Objectives: To analyze the rise of clinical epidemiology and its ideological basis.
Methodology: Historical analysis.
Results: The author analyzes different notions of ideology and opts, for purposes of this study, to employ two particular meanings. The first is a positivist notion of ideology, as the ideas of a fixed historical period; the second is a Marxist-inspired view of ideology, as the concealment of relationships of domination. Under the terms first sense, clinical epidemiology includes ideas from the 1980s, which convey a post-modern character, consistent with the individualist temper of those times. The author then points out certain myths concerning clinical epidemiology, which relate to the second meaning of ideology. Clinical epidemiology possesses a double ideology since it claims to confer greater scientific authenticity to both the empirical findings of the clinic and to knowledge in epidemiology influenced by sociology and politics.
Clinical epidemiology reduces epidemiological research to studies about the efficiency of diagnostic and therapeutic procedures performed on patients, who form groups to be studied simply because they bear a particular illness. Furthermore, clinical epidemiology distorts reality by excluding studies which might demonstrate the social factors at play in the process of health and illness.
Conclusions: Epidemiology can fulfill one of two possible roles. One is to shape clinical research according to an ideological enterprise. Under this scenario, clinical epidemiology plays an auxiliary role; its serves as a methodological aid, deprived of the object of its own research. In its second role, clinical epidemiology takes on a critical task of illuminating the contradictions and illusions in the dominant ideology and generates knowledge bearing on the collective dimension of health and illness.
Copyright 2007 University of New Mexico