One of my recent frustrations has centered around the misleading statements of scientists who study blood-borne pathogens and work in U. S. institutions.  Epidemiologists in other countries seem more forthcoming about how global mass vaccination programs and other medical  interventions spread infectious diseases.

It’s hard not to form impressions of the quality of various research projects after reading dozens of abstracts and articles in PUBMED.  Many of them are signed by multiple authors so one can’t zero in on the exact contributions of each who signed off on an article.  But when there are only one or two creators, judgments are more easily made and potential allies identified.  Here is the informal rating system I’m applying to various intellectual products as I find them:

Brave truth-seeking epidemiologists:   Five stars

Careful but generally helpful epidemiologists:  Four stars  

Frightened epidemiologists who find subtle ways to promote unbiased science:  Three stars

Timid epidemiologists who make limited contributions:  Two stars.

Ambiguous epidemiologsts who are protectors of the status quo and make limited contributions.   One star

Epidemiologists who lie, hide and evade issues for money, to save their reputations or those they worked for (sometimes saintly reputations at that), or for other reasons.    NO stars

French Canadian Dr. Pepin, a physician, epidemiologist, and professor, is also an ethicist who admits to unsafe vaccination procedures when he worked in Africa.  He explains how and why this occurred in his amazing book, The Origins of Aids (2011).   HCV is an important part of Pepin’s medical storytelling.  I am grateful to the author for articulating how blood-borne pathogens such as HCV and HIV have been transmitted iatrogenically through different types of medical interventions and settings.  Pepin looks at the big picture (science, history, social) and one can learn how the best epidemiologists reason through problems.  Looking at circumstantial evidence and direct evidence are part of the necessary processes used. 

Many physicians think that they are qualified to opine on epidemiology without dual degrees.  Here are two examples:

Gutherie S. Birkhead M.D., has a master’s in public health and CDC experience.  He works for the State of New York.  He gives Pepin’s book a “thumbs up;” He’s not an epidemiologist but close enough so I rate him three stars for his book review in JAMA and five stars for his blog comment (2nd comment down) giving his strong support for the One and Only One Campaign in response to a USA Today article.

But as soon as Federal government money becomes a major influence (as in big salary, benefits and glory or research dollars) the waffling begins.

For example, this book review is written by CDC newly hired Kevin DeCock, M. D. from Belgium.  Like Birkhead, he calls the book a “tour de force” but this quote leads me to  believe that he was hired to defend the status quo.

“The evidence offered by Pepin for the iatrogenic hypothesis is probably better presented than ever before.  Nevertheless, the evidence is speculative because it is based on circumstantial and ecologic associations, such as those between earlier medical practices and trends in hepatitis C virus infection. Despite excessive speculation in parts of the book, such as that concerning the role of the trade in plasma from Haiti, this work is still a “tour de force” and deserves widespread recognition.”

De Cock likes the book but calls it “excellent but frustrating” in the first sentence; I have to give him in the one star.

There is a big difference between a 3000-word study on a subject and a research-dense book.  Unfortunately,  studies are cited more often than books and are very influential.  The more citations, the more influential.

Pepin’s work sets a gold standard for epidemiologists.    He earns five stars from me.  If you can get The Origin of Aids from your librarian or on your Kindle app, I think you’ll appreciate Pepin’s work, which is also deals with HCV, as much as I do.