This response by @mlipsitch to my @BostonReview #COVID19 piece ( https://bostonreview.net/science-nature/jonathan-fuller-models-v-evidence) provides a fascinating (and philosophical) look inside epidemiological thinking at a time when understanding the science is crucial. Some thoughts... 1/ https://twitter.com/mlipsitch/status/1260237252506144769

I still argue there are different ‘philosophies of science’, one represented by orthodox evidence-based medicine ( #EBM), other by the pragmatic, pluralist epidemiological epistemology explored in @mlipsitch's piece. This is a description, not an endorsement of the dichotomy. 2/

Again, this an exception-ridden generalization, not a hard division. It describes different ways of thinking one may adopt. It’s not like there is a two-party system in epidemiology and epidemiologists register with one of these two parties. 3/

Clinical epidemiology has an unusual history, it did not evolve within epidemiology. On some of the early history, I recommend Jean Daly’s (2005) Evidence-Based Medicine and the Search for a Science of Clinical Care. 4/

I agree that any rigid ‘sectarianism’ is counterproductive to collaboration and to science. @mlipsitch rightly points out that my call for collaboration is undermined by the fact that one cannot insist on randomized studies and simultaneously welcome evidential diversity. 5/

My main point was to describe different virtues, attitudes and strategies in epidemiology. 6/

However, certain virtues can quickly become vices, as when skepticism turns paralyzing, or when one develops such a particular taste for ‘high quality’ evidence (i.e. randomized studies) that one cannot stomach other important pieces of evidence 7/

@mlipsitch: “With infectious diseases, especially new and fast-spreading pandemics, action can’t wait for the degree of evidentiary purity we get from fully randomized and controlled experiments, or from the ideal observational study.” 8/

Public health #COVID19 policy should not embrace the #EBM hierarchy of evidence. In solving the riddle of smoking and lung cancer, Jerome Cornfield (1959) and colleagues had it right: there are no “hierarchies of evidence” ( https://academic.oup.com/jnci/article-abstract/22/1/173/912572?redirectedFrom=fulltext) 9/

Also, Abraham Lilienfeld (1959): "[t]he plausibility of the causal hypothesis is assessed, not in terms of the results of one particular study or a 'crucial experiment,' but in terms of the totality of available biologic evidence" ( https://www.jclinepi.com/article/0021-9681(59)90016-5/fulltext) 10/

However, we don’t need to look to the past or to the epidemiology of noncommunicable disease to see this kind of thinking in action. @mlipsitch very nicely describes how this kind of pluralism and pragmatism is guiding #COVID19 infectious disease epidemiology. 11/11