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Neuroepidemiology—from principles to practice
  1. C N Martyn

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    Edited by Lorene M Nelson, Caroline M Tanner, Stephen K Van Den Eeden, and Valerie M McGuire. Published by Oxford University Press, Oxford, 2004, pp 449, £47.50 (hardback). ISBN 0-19-513379-X

    Everyone, at one time or another, feels misunderstood and unappreciated. Epidemiologists are no exception. They get fed up with hearing secondhand opinions that epidemiology is a blunt instrument or that epidemiological investigations don’t allow inferences to be drawn about aetiology. Their hearts sink when they encounter people who believe that its methodology amounts to little more than counting cases. Eventually, exasperation drives them to write a book explaining what their subject is really about. If this was the motive behind Neuroepidemiology—from principles to practice, I hope the authors and editors found the process of writing it therapeutic. Whether practicing neurologists, who are identified as a target readership in the preface, will find that it changes their view is another matter.

    The book follows a conventional format. Introductory chapters on methods are followed by accounts of specific neurological diseases. An attractive feature is the final section with descriptions of clinical trials, evidence-based medicine, and health services’ research as they apply in neurology.

    The trouble with epidemiological accounts of disease is that they often read like mystery stories without a dénouement. This isn’t the authors’ fault, of course. If the cause of a disease is still unknown, what can they do but describe investigations that are still in progress. They round up the usual suspects—things such as head injury, diet, cigarette smoking, and infections—and work them over. They tell us about the circumstantial evidence—such as global distribution, migrant studies, and time trends—that might provide a promising lead but which might equally turn out to be a red herring. In the end the story usually peters out and they rarely get a conviction. It’s useful to have a summary of the research that has been done—although other similar accounts exist—but, on the whole, it doesn’t make for gripping reading.