
MacMahon's letter provides an excellent example of the narrowing of epidemiology's vision to which I refer. When I first trained in epidemiology, I learnt from MacMahon's excellent textbook4 which defined epidemiology as ‘the study of the distribution and determinants of disease in human populations’. At the time, it was widely recognized that the determinants of disease (and injury) included both proximal (downstream) causes such as tobacco smoking and distal (upstream) causes such as socioeconomic factors. As I have said many times, the point is not to criticize studies of proximal factors, including those listed by MacMahon (I spend most of my time studying them myself), but to take a balanced approach in which upstream determinants of disease are also considered. The issue is not whether epidemiologists should be activists about the upstream determinants of disease, such as poverty, but whether they should study them.1 However, as MacMahon's letter illustrates, the vision of epidemiology has narrowed so that upstream factors such as poverty and climate change are no longer considered (by some) to be causes of disease (or injury). This is undoubtedly news to the victims of Hurricane Katrina. But fortunately things are changing, as indicated by the publications referenced in my commentary.
References
1 Pearce N. Commentary: The rise and fall of corporate epidemiology and the narrowing of epidemiology's vision. Int J Epidemiol (2007) 36:713–17.
2 Rothman KJ. he rise and fall of epidemiology, 1950–2000 AD. New England Journal of Medicine (1981) 304:600–2.[Web of Science][Medline]
3 Victora C. Commentary: Epidemiology and futurology – why did Rothman get it wrong? Int J Epidemiol (2007) 36:712–13.
4 MacMahon B, Pugh TF. Epidemiology: principles and methods. (1960) Boston: Little, Brown.
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