Credo: ‘If it isn’t fun, it isn’t epidemiology’

The oft-repeated credo of our field is credited to a 1965 conversation between “Stony” Stallones and younger colleagues, Dwayne Reed and Darwin Labarthe, on Guam en route to a field survey in Palau. Their exuberance was reinforced, no doubt, by the beauty of the setting and the charms of island living and “reef epidemiology,” but it also reflected the genuine excitement the investigators were finding in a branch of study only recently formalized: cardiovascular disease (CVD) epidemiology. The “fun” included not just exotic travels and introduction to other cultures, but also intellectual fun: the joy found in discovery, in a neat hypothesis, a clever design, an elegant analysis, and a powerful demonstration; the particular joy of finding a strong correlation or better, a departure from a regression, which hints of buried treasure. There is also the joy from beholding the transfigured face of a suddenly comprehending student, and that from working in a field team operating with the coordinated flow of an ant colony.

Tales of this excitement—and the knowledge gained from the research engendered—make up an enlightening and often entertaining history, starting with the notions and adventures of pioneer investigators. Take the time, for example, when Paul Dudley White and Ancel Keys, in the early 1960s, traveled to the Caucasus Mountains of Georgia to see for themselves the fabled centenarians of the region. They’d heard tell of a “cluster” in one area reputed to harbor more than 300 persons over the age of 100, and they hoped the visit would yield ideas about these individuals’ longevity, and ultimately, plans for a serious study of their survival traits. White and Keys found themselves one rainy day in a mountain fastness, guests of the garrulous Professor Kipshidsky of Tblisi. Keys wrote home with this joyful story:

“We spent a hilarious afternoon at one of the farms with an old man of 117, his eighth wife, his kid brother of 96, his youngest son age 23, and a flock of relatives and neighbors.”[ed. The old man’s age was verified by church parish registries, and it was also documented that he had built his farmhouse back in 1884. The visit of the researchers was celebrated with a feast during which there were many toasts.]

“Dr. Paul White and his ‘older brother’ as he called the old man, drank together two vodkas, bottoms-up, whereupon ‘old 117’ tried to teach younger ‘brother,’ Paul White, aged only 75, a Caucasian dance. This failing, he called for his horse and they mounted and trotted around in the rain making war hoops while we all howled with laughter.”(Journal Lancet)

Operational and conceptual difficulties kept the dreamt-of study from becoming a reality, but the story illustrates the point that the fun is often in the search, even if it leads nowhere, or to more questions than answers. [ed. Later ethnographic studies by Alex Leaf described groups of centenarians in the Caucasus and in the Andes and reported several common traits—chief among them an imperturbable daily routine.]

Reference

Introduction to the book in preparation: Preventing Heart Attack and Stroke; A History of Cardiovascular Disease Epidemiology, by Henry Blackburn, Darwin Labarthe, and Kalevi Pyörälä, Oxford University Press