The point about epidemiologists figuring out how to prevent health problems is an essential one. That’s a big reason why I’m an epidemiologist.
But there is one serious problem with the CDC’s approach to autism. As far as I can tell they have not done anything to understand how to prevent that developmental disorder. They don’t even admit that it’s a problem.
Moving responsibility for investigating the causes of autism to AHA is unlikely to help, beyond perhaps lip service to the problem. The apparent determination to blame it on vaccines will make matters worse, not better. Not only is it unscientific motivated reasoning, it will cause an even greater pushback from scientists who have long resisted investigating autism’s causes.
I don't know the CDC group that studies autism, but I wonder if they aren't demonstrating my point that the demand for services tends to overwhelm the interest in prevention - even at the nation's prevention agency. Their web pages show a disturbing increase in autism prevalence, but they then talk more about the implications of that increase for service delivery than the implications for our understanding of causes or for prevention.
Focusing on autism’s causes isn’t totally off whack but most cases are clearly the result of various genetic differences, some inherited, some not (de novo). Overfocusing on cause rather than treatment just results in stigmatisation & reduces necessary services in this area. Overfocusing on Autism’s causes also shifts attention away from more immediate issues that can be handled effectively such a pandemics.
The upstream metaphors are helpful, but can truly be fraught politically. Semmelweiss prevented puerperal fever in new moms but was ridiculed by contemporaries.
Thomas: Thank you for writing this and reminding people about why CDC is so important. One of my students said they were an "upstreamist". I love it. I also really appreciate how Geoffrey Rose framed the complimentary roles of the epidemiologist and internist in your parable as the population strategy and the clinical strategy. Rose's strategy for Preventive Medicine is one of the top 10 books public health scientists, physicians, and public health enthusiasts should read.
Excellent post, Thomas. Thank you.
The point about epidemiologists figuring out how to prevent health problems is an essential one. That’s a big reason why I’m an epidemiologist.
But there is one serious problem with the CDC’s approach to autism. As far as I can tell they have not done anything to understand how to prevent that developmental disorder. They don’t even admit that it’s a problem.
Moving responsibility for investigating the causes of autism to AHA is unlikely to help, beyond perhaps lip service to the problem. The apparent determination to blame it on vaccines will make matters worse, not better. Not only is it unscientific motivated reasoning, it will cause an even greater pushback from scientists who have long resisted investigating autism’s causes.
I don't know the CDC group that studies autism, but I wonder if they aren't demonstrating my point that the demand for services tends to overwhelm the interest in prevention - even at the nation's prevention agency. Their web pages show a disturbing increase in autism prevalence, but they then talk more about the implications of that increase for service delivery than the implications for our understanding of causes or for prevention.
Focusing on autism’s causes isn’t totally off whack but most cases are clearly the result of various genetic differences, some inherited, some not (de novo). Overfocusing on cause rather than treatment just results in stigmatisation & reduces necessary services in this area. Overfocusing on Autism’s causes also shifts attention away from more immediate issues that can be handled effectively such a pandemics.
Perfect illustration, a scene from one of those very stupid films that normalized disaster for decades.
They seem to have planned all this-
The upstream metaphors are helpful, but can truly be fraught politically. Semmelweiss prevented puerperal fever in new moms but was ridiculed by contemporaries.
Thomas: Thank you for writing this and reminding people about why CDC is so important. One of my students said they were an "upstreamist". I love it. I also really appreciate how Geoffrey Rose framed the complimentary roles of the epidemiologist and internist in your parable as the population strategy and the clinical strategy. Rose's strategy for Preventive Medicine is one of the top 10 books public health scientists, physicians, and public health enthusiasts should read.