AUDIOLOGICAL MEDICINE 2004; 2: 143
Book review
The Epidemiological Approach: an Introduction to Epi-
demiology in Medicine. By Nicholas J. Wald. 8.95, 86 pages:
Published: London, Royal Society of Medicine, ISBN:
1-85315-584-5
In the preface, Nicholas Wald identifies the purpose of the book
as an introduction to epidemiology for doctors and medical
students whose training is in clinical medicine. It aims to link
epidemiology with clinical medicine and to explain the role of
statistics within the subject. The book is split into four main
chapters: causes, epidemiological studies, screening, and popu-
lation statistics.
Audiol Med Downloaded from informahealthcare.com by McMaster University on 11/03/14
The first chapter describes fundamental concepts such as the
definitions of epidemiology and cause. It discusses problems
within the subject, such as bias and confounding, which obstruct
the goal of finding causality. The second chapter introduces
population standardization, the standardized mortality ratio, and
epidemiological studies. Different types of epidemiological
study are described, ranging from observational studies through
to intervention studies. The different characteristics of each
study are discussed and compared, including the advantages and
disadvantages of each.
The third chapter describes disease prevention measures. It
For personal use only.
outlines the different types of prevention, from primary
measures such as social change, to secondary measures such
as disease screening. The fourth chapter is a broad overview of
population statistics, especially the effect of individual charac-
teristics such as age, sex, ethnicity and social class on mortality
and morbidity. At the back are appendices with a reference
section for further reading, a glossary of useful terms, sources of
health statistics and a description of how to complete a death
certificate.
Walds narrative style makes the book easy to read and a very
accessible introduction to epidemiology for doctors and medical
students. Key words and important concepts are well defined and
set apart from the text. Where necessary, clear diagrams are used
to illustrate definitions. Excellent examples of this are the dia-
grams used to explain confounding, and the difference between
systematic (bias) and random error. The latter is achieved with
an analogy of an archer. There are 4 targets, each with a different
2004 Taylor & Francis. ISSN 1651-386X
DOI 10.1080/16513860310015595
combination of accuracy, and each with a different tightness of
grouping. Common statistical concepts are well explained, such
as confidence interval and p-value, the former being the
clearest definition I have seen. The last chapter discusses
mortality and morbidity of the UK population. A wide range of
graphs are used to illustrate the text, with an underlying theme of
interpretation of the graphs. Care and attention are stressed,
especially with respect to the differing meanings of a constant
slope on a line graph depending on whether the scale is
arithmetic or logarithmic.
Occasionally the author uses phrases of statistical jargon
without fully explaining what is meant. Typical examples are:
the study has greater statistical power and statistically, this is
said to be a test of the null hypothesis. Although understandable
to statisticians, such phrases may mean little to the average
doctor. Although a good definition of confidence interval is
given, there is no mention of how to calculate it. This is in
contrast with the section on screening statistics, where terms
such as sensitivity are given an explanation of the calculation.
Although the author does not claim the book to be a complete
guide to epidemiology, the area of medical ethics is largely
ignored. No mention is made of the protocol needed to carry out
a medical intervention study, which is lengthy. A large number
of people are involved in this important area of epidemiology.
Therefore, a description of the problems encountered, and stages
within an intervention study would be useful.
In summary, The Epidemiological Approach by Nicholas
Wald is a concise and readable introduction to epidemiology.
Most of the main subject areas are covered in enough detail to
give a basic understanding of the subject. A useful reference
section in the appendix gives sources of further reading.
Although primarily aimed at doctors, I would recommend this
book to students undertaking their first epidemiology course and
anybody who wishes to learn about epidemiology. Priced at
8.95 it is an affordable introduction to the subject.
Duncan Lee
Department of Mathematical Sciences
University of Bath
AUDIOLOGICAL MEDICINE 2004