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Guest contributor Dr. David C. Goff offers perspective on the future of epidemiology

March 13, 2013

The Future image -20034177A year ago, the NHLBI launched this forum in an effort to open an active discussion with the larger epidemiology research community about the future of epidemiology as it relates to cardiovascular disease. We want to thank everyone for their thoughtful contributions to the forum and look forward to further engaging with the research community on this important topic.

We are pleased to welcome guest contributor, David C. Goff, Jr., M.D., Ph.D., chair of the American Heart Association (AHA) Council on Epidemiology and Prevention, and dean of the Colorado School of Public Health, who will help us mark the one-year anniversary by sharing his perspective on the future of epidemiology:

Strong epidemiology has been a critical component of advances in public health over at least the past half-century and will remain important in the future.  The potential contributions of strong epidemiology include further elucidation of the social determinants of health, the molecular determinants of health, and the comparative effectiveness of various interventions, whether based on changes in policies, systems, environments, behaviors, or the use of pharmacologic, biologic, or device-based therapies. 

We need better science regarding the social influences that constrain healthy behaviors and the policy changes that can redress those constraints. The best science will likely come from strong collaboration between epidemiologists and social scientists. We need better science regarding the molecular basis of health, including how environmental exposures and behavioral patterns interact with the genome and microbiome to influence biologic systems, that can be examined with increasingly complex methods, such as epigenomics, proteomics, and metabolomics.  The best science will likely come from strong collaboration between epidemiologists and systems biologists.

We need better science regarding the impact of various interventions on population health.  In some instances, randomized trials will be the best approach, but for many policy-based interventions, other approaches may be needed.  For example, cross-sectional observational studies have shown associations between density of public food advertisements (e.g., billboards) and obesity prevalence, but association is not necessarily causation.  Evaluation of natural experiments in public food advertising could clarify this issue.

Strong epidemiology has contributed greatly to advances in cardiovascular health over the past half-century, and will be critical to efforts to advance global cardiovascular health for decades to come.

David C. Goff, Jr., MD, PhD
Chair, AHA Council on Epidemiology and Prevention
Dean, Colorado School of Public Health

2 Comments leave one →
  1. March 18, 2013 2:18 pm

    Dr. Goff, thank you for your optimistic and encouraging post.

    I, too, think that the greatest impacts of epidemiology are likely to be found in our collaborations with other types of scientists. For many of us, myself included, this would require stretching outside our comfort zones to explore, and maybe to fail in some attempts, but hopefully to succeed in developing fruitful collaborations with people from other disciplines.

    What role could the annual AHA Epidemiology and Prevention Conference play here? Is there an active effort to build sessions into the conference that could give birth to collaborations of epidemiologists with social scientists, systems biologists, etc.? If so, wonderful! I look forward to the conference this week in New Orleans as an opportunity to engage in conversation about how to move forward in the ways you propose. If this strategy has not already been part of the conference planning, maybe this could be an area of focus in developing the next couple annual conferences.

  2. Lue Ping Zhao permalink
    June 26, 2013 5:24 pm

    Dear Dr. Golf,
    In agreement with your view on important roles of epidemiology in the future disease research, I would like to add two points. The first point is that epidemiology should also play an important role in studies with designs somewhat between observational studies and randomized trials, for example, pragmatic clinical trials that have a randomization component and are conducted in an observation study context. Such studies can be useful for various scientific purposes, complementing observational studies and randomized trials. The second point is that we may need to expand the epidemiology paradigm, to embrace Big data initiative, since typical EMR-based researches are quite different from traditional cohort studies or longitudinal studies. In light of the Big data initiatives at NIH and other funding agencies, it seems really important for epidemiologists to think hard on challenges arising from such Big Data projects to study designs, data analyses in light of all constraints, and medical histories of time-varying clinical variables, etc.. At expense possibly being criticized as “self-serving”, I would like to say that epidemiology should strengthen its collaboration ties with biostatistics, bioinformatics and biomedical informatics. Only through close collaborations, which is exemplified by epidemiology and biostatistics collaborations in past 50 years, we will be able to come up clever study designs, innovative methodologies, and creative analyses, leading to scientifically valid conclusions.

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