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CSU 36/2009: FOEGE ON THE USES OF EPIDEMIOLOGY/ LANGMUIR ON THE EPIDEMIC INTELLIGENCE SERVICE
CSU 36/2009: FOEGE ON THE USES OF EPIDEMIOLOGY/ LANGMUIR ON THE EPIDEMIC INTELLIGENCE SERVICE
| Thursday, 4th of June 2009 |
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1) FOEGE ON THE USES OF EPIDEMIOLOGY
Is epidemiology an academic discipline, or a tool of public health? Both, most people would say.
Here is William Foege writing on the subject. In 1984, he called for tighter tobacco control (tobacco advertising is now forbidden on American television, and cigarettes now cost $10 per pack, including heavy taxes) and for the universal use of air bags (now mandatory on vehicles sold in the US).
Full text, including Foege's comments on epidemiology and immunization practice, is at
While Foege is most widely known for his work in the control and eradication of infectious disease, he has also written on nutrition. For his views on iron deficiency, especially the building of coalitions to combat it, see full text at
From 'Uses of Epidemiology in the Development of Health Policy,' Public Health Reports,May-June 1984, 99:3, 233-6.
'Chemical health hazards in the environment are responding to epidemiologic analysis even though they are much more difficult problems than any others previously seen in public health. Instead of following a disease to determine etiology, we are often in a position of following a chemical forward in time to see if there is an association with disease. Policy decisions related to environmental hazards have been required frequently in the past several years, and more will be needed in the future.
'For instance, at Love Canal, information on the distribution and concentration of chemicals was combined with information on the known human or animal effects of those chemicals, and policy decisions were made about habitation. At Times Beach, information on dioxin concentrations and distribution, again combined with estimated human exposure and animal studies, led to decisions on habitation and clean-up requirements.
'We have known for a long time that restraints in automobiles can save lives and reduce injuries. Yet the use of child restraints did not result so much from a national policy decision as it did from the passage of laws by States-first Tennessee and now more than 40 States.
'The scientific case for air bags is strong, yet the policy decision has been thwarted by other influences, basically political in nature.
'With drinking and driving, the epidemiology is clear. We are now seeking some change in this country, not because of logical decision making based on epidemiologic data, but because a group of mothers were personally touched by this tragedy.
'Finally, rarely has epidemiologic evidence been as strong as that which now exists linking cigarette smoking and impaired health and premature mortality. One thousand premature deaths per day occur in this country alone because of cigarettes. Yet, rational policy decisions in this area have been difficult and when made, they have often been diluted by political factors. The epidemiologic evidence permits no excuse for allowing cigarette advertising. There is no excuse for nonsmokers having to pay the health bill that results from cigarette smoking. And new ways must be devised to clearly convey what we know to the general public, especially to teenagers.
'In summary, the support system for epidemiologic analysis and its role in policy formation continues to improve and broaden. The use of epidemiology is clearly increasing in the making of public policy. Health problems caused by cigarettes, highway injuries, and alcohol abuse make it clear that epidemiology has not yet reached its potential for producing sound public health policies.'
2) LANGMUIR ON THE EPIDEMIC INTELLIGENCE SERVICE
A visit to the homepage of the Epidemic Intelligence Service at http://www.cdc.gov/eis/about/s1990.htm shows how, decade after decade, it has become a global service, catering to the needs of epidemiology training and investigation in five continents.
It was not always so.The Center for Disease Control (as it then was) and the Epidemic Intelligence Service, which has trained thousands of epidemiologists for work in the US and the world, both started from humble origins, at a time when malaria, the original focus of CDC attention, was still endemic in 14 of the 48 American states. Here is the first hand account of Alexander Langmuir, who founded the EIS.
‘During the first year of my tenure as Chief Epidemiologist at CDC from the summer of 1949 to 1950, my major concerns were recruiting epidemiologically qualified personnel and fighting an internal bureaucratic battle with the administrators of the National Institutes of Health over CDC’s right to mount a broad epidemiologic service program.’
‘An intensive recruiting effort yielded the sum total of two young physicians who were genuinely interested but totally untrained. Our start was slow.
The issue with NIH was long-lived and sometimes bitter. . .This issue was resolved by a simple agreement that whichever agency received an epidemic aid request would clear the situation with the other before sending out a team of epidemiologists.’
‘ [internationally]. . .Dozens of officers participated in the later stages of the ill fated efforts at malaria eradication. More than 100 participated at all levels, over the full 10 years, of the successful smallpox eradication program. In fact, the director of the smallpox program and many of his major lieutenants had been in the EIS programme. At least 50 officers served long or short tours of duty with the Cholera Research Laboratory [now ICDDR/B] in East Pakistan, later to become Bangladesh. They worked not only on cholera, but on all diarrheal diseases, the family planning evaluation and demographic studies, and famine relief after the cyclone of 1970.’
Full text of Langmuir's article is at http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=6106957
Good reading.
BD
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