“If there’s a god, she
meant me to be an editor”
John
Last, 1986
In 1977 I began to be transformed from a professor of
epidemiology into an editor. That word ‘editor’ doesn’t adequately describe my
new roles and responsibilities; and the transformation, though rapid, wasn’t
instantaneous. I’ll try to describe here some of the ways I was changed by this
experience – these experiences, because there were several, each subtly
different from all the others. First was the massive reference textbook of
public health, then the Canadian Journal
of Public Health, the Dictionary of
Epidemiology, the Oxford Illustrated
Companion to Medicine, Annals of
the Royal College of Physicians and Surgeons of Canada, the 4-volume Encyclopedia of Public Health, the Dictionary of Public Health, and along the way, several other editing and
writing assignments and ad hoc essays on assorted topics in public health for
half a dozen other encyclopedias.
I began with flimsy, barely credible, credentials, but with
powerful motivation and, probably the most important philosophical and
professional criterion, a broad and clear vision of what was needed in a
comprehensive reference textbook of public health sciences and practice. Other
books (CEOs of publishing houses call them ‘competing’ books) all had
deficiencies – as did the massive work I edited – but the deficiencies in the
big book I edited were minor and of a different order, and I’ll defer discussion
of these flaws to another occasion. All the competing books suffered from one
or more of several weaknesses. The other books didn’t cover every aspect of
public health sciences and practice; they were unbalanced, putting too much
emphasis on some aspects of the domain of public health sciences and practice,
not enough on others; they were too theoretical, not enough description and
discussion of how public health is actually done in the real world. One popular
book contained many beautifully written essays on specific aspects of public
health, but left other important aspects out altogether, and connecting
conceptual links between the essays were almost entirely absent. The book is an
anthology of essays on aspects of public health, a lovely book to handle and to
read, but unfortunately it has limited practical use.
My aim was to recruit authors who could write
authoritatively on each and every aspect of public health science and practice.
I came fairly close to succeeding. I
didn’t have a chapter on the public health impacts of nuclear power plants,
although we got one in subsequent editions. The failure I felt most keenly was
not my fault but the fault of an author who let me down. He had a good excuse, a marriage breakdown
that absorbed all his emotional energy and left him incapable of writing the
chapter he had agreed to contribute; if I’d been told in time I might have been
able to get somebody else to write this chapter but unfortunately he kept me in
the dark about his domestic situation until it was too late – the book was only
a few weeks away from going into production when he told me he hadn’t even
begun to write the chapter that he had outlined in detail in a letter a year or
so earlier.
I was blessed with a wide and deep acquaintance network – a
friendship network really, because most of those I invited weren’t merely
recognized authorities on the domains and topics I invited them to expound
upon, but were also personal friends with whom I was on first name terms,
through my work on the NIH Epidemiology and Disease Control Study Section of
the US Public Health Service, the Association of Teachers of Preventive
Medicine, the American College of Preventive Medicine, the American Public
Health Association, or their Canadian counterparts. When I was recruiting
authors of chapters, I could pick up the phone, and speak to Jim, or Steve, or
Mary, discuss the subject matter, the boundaries, the approximate length, the
level at which the text should be pitched (advanced postgraduate) integration of
text with supporting figures and tables, and more important, integration with
other chapters; and finally delivery dates, and other details like reward for
effort. For the 11th edition of Public
Health and Preventive Medicine, the reward was a dollar amount; as the
number of contributing authors increased with subsequent editions this was
changed to a complimentary copy of the book; contributors to encyclopedias were
rewarded with generous cash payments.
An editorial board made up mainly of elder statesmen of
public health was a great help. The members and the board as a whole advised me
about selection of authors for many specialized topics. They adjudicated rare disputes that arose,
provided much needed moral support in the solitary instance of a serious
disagreement with an author whose draft chapter was unacceptable, and individual
members often acted as peer reviewers and provided expert advice to chapter
authors and to me. I was lucky not to get caught in the crossfire of competing hypotheses about the underlying cause of coronary heart disease or common cancers, so didn't have to deal with the problem that less fortunate colleagues faced, of diametrically opposed statements appearing in adjoining chapters of the book - though I suppose if that situation had arisen it might have made for some interesting debates among users of the book.
I’ve cared about definitions since I was a schoolboy – I
always wanted to be sure of agreement that all concerned meant the same thing
when alluding to a particular word or phrase. I first became aware of doubts
and disagreements about the terminology of epidemiology at the international
scientific meeting of the International Epidemiological Association (IEA) in
Princeton, New Jersey, in 1964. The theme of the meeting was Comparability in
International Epidemiology and was mainly concerned with inconsistency in use
of diagnostic labels for coronary heart disease, chronic respiratory disease,
and common varieties of cancer. It soon became clear that there was another
kind of inconsistency, in the use of technical terms we used to describe the
concepts, methods and procedures of epidemiology. Several different terms were in common use to
describe commonly used research methods and there was no consensus as to which
was the preferred term. One term, case control study, was occasionally used to
describe the research method that almost everybody else called a randomized
trial. At the very least some sort of glossary was needed, as well as firm
statements by intellectual leaders of the discipline of epidemiology about
permitted and proscribed usage. Several of us who cared deeply about this used
to cry into each other’s beer throughout the 1970s, when we met once or twice a
year at gatherings such as the epidemiology section of the American Public
Health Association, the Society for Epidemiologic Research, and regional
meetings of the IEA. Anita Bahn at the Medical College of Pennsylvania in
Philadelphia got a grant from the National Library of Medicine to compile a
glossary of epidemiological terms. I began working with Anita Bahn, but she
died suddenly. The International Epidemiological Association (IEA) picked up
where Anita Bahn left off, and I was appointed by the IEA to compile and edit
the Dictionary of Epidemiology. My friend and mentor Kerr White, who was
president of the IEA at the time, negotiated a contract with Oxford University
Press to publish the book. Jeff House
was editor of the medical science division of OUP (USA) and my friendship with
Jeff dates from that time.
A different process from that used for textbooks worked well
with the Dictionary of Epidemiology.
I have described this process in several journal articles and summarized
essential details in the Preface of the dictionary. I began by compiling a list
of keywords and phrases, mostly culled from the indexes of textbooks, journals
and monographs, distributed this widely and used the feedback to refine the
list of headwords and phrases into those for which a dictionary definition was
essential. I composed many definitions myself, and collaborating colleagues
composed or helped to compose others. Everything went through an iterative
process; I distributed several successive sets of draft definitions, 4 or 5 in
all, each of which was revised and refined in light of feedback from a
worldwide network of 30-60 or more corresponding contributors. This was a slow
process that relied on air-mail for the first edition (1983); by the 3rd
edition (1994) feedback was partly by fax, and by the 4th and 5th
editions, we were using email for almost all exchanges and
feedback, so the process was greatly accelerated and took a year less from
start to finish than earlier editions.
The first edition of the Dictionary
of Epidemiology was financially supported by a grant from the Rockefeller
Foundation, which bankrolled a 5-day meeting in New York, attended by a dozen
or so of us, at which we thrashed out draft definitions of the most important
abstract terms, epidemiological concepts and methods: at that meeting we
drafted definitions of rate, proportion, case control and cohort studies,
controlled trial, epidemiology, and a couple dozen other terms on which there
had previously been disagreement or uncertainty. Several draft definitions were
further refined later, most memorably the definition of epidemiology. The final
wording of this important definition was decided during a long drive across the
plains of West Bengal, during which my friend the Polish epidemiologist
Zbigniew Bryzinski and I discussed the important philosophical issue, whether
epidemiology is an abstract ‘value-neutral’ scientific disciplie, or a set of
methods and procedures that aims to improve the human condition. Zbig and I
agreed that epidemiology is the latter, not the former, and the final phrase of
the definition reflects this conclusion. Interestingly, our French-speaking
colleagues don’t share this view and omitted the final phrase of the definition
when it was translated into French. It
appears in the Spanish, Serbian and Portuguese translations but I don’t know
whether it’s there in the Chinese, Japanese, Arabic, Farsi, Russian or Ukrainian
translations.
Here is the English language definition:
Epidemiology The study of the distribution and determinants of health-related states
or events in specified populations and the application of this study to the
control of health problems.
This is followed by a lengthy paragraph in which
each word or phrase is further discussed and explained. It was a long and sometimes acrimonious
process reaching agreement on the wording of this, and many other entries in
the dictionary, which went through five editions between 1983 and 2008.
I don’t think I’ve ever had more fun than compiling
and editing the Dictionary of Epidemiology. Some of this fun began very
soon after I started the work, when I received the first of what eventually
became a long sequence of notes, typed on an electric typewriter with a faded
red ribbon and with numerous typos, and frequent apt quotations from the lesser
known works of Lewis Carrol. These
letters came from Michel Thuriaux, a Belgian epidemiologist who was then
working for WHO in Dahomey in French Equatorial Africa. Michel and I met face
to face at that New York meeting, and have been good friends ever since,
alternatively buying meals for each other whenever we meet, usually in
Geneva. I had fun too when I adjudicated
a mild dispute between a ‘words and concepts’ epidemiologist and another who
believes that a mathematical formula says it all. These two engaged in a polite though somewhat
acerbic debate via me, reminiscent of the ‘exchanges’ in the correspondence
columns of the New York Review of Books. It was very good also to see
two contributors whose names came next to each other when arranged in
alphabetical order, one from Israel, the other from Syria, two countries then
at war. Their concern for clarity and consistency in epidemiological
terminology trumped the hostility of their two nations.
All this correspondence is now lodged in the
National Archives of Canada.
Editing an encyclopedia calls for different
editorial skills and judgement. Each entry should be prepared by an acknowledged
authority. Macmillan’s publishing house invited my friend and mentor Lester
Breslow to edit a 4-volume Encyclopedia of Public Health, and Lester invited me
and several others to join him in this work.
I think I was probably the most active; I certainly wrote more entries
than anyone else, and probably recruited more contributors too. I had a similar level of input into another
encyclopedia, the Oxford Illustrated Companion to Medicine.
Editing a serial publication such as a weekly,
monthly or bi-monthly journal requires an entirely different skill set. Indeed
there are so many ways that the roles and functions of the editor, editorial
board, peer reviewers, and interactions with contributors and correspondents
can play out, that discussion requires at least as much space as I have already
devoted to what’s described here. I will
discuss this in a separate piece.
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