Contributions of CVD Epidemiology (part 3): “Bottom Line” and Policy

The disciplines of bench, clinical, and epidemiological research are complementary and synergistic. There is no predicting which of the three major methodologies—clinical, laboratory, or epidemiological—will produce the next great stimulus to research or the public health.

• Epidemiological studies and trials indirectly drive public policy, NIH funding, and the delicate relation of NIH with the Congress, by their clear examples of the applications of a “value-free” scientific quest for truth.
• Epidemiology indicates that CVD risk factors also predict or protect from other major causes of early death, including many cancers; thus the control of common causes influences larger areas of health.
• Epidemiology often provides the “bottom line” of how a cause, a diagnosis, or a treatment actually works out in the population setting. The effect in the population is central to patient care and to public health and is only ascertainable from epidemiological approaches.
• Epidemiology provides the sound quantitative basis for an effective and responsible public health policy and from the best evidence available.
• The epidemiologist is often called upon to synthesize the results of research, point out the implications, and formulate policy recommendations.

Summary

Epidemiology provides clues to mechanisms and stimulates new areas of clinical and laboratory science. Each research strategy is independent and complementary of the other. The broadest understanding of disease phenomena derives from integration of the evidence from all three major research strategies: bench, clinical, and epidemiological.

For all these reasons, and within a rapidly changing picture of diseases and health care, it is essential that the medical community—having its primary mission the care of patients— and academia, concerned mainly with mechanisms—understand the basic contribution, the role, and the importance of epidemiology. For all these reasons, a continuing balance is needed among the three research strategies: in thinking, responsibility, research program, national policy, and fiscal support. (Henry Blackburn)