Pearce N
Facoltá di Medicina di Wellington, Nuova Zelanda.
Epidemiol Prev. 1997 Apr-Jun;21(2):92-9.
There have been significant developments in epidemiologic methodology during the past century, including changes in basic concepts, methods of data analysis, and methods of exposure measurement. However, the rise of modern epidemiology has been a mixed blessing, and the new paradigm has major shortcomings, both in public health and scientific terms. The changes in the paradigm have not been neutral but have rather helped change- and have reflected changes in-the way in which epidemiologists think about health and disease. The key issue has been the shift in the level of analysis from the population to the individual. Epidemiology has largely ceased to function as part of a multidisciplinary approach to understanding the causation of disease in populations and has become a set of generic methods for measuring associations of exposure and disease in individuals. This reductionist approach focuses on the individual, blames the victim, and produces interventions that can be harmful. We seem to be using more and more advanced technology to study more and more trivial issues, while the major causes of disease are ignored. Epidemiology must reintegrate itself into public health and must rediscover the population perspective.
在过去的一个世纪里，流行病学方法有了重大发展，包括基本概念、数据分析方法和暴露测量方法的变化。然而，现代流行病学的兴起是一把双刃剑，这种新范式在公共卫生和科学方面都有重大缺陷。范式的变化并非中立，而是有助于改变——并反映了——流行病学家思考健康与疾病方式的变化。关键问题在于分析层面从人群转向了个体。流行病学在很大程度上已不再作为理解人群疾病病因的多学科方法的一部分发挥作用，而是变成了一套用于测量个体暴露与疾病关联的通用方法。这种还原论方法聚焦于个体，指责受害者，并产生可能有害的干预措施。我们似乎在使用越来越先进的技术去研究越来越琐碎的问题，而疾病的主要病因却被忽视了。流行病学必须重新融入公共卫生，并重新找回人群视角。
