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Authors: M. Karvonen and M. Mikheev; translated by Anatoli Nosikov


This is a translation from WHO Regional Publications, European Series № 20 and comes to denote a landmark in the epidemiology of non-infectious disease in Bulgaria. It broke the long term monopoly of socialist epidemiologists, mainly, as to the application of a risk orientated methodology in the investigation of diseases and their determinants. It couldn't solve, however, the insoluble - namely, to establish some consistent trends in the development of epidemiologic sciences in Eastern Europe. While the reasons are manifold and I have discussed some of them in the occasional publications of this booklist - subsequently, I wish to expand my vision on some elements of the history of epidemiology.

I am firmly convinced, that, a topic like this is subject for a tenure track position in academic research. My efforts as a scholar and working in the periphery of this entangling scientific discipline could produce no more than a scattered outlook. This has sad connotations and is, unfortunately, in concord with a state of knowledge and order that prevails in the countries of Eastern Europe, as a whole. The reasons for delayed development are obvious and contrary to the expectations there are few perspectives for an improvement.

I remember having spoken to a notable epidemiologist from a Western university and some 10 /ten/ years ago he tried to explain this outstanding superiority of western science and technology over the rest of the world. His answer sounded something like this, - viz., "After all, a dog does not piss on a moving car".

Now, let me continue with this fragmentary notes and regarding the history of epidemiology. I don't think it is very precise or having in-depth of thought, notwithstanding, this is our momentary shot on the subject. Also, see Fig. 1 for an illustrative approach in defining the epidemiologist's black box.

There are several viewpoints on the evolving science of epidemiology - mainly, in the form of inferences and conclusions:

Epidemiological inference - the term "epidemiology" has come to displace an old term "loimologia", which meant the study of plague diseases - cf. epidemiology history. Etimologicaly, it follows as a compound from greek words epidemia /occurrence of disease/, and, logos /science, branch of scholarship/.

Observational inference - epidemiology seeks the objective laws of advent-development-extinct in disease process, as given: sporademia, epidemia, pandemia.

Analytical inference - the growth of epidemiology as a "science", which, study the principles of epidemiologic case vs. territory occurrence; all-in-all, it contains the rationale for prophylactics and prevention of disease.

Marxist-Leninist inference - 1. as a dialectic category, epidemiology reflects the forms for movement of matter; 2. as a universal classificator, epidemiology study the human population with the changes it undergo; 3. as a system whole, epidemiology is the totality of an ideology with an aim to transform "science" and "art" into a socialist /N.B. editor note, understand here a "society belonging to the individual, and, not vice versa"/ reality.


Figure 1: Provisional scheme of the epidemiologist's black box.

(i). Epidemiology is not an airplane and it is not crashing somewhere in indefinite space and time. A black box doesn't give a latest visionary and memory of the perished passengers. Such an object simply is non-existent, since, any type of a recorder or other similar technical device couldn't possibly survive an accident that took human life on such a wide scale.

Supplement I: One problem that has been consistently creeping in my mind, while, approaching this cumbersome territory of research and whether there was a definitive point, when, a growth occurred from "statistics in medicine" methodology to "theoretical epidemiology" methodology. I couldn't find a single body of literature trying to evaluate this issue. If I am right, then, all historical essays have been treating a contribution of a single scholar or an institutional organization and towards more cohesion in the definition and application of epidemiologic methods in practice. My search in the WHO database, however, found some evidence on such methodological growth. An interested reader could have a look at the following publications:

1. WHO Expert Committee on Health Statistics (1966) Sampling methods in morbidity surveys and public health investigations, Wid Hlth Org. Techn. Rep. Ser., No. 336

2. WHO Expert Committee on Health Statistics (1967) Epidemiological methods in the study of chronic diseases, Wid HIth Org. Techn. Rep. Ser., No. 365

3. WHO Expert Committee on Health Statistics (1971) Statistical indicators for the planning and evaluation of public health programs, Wld Hith Org. Techn. Rep. Ser., No. 472

4. WHO Expert Committee on Health Statistics (1972) Statistical principles in public health field studies, Wld Hith Org. Techn. Rep. Ser., No. 510

Supplement II: One more detail that was omitted in the commentary above but should be added now. This book which is definitively the best available translation of epidemiology text in Bulgarian, contains as appendix the abridged version of John Last's "Dictionary of Epidemiology". It has been adapted to real-time knowledge in Bulgaria though insufficient for scientific purposes.

Supplement III: I dare add a single link to this database which otherwise have been neglected in the recent several years. The reasons are multiple but I shall try to give some elucidation, even and only, for the sake of coming generations. The author of these lines is coming from Bulgaria and in those not so distant years away the book "Epidemiology of occupational health" edited by M. Karvonen and M. Mikheev was still very popular in its Bulgarian translation and utterly unpopular (or unavailable) in its English original language.

The misnomer of this autarchic situation caused several illicit consequences to the development of epidemiologic science in Bulgaria, which in the year 2012 is still in an embryo position although the country became recently a full member of the European Union. The running to and fro of Euro commissars and other liaison persons have remained in vain; the institutionalization of Epidemiology science is still lagging or is opted to be in the hands of unfaithful people. Thus the most important dilemma of science national or international has remained stagnant in Bulgaria and hopes for the near future are unrealistic.

I write those lines not because I have remained a disillusioned research scholar in the past 20 years or so. I am nearing my fifties and my health is not so good as it was in my younger age. The people who shattered my academic career are still there and mostly still enjoying the fruits of their scientific spoil. The fact that I have been recommending epidemiologic literature in English language for years in a row but was hilariously neglected by the Bulgarian community doesn't seem to bother anyone in particular. Keep on going brothers and sisters!

I hope this link is not going to dead end,




Copyright 2005, 2012 by the author.