Clinical Epidemiology in Developing Countries: Current Situation and Suggestions for the Indian Context

Abstract

Introduction Epidemiology in medicine or Clinical Epidemiology (CE)CE has now gained a well established footing in academic institutions especially in developed countries. In the context of the established network of 'epidemiology teaching learning centres' , CE is slowly becoming popular in the schools of medicine in India also [1,2]. Originally epidemiology was evolved as a fundamental science of public health. When the importance of application of principles of epidemiology in the bedside setting for improving clinical outcomes was recognized, the branch of clinical epidemiology was slowly accepted. During the course of evolution of organized health care, the dichotomy of public health and clinical medicine was inevitable and discussions on this dichotomy still continue. This schism as it was coined by KerrL White can be considered as one of the causes of low popularity of CE among clinicians [3]. Clinical practitioners are always concerned with the immediate benefits for their patients and may not use epidemiological principles in their daily practice unless it is convincingly useful for immediate patient benefits. With the evolution of the branch of clinical epidemiology, with tools like diagnostic test evaluation, prognostic prediction, and clinical trials and meta-analysis, CE is becoming more and more popular among clinicians. This may be the main reason for popularity of epidemiology among clinicians rather than merely an attitude of altruism towards scientific practice of medicine. The altruistic concept of practice of medicine as it was discussed needs a deeper understanding of public health [4]. The criticisms about use of epidemiology by clinicians were discussed in detail by Paul K Whelton [5]. Public health and clinical epidemiologyAfter discussing about the popularity of epidemiology in clinical medicine let us discuss on the applications of epidemiology in public health. In the public health context, application of epidemiological principles is more for prevention than for treatment. Integrating prevention to routine functioning of health services was mostly through implementation of public health programs as governmental responsibility [6]. The public health programs in India are supported by epidemiological database and monitoring and evaluation also are periodically done based on epidemiological principles. During the implementation of at least some of the public health programs, private sector which has the vast majority of the practicing clinicians in the country was not taken into full confidence. Of late this strategy in India was changed and the tuberculosis control program is a typical example of effective public-private partnership [7]. The private-public dichotomy is perhaps more crucial than the so called 'public health-clinical schism' in practice and popularisation of clinical epidemiology in India. INCLEN and CE in India