Features Health and life
LONGEVITY BULLETIN:
RESEARCHING RESEARCH: THE UPS AND DOWNS OF EPIDEMIOLOGY
PHARMA ISSUE
Readers of articles summarising medical studies might assume that the combination of rigorous study design, impartial analysis and independent peer review would make the output ‘cast iron’. Why, then, do we read statements such as: ‘Much of the scientific literature, perhaps half, may simply be untrue’ (Richard Horton, editor, The Lancet, April 11, 2015) ‘It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines’ (Dr Marcia Angell, former editor of the New England Journal of Medicine).
From epidemiology to polypharmacy, Matthew Edwards provides a selection of highlights from the IFoA’s forthcoming Longevity Bulletin
T
he forthcoming issue of the Longevity Bulletin looks at the issue of ‘pharma’. In this feature, I summarise the main points of an article about epidemiology (written by Dan Ryan and myself ), likely to be of interest to readers working in data analytics. I also highlight a fascinating article on polypharmacy by Dr Malcolm Kendrick, which asks whether more medicine is making us worse, not better.
MATTHEW EDWARDS AND DAN RYAN
What has driven these concerns? And if they are well-founded, how can we assess the validity of any published research? How did epidemiology come to be in this position?
Early epidemiology Epidemiology became a promising field of medicine in its own right in the 1950s, with well-known studies relating to smoking and the discovery of the harm caused by tobacco, as well as hypertension. How, in the field’s infancy, would one interpret or judge epidemiological results? In 1965, Bradford Hill (whose work with Richard Doll helped determine the link between smoking and lung cancer – see Figure 1) published ‘The Environment and Disease: Association or Causation?’ in the Proceedings of the Royal Society of Medicine. In this paper, he introduced what have been known since as ‘the Bradford Hill criteria’ (see box). They have remained the standard criteria for distinguishing association and causation ever since, with a much wider scope than just medicine. FIGURE 1: Richard Doll and Bradford Hill’s 1954 paper
The rise and fall of epidemiology? For some time, there has been a ‘diminishing returns’ problem: each decade has felt less illuminating than the previous decade. Far from the aforementioned ground-breaking studies on 32 | THE ACTUARY | JANUARY / FEBRUARY 2020
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