Forward Together in Epidemiology and Biostatistics

The phrase "Forward Together" embodies the central theme of the UF&Shands strategic plan. This theme refers to the bridges and partnerships that we are building across our academic health center — between faculty and hospital, and between colleges. One recent example of how Forward Together can be applied across colleges is the establishment of two new academic departments, each of which is housed in two colleges.

Just like biochemistry and physiology are disciplines that provide the basic science underpinnings for biomedical research, the disciplines of epidemiology and biostatistics are the "basic sciences" of clinical research. Epidemiology started out as the science of epidemics and epidemic diseases, pertaining to the study of a population rather than the individual. As the field of epidemiology has matured, however, it has come to embrace a much broader span of inquiry — including the study of risk factors that determine the frequency and distribution of diseases in a population and the study of diagnostic tests and of preventive or therapeutic interventions. Epidemiologic methods can be used to tease out information on risk factors from existing data sets (observational studies), or to estimate the efficacy of new treatments from a randomized clinical trials (clinical experimental studies). The new frontier of epidemiology – and of translational research in general - is the evaluation of disorders and risk factors in real time, and in community populations, so they can be linked to health services in a timely manner.

Biostatistics is the application of statistical methods to biology and medicine. Statistics can be viewed as the art and science of learning from data. Some statistics are purely descriptive (e.g., what is the mean blood pressure in a population, and what is the variation around the mean?). More importantly from the standpoint of research questions, however, statistical methods can be used to test hypotheses (e.g., in a group of individuals with elevated blood pressure, do the data show that drug A reduces blood pressure more than drug B?).

Epidemiology and biostatistics are usually connected at the hip. If existing data on individuals with high blood pressure are used to make inferences about whether one drug is better than another in reducing blood pressure, for example, complex statistical methods must be applied to control for background characteristics such as age, weight, level and duration of hypertension, and the use of other drugs. If a randomized clinical trial were conducted to compare these two drugs, however, in which individuals with a variety of characteristics were randomly assigned to receive drug A or drug B, then these background factors would be evenly distributed between the two groups and much simpler statistical methods could be applied. The latter epidemiologic design, with the simpler statistics, is much more powerful and definitive, but more expensive and time-consuming.

Last year, we decided to embark on a process that has now culminated in two new departments at UF: Epidemiology and Biostatistics. These departments distinguish themselves by being the first at UF that bridge two colleges — in this case the College of Medicine and the College of Public Health and Health Professions. Indeed, to our knowledge this is a new model nationally; in the spirit of cross-campus collaboration and interprofessional education, it might catch on!

There are a number of excellent statisticians and epidemiologists at the UF Health Science Center. Historically, they were appointed in a variety of departments across a number of colleges, based on the specific research projects that they were asked to join. This research has flourished, and some of the biostatistics and epidemiology faculty have gone on to obtain their own independent research funding.

In view of the importance of clinical and translational science in our overall strategic plan, however, it was decided that future research in these areas could be strengthened if their two foundational disciplines of epidemiology and biostatistics were given distinct identities and administrative academic homes. In an era that emphasizes interdisciplinary research and the blurring of discipline-based barriers, this might seem counterintuitive. But most of our peer academic health centers have distinct departments of epidemiology and biostatistics, and this has become an expectation for most faculty candidates in these fields. Biostatisticians and epidemiologists in these new departments will spend part of their time collaborating with colleagues across the entire Health Science Center in a variety of interdisciplinary projects, but they will also conduct their own research in their respective fields, and interact with colleagues who have similar academic interests and backgrounds on a day-to-day basis. They will also extend their collaborations to new partnerships, to gain new expertise and new interests with common research methods to make new contributions to science. Having a home academic department based on one’s discipline, but collaborating with faculty in many other disciplines, is entirely consistent with the college-department model for virtually all other faculty at the HSC.

The Department of Epidemiology will be housed in the fourth floor of the new Clinical and Translational Research Building (CTRB), a new facility to be located on Mowry Road across from the Wilmot Gardens. The Department of Biostatistics will be located on the CTRB’s fifth floor. Design of the CTRB is in its last stages, and construction will begin in June.

Dean Good, Dean Perri and I are grateful to the chairs of the relevant departments in the College of Medicine and the College of Public Health and Health Professions, and to the faculty in those departments, for supporting this plan. Such support was instrumental in obtaining approval from the UF Faculty Senate. Faculty members have the choice of remaining in their current department or transferring to the new department. The national search for a founding chair of the Department of Epidemiology has concluded with the appointment of Linda B. Cottler, Ph.D., M.P.H., who will join us on July 1. Dr. Cottler is currently a professor of epidemiology in the department of psychiatry at Washington University School of Medicine in St. Louis, where she directs the Epidemiology and Prevention Research Group and the Center for Community Based Research. She also founded HealthStreet, which connects St. Louis residents to health care referrals, medical care, social services and opportunities to participate in research. Dr. Cottler’s research, which has been supported by NIH and other major research agencies and foundations for over 20 years, has focused on drug and alcohol use and dependence in vulnerable populations.

The search for the founding chair of the department of biostatistics is well underway.

No doubt, classical epidemiology, clinical trials and biostatistics will continue to be critical in much of the clinical and translational research to be conducted at the Health Science Center. But the creation of these two new departments, with increased focus on the roles of epidemiologic and statistical methods in clinical and translational science, comes at a time of excitement about a future of personalized medicine. In this future world, health care decisions and practices will be tailored to an individual based on detailed molecular data of his or her "omics" profile — genomic, proteomic and metabolomic. Using these data as molecular fingerprints, the goal is to optimize an individual patient’s preventive and therapeutic care. We are at some distance from this future state, but each step that will be needed to link these factors depends on carefully characterizing risk and symptoms. Epidemiologic and statistical expertise will be the driving force in elucidating such linkages.

Forward Together,

David S. Guzick, M.D., Ph.D. Senior Vice President, Health Affairs President, UF&Shands Health System