A brave new epidemiological world

I was interviewed on Friday for a slot at a very competitive and prestigious university’s Doctor of Public Health program. It wasn’t a tough interview. Like the one last year for the same program, it was more of a chat. Admittedly  my GRE score and letters of recommendation were not as good last year, so I’m not surprised that I didn’t get in. At the same time, I know that there are better students out there than me, albeit with less experience. So I won’t be surprised if I don’t get in this year. (They’ll give me an answer in the next couple of weeks.) I’ll continue to improve and grow within my profession in order to make myself a better candidate.

So that’s that. But I’d like to share and expand on something I started discussing on Friday…

A set of questions came up during the interview asking how I see the world of epidemiology and public health changing and moving forward. Here is my answer, to the best of my recollection and with a lot more things added on to explain the way I see things:

I believe that I am living in a time where epidemiology in particular and public health in general have just passed a watershed moment. Before the watershed, epidemiology was conducted in the deep, dark rooms of health departments and research-oriented institutions. Computers crunched the numbers, and epidemiologists interpreted the numbers to their bosses. In turn, the bosses would enact some policy or take some action. Maybe, if there was enough impetus to do so, a recommendation would go out that prevented something from happening again.

This is not to say that it was the wrong way to do epidemiology. After all, data-and-evidence-driven intervention are better than things done on a whim. John Snow didn’t remove the Broad Street pump handle on a whim. He had a map, numbers of sick people, and their proximity to the pump. Likewise, we need to provide data to those who are in the position to do something about a disease or condition, and, by God, that data must be high quality.

After the watershed moment, epidemiology began to trickle out of health departments and into private organizations, businesses, and into the community. You now have several “start-ups” doing epidemiology through their tracking of data entered into search engines, or by analyzing the buying habits of people. Of course, there are also “apps” and other programs to analyze disease in the community. Have you seen the flu-tracking apps?

Epidemiologists, like me, cannot be hidden in an office anymore, and we certainly cannot exist without communicating with non-public health people. In fact, we need to guide epidemiology outside our institutions so that it can also be of benefit to the people that we serve. We must be the specialists with the know-how to interpret what these start-ups and others are seeing in their data and in the data from traditional sources.

For example, take a look at this outbreak report from the Wyoming state health department. It details the investigation into a norovirus outbreak associated with a restaurant. It tells the reader how the outbreak was detected, the number of cases, how the investigation progressed, and what the findings were. As you can see, the report is posted online. Anyone with a smartphone, tablet, or personal computer anywhere in the world is capable of reading this report. Everyone should learn a lot from it, like not allowing employees who are sick to come in and handle food. And I do mean everyone, even a taco stand in downtown Chihuahua City. That’s the world we live in now.

Now, the watershed moment was not one single thing that happened on a summer day in 2003 or 1998 or 1990. This watershed took place gradually and over a long time, and, yes, it has a lot to do with telecommunications, with a shrinking world. Email kicked it all off by allowing researchers to instantly communicate with each other and collaborate on different projects. Later, the internet allowed research to be published quickly and to a lot of people. Then social media came along and allowed for the collection of data right from the people and in almost real time.

It’s a brave new world for epidemiologists, and I’ve been lucky/blessed/privileged to have been born into a generation that grew up at the end of the previous generation of epidemiologists and at the beginning of the new generation. I’m in between, and I can see how the old ways of doing epidemiology can be applied to the new technologies that are always increasing and expanding nowadays. I grew up with video games and personal computers. It wasn’t until I was in college that I had daily access to email and the internet. And it was only a few years ago that I dove completely into social media.

Combine my position in life with my personality, and you have an epidemiologist who is an early adopter of technology and someone who understands that the “old ways” of doing things are not necessarily wrong nor antiquated. You still have to wear out your shoe leather to get at some data, but there are also better ways to do data collection, analysis and distribution. I hope to be the bridge between the old and the new epidemiology, and to remind each side that the other has something to contribute.

This leads me to my last point. It has become abundantly clear that, at least in the United States, many of our political leaders lack the science and technology background to keep the country at the forefront of many disciplines, public health being one of them. When a presidential candidate unabashedly states that a vaccine causes bad outcomes only dreamed-up by conspiracy theorists and devoid of an evidence, alarms should have been going off in all institutions that teach epidemiology and public health. These alarms should have been going off because these kinds of statements by politicians, or people in power and with authority, come from the result of a lack of oversight and rectification of pseudoscience. Epidemiologists the world over shook their heads, but very few of them had clearance from their bosses to say anything about it.

So my final analysis of how I see things changing is that more and more of us who want to speak out against misinformation (and lies) are taking it upon ourselves to become bette educated and gain those extra degrees (and letters after our names) in order to counter it all. People do perk up their ears and listen when someone named “Doctor” so-and-so gives an opinion. (A perfect example is Dr. Phil’s popularity and authority.) It’s not going to be easy to earn a DrPH degree, especially at that institution I applied. But I’m willing to put in the long hours, do the long readings, attend the long seminars and conferences, and collaborate with all sorts of people. I’m willing to do all that for the benefit of science in general and public health in particular.

The DrPH would not be about me. It really wouldn’t. We’ll see how it goes.

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