Evolution of epidemiologic methods and concepts in selected textbooks of the 20th century

Abstract

Introductory note by Alfredo MorabiaThis article closes the series of contributions on the history of epidemiologic methods and concepts. It traces, in some epidemiology textbooks published in the 20 th century, the evolution of the way five main topics have been taught: study designs (cohort studies and case-control studies), confounding, bias, interaction, and causal inference. These correspond to the topics covered by the other papers in the series. The only exception is the concept of interaction, for which I had not been able to find an author. This final paper has been sent to review and/or comment to all the living authors of the textbooks. Three authors opted for commentaries which are also published in this issue of Social and Preventive Medicine and two for reviews. Our publisher, Birkhäuser, has been kind enough to let us post the pdfs of all these papers on the website: www.epidemiology.ch (choose history). A revised version of these papers accompanied by a substantial introduction, pooled bibliography and index will appear in 2004 as a book entitled "The history of epidemiological methods and concepts" (Birkhäuser). SummaryTextbooks are an expression of the state of development of a discipline at a given moment in time. By reviewing eight epidemiology textbooks published over the course of a century, we have attempted to trace the evolution of five epidemiologic concepts and methods: study design (cohort studies and case-control studies), confounding, bias, interaction and causal inference. Overall, these eight textbooks can be grouped into three generations. Greenwood (1935) Miettinen (1985) and Rothman (1986)'s textbooks belong to a third generation, "modern epidemiology", presenting an integrated perspective on study designs and their measures of outcome, as well as distinguishing and formalizing the concepts of confounding and interaction. Our review demonstrates that epidemiology, as a scientific discipline, is in constant evolution and transformation. It is likely that new methodological tools, able to assess the complexity of the causes of human health, will be proposed in future generations of textbooks.

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