On tools in psychiatric epidemiology (and the value of long distance networking)

Study the most influential contributors in your chosen field: Tools you can use

Available via MSU and other e-resources, if not direct from Wiley Online.

You can interview those who are most expert in your own specialization area.

I was lucky to be paid by DEA to travel around the US and to interview many luminaries in preparation for my dissertation research.

Often, in those days (early 1970s), it just required writing in advance and getting reply to request (all snail mail until Group 2 telefax machines made fax fast and cheap in late 1970s), and then flying to a meeting, either a scientific or professional meeting where the expert was willing to meet, or to the office. The interviews fed directly into the conceptual model I had to build, but also gave me valuable career advice.

(DEA was generous. I flew all over the place and made wonderful contacts with field leaders, some of whom ended up writing letters of recommendation for my promotion and tenure at Hopkins, for my election to scientific organizations, etc. -- because they knew me since I was 23-25 years old, and could see what I was doing over the years.)

[In 1972-75, each page of a fax took as many as 7-8 minutes to send, over a standard telephone line. In 1972, when I was writing the research proposal to DEA, most offices did not have a fax machine; it all was snail mail for this type of correspondence unless you got someone who would take a blind call on the long distance phone (still pretty much a telephone monopoly and priced accordingly).]

You can't believe how happy we were when the Group 2 fax standard came out in ~1978 and most offices could afford a fax machine and to pay for the outgoing call, but within about five years (1982-83) ARPA BITNET came online for academia, and made it possible for me to forge a trans-Pacific proposal for Alzheimer's disease research in Australia, where Scott Henderson and Tony Brie were based. Then, eventually, by 1985, they had cobbled together funds from the Australian MRC and our Fulbright Commission so I could fly the family to Sydney-Canberra for three months in 1986 to finalize design and conduct of the first community-based case-control study of Alzheimer's type dementia. In the process, I was able to convert my early use of the Mini-Mental State Examination for ECA sampling of community dementia cases, and put it to work in a general practice surveillance for dementia among seniors living in a Sydneyside catchment area. In this work, we picked up a signal of potential protection from OTC analgesic and anti-inflammatory drug compounds like aspirin, as we had hoped to see based on prior pre-clinical studies:

https://www.ncbi.nlm.nih.gov/pubmed/1615110

Concurrent with set-up and completion of that work in Australia, John Breitner and I had been trying (unsuccessfully) to get funds for epidemiological research on AD in the US, and with Marshal Folstein's help, I had been working out details for putting the McHugh-Folstein Mini-Mental to work as a first stage large sample assessment tool in a sequenced multi-stage sampling (SMSS) for probability gradient sampling of cases and non-cases for intensive diagnostic workup, and assessments of suspected causal influences. Perhaps coincidentally, the NIMH ECA leadership decided they needed a standardized assessment of cognitive functioning for the five-site epidemiological catchment area surveys; they chose the Mini-Mental, allowing us to take the community design John and I had written into our first (unsuccessful) NIMH R01 proposal, and put it into play with an NINCDS supplement to the NIMH ECA collaborative agreement. The SMSS design can be seen in #1 in pilot form for general medical ward research, and in #2 in community survey form:

Mini-Mental MMSE Epidemiology Early Days

While in Australia with Scott and Tony, I continued working with John Breitner on his insights into the use of co-twin studies of our hypothesized protective associations, but that's another story that unfolded into the era that included widespread global communication and resource-sharing via the post-BITNET internet tools for our research collaborations:

Some neuropsychiatric epidemiology history on using aspirin and other anti-inflammatories to prptect against Alzheimer's type dementias

Methods and tools pay a central role in the discovery processes of psychiatric epidemiology.

* See Holst Norwegian surveys of 1825-35, Rosanoff Nassau County survey from 1916-17, Gruenberg survey of civil commitment-eligible community elders, and Lemkau-Stampar survey of schizophrenia in NE Yugoslavia for where I got the idea to harness MMSE in large sample epidemiological studies of the dementias, with second stage diagnostic workup. Scott Henderson's panel survey of stressors and psychiatric morbidity in the mid-1970s provided key references to the quality control work of Eugene Deming, and I think Scott said he worked those out with the help of Paul Duncan-Jones, a great thinker who died too young. I covered Holst, etc., in prior blog posts. I'll try to add on on the Henderson panel survey before too long.

p.s. Let me know if these embedded links are not working. I set them up, possibly incorrectly.