The Development of Modern Epidemiology: Personal Reports from Those Who Were There (review)

This book blends autobiography and analysis to describe and interpret the history of epidemiology during the twentieth century. Fifty-five contributors from twenty-two countries have written about their careers and the history of either an area of epidemiology or the development of the field in a country or region of the world. Their book contributes to the history of disease, of public health policy and practice, of the methods, priorities, and politics of health research, and of institutions that educate, employ, and finance health scientists.

The editors array thirty-seven chapters in five sections. The chapters in the first section, "History and setting the scene" address the history of epidemiological concepts and methods, the present situation of the discipline, and the recent global burden of disease. The title of the second section "Specific disease areas of concern" is misleading because chapters in it address perinatal epidemiology, war, and natural disasters. The third section "Applications and role of epidemiology in related domains" has chapters on public health practice, health services research (HSR), as well as occupational, nutritional, and social epidemiologies. The chapter in Section 4, "Methodology," discuss theory, field investigation, data sources, and the growing importance of clinical epidemiology. The fourteen chapters in the final section, "Regions and countries," offer a geographical survey of the history of the discipline.

The chapters employ a common format. Each provides chronological description and analysis, preceded by a brief account of the relevant "personal experiences" of its author(s). The only exception is John Pemberton's chapter on the history of the International Epidemiological Association (IEA), which is primarily autobiographical because of Pemberton's prominence in organizing and leading the IEA.

This reviewer's favorites, among many informative and challenging passages, include: Rodolfo Saracci's insight that, as a result of the high value placed on "social solidarity" after World War II, policy-makers applied findings from epidemiological research more consistently than they do in the current "climate of neo-liberalism" (38); Colin Mather's assessment that controversial studies of the global burden of disease, despite severe methodological limitations, have "help[ed] to raise the profile of such low-mortality conditions as mental illness, musculoskeletal and sensory disorders, and dementia" (47); Henry Blackburn's observation that the "mobilization of a powerful bench and clinical elite" opposed to epidemiological research was an unintended consequence of the success of studies of risk factors in cardio-vascular disease (86); Mervyn Susser's and Landon Myer's claims that research on social determinants of health should be more important than assessing risk factors in disease (215); and Richard Heller's astute conclusion that "much public health policy is conceived and carried out without any epidemiological evidence" (270).

A number of authors omit notable events or distort evidence. Claude Rumeau-Rouquette and Gerard Breart limit their chapter on perinatal epidemiology to research in France. They ignore, for example, the landmark volumes by Iain Chalmers and colleagues that, for the first time, applied the methodology for conducting systematic reviews of clinical studies across an entire field of practice (Effective Care in Pregnancy and Childbirth, 1989). Lester Breslow declares that "as a result of epidemiological research and interventions based on them, the average life expectancy in the US . . . increased from 47.3 years at the beginning of the century to 77.2 years by the end of the century" (178). But a rising standard of living also contributed to longevity. Kerr White conflates the history of HSR with his autobiography, as he also does in several journal articles, a book, and an oral history interview. As a result he omits significant themes and events in the history of HSR and commits factual errors. Combining slander with error, for example, he claims that between the early 1970s and the 1990s the directors of the federal agency that conducts and finances most HSR in the United States...