Epidemiology: quo vadis?

Abstract

In our etiologic research, we epidemiologists need to leave behind the concepts of 'cohort' study and 'case-control' study and adopt that of the etiologic study as the singular substitute for these. We then need to realize that the etiologic study is well suited to be viewed as paradigmal for intervention studies. We finally need to become serious about object design before methods design in both etiologic and intervention research. Once these developments have occurred, we'll be ready for truly meaningful research to advance the knowledge base of both types of causality-oriented 'gnosis' in the practice of clinical medicine, etiognosis and intervention-prognosis; and descriptive-prognostic study we'll see as inherent in any intervention-prognostic study. As for diagnostic research, then, we need to come to see it as nothing but a special case of our familiar descriptive prevalence research. Because of this readily attainable theoretical readiness peculiar to us research epidemiologists, and for other reasons besides, only we can assume the central role in the production of the knowledge base for scientific medicine. We consequently have the obligation to assume this larger and higher, meta-epidemiologic mission--and some even higher ones besides.