Conflict of Interest
J.P. Kassirer
Independent science is increasingly exposed to tough questions related to conflict of interest (COI) fuelled by a myriad of unwanted personal, institutional or financial ties between the research community, sponsors and the audience of the scientific results. For epidemiologists, managing COI is a struggle of daily life as there always stakeholders involved (e.g. sponsors, study subjects, users of the study outcomes) with possibly different and incompatible interests. COI may encourage bias in research and may breed distrust in society regarding science as an independent source of evidence. In this keynote session Dr Jerome P. Kassirer, former Editor-in-Chief of New England Journal of Medicine for more than 8 years, distinguished professor at Tufts University School of Medicine and author of the best-seller book ‘On the Take', coined as an brilliant diagnosis of an epidemic of greed in biomedical research, will offer an unsettling look at how financial interests may compromise, and even corrupt, epidemiological research. Dr Kassirer will share with us his thought provoking analyses of the checks and balances of financial enticements in epidemiological research. You can't miss this event!
Proteomics and Genomics and Epidemiological Research
D. Ransohoff & R. Westendorp
Proteomics and genomics are supposed to be related to epidemiology and clinical medicine, among other because of the putative diagnostic usefulness of proteomics and genomics tests. Hence, clinical and sometimes even public health applications are promised by basic sciences. It is debated whether such promises and subsequent expectation are fulfilled. What are at meaningful and consequential examples of current findings in proteomics, genomics and similar approaches in biomedical research? Are they different from the "classic" tools and frameworks of clinical epidemiology?
In the context of proteomics and genomics, etiologic studies, primary prevention, epidemiological surveillance and public health are concerned with the influence of environmental exposures on gene expression and on the accumulation of genetic alterations. Proponents and advocates of proteomics and genomics have suggested that their products can yield clinically useful findings, e.g., for early diagnosis, for prognosis, for therapeutic monitoring, without always needing to identify the proteins, peptides or other 'biomarkers' at stake. Do we feel comfortable with this "black-box" reasoning, i.e. do we question the role of pathophysiological and mechanistic reasoning in clinical medicine?
How much sense does it make for epidemiology to play with and scrutinize proteomics and genomics approaches in epidemiology and clinical medicine? What are at present (and in the near future) the main biological, clinical and public health implications of current findings in these research fields?
In this plenary session these questions regarding the place and role of proteomics and genomics in clinical epidemiological research are discussed from different perspectives.
Infection diseases: Beneficial or Disaster for man?
R. Anderson & E. von Mutius
Infectious diseases pose an increasing risk to human and animal health. They lead to increasing mortality, in contrast to the situation fifty years ago when new control measures still provided hope of overcoming many problems in the future. Improved hygiene, better socio-economic circumstances, vaccination and use of antibiotics has led to a gradual decline of tuberculosis, rheumatic fever, measles and mumps in Western societies over the last five decades. Paradoxically, absence of exposure to infectious agents has a major impact as well. The decline in infectious disease risk is accompanied by a gradual increase of allergic and autoimmune diseases and this association is believed to be causal. Exposure to infectious agents from early on in life can markedly boost an individual's natural resistance and hence influence the individual's reaction to future exposure to both biological and non-biological antigens. In this plenary session we want to emphasise both aspects of the effect of infectious agents on human and animal health.
Evidence Based Medicine in Health Care Practice and Epidemiological Research
P. Glasziou & L. Bonneux
Evidence-based medicine is defined as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. Proponents of evidence-based medicine maintain that coming form a tradition of pathophysiological rationale and rather unsystematic clinical experience, clinical disciplines should summarize and use evidence concerning their practices, by using principles of critical appraisal and quantitative clinical reasoning. For this they should convert clinical information needs into answerable questions, locate the available evidence, critically appraise that evidence for its validity and usefulness, and apply the results of the best available evidence in practice. Applying the principles of evidence-based medicine implies improvement of the effectiveness and efficiency of health care. Therefore, evidence-based medicine has commonalties with clinical medical and epidemiological research.
For integration of evidence-based medicine into health care practice the challenge is to translate knowledge from clinical medical and epidemiological research, for example in up to date practice guidelines. The limitations of using evidence alone to make decisions are evident. The importance of the values and preference judgments that are implicit in every clinical management decision are also evident. Critics of evidence based medicine argue that applying best available research evidence in practice in order to improve the effectiveness and efficiency of health care contradicts with the importance of the values and preference judgments in clinical management decisions. In this plenary session we want to contrast these viewpoints on evidence based medicine in health care practice.