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Notes on the history of the American College of Epidemiology

 

(During her year as ACE President, Melissa J. Perry, ScD, MHS, FACE sent a monthly email with American College of Epidemiology President’s Notes, incorporating information about the history of the College. In her December 2014 email she wrote:  “This month, we are inaugurating what will become a regular feature for the next few months on the history of the American College of Epidemiology. A special thanks to Vic Schoenbach and David Lilienfeld for generously sharing their historical knowledge.”)

 

 

American College of Epidemiology President's Notes  - December 2014 (12/1/2014 email)

 

Who/what is an epidemiologist – and does it matter?

The answers to these questions were key motivations for the creation of the American College of Epidemiology.  A half century ago, the field of epidemiology was growing. It was expanding beyond the medical profession, and the designation “epidemiologist” was growing in its appeal.  But because there was no governmental or professional body to certify who had the knowledge/skills to merit that designation, it could be adopted by anyone.

At one time, the American Epidemiological Society (AES) could say who an epidemiologist was.  But the AES limited its size to 125 members, thereby excluding relatively recent entrants to the field and most epidemiologists studying chronic diseases and mental health.  For a time, the Fellows of the Epidemiology Section of APHA could answer this question, but the section lost the ability to serve a credentialing function in the late 1960s when its parent organization discontinued having a separate category for Fellows.   (Next month: The Society for Epidemiologic Research’s role in bringing together epidemiologists from different generations and different specialty areas.)

 

 

American College of Epidemiology President's Notes - January 2015 (1/5/2015 email)

 

ACE History Installment II:  The Society for Epidemiologic Research’s Big Tent

In 1968, Abe Lilienfeld, Brian MacMahon, and Milton Terris – the chairs of the departments of epidemiology in the schools of public health at, respectively, Johns Hopkins, Harvard, and the New York Medical College – teamed up to create the Society for Epidemiologic Research. Its purpose, as explained at the time by Milton Terris, was to “provide a common meeting ground for the different generations of epidemiologists and the various categories of specialists in infectious, chronic and mental disease epidemiology.” The existing epidemiology organizations could not fulfill this need because the American Epidemiological Society had capped its membership, and the agenda and identity of the APHA Epidemiology Section went well beyond epidemiology teaching and research. With its more focused agenda and much smaller meetings than those of APHA, the new SER would enable “epidemiologists to get together to discuss their work in a setting which fosters informal as well as formal discussion. It is hoped also that the younger people will have a chance to meet, argue and consult with the veterans in the field.”

 

The new society was a success.  SER’s existence was a boon for both epidemiologists and the growing field itself.  In addition to helping to enhance training opportunities, particularly for researchers entering the field from outside medicine, the new organization expanded members’ opportunities for interacting with others in their field.  But to the discomfort of the founders, the new society was in some ways too much of a success. Because SER’s mission was specifically tied to epidemiologic teaching and research, anyone belonging to SER was “associated” with epidemiology – and since membership was open to “all interested individuals,” anyone could join and become an epidemiologist-by-association!  As the ramifications of this situation became apparent, several of the SER founders found themselves again confronting the question of “who/what is an epidemiologist?” (Next month: A fateful phone call.)

 

From: American College of Epidemiology President's Notes - February 2015  (2/2/2015 email)

 

ACE History Installment III:  A Fateful Phone Call

In 1976, Abraham M. Lilienfeld, who had by then stepped down as the chair of the department of epidemiology at Johns Hopkins University’s School of Hygiene and Public Health to become a University Distinguished Service Professor, was taken aback by an unexpected phone call.  The caller was a chemist working as an ecologist at a major chemical company.  She asked Dr. Lilienfeld what epidemiology was and how she could learn more about it. When he asked why, she explained that she had been told earlier that week that she was to meet with some Congressional staffers who wanted to talk with the company’s epidemiologist.  She was trained in computer programming and knew a bit about statistics, and she was smart enough to realize that it would be wise to learn at least a little bit more about the field in advance of that meeting.

After making her trip to Capitol Hill, the chemist called Dr. Lilienfeld to thank him for his good advice.  She ended up testifying before Congress as an epidemiologist, she said, and she reported listing her membership in the Society for Epidemiologic Research as a credential.   She also expressed gratitude to Dr. Lilienfeld for his suggestion that she read a couple of reference texts on epidemiology such as Maxcy-Rosenau’s Preventative Medicine and Public Health.

The phone call with that chemist made Dr. Lilienfeld realize that, at the time, no professional organization was focused on answering the question of who and what an epidemiologist was.  It inspired him to begin the process that ultimately led to the creation of the American College of Epidemiology. (Next month: A Board Exam for Non-Physician Epidemiologists)

 

 

American College of Epidemiology President's Notes - March 2015 (3/2/2015 email)

 

ACE History Installment IV:  A Board Exam for Non-Physician Epidemiologists

After becoming a University Distinguished Service Professor at Johns Hopkins University’s School of Hygiene and Public Health and before founding the American College of Epidemiology, Dr. Abraham M. Lilienfeld spent several years developing his ideas for creating a new epidemiologic society.  During the 1976 summer public health training program in Minneapolis, he taught a history of epidemiology course.  Approaching a colleague and friend, Leonard Schuman, director of the University of Minnesota’s epidemiology program, he described a phone call he'd received during the prior academic school year from a chemist who had joined the Society for Epidemiologic Research because she had been appointed as her company's epidemiologist and was preparing to testify at a government panel in Washington, D.C.

Schuman pointed out that in medicine, board examinations played a key role in establishing the different communities of specialists, such as internists, orthopedic surgeons, and so on.  The American Board of Dermatology was based in Minneapolis, and Schuman offered to get a copy of its bylaws. By the end of the summer, Lilienfeld had a copy of those bylaws in hand and was contemplating the idea of creating a society that would offer a board exam for non-physician epidemiologists.  (Next month:  A New Model for an Epidemiology Board Exam.)

 

American College of Epidemiology President's Notes - April 2015  (4/1/2015 email)

 

ACE History Installment V:  A New Model for an Epidemiology Board Exam

The years that Dr. Abraham M. Lilienfeld spent developing his ideas for creating a new epidemiologic society brought to his attention that the American Board of Preventive Medicine offered a board exam for public health, but it was available only to physicians.  Non-physicians were expressly excluded. (Further investigation disclosed that the National Institutes of Health did not have a personnel classification for non-physician epidemiologists; epidemiologists working at the NIH had been classified as statisticians or demographers, while physician-epidemiologists were classified as medical officers, sometimes as Public Health Service officers.)

After consulting with colleagues, some of whom would later serve on the new organization’s first Board of Directors, Dr. Lilienfeld decided to create a society with a board exam available to both non-physicians and physicians alike.  He then recruited two non-physicians, Cedric Garland (at Johns Hopkins) and Curt Meinert (at the University of Maryland, Baltimore), to help him incorporate the new organization, the American College of Epidemiology. The College would enable professionals in diverse disciplines, including statistics, sociology, genetics, and biology, to be certified as epidemiologists.   As for the structure of the examinations, the College would use the model of the Society of Actuaries, with its series of exams covering different areas of the discipline. Lilienfeld thought that approach would help epidemiologists in passing the exams rather than having to take one overarching hit-or-miss examination. As he would soon find out, that view was hardly universal among epidemiologists. (Next month:  The Founding – and a Fast and Furious Response.)

 

 

American College of Epidemiology President's Notes - May 2015  (5/4/2015 email)

 

ACE History Installment VI:  The Founding – and a Fast and Furious Response

The American College of Epidemiology was officially incorporated in 1979, with bylaws loosely modeled on those of the American Board of Dermatology (in Minneapolis).  Its origins can be traced back to a phone call from a young toxicologist who had been informed that she was now the company's epidemiologist and would provide testimony as such to the Congress. She called Dr. Abraham M. Lilienfeld, University Distinguished Service Professor at the Johns Hopkins University, to ask him what epidemiology was. Lilienfeld realized that there was no available certification of who was or was not a qualified epidemiologist.  Discussions between Lilienfeld and his close colleague Dr. Leonard Schumann (Chair of Epidemiology at the University of Minnesota, Minneapolis) led to the organization of the College. The original Board of Directors, each invited personally by Lilienfeld, consisted of 15 leaders in the field. By design, about half of these initial directors were non-physicians, and the majority were from academic institutions. Soon after word of the College’s founding began to circulate in the field, rumors surfaced regarding the founders’ motives. Some skeptics suggested that the organization was the result of a plot by physician-epidemiologists to keep non-physician epidemiologists out of the field. Another suspicion raised was that the College sought to pre-empt academic epidemiology training programs. Some of the more formal responses were not encouraging.

 

Proponents of the College saw it as a way to provide a professional identity for a field that could be entered from different paths. Physicians were readily accepted as epidemiologists, but a non-physician would typically need an epidemiology (or perhaps biostatistics) doctoral degree. A prominent exemplar was Jerome Cornfield, who as a past President of the American Epidemiological Society (AES) was indisputably an epidemiologist yet he possessed neither a medical nor other doctoral degree. If he had not been a member of AES, what certification could he claim?

 

The solution appeared to be to have a credentialing examination for admission to the College.  The model Lilienfeld used in setting up the exam was the Society of Actuaries, in which topics were covered in a series of exams, each of which could be passed independently of the others. (This approach, Lilienfeld noted, was not notably different from the one used by the National Board of Medical Examiners in credentialing medical students and interns.)”

 

But the news of the College’s founding and its accompanying credentialing examination evoked a fast and furious response. Letters written by two prominent physician-epidemiologists typify this fast and furious response. Dr. Warren Winkelstein, then dean of the School of Public Health at the University of California at Berkeley (and one of Lilienfeld's former students/mentees), sent Lilienfeld a sharply-worded letter that said, in effect, “Who was the College to suggest who/what is an epidemiologist? The academic programs did that already, thank you very much.” Another letter sent by Dr. Roger Detels, then chair of epidemiology at the University of California at Los Angeles’ School of Public Health, was more colorful, but had the same gist.

 

Not all of the responses were negative.  For example, Dr. Jacob Brody, who was then at the National Institutes of Health, expressed optimism that membership in the College would be seen as equivalent to being "boarded" in preventive medicine.  At the time, being boarded raised one's salary by a significant sum for physicians at the NIH. (Brody, trained as an officer of the Center for Disease Control's Epidemic Intelligence Service, was not boarded, yet he founded the epidemiology program at the National Institute on Aging--among his many accomplishments at the National Institutes of Health.) (Next month:  A Rocky Start.)

 

American College of Epidemiology President's Notes - June 2015  (6/1/2015 email)

 

ACE History Installment VII:  A Rocky Start

At the 1979 Society for Epidemiologic Research conference in New Haven, Conn., an impromptu meeting was called for Lilienfeld to explain what need the nascent American College of Epidemiology would address, and how the College would operate. It became clear that there were more people interested in attending the session than could fit into the assigned room, and so the session moved outside. Speaking without any microphone, Lilienfeld found himself hard-pressed to project his voice to be heard by everyone now crowded around him. He had been intubated several months before and was still recovering from laryngeal damage, something not known to the crowd.  Soon after Lilienfeld started talking, a voice from the back of the crowd called out that Lilienfeld could not be heard. Someone closer to the middle of the group shouted back, "He's talking softly so that he can't be heard and we won't find out what is going on." Now badly hoarse and feeling frustrated, Lilienfeld announced that he would be sending letters describing the College’s mission to the major publications in the field. It was a rocky start for the ACE.

Many in the field perceived the College as a threat to the academic training programs (despite the heavy prevalence of those from academia on the Board of Directors). Others considered it one more barrier for them to overcome to be considered an epidemiologist; many in this camp argued that passing their written comprehensive exams and defense of their dissertations should suffice.

Despite the early opposition, the College had been founded, and its founding board of directors (Philip Brachman, Fred Ederer, Lila Elveback, Harry Feldman, Cedric Garland , Saxon Graham, Samuel Greenhouse, Michel Ibrahim, Dwight Janerich, Jennifer Kelsey, Abraham Lilienfeld, Curtis Meinert, Ralph Paffenbarger, Jr., Leonard Schuman, Milton Terris) read like a Who’s Who of epidemiology.  Admission to the College would involve passing a certification examination, but for the first few years qualified epidemiologists could be admitted on the basis of their training and experience. To junior epidemiologists wanting to hedge their bets in case membership in the College at some point conveyed real advantages, the prospect of having to pass an entrance examination provided a stimulus to apply before the “grandfathering” period ended.  (Next installment: An Aging Cohort.)

 

 

American College of Epidemiology President's Notes - September 2015  (9/22/2015 email)

 

ACE History Installment VIII: An Aging Cohort

Over the past three decades, epidemiology has matured both as an academic discipline and as a field of practice in a large variety of health agencies, hospitals, and research institutions. Through these years, the American College of Epidemiology has benefited from the leadership of some of the world's pre-eminent epidemiologists.

 

The College continues to fulfill Abraham M. Lilienfeld's original objectives for the organization. ACE was founded to serve as the professional organization of American epidemiologists. It is that today. It was founded to enable a person to be formally recognized as an epidemiologist. Membership in the organization essentially serves that function today. ACE was founded to represent the epidemiology community on issues of national and international importance germane to the field. The ACE not only took the lead in this area among all the epidemiology societies, but it was also a principal for the establishment of the International Joint Policy Committee of the Societies of Epidemiology. The ACE has pioneered in the implementation of pre-meeting courses as continuing education. In the process of achieving these objectives, ACE has attained a leading role in the field.

 

For a period of time, however, the ACE's evolution as a credentialing organization in a field for which credentialing is not mandatory made the College into a fixed cohort, with its inherent dynamic of attrition and aging. When the grandfathering period ended, so that joining ACE meant having to pass the entrance examination, accrual of new members slowed to a trickle. In the early 1990s it was decided to change the by-laws, replacing the examination with a review of credentials. This change enabled the College to begin growing again. A decade or so later, ACE changed the by-laws to create an Associate Member category, through which people could join the College if they were enrolled in a training program that when completed would qualify them for regular membership. This mechanism has infused the College with a new source of youthful energy and creativity. Many new regular Members were once Associate Members, so the process is functioning as envisioned, and a growing number of other epidemiologists have also joined the College, so that it is now an open cohort, poised for growth and further advances.

 

 

(ACE President, Melissa J. Perry, ScD, MHS, FACE: Thanks again to David Lillienfeld and Victor Schoenbach for all of their contributions to these History Installments. In closing, I want to express my gratitude to the many remarkable people who work so hard to make the College the prominent and trusted organization that it is. It has been an exciting year of progress for the College on many fronts. I know that many more good things are on our organization's immediate horizon.)