Epidemiology As A Liberal Art
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Cited References
Aesthetic Values
All good work is sound. Some is elegant. The four methods of thinking described above may permit the student to tell the sound from the flimsy, but a liberal arts education should go further, to give the student a sense of beauty.
Since 1966, the Centers for Disease Control (CDC) has awarded the Alexander D. Langmuir Prize to the epidemiology trainee who has written the best paper summarizing an epidemic investigation or study. The award honors the founder of CDC's Epidemic Intelligence Service, a two-year training program in epidemiology that was initiated in the early 1950s as a defense against the threat of biologic warfare and that has produced more than 1000 persons trained in shoe-leather epidemiology.
As practical as training in the Epidemic Intelligence Service has been, the Langmuir award is traditionally given not to the most important paper or the most publicized outbreak, but to the work that shows the greatest elegance in design and execution. It is, quite clearly, an award for artistic merit, and since it is the only award specifically for Epidemic Intelligence Service officers, it sets a fine standard for all epidemiologists to live up to.
The award was given in 1980 for a study of the effectiveness of various actions taken to avoid injury during a tornado (Ref. 17). By interviewing those who were injured in the Wichita Falls tornado of 1979 and a sample of those who were not, the winner disproved the mythic advantage of driving in a direction perpendicular to the path of a tornado and showed the danger of staying inside a mobile home. In 1981, the award was given for a study that demonstrated that toxic shock syndrome was particularly common in women who used tampons (Ref. 18). Although the study was highly publicized, what was striking about it for the purposes of the award was that, once 54 cases of toxic shock syndrome had been reported to the CDC, the study was designed and carried out entirely by telephone, and the data were analyzed, in less than a week. The investigators called women with toxic shock syndrome, asked each for the name of a female friend, and interviewed both sets of women about a range of experiences and behavior in the weeks before the onset of the illness in the case. The use of tampons stood out as the one activity clearly associated with risk.
My favorite, however, was the Langmuir award winner in 1984, which involved the investigation of a curious cluster of unexplained deaths in a Toronto children's hospital (Ref. 19). One nurse had been arrested briefly on suspicion of murder. The epidemiologic study showed that the unexpected deaths clustered during the night shift, especially on nights when a particular nurse -- not the one who had been arrested -- was on duty. Strong evidence was collected that suggested that she had given the infants fatal doses of digoxin intravenously. Such selections may suggest that the aesthetic sense is acquired, and such is no doubt the case. But so it is with each of the methods of thinking that we try to help our students master.
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