PDF《Beyond Black Box Epidemiology》

Commentary Beyond Black Box Epidemiology Douglas L.

Weed, MD, PhD Black box epidemiology is the most recent addition to a long list of disciplinary subgroups although few practitioners would likely trumpet their allegiance to it. Epi- demiology'

s many subdisciplines represent the wide applicability of a growing and dynamic field and, paradoxically, an ele- ment of professional incohesiveness. Nowhere is this paradox more evident than in a provocative discussion in the recent lit- erature;

I call it the black box debate. Its provocativeness stems from strong claims and counterclaims regarding a colorful metaphor. Its importance lies in its potential to unite epidemiology in all its disciplinary complexity. My purpose is to briefly describe the historical threads of this discussion, weav- ing in the black box concepts of systems theory. What arises is a foundation for building conceptual bridges within epi- demiology. Two problems also emerge, the solutions of which may frame future dis- cussions. The first involves weaknesses inherent in systems theory. The second concems the divisive forces creating con- ceptual rifts among epidemiologists, including contributors to the black box debate. Historical Background The history of epidemiology can be seen both as discrete eras or paradigms'

and as gradually evolving concepts.2 Some consider history a fabric woven of many threads.3 The black box discussion, occur- ring at the junction of two eras and reflect- ing evolving paradigms, comprises at least two such threads: the first in papers by Peto,4 Vandenbroucke,5 Savitz,6 and Skra- banek,7 and the second in papers by Loomis and Wing,8 Krieger,9 and Susser and Susser.10 The First Thread In 1984, Peto described two comple- mentary approaches to cancer epidemiology and prevention.4 The first he called a mech- anistic approach;

it emphasized the biology of carcinogenesis. The second he dubbed the black box strategy because it ignored biology in favor of behavioral risk corre- lates. Peto noted its low scientific repute. Vandenbroucke echoed this sentiment when he argued that epidemiology must integrate molecular biology with its traditional black box strategy or suffer academic disrepute.5 Recently, Savitz6 defended the tradition of black box epidemiology, arguing that it allows for disease prevention in the absence of a clear understanding of mechanism. Skrabanek,7 on the other hand, marked black box strategies as futile exercises in non-science and an embarrassing liability to those who dismantle the black box in their search for universal laws. The Second Thread For Loomis and Wing,8 neither black box strategies nor molecular-based strate- gies are adequate. These researchers sug- gest an integration ofbiology, behavior, and sociopolitical forces. Krieger9 also calls for a broader conceptualization, as have Susser and Susser, who proclaim the advent of an expansive era called eco-epidemiology, stretching from societal dynamics to intra- cellular dynamics.

10 These second-thread The author is with the Preventive Oncology Branch, Division of Cancer Prevention and Con- trol, National Cancer Institute, Bethesda, Md. Requests for reprints should be sent to Doug- las L. Weed, MD, PhD, Preventive Oncology Branch, Division of Cancer Prevention and Con- trol, National Cancer Institute, EPS T-41,

9000 Rockville Pike, Bethesda, MD 20892. This paper was accepted April 25, 1997. January 1998, Vol. 88, No.

1 Commentary authors assume that black box and mecha- nistic strategies can be integrated. But given the strongly negative opinion of black box strategies found in the first historical thread,45'