ACE HistoryAs written by Past President, Melissa J. Perry, ScD, MHS, FACE In 1976, Abraham M. Lilienfeld, who had by then stepped down as the chair of the department of epidemiology at Johns Hopkins University’s School of Hygiene and Public Health to become a University Distinguished Service Professor, was taken aback by an unexpected phone call. The caller was a chemist working as an ecologist at a major chemical company. She asked Dr. Lilienfeld what epidemiology was and how she could learn more about it. When he asked why, she explained that she had been told earlier that week that she was to meet with some Congressional staffers who wanted to talk with the company’s epidemiologist. She was trained in computer programming and knew a bit about statistics, and she was smart enough to realize that it would be wise to learn at least a little bit more about the field in advance of that meeting. After making her trip to Capitol Hill, the chemist called Dr. Lilienfeld to thank him for his good advice. She ended up testifying before Congress as an epidemiologist, she said, and she reported listing her membership in the Society for Epidemiologic Research as a credential. She also expressed gratitude to Dr. Lilienfeld for his suggestion that she read a couple of reference texts on epidemiology such as Maxcy-Rosenau’s Preventative Medicine and Public Health. The phone call with that chemist made Dr. Lilienfeld realize that, at the time, no professional organization was focused on answering the question of who and what an epidemiologist was. It inspired him to begin the process that ultimately led to the creation of the American College of Epidemiology. After becoming a University Distinguished Service Professor at Johns Hopkins University’s School of Hygiene and Public Health and before founding the American College of Epidemiology, Dr. Abraham M. Lilienfeld spent several years developing his ideas for creating a new epidemiologic society. During the 1976 summer public health training program in Minneapolis, he taught a history of epidemiology course. Approaching a colleague and friend, Leonard Schuman, director of the University of Minnesota’s epidemiology program, he described a phone call he'd received during the prior academic school year from a chemist who had joined the Society for Epidemiologic Research because she had been appointed as her company's epidemiologist and was preparing to testify at a government panel in Washington, D.C. Schuman pointed out that in medicine, board examinations played a key role in establishing the different communities of specialists, such as internists, orthopedic surgeons, and so on. The American Board of Dermatology was based in Minneapolis, and Schuman offered to get a copy of its bylaws. By the end of the summer, Lilienfeld had a copy of those bylaws in hand and was contemplating the idea of creating a society that would offer a board exam for non-physician epidemiologists. The American College of Epidemiology was officially incorporated in 1979, with bylaws loosely modeled on those of the American Board of Dermatology (in Minneapolis). Its origins can be traced back to a phone call from a young toxicologist who had been informed that she was now the company's epidemiologist and would provide testimony as such to the Congress. She called Dr. Abraham M. Lilienfeld, University Distinguished Service Professor at the Johns Hopkins University, to ask him what epidemiology was. Lilienfeld realized that there was no available certification of who was or was not a qualified epidemiologist. Discussions between Lilienfeld and his close colleague Dr. Leonard Schumann (Chair of Epidemiology at the University of Minnesota, Minneapolis) led to the organization of the College. The original Board of Directors, each invited personally by Lilienfeld, consisted of 15 leaders in the field. By design, about half of these initial directors were non-physicians, and the majority were from academic institutions. Soon after word of the College’s founding began to circulate in the field, rumors surfaced regarding the founders’ motives. Some skeptics suggested that the organization was the result of a plot by physician-epidemiologists to keep non-physician epidemiologists out of the field. Another suspicion raised was that the College sought to pre-empt academic epidemiology training programs. Some of the more formal responses were not encouraging. Proponents of the College saw it as a way to provide a professional identity for a field that could be entered from different paths. Physicians were readily accepted as epidemiologists, but a non-physician would typically need an epidemiology (or perhaps biostatistics) doctoral degree. A prominent exemplar was Jerome Cornfield, who as a past President of the American Epidemiological Society (AES) was indisputably an epidemiologist yet he possessed neither a medical nor other doctoral degree. If he had not been a member of AES, what certification could he claim? The solution appeared to be to have a credentialing examination for admission to the College. The model Lilienfeld used in setting up the exam was the Society of Actuaries, in which topics were covered in a series of exams, each of which could be passed independently of the others. (This approach, Lilienfeld noted, was not notably different from the one used by the National Board of Medical Examiners in credentialing medical students and interns.)” But the news of the College’s founding and its accompanying credentialing examination evoked a fast and furious response. Letters written by two prominent physician-epidemiologists typify this fast and furious response. Dr. Warren Winkelstein, then dean of the School of Public Health at the University of California at Berkeley (and one of Lilienfeld's former students/mentees), sent Lilienfeld a sharply worded letter that said, in effect, “Who was the College to suggest who/what is an epidemiologist? The academic programs did that already, thank you very much.” Another letter sent by Dr. Roger Detels, then chair of epidemiology at the University of California at Los Angeles’ School of Public Health, was more colorful, but had the same gist. Not all of the responses were negative. For example, Dr. Jacob Brody, who was then at the National Institutes of Health, expressed optimism that membership in the College would be seen as equivalent to being "boarded" in preventive medicine. At the time, being boarded raised one's salary by a significant sum for physicians at the NIH. (Brody, trained as an officer of the Center for Disease Control's Epidemic Intelligence Service, was not boarded, yet he founded the epidemiology program at the National Institute on Aging--among his many accomplishments at the National Institutes of Health.) At the 1979 Society for Epidemiologic Research conference in New Haven, Conn., an impromptu meeting was called for Lilienfeld to explain what need the nascent American College of Epidemiology would address, and how the College would operate. It became clear that there were more people interested in attending the session than could fit into the assigned room, and so the session moved outside. Speaking without any microphone, Lilienfeld found himself hard-pressed to project his voice to be heard by everyone now crowded around him. He had been intubated several months before and was still recovering from laryngeal damage, something not known to the crowd. Soon after Lilienfeld started talking, a voice from the back of the crowd called out that Lilienfeld could not be heard. Someone closer to the middle of the group shouted back, "He's talking softly so that he can't be heard and we won't find out what is going on." Now badly hoarse and feeling frustrated, Lilienfeld announced that he would be sending letters describing the College’s mission to the major publications in the field. It was a rocky start for the ACE. Many in the field perceived the College as a threat to the academic training programs (despite the heavy prevalence of those from academia on the Board of Directors). Others considered it one more barrier for them to overcome to be considered an epidemiologist; many in this camp argued that passing their written comprehensive exams and defense of their dissertations should suffice. Despite the early opposition, the College had been founded, and its founding board of directors (Philip Brachman, Fred Ederer, Lila Elveback, Harry Feldman, Cedric Garland , Saxon Graham, Samuel Greenhouse, Michel Ibrahim, Dwight Janerich, Jennifer Kelsey, Abraham Lilienfeld, Curtis Meinert, Ralph Paffenbarger, Jr., Leonard Schuman, Milton Terris) read like a Who’s Who of epidemiology. Admission to the College would involve passing a certification examination, but for the first few years qualified epidemiologists could be admitted based on their training and experience. To junior epidemiologists wanting to hedge their bets in case membership in the College at some point conveyed real advantages, the prospect of having to pass an entrance examination provided a stimulus to apply before the “grandfathering” period ended. Since its founding, epidemiology has matured both as an academic discipline and as a field of practice in a large variety of health agencies, hospitals, and research institutions. Through these years, the American College of Epidemiology has benefited from the leadership of some of the world's pre-eminent epidemiologists. A decade or so later, ACE changed the by-laws to create an Associate Member category, through which people could join the College if they were enrolled in a training program that when completed would qualify them for regular membership. This mechanism has infused the College with a new source of youthful energy and creativity. Many new regular Members and Fellows were once Associate Members, so the process is functioning as envisioned, and a growing number of other epidemiologists have also joined the College, so that it is now an open cohort, poised for growth and further advances. The College also began accepting their first cohort of Affiliate members in 2022, a new membership category open to individuals who practice epidemiology, but do not meet the minimum criteria for admission to Member status and are not current epidemiology students. This change further expanded the reach of ACE, helping to promote the field of epidemiology to a new and multidisciplinary group of scholars from the U.S. and abroad. Special thanks to Melissa Perry, former ACE President, for crafting this historical message. Thanks are also owed to David Lillienfeld, Victor Shoenbach, and Jan Eberth for their contributions. |