PDF《Beyond Black Box Epidemiology》

9 Systems theory is not very effective for solving qualitative problems of moral- ity, law, politics, knowledge, attitudes, beliefs, and social forces, to name a few. Social forces-values-within the sci- entific community of epidemiology deserve consideration. Values have an undeniable influence on the way epidemiologists thinkl20 and therefore on the way we under- stand the relationship between the ever- growing list of subdisciplines and the level(s) of the structure of knowledge they examine. Molecular and behavioral epi- demiology provide an apt illustration;

not everyone is equally enthusiastic about a balanced effort between the two. Although it is reasonable to conceptualize connec- tions from the top to the bottom of the structure of scientific knowledge,21 epi- demiologists may not be willing to make connections between different levels nor suffer others to do the same. The sharp debate between proponents6 and opponents7 ofblack box epidemiology reveals epidemi- ologists'

vastly different worldviews about the conduct and interpretation of research involving behavior and biology. Philosophers call such stark differ- ences incommensurabilities,

22 and there is something to be said for examining this problem in terms of the philosophy of sci- ence.23 There it is claimed that social forces can foster divisiveness24such as that seen in epidemiology, with its relatively new sub- disciplines of public health25 and clinical epidemiology. Add to this trend toward sub- specialization26 a derisive voice7 and senti- ments such as the one that nonmedically trained epidemiologists lack sophisticated biological knowledge,27 and the result is a social environment within epidemiology ripe for fractionation and replete with par- tially incommensurable methodologic para- digms22 providing fodder for the black box discussion. Beyond appeals to reasonableness28 and disclosure,29countering such divisive forces requires a reassessment of some basic ques- tions: What is the nature of epidemiology? What is our professional telos-that is, the goals intemal to the practice of epidemiol- ogy?30Do we share a common vision and a common purpose? Answers to these ques- tions may not come easily. As shown above, there is diversity in what counts as a legiti- mate scientific approach. And even if we could agree on a coherent scientific para- digm, we need something more than science to ensure our commitment to public health.0l We need a common set of moral values,23 yet we do not even have a clear consensus on something as basic as our obligation to public health.3'

American Journal ofPublic Health

13 January 1998, Vol. 88, No. I Commentary Recommendations In closing, two recommendations emerge. First, there is a need to explicate and to agree on the basic values of the dis- cipline in this era of professional inco........