Given the theme of the conference – from Paradigms to Pragmatism – starting the second day with a keynote from Dr. Sholom Wacholder, a methodologist and a pragmatist, was very fitting. After a brief introduction where he called for the implementation of a general theoretical approach when thinking about public health questions, he introduced the foundations of basic translational science. Here he focused not only on the importance of understanding the language and the ideas, but also the need to move on to that next step of actually applying the ideas in our unique, individual situation. With such a strong focus on getting large effects sizes and having large samples, it is easy to forget to think about public health in our research. When conducting public health research, we need to identify appropriate interventions; without these, it is not clear where the translation will come from. Giving examples in several areas of his own research, Dr. Wacholder emphasized key methods and tools for implementing translational research.
Dr. Wacholder went on to discuss the quantitative framework for conducting translational research. In the conception stages of a study, the problem needs to be thought about at a program level – what are the clinical guidelines, what public health policy surround the issue, etc. When considering interventions, both the desired and unintended consequences need to be taken into account, and the program with the greatest net positive impact needs to be implemented. The use of risk differences provides a utilitarian basis for clinical or public health. This includes considering the benefit to the population of providing treatments to individuals at increased risk or implementing prevention tools across a community. When thinking of interventions, it is also necessary to keep in mind the effectiveness of an intervention as well as risk stratification – risk is rarely linear. Finally, unintended limitations need to be considered – when the action of an individual influence the health of others, what is the value of autonomy versus coercion? These tools facilitate the collaboration of all stakeholders required to implement changes to improve the health of the population.
Dr. Wacholder ended his lecture reminding us that we need to count. Public health is about body count; we need to learn to count, learn to know what the denominator is, and start internalizing Bayes’ rules. Without a risk difference, there can be no translational claim. As epidemiologists and biostatisticians, we have an enormous responsibility. To live up to this responsibility, we have to keep learning and keep incorporating these new tools that are becoming available to us to ensure that the research we do is used to make real changes.
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