Table Of ContentEpidemiological Research
O.S. Miettinen • I. Karp
Epidemiological Research:
An Introduction
123
O.S.Miettinen I.Karp
McGillUniversity Universite´deMontre´al
Universite´deMontre´al Montre´al,QC
Montre´al,QC Canada
Canada
CornellUniversity
NewYork,NY
USA
ISBN978-94-007-4536-0 ISBN978-94-007-4537-7(eBook)
DOI10.1007/978-94-007-4537-7
SpringerDordrechtHeidelbergNewYorkLondon
LibraryofCongressControlNumber:2012942327
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Foreword
‘In my life ever since medical-school graduation half-a-century ago, I’ve had the
dreamofreachingtrueunderstandingofthetheoryoftheresearchthatwouldbest
servetoadvancetheknowledge-baseofmedicine,ofgenuinelyscientificmedicine.’
OlliMiettinenwrotethisayearorso agoinhisEpidemiologicalResearch:Terms
and Concepts. For those who have had the privilege to witness his odyssey since
the 1970s, the current book comes as both a wonderful revisit of the past and
a great leap into the future. Miettinen’s text accompanying his course in the
1970satHarvardwas‘thefirstsystematicintroductiontotheoreticalepidemiology’
(Greenland) and can be viewed as the start of ‘modern epidemiology’(Morabia).
But he never published it and therefore the book that you read now is the first
publishedintroductionto epidemiologicalresearchby thefatherandgrandmaster
ofmodernepidemiology.
Epidemiological Research: An Introduction, the current book of Miettinen,
in collaboration with his junior colleague Igor Karp, is a true milestone for
epidemiology, but a cautionary word may be in place about the ‘introduction.’ I
remember Miettinen referring to his courses as basic, but not basal. The current
book,similarly,isbasic,butnotbasal.Itisintroductoryinthatitdevelopstheobjects
and methods of epidemiological research from first principles, but it does so in a
breathtakinglysophisticated way, alternatinglygrandand subtle in argumentation,
visionaryanddown-to-earth,broadanddeep.Forthisreaderonethingisparticularly
clear:Miettinen’sdiscussionisstillunparalleledinourfield,thelogicandcoherence
isasspellbindingasever(andIneedtothinkabitmore,andbetter,ifandwhenI
donotfullyunderstandwhathewrites).
Thestructureofthisbookmustbeatreatforallepidemiologists.From‘epidemi-
ology:grapplingwith the concept’through‘etiologyas a pragmatic concern’and
the ‘objectof study’ to the book’score on ‘objectsdesign’and ‘methodsdesign,’
it is like travelling to familiar destinations along new roads. Although Miettinen
has always stressed the importance of objects design from first principles, I think
this book is the first to treat this topic systematically and somewhat extensively.
AndalthoughMiettinenhaspublishedquitecomprehensivelyonthefallaciesinthe
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design of epidemiologicalstudies and their remedies, I find his discussion of ‘the
etiologicstudy’freshandsummarizedaptlyandsuccinctlyin‘epluribusunum’and
‘eunumpluribus.’
What will be the effect on the practice of epidemiologicalresearch? I have no
doubt that it will be vast, but also that it will be slow to come. In the long run,
his arguments will turn out to be irresistible, although most likely modified and
expanded.Itisliketheeffectofepidemiologicalresearchonmedicalpractice:itis
hardlyeverdirect,itnearlyalwaystakesalongtime,butintheenditmakesatrue
corecontribution.
Ipaytributetothefatherofmodernepidemiology,andrecommendthisvolume
to assist in deep epidemiological introspection. It will benefit epidemiology and
epidemiologistsgreatly.
Albert Hofman, M.D., Ph.D., Professor and Chair, Department of Epidemiology,
ErasmusMedicalCenter,Rotterdam,TheNetherlands.
Preface
Anyoneconductingepidemiologicalresearchis proneto encounterobviousmajor
challengesofaconceptualnature,sometimesseeingthemtobetauntinglycomplex,
at other times subtle beyond concrete grasp. But the challenges can also remain
unrecognizedandtherebyunmet,onesofmajorconsequenceincluded.
Even when no longer a beginner in the research, the investigator may wonder
abouttheadequacyofthecopingswiththesechallenges,notablywhenconsidering
howcontroversialmanyofeventhemuch-researchedsubstantiveissuesremainand,
thus, how little consequence the research – his/her own and that of others too –
is having in the evolution of knowledge-based societal policies about healthcare
and in the advancement of public-health practices within their respective policy
frameworks.
The keyto attaining,andmaintaining,the conceptualunderstandingsthatform
thebasisformaximallyconsequentialcareersinepidemiologicalresearchwetaketo
besuitableintroductionto–andtherebytheattainmentofawholesomeoutlookin–
suchresearch.To thisend,authorsof introductorytextbooksonthe researchneed
to try to present basic ideas that are so obviously well-focused and so obviously
tenablethattheytherebygettobe–evenwheretheyaren’tyet–commonlyagreed
upon by the teachers as properly constituting the core content of an introductory
courseontheresearch.
In our view, an introductory course on epidemiological research should bring
to focus, and give tenable answers to, such orientational, normative questions as:
To what pragmatic ends should the research be conducted? What, as for both
substance and form, should the population-level research be about? What should
be understood to be the necessary, logical nature of those studies themselves on
the principal generic types of object of study? What are the main concerns and
principles in the optimization of the objects and methods of those studies? and
Howshouldtheevidencefromthestudiesbetransmutedintoknowledgeaboutthe
respectiveobjectsofstudy?
We here make a serious effort, our first, to formulate answers to these, and
related, questions for possible incorporation into teachers’ efforts to properly
introduce their students to the research – specifically, as insinuated above, to
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viii Preface
epidemiological research that would be maximally consequential and hence per-
sonallymostgratifyingtothem,withsocietyatlargenotonlythesponsorbutalso
thecorrespondingly,ifnotevenmorerichly,rewardedbeneficiaryofit.
In this effort we are guided by our belief that a proper introductorycourse on
epidemiologicalresearch,like its counterparton physicsforexample,conveysthe
mostadvancedinsightsintothemostelementary–themostappropriatelychosento
bethemostelementary–componenttopicswithintheoveralltopic;andouraimis
tointroducetheminalogicalsequence,formostnaturalandeffectivestudybythe
students.Acontemporaryintroductorycourseonphysicsteaches,forexample,that
theformerlycommonideaofetherasaubiquitousmediumforelectricandmagnetic
forces(a`laMaxwell’sequations)isnowseentohavebeenamisunderstanding;and
a suitablyadvancedintroductorycourseonepidemiologicalresearchnowteaches,
forexample,thatthestill-commonconceptsofcohortstudyandcase-controlstudy
shouldalreadybepasse´.
Thereisastory(apocryphal)aboutthephysicistNielsBohrandthephilosopher
Bertrand Russell concerningtheir respective decisions notto study psychologyin
preparationforacareerinit,abouttheirrespectivedecisionstostudymathematics-
cum-physicsandmathematics-cum-philosophyinstead.Bohrissaidtohaverejected
the psychologyoptiononthe groundthatthisfield is too easy,and Russell onthe
groundthatitistoodifficult,togainmasteryof.Weareoftheviewthatpreparation
foraproductiveandtherebygratifyingcareerinepidemiologicalresearch–different
fromastellarcareerinquantumphysicsortheoreticalphilosophy–doesnotrequire
anyextraordinarytalent.Butwealsoarekeenlyaware,fromourpersonalstruggles,
that it requires much effort and – to say it again – a proper introduction and its
consequentproperorientationasimportantprerequisites.Thestudentneedstomake
the investment of the effort, upon us having endeavored to help the teacher to
providethelatter.
Muchofanintroductorycourseonepidemiologicalresearchnecessarilyisabout
concepts – and the corresponding terms – germane to such research (refs. 1, 2
below). It thus likely would materially enhance the teaching, and the learning, to
supplementthistextbook(oranyother,forthatmatter)byacompendiumproviding
suitableintroductoryexpositionanddiscussionofthoseconceptsandterms(ref.2),
forconsultationas needed.For,dwellingon theconceptsandtermsin the flowof
a course like this would tend to take away from the students’ grasp of the logic
underpinningthesequenceofconcepts-basedideasbeingintroduced,manyofthem
quiteoriginal.
References
1. Miettinen OS. Important concepts in epidemiology. In: Olsen J, SaracciR,
Trichopoulos D. Teaching Epidemiology. Third edition. Oxford: Oxford University Press,
2010.
2. MiettinenOS.EpidemiologicalResearch:TermsandConcepts.Dordrecht:Springer,2011.
Acknowledgements
Miettinen fils – a polymath, even if thus far without the evidentiary portfolio of
writings–studiedalate-versionmanuscriptofthisbook.Weaskedhimtoimagine
the youngest one of his children, the only one still young enough to realistically
consider, as a potential student of one of this youngster’s paternal grandfather’s
fields (theory of epidemiological research, the other one being theory of meta-
epidemiological clinical research) and to consider – critically! – this text as the
textbook in that youngster’s introduction into this field. And we asked him to
commentfromthegeneralindustrialperspectiveonwhatwewrote(sect.14.5)about
epidemiologists’role in quality assurance – economic as well as medical – in the
hospital-basedsegmentofhealthcare,which in Canada now absorbsabouthalfof
theeverlesssustainablefiscalburdenofthecountry’spublic-healthindustry.
Hedelightedus,forone,withalearnedcommentaryonintroductoryteachingof
scholarlysubjectsatlargeandonhowthistextconformswiththemostnotableideas
aboutit;andforanother,heprovideduswithanequallyinsightfulcommentaryon
industrial quality assurance in general and on its implications for modern public-
healthpractice.Andforgoodmeasure,hepermittedustoincorporatebothofthese
commentariesinthisbook(Apps.4,5).
We also asked Albert Hofman, of Erasmus University Medical Centre, Rotter-
dam – today’s preeminent leader of teaching on all aspects of epidemiological
research,fromintroductorycoursesonup,inthe ErasmusSummerProgrammein
particular – to critically review a near-final draft of this book, with a view to his
possiblywritingtheForewordtoit.
Hofman indeed was kind enough to read the draft, and he had quite gratifying
wordstosayaboutit.Whatismuchmore,hedidagreetowritetheForeword.We
aremuchobligedtohim.
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