Commentary: The rise and rise of corporate epidemiology and the narrowing of epidemiology's vision.

摘要

Reports of the impending death of epidemiology have proven premature. The year 2000 dawned, and our computer systems, and our system of epidemiological research, both continued to function. When judged by the numbers of epidemiology journals, publications and academic positions, the field is clearly thriving. Nevertheless, to have survived is not necessarily enough, and more is not necessarily better. The Rolling Stones have also survived since the 1960s, and sell more albums and concert tickets than ever, even though their ages passed their IQs in the 1990s and Keith Richards was lost to follow-up back in about 1975. When the current state of epidemiology is assessed in terms of quality rather than quantity, it is arguable that Ken Rothman's pessimistic vision of decline has partly been realized. The 'golden age' of risk factor epidemiology seems to have passed. The major discoveries (e.g. tobacco smoking and lung cancer, asbestos and lung cancer, diet and cardiovascular disease) occurred in 1950-80, and those of us who were bom too late have been left with studying the crumbs (or, worse still, studying EMFs). Moreover, the legacy of risk factor epidemiology is not, as Rothman predicted, 'the demise of major 20th-century epidemics attributable to tobacco, dietary fats and some carcinogens in the workplace'. In fact, dietary fat is with us in even greater quantities than before, and global tobacco and asbestos production have hardly changed since 1980-we have merely succeeded in moving their consumption to developing countries.