“It Isn’t Always Fun.” – Foreword
This continuation of “a different sort of medical life” is, like the preceding volume, both autobiographical in approach and broadly historical in significance. As Volume I recounts the ‘fun’ of epidemiology, Volume II reveals the largely behind-the-scenes operations and arrangements required for this kind of fun to be realized. We see, through Henry Blackburn’s experiences, the interplay of key influences that converge to make a great program and great achievements possible. And we see that, from the perspective of the designated leader (‘il capo’ as Henry styles it here), the task of orchestrating these influences “isn’t always fun.”
Two observations add to appreciation of this rich account. The first concerns authority. ‘Il capo’ speaks, by definition, as the ‘head man.’ But the metaphor extends much further on considering the institution in which ‘il capo’ served — first the Laboratory of Physiological Hygiene and then the Division of Epidemiology in the University of Minnesota School of Public Health. On a recent visit to the Division as Martinson Lecturer, I was struck by the following realization: Just as Itasca, Minnesota (a name contrived from ‘veritas caput’, or ‘true head’) marks the headwaters of the great Mississippi River, so the Laboratory and Division can be seen as the headwaters of epidemiology and prevention of cardiovascular diseases for over a half-century. Although my hosts modestly disclaimed this view, the case is strong — and so, too, is the authority — of this present volume in illustrating the critical place that building a unique institution, developing an extraordinary team, and establishing a monumental research and training program have in making the ‘fun’ of epidemiology possible.
The second observation concerns the concept itself of epidemiology as ‘fun’. It may well be, as quoted in “First Things” earlier in this volume, “. . . there is no fixed history, no history that is true.” This view is supported by recent inconclusive attempts to reconstruct the actual origin of the maxim, “If it isn’t fun, it isn’t epidemiology.” Time and place are variously recalled, but three parties to the conversation are accepted by consensus of the two surviving members. The three were: Stony Stallones, Dwayne Reed, and myself. A late-afternoon conversation, over a beer, had turned to the joys of the epidemiologist’s life — intellectual excitement, warm collegiality, and chance (mis)adventures — much of the sort described in Volume I of Henry’s memoir and in his earlier recounting of the Seven Countries field surveys. The conversation might have gone, “This is real epidemiology.” “And it’s fun!” “Yeah . . . if it isn’t fun it isn’t epidemiology!” “Right!” (Who spoke which part remains uncertain.)
Readers of these volumes owe much to Henry Blackburn for recounting both the fun of epidemiology (in Volume I and its predecessor, “On the Trail of Heart Attacks”) and here in Volume 2, the rare blend of ingredients that makes the fun of epidemiology possible in certain places, at certain times, such as in Minnesota, under ‘il capo,’ at the veritas caput of cardiovascular epidemiology and prevention.
Darwin Labarthe, M.D., PhD.
Associate Director, Cardiovascular Health Policy and Research Centers for Disease Control