Three Views on the Track Record of Epidemiology
• View 2: Rodolfo Saracci
Director of Research in Epidemiology
National Council, Pisa, Italy and Adjunct Professor of Epidemiology, University of Aarhus, Denmark

Modern or post-modern epidemiology?

The label “modern” epidemiology has come to denote – in essence- epidemiology as developed on the basis of renewed and rigorous methodological foundations in all substantive areas (non-communicable and communicable diseases, studies of reproduction, physical and mental development etc.) in the three decades that followed World War II as well as its subsequent expansions till present day. Methodology is the common characterizing trait, a feature that soundly supports the claim that modern epidemiology is “needed everywhere” in medicine and public health. This all pervasive role of epidemiology may not be maintained, however, without a cost, as an always-needed tool easily becomes an all-purpose tool, with no sharp priorities outside its own internal development. It can be argued that this cost may already started to materialize in the current social climate, dominated by “neoliberal” economic thinking and practices, in which an unobstructed continuity between epidemiological results and their translation into benefits for all sections of society appears no longer (unlike the first post-World War II decades) warranted, as economically based – or so alleged- political barriers may be raised to obstruct or distort this transfer at any stage. To ensure that these widespread barriers are bypassed and epidemiological research results are transferred into health benefit for all people demand an active involvement of variable form, from assistance to full participation in health related decision making processes, from social critique to advocacy, that epidemiologists may see well beyond their all-absorbing commitment to research , particularly in a period in which the new biology has opened plenty of novel avenues to epidemiology. To the extent that this attitude is prevalent modern epidemiology may be better characterized as “post-modern” , sharing with post-modern thinking the reluctance to engage in any global design, like the active pursuit of an “health for all people” programme, at the levels of local, regional, national and international communities. It is well to reiterate with the late A .Lilienfiled that if without epidemiology there is no public health, the reciprocal also holds, namely without public health there is no epidemiology, as epidemiological research becomes amputated of its not exclusive but certainly key justification. Hence averting the post-modern risk demands- consistent with the historical role of epidemiology- a continuously renewed, proactive alliance with public health (a development which may deserve the label of “neo-classical “ epidemiology).

References
The considerations summarized in this abstract have been elaborated in previous papers :
- Epidemiology in progress : thoughts, tensions and targets. Int J Epidemiol 1999;
28 : S997-8.
- Caminante no hay camino, se hace camino al andar . Eur J Epidemiol 2004 ; 19 : 725-8.
- Epidemiology : a science for justice in health. Int J Epidemiol 2007 ; 36 : 265-68
- Epidemiological concepts pre-1950 and their relation to work in the second half of the century . In : Holland WW, Olsen J, Florey C du V (eds). The development of modern epidemiology. Oxford University Press : Oxford; 2007. pp.31-40 [this book is a valuable source of information ]
- Health information and health deformations : a critical look at post-modern epidemiology. Epidemiol Prev 2007 ; 31 : 239-46. [in Italian]

Job Title: Director of research in epidemiology, National Council, Pisa, Italy and Adjunct Professor of Epidemiology, University of Aarhus, Denmark; Scientific consultant, International Agency for Research on Cancer, Lyon, France.

Main Qualifications: M.D.; PhD in medical statistics

Research Interests: During my clinical years my early research was in clinical trials and methodological evaluation of laboratory tests. Subsequently I developed these areas for more than twenty years at the international Agency for Research on Cancer where I have been co-ordinating large multinational studies on cancers in relation to the general, residential and occupational environment and more recently, in relation to nutritional factors. Currently I am responsible for the expansion of the latter studies to the investigation of cardiovascular diseases. I keep an active involvement on methodological issues, in particular on methods for improving exposure assessment in epidemiology and on interaction between aetiological agents, as well as on ethical issues in epidemiology.

Linked to research training I started and have been directing the international summer school of the "European Educational Programme in Epidemiology" in Florence, currently in its eleventh year.

Throughout my career I have served on the editorial board of several leading epidemiological journals, in a number of epidemiology and public health international committees - particularly at the level of the European Union and as president of the ADELF, the international association of French speaking epidemiologists.