Epidemiologic practice and conduct guidelines: a new kid on the block Henrique Barros, MD, PhD
PII: S0895-4356(18)30293-2
DOI: 10.1016/j.jclinepi.2018.04.001
Reference: JCE 9627
To appear in: Journal of Clinical Epidemiology
Received Date: 4 April 2018 Accepted Date: 4 April 2018
Please cite this article as: Barros H, Epidemiologic practice and conduct guidelines: a new kid on the block, Journal of Clinical Epidemiology (2018), doi: 10.1016/j.jclinepi.2018.04.001.
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Epidemiologic practice and conduct guidelines: a new kid on the block Henrique Barros, MD, PhD
Institute of Public Health of the University of Porto International Epidemiological Association, President
Learned societies have a fundamental role in developing standards for practice. They aim at building common values, to prevent misconduct and to promote best practices and, in general, to contribute to the advancement of their field of interest and expertise. The Netherlands Epidemiological Society (NES) has been very actively involved in the training of
epidemiologists, in promoting a fertile dialogue with other disciplines, and in pursuing a broad international understanding of the epidemiological research. Also, Dutch epidemiologists have a remarkable visibility in the multiple fields where epidemiological reasoning has helped to advance knowledge. It seems quite natural that the large Society membership engaged in presenting their own thoughts regarding epidemiologic research practice with the objective of increasing transparency and accountability, and particularly contributing to prevent
detrimental research practices (1).
Epidemiology is a basic science that provides the practice of public health and of clinical medicine with a large and essential body of evidence. But epidemiology is also a profession, with its own mission and field of work, its specific competences and conflicts of interest. Thus, an epidemiologist, regardless of the specific working conditions involved – from private to public institutions, from individual consulting to academic teams – faces complex
deontological and ethical dilemmas. And the organization of a code of conduct or a reasonable standardization of responses to the identified challenges are especially difficult concerning the fact that most occupational classifications in a large number of countries all over the world do not recognize epidemiology as a true profession in itself. The responsible epidemiologic research practice, as a guideline developed by a working group of the NES, used elements of diverse codes of conduct, as they relate with epidemiologic studies. It takes into consideration the necessity of overcoming the lack of soundness of an important fraction of scientific research and the often quoted limited reproducibility of research results. However,
specificities of epidemiological research, predominantly in what refers to population groups’ singularity, continue to deserve reflection on the conflicting relevance of internal versus external validity. Or, in other words, how the traditional reductionist reasoning of physical sciences apply to population health, which is not solved by the present guidelines.
Fraud and misconduct are well-known problems in science for centuries. And epidemiologists, by definition, are aware of its importance, its determinants and the actions needed to control it. Maybe what is lacking is a truly epidemiology of research fraud as an essential introduction to any responsible practice guidelines! Inappropriate training and conflicts of interest are probably the principal causes of detrimental research practices, and the essential deterrents will be high quality education in every phase of life, with special emphasis on continued professional education, embedded in a set of moral values and social awareness that need to be present since very early in each individual life course. Guidelines are important, need to be implemented but we cannot expect from them more than they can give: a framework for
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A document developed for the International Epidemiological Association (IEA)-European Federation, suggesting a set of Good Epidemiology Guidelines was proposed almost two decades ago and modified over the years, namely in response to newly identified threats to the epidemiological activity in areas such as data protection, population health protection, corporation interests or misappropriation of information. The IEA Council approved a version in November 2007, as the association guidelines for proper conduct in epidemiologic research (2) but they also considered developments to support epidemiologists to attempt to provide consensus advice on how to act for instance under the political pressures of rationing scarce resources, and unwillingness of governments to disclose findings of public health importance but of adverse political consequence. Those are some of the needed steps that lead from academic research, to field research and implementation science or simple honest risk communication. Most of what IEA guidelines proposed, from the role of ethic committees to good research behavior in the different phases of a study, is covered in the NES guidelines. They seem also intended to promote discussion and to inform and educate young
epidemiologists, as IEA proposed their guidelines, but placed less importance in creating a code of practice for the evaluation of research and of each other’s work while stressing in a more ambitious tone the need for epidemiologic research to be reproducible and relevant to society. However, there still is a lack of a comprehensive proposal that overflows the most academic or strictly research oriented activities towards field epidemiology or that simply regards the exercise of the profession in their multiple contexts.
The NES guidelines present a well-organized check-list for study preparation, making a very good point on the recommendation that any study should be based on a protocol accessible to others, as it is good practice for clinical trials. However, there is not sufficient thinking in what regards the failure of the scientific community to build effective mechanism to protect from improper influence by vested interests as it is a continued concern of the International Joint Policy Committee of the Societies of Epidemiology in discussing conflicts of interest and disclosure processes and requirements (3).
Decency should be everybody’s concern: in scientific research or in daily activities which seek to apply scientific methods and principles of epidemiology to understand and to transform the health reality of individuals or especially of populations. Most often these tasks are
accomplished by following already-tested protocols, lists of known paths, or by applying survey methods that fit the art of health professions. However, in other cases, in the face of
unexpected emergent phenomena or genuinely unknown threats, practitioners take up with their training as, or become scientists, and the need to follow responsible practices becomes even more evident, to ensure that also epidemiology first does no harm. It is the responsibility of all epidemiologists to carefully consider the NES guidelines, as well as all other proposed guidelines, to keep the continued effort to increase the quality of the process involved in any epidemiological exercise.
References
1. Swaen GHM, Langendam M, Weyler J, Burger H, Siesling S, Atsmaa WJ, Bouter L. Responsible Epidemiologic Research practice (RERP). A guideline developed by a working group of the Nederlands Epidemiological Society. J. Clin Epidemiol 2008; vol: pp
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2. International Epidemiological Association: http://ieaweb.org/good-epidemiological-practice-gep/
3. International Joint Policy Committee of the Societies of Epidemiology: https://www.ijpc-se.org/?p=initiatives
