How good are the job prospects for Infectious Disease Epi?

[skiracer721]

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Hi all! I'm new to this forum and have a ways to go before I start applying for grad school, but I want to get a jump start on research now.

I've always had an interest in infectious diseases and micro, and I loved my undergraduate epi class I took. I'm looking at getting an MPH in Epidemiology, particularly one that might focus on infectious disease.

I honestly don't know many jobs one could get with this degree besides the typical Epidemiologist. Could anyone give some insight into where I could be expecting to work with this degree? Does anyone know how the job prospects are in this area?

Any help would be much appreciated! Thanks!

 

[slivingston]

I graduated with my MPH in Epi degree in 2009, with high hopes of working in the infectious disease/outbreak surveillance field. Unfortunately, majority of that career field is within the federal gov't so getting your foot in the door is the hardest part. It has been about 3 years and I have yet to achieve it. I have been "stuck" at a government contractor working as a data analyst/statistician on a few healthcare contracts but nowhere near the infectious epi realm. I am also in the DC metro area, so when jobs do come up I am first to apply, however so far no such luck. Don't mean to shoot it down but you might want to properly research the area within your geographic location first.

 

[Stories]

Infectious disease is one of those areas that not as big as it once was because the burden of ID is much less than it used to be. So keep that in mind when going into the field.

 

[EpiWin]

I graduated with my MPH in Epi degree in 2009, with high hopes of working in the infectious disease/outbreak surveillance field. Unfortunately, majority of that career field is within the federal gov't so getting your foot in the door is the hardest part.

Don't state and local governments typically see the bulk of ID investigations, with the federal government only getting called in for larger outbreaks?

 

[chuz]

The way it is in my state (I currently work at the health department), there are general state epidemiologists who literally do every kind of epi. One week they might be tracking the flu, one week they'll take care of a foodborne outbreak, the next they'll be helping with a chronic disease study, etc. She's even gone out collecting bats because rabies reared its ugly head for a short period last year. It seems like a pretty good gig to me, but the pay is quite unfortunate, especially with a doctorate (which my district's epidemiologist has).

It seems to me the only way to be an infectious disease epidemiologist full time is to be at the CDC or doing research on the small niche you find interesting and, most importantly, reimbursable by some entity. Correct me if I'm wrong, but chronic disease stuff is where the vast majority of grant money is at. I want to do infectious disease stuff too, but I've come to terms with the fact that you have to be flexible if you ever want a job. Everyone wants to go virus hunting and discover Ebola's new cousin, but it's just not something anyone wants to pay for these days.

 

[VCUram]

The ID Epidemiologists I know of are MD/MPH's with Internal Medicine fellowhips in ID. They practice split time as hospital epidemiologisits, with time in the ID clinic, and are part of the bio-terrorism response network in the state.

 

[skiracer721]

It seems to me the only way to be an infectious disease epidemiologist full time is to be at the CDC or doing research on the small niche you find interesting and, most importantly, reimbursable by some entity. Correct me if I'm wrong, but chronic disease stuff is where the vast majority of grant money is at. I want to do infectious disease stuff too, but I've come to terms with the fact that you have to be flexible if you ever want a job. Everyone wants to go virus hunting and discover Ebola's new cousin, but it's just not something anyone wants to pay for these days.

I probably should have figured as much. What about the opportunities in chronic epi? What types of jobs are available there, do you know?

 

[Lemon Meringue]

Infectious disease is one of those areas that not as big as it once was because the burden of ID is much less than it used to be. So keep that in mind when going into the field.

This is factually wrong, in terms of absolute numbers! Consider the following:

1. Many more people will die from AIDS in coming half century than since the pandemic began, by several factors. This is because there are much more people infected with HIV now in the world than the number who have died. This will continue to place a huge burden on heavily effected regions.

2. The HIV/AIDS pandemic could literally bankrupt the American health care system as the prevalence of HIV/AIDS patients is increasing. When two times the number of HIV/AIDS patients are receiving antiretroviral medications in the U.S., there will be a scramble to prevent new infections.

3. Malaria is a time bomb, once effective medications are no longer effective.

4. TB is a nuclear time bomb, seriously, high resistant cases that kill at a high percentage rate despite the best therapy have begun popping up in immigrants arriving in the US and Europe. Urgent research is needed to understand the scope of this problem.

5. Due to cheap airplane tickets, infectious disease epidemic taking root on the other side of the world have a direct bearing on what happens in the US.

6. With global warming, it is expected that vectors, such as mosquitoes, will start appearing in areas further north than ever before.

7. Antibiotic resistance is a time bomb. Seriously, once easily treatable infections are becoming harder to treat, the need for ID surveillance in the states will increase over the following decades.

8. Polio was supposed to have been eradicated over a decade ago, but new cases keep popping up.

9. Avian flu, SARS, mad cow. As one I.D. person said, we are seeing a new disease pop up every year and all the old ones are back. (http://www.hdhudson.com/global-publ...l-information/34-old-new-diseases-taking-hold)

Sorry, but the above comment above is 100% wrong as the burden of ID is increasing, and it is a misleading statement to say otherwise, perhaps by somebody with little to no ID experience, or somebody who works outside of the ID field.

Yes, chronic diseases are taking root in developing countries, but you also have the trend of infectious diseases becoming an increased burden on societies worldwide. The two are interrelated, perhaps the poster above has read recent articles about certain IDs triggering cancer, or at least predisposing a population to certain cancers?

The general media loves to trump articles about chronic diseases increasing in developing countries, true, but a lot of this is sensationalism and naive reporting by journalists uneducated in public health who incorrectly believe that IDs are dropping off, and who don't understand antibiotic resistance. Much of the increase in chronic diseases in developing countries is well understood and researched already as cigarette smoking is already known to causes lung cancer and heart disease, which will sky-rocket in China due to millions of new smokers. Where's the need for public health specialists here to study stuff? The Chinese government knows about this problem but have stuck their head in the sand, don't expect it to create a lot of jobs for American citizens.

The economic recession has given global health budgets a hair cut, but once things improve, a massive investment will be needed in ID surveillance/research in developing countries.

I wish that what the above poster was said was true, but you can see it is the exact opposite. Do what you like to do and don't worry about opportunities in ID, tons and tons of surveillance and data crunching is urgently needed, and the urgency will only increase.

 

[Stories]

This is factually wrong, in terms of absolute numbers! Consider the following:

1. Many more people will die from AIDS in coming half century than since the pandemic began, by several factors. This is because there are much more people infected with HIV now in the world than the number who have died. This will continue to place a huge burden on heavily effected regions.

2. The HIV/AIDS pandemic could literally bankrupt the American health care system as the prevalence of HIV/AIDS patients is increasing. When two times the number of HIV/AIDS patients are receiving antiretroviral medications in the U.S., there will be a scramble to prevent new infections.

3. Malaria is a time bomb, once effective medications are no longer effective.

4. TB is a nuclear time bomb, seriously, high resistant cases that kill at a high percentage rate despite the best therapy have begun popping up in immigrants arriving in the US and Europe. Urgent research is needed to understand the scope of this problem.

5. Due to cheap airplane tickets, infectious disease epidemic taking root on the other side of the world have a direct bearing on what happens in the US.

6. With global warming, it is expected that vectors, such as mosquitoes, will start appearing in areas further north than ever before.

7. Antibiotic resistance is a time bomb. Seriously, once easily treatable infections are becoming harder to treat, the need for ID surveillance in the states will increase over the following decades.

8. Polio was supposed to have been eradicated over a decade ago, but new cases keep popping up.

9. Avian flu, SARS, mad cow. As one I.D. person said, we are seeing a new disease pop up every year and all the old ones are back. (http://www.hdhudson.com/global-publ...l-information/34-old-new-diseases-taking-hold)

Sorry, but the above comment above is 100% wrong as the burden of ID is increasing, and it is a misleading statement to say otherwise, perhaps by somebody with little to no ID experience, or somebody who works outside of the ID field.

Yes, chronic diseases are taking root in developing countries, but you also have the trend of infectious diseases becoming an increased burden on societies worldwide. The two are interrelated, perhaps the poster above has read recent articles about certain IDs triggering cancer, or at least predisposing a population to certain cancers?

The general media loves to trump articles about chronic diseases increasing in developing countries, true, but a lot of this is sensationalism and naive reporting by journalists uneducated in public health who incorrectly believe that IDs are dropping off, and who don't understand antibiotic resistance. Much of the increase in chronic diseases in developing countries is well understood and researched already as cigarette smoking is already known to causes lung cancer and heart disease, which will sky-rocket in China due to millions of new smokers. Where's the need for public health specialists here to study stuff? The Chinese government knows about this problem but have stuck their head in the sand, don't expect it to create a lot of jobs for American citizens.

The economic recession has given global health budgets a hair cut, but once things improve, a massive investment will be needed in ID surveillance/research in developing countries.

I wish that what the above poster was said was true, but you can see it is the exact opposite. Do what you like to do and don't worry about opportunities in ID, tons and tons of surveillance and data crunching is urgently needed, and the urgency will only increase.

In terms of global burden, you're right that ID is still a major issue. And it's probably the first issue to be looked at from a rural and less developed point of view. However, I was framing the question more in terms of the US (as I'm assuming the OP was asking about job opportunities in the US), where as we all know, ID is not quite the issue it used to be.

CDC has shifted their focus on what to educate the public about in terms of most applicable to the US population, and this is reflected in the Healthy People 2010 Initiative and in their all-cause mortality list:

CDC's Healthy People 2010: http://www.cdc.gov/nchs/healthy_people/hp2010/hp2010_indicators.htm
CDC's report of all-cause mortality: http://www.cdc.gov/nchs/fastats/lcod.htm

In general, the flu has the biggest focus in terms of ID in this country, and by raw numbers, it tends to get less focus than many other diseases in the US. This also is reflected in research dollars spent by the NIH: http://report.nih.gov/categorical_spending.aspx

For US based opportunities, the biggest net is definitely in chronic disease, and that has been the direction of the biomedical community for some time now. In no way am I saying that ID is not important to study because it is, but it's good to know where money has been allocated.

 

[Lemon Meringue]

where as we all know, ID is not quite the issue it used to be.

The causes of mortality in the US haven't changed much for decades (except the emergence of HIV/AIDS as a top killer among certain segments of the population) what has changed is an increased burden of emerging and re-emerging diseases. Oh, and heart disease deaths have gone down over the past decades. Oh, and Washington D.C. is dealing with an HIV/AIDS pandemic on the level of the ones in hard-hit countries in sub-sahara Africa without any end in sight.

I wouldn't look the Healthy People goals as evidence of changes in funding priorities as, laughably, one could say that because one of the goals is to "decrease homicide", more money will be spent on this endeavor. Violent crime has gone down in recent years.

Here's another article for lay persons:
http://healthyamericans.org/newsroom/releases/?releaseid=146

Here's a blurb, ""newly emerging and re-emerging infectious diseases ... will complicate U.S. and global security for the next 20 years. These diseases will endanger U.S. citizens at home and abroad, threaten U.S. armed forces deployed overseas, and exacerbate social and political instability in key countries and regions in which the U.S. has significant interests."

If you read the medical literature regarding infectious diseases you would know the increased incidence of IDs once thought well controlled in the United States, and the reality that we could see TB sanitariums again as TB is the bug that won't die. You don't seem to want to discuss specific infectious diseases, and I suspect that it is because you are not an expert in this area as the TB issue doesn't seem to register on your radar at all.

You also list the single point in time figures for all cause mortality, we are talking trends here, over the years and decades.

It is not disputed that the prevalence of HIV/AIDS will skyrocket in the US, as patients live longer, and that a plethora of drug resistant bugs such as TB, gonorrhea, MRSA and antibiotics gram negative bugs, will impact the US health care system in huge ways. A half-million more HIV/AIDS patients means more MPH jobs in this field, issues of drug resistance and HIV are turning out to be a lot more complicated than originally believed, and barring a wonder drug, surveillance and research will become increasingly important. Outbreaks of re-emerging measles and mumps, will also need to be dealt with.

Funding for ID hasn't really gone down that much, small downturns effect all sorts of preventive measures such as smoking cessation, are also lowered because of budget cuts. As globalization marches on, the US will be paying more and more for ID surveillance within the United States, as well as plenty of research and number crunching.

It seems to me that as you are not an ID expert, you promulgating a theory of decreased attention on IDs based upon what you read in the newspapers, though ID issues frequently make the front pages. We all have a pretty good idea of what you read to reach this conclusion, articles concerning the increased impact of chronic diseases outside the United States, and articles involving increased diabetes in the U.S., and similar such articles. However, need for chronic diseases public health experts and infectious disease experts are not mutually exclusive, it is a logical fallacy to assume that as the number of diabetes cases rise, the funding for ID surveillance will plummet, and similar unfounded conclusions.

I guess you have a right to throw in your two cents, but your conclusions are not reflective of the reality of the current situation, probably because you study non-infectious diseases.

There will be increased job availabilities in ID-related fields, no question about it, over the next twenty years. You can continue to argue your point based upon press releases and dubious conclusions, but you argue from a non-expert opinion outside the field.

I do wholeheartedly agree that diabetes, and diabetes related issues, will become more of a major public health issue, as we have seen in children. But increased need for public health work with chronic diseases and IDs are not mutually exclusive, and involve different approaches in some respects. ID-wise, "we" as in the world, need a global surveillance system for TB and other big killers which, like it or not, are coming to the US. Will poor countries pay for this? Unlikely, but the US increasingly will need to fund these programs as these patients start arriving in our airports, or else we could be faced with some very nasty TB epidemics within the country. Its a paradigm change, but one that is happening.

 

[Stories]

Its a paradigm change, but one that is happening.

As I wrote before, I'm not saying that ID isn't important. It clearly is. Was saying that funding has been directed specific directions, and generally, funding in ID hasn't received the attention of other diseases and conditions (particularly at the national NIH-level).

I'm just reporting what I know from my perspective. You're right, I don't work in ID epi, I work in cancer, but I have the NIH perspective where I get a lot of the updates and memos from the institutes as to seminars, colloquia, competitive grant applications, and so forth which are put out by various institutes.

The last congressional call was made for action in to obesity research. This was recently a $800m effort a few months ago (March, I think? http://www.nih.gov/news/health/mar2011/niddk-31.htm). The most recent push after that was for a call for high-throughput informatics work due to the plethora of data streaming in from the genomics, proteomics, metabolomics, and other -moic worlds.

 

[cerealrhapsody]

Here's a link to the Council of State and Territorial Epidemiologists (CSTE) 2010 enumeration of state and local epidemiologists.

http://www.cste.org/webpdfs/ECAEnumeration4pgFINAL.pdf

From this assessment we can see that, at local- and state-level agencies, there are considerably more epidemiologists working in ID than CD (Fig 2), and from 2009 to 2010 the number of ID epidemiologists increased faster than CD epidemiologists (16% vs 11%).

However, it does seem like academic/research settings tend to emphasize chronic disease. Perhaps chronic disease research gets more funding from places like NIH and ID epi is more prevalent in applied public health practice at the local or state level. I think Stories and Lemon Meringue both have valid arguments.

Another thing to note: even if there were more ID epi jobs overall (which seems dubious), they seem to be more competitive, perhaps because more people are pursuing them? Anecdotally, it seems like I run into a lot more ID students then CD students.

 

[Stories]

Here's a link to the Council of State and Territorial Epidemiologists (CSTE) 2010 enumeration of state and local epidemiologists.

http://www.cste.org/webpdfs/ECAEnumeration4pgFINAL.pdf

From this assessment we can see that, at local- and state-level agencies, there are considerably more epidemiologists working in ID than CD (Fig 2), and from 2009 to 2010 the number of ID epidemiologists increased faster than CD epidemiologists (16% vs 11%).

However, it does seem like academic/research settings tend to emphasize chronic disease. Perhaps chronic disease research gets more funding from places like NIH and ID epi is more prevalent in applied public health practice at the local or state level. I think Stories and Lemon Meringue both have valid arguments.

Another thing to note: even if there were more ID epi jobs overall (which seems dubious), they seem to be more competitive, perhaps because more people are pursuing them? Anecdotally, it seems like I run into a lot more ID students then CD students.

It definitely makes sense that there'd be a much greater representation of local agencies and their focus on ID due to the nature of outbreak investigation, which local agencies are in charge of. Nation-wide outbreaks are handled by CDC.

ID epi is definitely the more traditional public health-y subdiscipline of the two, and I've found that it appeals to the more traditional public health student in that the focus tends to be on the more immediate impact of health and poorer/rural/global prospective. This was especially true of students I taught when I was teaching. Examples I gave from my own person experience weren't as interesting to these students (since I do genetic variability and metabolism work).

In NIH's research portfolio, it's evident that the focus is on chronic disease, and looking at the latest issues of the top biomedical journals, NEJM, JAMA, BMJ, Lancet, there's a very large representation of chronic diseases (mostly cancer, diabetes, heart disease, stroke). So this gives more credence to the idea that research is clearly more focused on CD.

Now, the question should boil down to when it comes to opportunities, how do the number of local/state jobs in ID compare to the number of research jobs in CD.

 

[Lemon Meringue]

Here's a link to the Council of State and Territorial Epidemiologists (CSTE) 2010 enumeration of state and local epidemiologists.

http://www.cste.org/webpdfs/ECAEnumeration4pgFINAL.pdf

From this assessment we can see that, at local- and state-level agencies, there are considerably more epidemiologists working in ID than CD (Fig 2), and from 2009 to 2010 the number of ID epidemiologists increased faster than CD epidemiologists (16% vs 11%).

However, it does seem like academic/research settings tend to emphasize chronic disease. Perhaps chronic disease research gets more funding from places like NIH and ID epi is more prevalent in applied public health practice at the local or state level. I think Stories and Lemon Meringue both have valid arguments.

Another thing to note: even if there were more ID epi jobs overall (which seems dubious), they seem to be more competitive, perhaps because more people are pursuing them? Anecdotally, it seems like I run into a lot more ID students then CD students.

This is a great post as it has specific facts.

The original question in this thread regarded the future possibilities for ID-related jobs in public health. The poster above doesn't work in the ID field and believed that,

"Infectious disease is one of those areas that not as big as it once was because the burden of ID is much less than it used to be."

This is factually incorrect from several standpoints, as the above post with facts has disproved. For anybody who's taken calculus-level math, or is familiar with the concept of a "rate of change", we are discussing the future opportunities for ID jobs. I think I provided enough examples of how IDs will rise in prevalence, and more importantly how drug resistance and global health trends, will require more funds for ID, independent of other things.

I read NEJM every week, there are plenty of ID articles, but it would be a logical fallacy to assume you could simply look at the contents and assume that ID is not a big field, or a field that will need more MPH types. If you actually read the articles on TB, HIV/AIDS and a plethora of IDs then you would know that IDs will become more difficult to treat, and that new ones emerge on a yearly basis.

The question does not "boil down" to absolute job numbers regarding ID and chronic diseases, but rather the rate of change, the delta, the future job prospects which centers on job growth, which are good for ID jobs in general.

Also, as I have studied chronic diseases, such as diabetes, the big ones are in some respects easier to study than rare IDs which could flare up and kill thousands. Yet diseases like diabetes affect many more, so in some respects you're comparing apples and oranges. Should, for example, extremely drug resistant TB turn into the nightmare scenario over a period of years, the big agencies, such as CDC, would no doubt request more funds from Congress to combat something this big, not necessarily taking funds away from chronic diseases. Meaning funding of IDs and CDs is not necessarily mutually exclusive.

I would ask the poster who worked outside of ID not derail this thread by talking in generalities about ID and chronic disease research and their impression of press releases. You can't just wave a wand and say that it looks like there is less ID research so . . . ID is going downhill. This doesn't add to the discussion or help inform students who are interested in ID, its just a lot of hubris and trying to maintain a position that is uninformed.

 

[Stories]

This is a great post as it has specific facts.

The original question in this thread regarded the future possibilities for ID-related jobs in public health. The poster above doesn't work in the ID field and believed that,

"Infectious disease is one of those areas that not as big as it once was because the burden of ID is much less than it used to be."

This is factually incorrect from several standpoints, as the above post with facts has disproved. For anybody who's taken calculus-level math, or is familiar with the concept of a "rate of change", we are discussing the future opportunities for ID jobs. I think I provided enough examples of how IDs will rise in prevalence, and more importantly how drug resistance and global health trends, will require more funds for ID, independent of other things.

I read NEJM every week, there are plenty of ID articles, but it would be a logical fallacy to assume you could simply look at the contents and assume that ID is not a big field, or a field that will need more MPH types. If you actually read the articles on TB, HIV/AIDS and a plethora of IDs then you would know that IDs will become more difficult to treat, and that new ones emerge on a yearly basis.

The question does not "boil down" to absolute job numbers regarding ID and chronic diseases, but rather the rate of change, the delta, the future job prospects which centers on job growth, which are good for ID jobs in general.

Also, as I have studied chronic diseases, such as diabetes, the big ones are in some respects easier to study than rare IDs which could flare up and kill thousands. Yet diseases like diabetes affect many more, so in some respects you're comparing apples and oranges. Should, for example, extremely drug resistant TB turn into the nightmare scenario over a period of years, the big agencies, such as CDC, would no doubt request more funds from Congress to combat something this big, not necessarily taking funds away from chronic diseases. Meaning funding of IDs and CDs is not necessarily mutually exclusive.

I would ask the poster who worked outside of ID not derail this thread by talking in generalities about ID and chronic disease research and their impression of press releases. You can't just wave a wand and say that it looks like there is less ID research so . . . ID is going downhill. This doesn't add to the discussion or help inform students who are interested in ID, its just a lot of hubris and trying to maintain a position that is uninformed.

You've completely misconstrued my posts and are unnecessarily criticizing what I write. Somehow you believe to be in mutually exclusive to my thoughts on the subject matter. I've tried to write with references to some of my claims and you just discount them.

Look, I'm a moderator on this board to help facilitate conversation and attacking someone as vehemently as you're doing doesn't help anyone. Keep this constructive.

 

[Lemon Meringue]

You've completely misconstrued my posts and are unnecessarily criticizing what I write. Somehow you believe to be in mutually exclusive to my thoughts on the subject matter. I've tried to write with references to some of my claims and you just discount them.

Look, I'm a moderator on this board to help facilitate conversation and attacking someone as vehemently as you're doing doesn't help anyone. Keep this constructive.

??? I have no idea what you saying about your thoughts on this matter and me, with regards to the first sentence in bold.

Sorry if I offended, didn't know you were a moderator, I'll readily admit there is a fine line between attacking what someone is reporting as a fact, and attacking that person. Since I obviously don't know you, I am besieging the faulty assumptions flippantly displayed as facts.

It is entirely justifiable to correct false statements presented as facts when proffered in a forum where people are planning their future careers. You do cancer research, entirely respectable and fascinating, and I raise my glass to you, you also probably know that ID causes of cancer is a potential area for more research. Nonetheless, I take issue with what you wrote, which is factually in error,

"Infectious disease is one of those areas that not as big as it once was because the burden of ID is much less than it used to be. So keep that in mind when going into the field."

ID burden has gone up in the U.S. and in the world as a whole, every year more and more people in the U.S. are living with HIV/AIDS, and there are tons of emerging and re-emerging diseases cropping up, more each year with increased global travel and immigration, to say nothing of drug resistance issues. Check out this blurb, Gonorrhea superbug cases double in Europe (and people are afraid its going to come here, which it of course will),

http://articles.chicagotribune.com/..._drug-resistant-gonorrhea-superbug-infections
http://www.latimes.com/news/nation/nationnow/la-na-nn-gonorrhea-20120607,0,2300767.story

There are 600,000 cases of gonorrhea in a year in the U.S., we thought we had cured it, now it looks that that might have been optimistic.

To anyone reading this thread, I would say that ID is an expanding field, and notwithstanding emerging diseases, TB, and HIV/AIDS, infectious etiologies for such common diseases as cancer could help grow a field that is already growing.

Apologies to the moderator, but even moderators make mistakes and faulty assumptions from time to time and are no less deserving of correction than anybody else.

 

[Stories]

Let's refocus this topic towards jobs.

My personal experience has been that friends who've initially attempted to enter into the job market with ID as their area of interest ended up choosing different areas due to difficulty in landing a job in that area, so my suggestion is to keep an open eye to the market and whatever is available. A good alternative to a traditional job is finding a fellowship which can transition into a job.

As cerealrhapsody suggested, many of the opportunities in ID exist in local and state health agencies, but unfortunately, these two areas are where the budget and economic woes have hit the hardest. There are a few scattered fellowships through CSTE (http://www.cste.org/dnn/ProgramsandActivities/FellowshipPrograms/tabid/259/Default.aspx) and some ASPH fellowships (http://fellowships.asph.org/) which are worth keeping an eye on which can serve as a transition into these types of jobs. These two fellowships range the entire spectrum for opportunities from surveillance to investigation and in a variety of outcomes, so keep that in mind.

For PhD grads, there are a number of opportunities within NIH as well, and they cover many of their postdoc opportunities in the OITE website (https://www.training.nih.gov/career_services/postdoc_jobs_nih) is always a good place to start as the breadth which NIH covers is vast.

 

[Big Dog]

...you take a big leap from "need" to job opportunities. Just because there may be a growing need for "ID surveillance/research", doesn't necessarily mean that such need will turn into funding and therefore job opportunities.

The economic recession has given global health budgets a hair cut, but once things improve, a massive investment will be needed in ID surveillance/research in developing countries.

And where might you expect that "developing countries" will find the funds? From the developed countries? Entirely possible, but the last time I checked, all developed countries had some serious economic problems domestically.

 

[Lemon Meringue]

...you take a big leap from "need" to job opportunities. Just because there may be a growing need for "ID surveillance/research", doesn't necessarily mean that such need will turn into funding and therefore job opportunities.



And where might you expect that "developing countries" will find the funds? From the developed countries? Entirely possible, but the last time I checked, all developed countries had some serious economic problems domestically.

But it isn't a big leap to make future job predictions based upon an assessment of future need. When they invented automobiles, somebody probably noticed that the folks who made horseshoes might faced decreased job prospects in the long run. Much of policy making involves a sort of actuarial practice which looks at future trends and how to direct resources.

For example, the U.S. Bureau of Labor and Statistics has this to say about job prospects for epidemiologists:

http://www.bls.gov/ooh/life-physical-and-social-science/epidemiologists.htm

Certainly, those doing ID-related work are included in this.

With regards to the current economic downturn (the worst since the Great Depression and worse than it in some respects), there will eventually be fatter sovereign budgets which will allow increased funding for infectious disease related issues, as well as the possibility of increased funding from private players. Career-wise I assume we're talking about a time frame longer than a couple years, and if a person is motivated to do ID related work, the future demand will be there.

The problem with message boards such as these is that people can post comments and make conclusions unsupported by fact, I simply weighed in on comments made which concluded that,

"Infectious disease is one of those areas that not as big as it once was because the burden of ID is much less than it used to be. So keep that in mind when going into the field."



ID burden is going up in the US and worldwide, and now I guess we're arguing that despite the evidence that IDs will endanger the lives of millions more in the US, that some how there won't be more funding for MPH type ID work? There is a push in several quarters for more surveillance, research and an intensified public health approach to deal with this problem.

 

[Stories]

But it isn't a big leap to make future job predictions based upon an assessment of future need. When they invented automobiles, somebody probably noticed that the folks who made horseshoes might faced decreased job prospects in the long run. Much of policy making involves a sort of actuarial practice which looks at future trends and how to direct resources.

For example, the U.S. Bureau of Labor and Statistics has this to say about job prospects for epidemiologists:

http://www.bls.gov/ooh/life-physical-and-social-science/epidemiologists.htm

Certainly, those doing ID-related work are included in this.

With regards to the current economic downturn (the worst since the Great Depression and worse than it in some respects), there will eventually be fatter sovereign budgets which will allow increased funding for infectious disease related issues, as well as the possibility of increased funding from private players. Career-wise I assume we're talking about a time frame longer than a couple years, and if a person is motivated to do ID related work, the future demand will be there.

The problem with message boards such as these is that people can post comments and make conclusions unsupported by fact, I simply weighed in on comments made which concluded that,

"Infectious disease is one of those areas that not as big as it once was because the burden of ID is much less than it used to be. So keep that in mind when going into the field."



ID burden is going up in the US and worldwide, and now I guess we're arguing that despite the evidence that IDs will endanger the lives of millions more in the US, that some how there won't be more funding for MPH type ID work? There is a push in several quarters for more surveillance, research and an intensified public health approach to deal with this problem.

Another thing to also think about is that the general population, as it gets older, has to deal with ALL diseases becoming a bigger and bigger problem. Especially as the latter end of the baby boomers age (the first set of boomers are retiring now). So ID is necessarily an issue, but diseases associated with age is also going to be increasing.

Unfortunately for all of us, there's limited money (and probably won't be increasing for a while) to dedicate towards certain workforces, and someone is going to be making decisions on those initiatives.

 

[Big Dog]

The problem with message boards such as these is that people can post comments and make conclusions unsupported by fact...

I guess we're arguing that despite the evidence that IDs will endanger the lives of millions more in the US, that some how there won't be more funding for MPH type ID work?

Nope, not arguing anything. Just suggesting that one doesn't necessarily lead to the other.

Should, for example, extremely drug resistant TB turn into the nightmare scenario over a period of years, the big agencies, such as CDC, would no doubt request more funds from Congress to combat something this big, not necessarily taking funds away from...

And you know this, how? Do you work on The Hill? With NIH? Have inside info to Congressional budgetary processes?

 

[Lemon Meringue]

Nope, not arguing anything. Just suggesting that one doesn't necessarily lead to the other.

And you know this, how? Do you work on The Hill? With NIH? Have inside info to Congressional budgetary processes?

Have you studied drug resistant tuberculosis? (A general term btw as drug-resistant TB is classified into different categories). There was a sad case of an immigrant who required something like seven months of intensive, chemo-therapy-like, treatment to survive his XDR-TB.

One case.

I don't follow it that closely, but should say, 2,000 cases appear, (which could plung the US back to the age of tuberculosis sanitariums), then this would deal a serious blow to the US healthcare system which would have trouble taking care of all of these patients should they increase markedly in absolute number. Just how fast can XDR-TB spread in the U.S.? In 2011 there were 10,521 cases of TB, I shudder when I think of the humanitarian disaster that would unfold should most of these cases be caused by XDR-TB.

Oh yes, XDR-TB could get wicked bad. It is entirely logical to assume that healthcare dollars would be spent to combat this, should it happen.

But here's one of many of my "inside sources" for your consideration,

http://www.huffingtonpost.com/kari-stoever/new-g20-austerity-measure_b_1604469.html

I like the last paragraph, (the article discusses new commitments for drug resistant TB),

"The old adage that an ounce of prevention is worth a pound of cure could not ring more true. As G20 leaders discuss austerity measures in Europe, perhaps they should also consider austerity measures to address the annual loss of more than $300 billion from a disease that with the right investments today would pay long-term dividends in lives saved, productivity gains and ultimately make advances toward economic and moral solvency for at least six of the G20 countries bearing the biggest cost to their economies."

And before you jump all over me like a pack of wild dogs, this is in regards to global health commitments for poor countries. Should XDR-TB, a new plague, arrive on the U.S.'s doorstep, oh yes, there will be funds to address it, especially from a public health perspective. HIV/AIDS wasn't on the radar decades ago, yet the funds appeared to combat this problem, which actually may be getting much worse in certain populations, (http://www.washingtonpost.com/natio...-black-women/2012/06/20/gJQAXIqKrV_story.html)

This may sound crass, but however fun arguing from an untenable position is, (certainly politicians must enjoy it), you don't learn anything. As a medical student having already earned a PhD, you need to know what you don't know, and to not base conclusion on hunches, and obstinate positions. I mentioned drug resistant TB in my post, you doubt the US response to such a disaster on my part but you handily revealed your unfamiliarity with the subject.

It is always fun to teach an undergrad who can also teach me something new, do you have something new to add to this conversation?

 

[Lemon Meringue]

Another thing to also think about is that the general population, as it gets older, has to deal with ALL diseases becoming a bigger and bigger problem. Especially as the latter end of the baby boomers age (the first set of boomers are retiring now). So ID is necessarily an issue, but diseases associated with age is also going to be increasing.

Unfortunately for all of us, there's limited money (and probably won't be increasing for a while) to dedicate towards certain workforces, and someone is going to be making decisions on those initiatives.

Once again, increasing funding for IDs and other diseases are not necessarily mutually exclusive. Of course age-related diseases will increase in prevalence, more hip-replacements, increases in prevalence of certain cancers, more osteoarthritis and many others. Certainly, the initiation of public health prevention programs for seniors will be crucial.

But certain IDs are also impacting seniors, infectious etiologies are blamed for one in six cancers!

http://www.bbc.co.uk/news/health-17989371

Diabetics are dealing with antibiotic resistant strains of bacteria, and the success of doctors to deal with the burgeoning diabetes epidemic will depend in part on how public health experts handle the ID side of the coin.

About half of the patients I've seen in the ICU with a myriad of ID-related conditions are seniors, as you age the immune system sometimes doesn't work as well as it once did. Centuries ago, they called pneumonia an "old man's friend."

ID surveillance will become increasing important with regards to the health care of seniors, in fact, seniors often remain sexually active, and we're seeing IDs being contracted by seniors, "baby boomer" seniors, who have adopted a different lifestyle in the nursing home somewhat different from how seniors in the past have spent their golden years, tongue in cheek.

I don't feel the need to bash chronic diseases, because I know the general trends and that the public health budget will grow with the population increase, at one rate or another, over the long term. Emerging IDs also command $, irrespective of the total size of the pie, in the case of HIV/AIDS this ID was paid for with new funds in a lot of cases.

 

[Stories]

Once again, increasing funding for IDs and other diseases are not necessarily mutually exclusive. Of course age-related diseases will increase in prevalence, more hip-replacements, increases in prevalence of certain cancers, more osteoarthritis and many others. Certainly, the initiation of public health prevention programs for seniors will be crucial.

But certain IDs are also impacting seniors, infectious etiologies are blamed for one in six cancers!

http://www.bbc.co.uk/news/health-17989371

Diabetics are dealing with antibiotic resistant strains of bacteria, and the success of doctors to deal with the burgeoning diabetes epidemic will depend in part on how public health experts handle the ID side of the coin.

About half of the patients I've seen in the ICU with a myriad of ID-related conditions are seniors, as you age the immune system sometimes doesn't work as well as it once did. Centuries ago, they called pneumonia an "old man's friend."

ID surveillance will become increasing important with regards to the health care of seniors, in fact, seniors often remain sexually active, and we're seeing IDs being contracted by seniors, "baby boomer" seniors, who have adopted a different lifestyle in the nursing home somewhat different from how seniors in the past have spent their golden years, tongue in cheek.

I don't feel the need to bash chronic diseases, because I know the general trends and that the public health budget will grow with the population increase, at one rate or another, over the long term. Emerging IDs also command $, irrespective of the total size of the pie, in the case of HIV/AIDS this ID was paid for with new funds in a lot of cases.

I've always found virus-based etiology for cancer interesting. Luckily for us, the HPV-Cervical cancer axis should be addressed in many areas of the country as we continue to enforce vaccinations among girls (assuming continued vaccination happens). H. pylori for GI cancers is obviously going to be a big concern, as the prevalence of infection is so high in the entire world, but luckily, most people will never have any adverse reaction to infection, and for those that do, will exhibit pre-cancerous symptoms, and is treatable. But for liver cancer and HpA/B/C, we just have to get people to get vaccinated, although for some reason, infection rates continue to be high despite requirements for vaccination for A/B. Hopefully a vaccine for C will become more common soon enough.

So there's definitely work to be done there on the virus-cancer front.

Funding is not mutually exclusive, and budget slashes are fairly uniformally cut across the board, and we all recognize there are issues to take care of. The only thing I'm not as optimistic as you are is that we'll see an increase in job opportunities. NIH budget's have been cut 3-7% annually since 2008. And so, what I have to look at now are simply the opportunities that currently exist at NIH and the rest of the academic community, which has been more focused on CD than ID the past 15 years. I haven't really heard much on the table in terms of changes in direction except towards an increase in efforts on the genomic and stem cell front and other topical issues (like obesity) (recent interview from Francis Collins, Director of NIH and former Director of NHGRI: http://www.medscape.com/viewarticle/758435). Having a guy who was the former NHGRI leader tends to give a little insight into the direction the Institutes will be taking.

Of course if some of the proposed budgets on the congressional floor go through, we could see upwards of 40% budget cuts (although I don't think certain folks would let that kind of budget through), which would be... in a word, bad.

To me, it seems like genetic epidemiology is the direction where more opportunities are going to lie in the future (the general direction the field has been going the past decade or so) and there are a lot of opportunities right now in that area (particularly with all this sitting data we have from GWAS).

 

[Lemon Meringue]

I've always found virus-based etiology for cancer interesting. H. pylori for GI cancers is obviously going to be a big concern, as the prevalence of infection is so high in the entire world, but luckily, most people will never have any adverse reaction to infection, and for those that do, will exhibit pre-cancerous symptoms, and is treatable.

You are obviously not a clinician as you would know that most H. pylori associated gastric cancer is not caught at a curable stage. The five years survival rate for gastric cancer is about 28%, as most cases are caught in a later stage in the US, some countries have better screening programs.

At any rate, there is the distinct possibility that certain chronic diseases believed to have arisen de novo may be caused by infectious disease factors yet to be identified. Specifically, there is an obvious pathophysiological link between heart disease and inflammation, and research has demonstrated a link between periodontal disease and heart disease, http://www.perio.org/consumer/mbc.heart.htm.

I brush my teeth (and more importantly gums) BID (two times daily) to help prevent heart disease, do you?

Here's an article regarding current funding and relationship with current and expected disease burden.

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0016837

I find some of the graphs interesting, yet I do not agree with some of the conclusions, yet the authors do offer an explanation why, for example, lung cancer has less funding based on disease burden,

The availability of proven cost-effective interventions (e.g., tobacco-related prevention strategies) may also influence funding since development of new interventions may be unnecessary when effective strategies have already been identified.

Despite my interest in IDs, I am well aware that lung cancer will become a greater burden worldwide, in the U.S., I do not know the specific data to date, but lung cancer incidence appears to be increasing among women.

Yet, we know how to prevent the vast majority of lung cancer cases already, smoking cessation! Should we pay for expensive genetic epidemiology studies on lung cancer when it is unlikely to produce a new public health intervention? This is the question posited by the authors.

I get the moderator's argument, but it seems that the mod's research is much more basic science oriented than public health. About 55% of the NIH budget is basic science research which is hard to attribute to a specific disease, obviously, basic immunology research may produce unexpected benefits in other fields. Especially in genetics, where findings in one disease may produce benefits for the understanding of another.

The flip side of the coin of genetic epidemiology is interacting environmental factors, which often play a role.

While diabetes is often portrayed as an up-and-coming chronic disease, per the article I cited, it appears to be over-funded based on simplistic calculations of burden. Yet all human diseases are not created equally, some have the potential to become much worse more quickly, and perhaps as a hedge, these diseases received and deserve increased funding.

There is no need for an early warning system for obesity in the country, we already are in the thick of it, yet for XDR-TB, oh yes, we need to address this in the US and on a global scale. Monitoring drug resistance infections may well be more complex than surveillance for a certain cancer.

Given your false assertion regarding H. pylori, I don't believe you when you say that ID funding has fallen off over the past 15 years, for example, do you count HIV/AIDS as an ID?. Funds for HIV/AIDS outstrip other diseases as:

1. Political activism
2. Potential of a runaway pandemic. There are many different models of what the HIV/AIDS pandemic might look like in 30 years, with differences in the number of deaths in the tens of millions. HIV/AIDS is a hard egg to crack in terms of predictions, ditto for XDR-TB. In the study above, I fault for the authors for trying to predict the future worldwide and US burden for HIV/AIDS as even Dr. Fauci had admitted that epidemic such as HIV/AIDS tend to flare up after appear to wane for years.

3. HIV/AIDS is a relatively new disease, and thus the need to do a lot of basic research, such as epidemiology quickly. Emerging diseases will require these spurts of funding to form a foundation for future work.

No doubt, NIH's budget will grow again one day, and perhaps most parts of the budget will grow as well, including IDs. Bioterrorism and HIV/AIDS have brought an increased in spending for IDs over the longterm view since 9/11. As IDs such as XDR-TB are viewed as threats to the US as well, more funding will come.

10,000 cases of TB in the US each year, should they become XDR-TB, which costs between $30,000 and $500,000 just to save half of the patients (the other half can't be saved), that would mean 5,000 dead a year and about $300 million to perhaps $3 billion in medical costs a year, assuming we could build the ICUs and new TB sanitariums to deal with this problem, which of course would cost billions more. Of course, this disaster would be a slow-moving train wreck with a slowly upticking number of XDR-TB cases, and ramped-up budgets to deal with this issue.

 

[Stories]

You are obviously not a clinician as you would know that most H. pylori associated gastric cancer is not caught at a curable stage. The five years survival rate for gastric cancer is about 28%, as most cases are caught in a later stage in the US, some countries have better screening programs.

At any rate, there is the distinct possibility that certain chronic diseases believed to have arisen de novo may be caused by infectious disease factors yet to be identified. Specifically, there is an obvious pathophysiological link between heart disease and inflammation, and research has demonstrated a link between periodontal disease and heart disease, http://www.perio.org/consumer/mbc.heart.htm.

I brush my teeth (and more importantly gums) BID (two times daily) to help prevent heart disease, do you?

Here's an article regarding current funding and relationship with current and expected disease burden.

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0016837

I find some of the graphs interesting, yet I do not agree with some of the conclusions, yet the authors do offer an explanation why, for example, lung cancer has less funding based on disease burden,

The availability of proven cost-effective interventions (e.g., tobacco-related prevention strategies) may also influence funding since development of new interventions may be unnecessary when effective strategies have already been identified.

Despite my interest in IDs, I am well aware that lung cancer will become a greater burden worldwide, in the U.S., I do not know the specific data to date, but lung cancer incidence appears to be increasing among women.

Yet, we know how to prevent the vast majority of lung cancer cases already, smoking cessation! Should we pay for expensive genetic epidemiology studies on lung cancer when it is unlikely to produce a new public health intervention? This is the question posited by the authors.

I get the moderator's argument, but it seems that the mod's research is much more basic science oriented than public health. About 55% of the NIH budget is basic science research which is hard to attribute to a specific disease, obviously, basic immunology research may produce unexpected benefits in other fields. Especially in genetics, where findings in one disease may produce benefits for the understanding of another.

The flip side of the coin of genetic epidemiology is interacting environmental factors, which often play a role.

While diabetes is often portrayed as an up-and-coming chronic disease, per the article I cited, it appears to be over-funded based on simplistic calculations of burden. Yet all human diseases are not created equally, some have the potential to become much worse more quickly, and perhaps as a hedge, these diseases received and deserve increased funding.

There is no need for an early warning system for obesity in the country, we already are in the thick of it, yet for XDR-TB, oh yes, we need to address this in the US and on a global scale. Monitoring drug resistance infections may well be more complex than surveillance for a certain cancer.

Given your false assertion regarding H. pylori, I don't believe you when you say that ID funding has fallen off over the past 15 years, for example, do you count HIV/AIDS as an ID?. Funds for HIV/AIDS outstrip other diseases as:

1. Political activism
2. Potential of a runaway pandemic. There are many different models of what the HIV/AIDS pandemic might look like in 30 years, with differences in the number of deaths in the tens of millions. HIV/AIDS is a hard egg to crack in terms of predictions, ditto for XDR-TB. In the study above, I fault for the authors for trying to predict the future worldwide and US burden for HIV/AIDS as even Dr. Fauci had admitted that epidemic such as HIV/AIDS tend to flare up after appear to wane for years.

3. HIV/AIDS is a relatively new disease, and thus the need to do a lot of basic research, such as epidemiology quickly. Emerging diseases will require these spurts of funding to form a foundation for future work.

No doubt, NIH's budget will grow again one day, and perhaps most parts of the budget will grow as well, including IDs. Bioterrorism and HIV/AIDS have brought an increased in spending for IDs over the longterm view since 9/11. As IDs such as XDR-TB are viewed as threats to the US as well, more funding will come.

10,000 cases of TB in the US each year, should they become XDR-TB, which costs between $30,000 and $500,000 just to save half of the patients (the other half can't be saved), that would mean 5,000 dead a year and about $300 million to perhaps $3 billion in medical costs a year, assuming we could build the ICUs and new TB sanitariums to deal with this problem, which of course would cost billions more. Of course, this disaster would be a slow-moving train wreck with a slowly upticking number of XDR-TB cases, and ramped-up budgets to deal with this issue.

Again, I'm not trying to argue that ID research isn't important. And you keep listing facts off about why it is important, which is a point I'm not argue against. Need hasn't always been followed by action, particularly when it comes to politics, which I'm sure we all are well aware of. Congress has typically been reactionary rather than proactive, and as a result, I think we'll continue to see funding for research distributed in this fashion unless something fundamentally changes. I really have no clue how big of a priority NIH's funding is, but my guess is that congress doesn't necessarily view NIH's $30b annual budget to be that big of a priority in the grand scheme of things they're concerned with these days (how to cut the deficit).

With diabetes, I think it's a disease that has so many different methods of coming to fruition which is why it's studied so much? Particularly with things like age, obesity which can really raise the risk, plus additional complications associated with having diabetes which can be problematic? Hence the additional research also going into obesity because of the other complications (and the rising prevalence of both: http://www.diabetes.org/diabetes-basics/diabetes-statistics/; http://www.cdc.gov/obesity/data/adult.html).

I think you misinterpreted what I meant about h. pylori--what I meant was that many individuals that end up getting gastric cancer will exhibit other symptoms of non-cancerous outcomes (such as peptic ulcers). The h. pylori colonization -> peptic ulcers -> gastric cancer is a pathway that's fairly established at this point, I believe (I'm not a gastric cancer expert).

I actually do GxE research, and it is interesting (to me). But unfortunately, wide scale studies are still very expensive to do, so it's a bit difficult to do right now. The focus on many studies is next generation sequencing (eg. full exome, full sequencing) which could lead to some very interesting findings in the future. So, I agree, there's some room for cool stuff here. A sad thing is, most of the "low hanging fruit" has been discovered already, so we're now looking for risk factors which contribute a small increase in risk and pathways into disease etiology, which is the reason for the drastic shift into molecular epidemiology studies. It's just the nature of any field that is undergoing changes and shifts.

In some circles, I know HIV is considered to be a chronic disease due to its management. Its a livable condition with the proper care and time (and money). Magic Johnson was one person who has really shown what can be done if the proper time and money is dedicated towards living with the infection.

That PLoS ONE paper is interesting and I've always found analyses where diseases are turned into numbers to be particularly fascinating. That said, I don't know enough about that kind of thing to say much more than that.

 

[Lemon Meringue]

Again, I'm not trying to argue that ID research isn't important.

I think you misinterpreted what I meant about h. pylori--what I meant was that many individuals that end up getting gastric cancer will exhibit other symptoms of non-cancerous outcomes (such as peptic ulcers). The h. pylori colonization -> peptic ulcers -> gastric cancer is a pathway that's fairly established at this point, I believe (I'm not a gastric cancer expert).

I actually do GxE research, and it is interesting (to me).

With all due respect for a moderator, you have argued that the burden of ID diseases is going down, and you clearly incorrectly concluded that H. pylori caused gastric cancer is easily detected and treated, which is not true in this country,

H. pylori for GI cancers is obviously going to be a big concern, as the prevalence of infection is so high in the entire world, but luckily, most people will never have any adverse reaction to infection, and for those that do, will exhibit pre-cancerous symptoms, and is treatable.

The overall 5-year survival rate of all people with stomach cancer in the United States is about 28%.

In Japan, for example, they have a much more rigorous gastric cancer screening program, in the US were the incidence of gastric cancer is lower such mass screening programs are not as effective and hence are not used, yet what might yield more useful results would be continued study of H. pylori, this is one of those hanging fruits you don't believe exist. A lot of gastric cancer patients present with PUD symptoms, are biopsied, and found to have gastric cancer which is by and large not curable. Apparently you have't studied screening for gastric cancer in other countries with a higher incidence. Does screening for breast cancer involve waiting for a patient's breast to start showing signs of the underlying malignancy, such as necrotic tissue? Basically, you weighed in on a topic that you have very limited familiarity with.

It should be a required course that public health students learn about the different types of screening programs so that they are able to discuss and understand these topics.

With diabetes, I think it's a disease that has so many different methods of coming to fruition which is why it's studied so much? Particularly with things like age, obesity which can really raise the risk, plus additional complications associated with having diabetes which can be problematic? Hence the additional research also going into obesity because of the other complications (and the rising prevalence of both: http://www.diabetes.org/diabetes-basics/diabetes-statistics/; http://www.cdc.gov/obesity/data/adult.html).

A sad thing is, most of the "low hanging fruit" has been discovered already, so we're now looking for risk factors which contribute a small increase in risk and pathways into disease etiology, which is the reason for the drastic shift into molecular epidemiology studies.

Let's look at Type II diabetes, a complex polygenic disorder, you have a certain genetic substrate, as well as environmental factors. I would guess that much of the research of genes which contribute a small amount to the risk would yield "fruit" by elucidating the pathophysiology. Or a patient gets their genome scanned and based upon their risk, a clinician then decides to offer more or less counseling and pre-emptive treatment of associated conditions which together increase the risk for the big diabetes killer, heart disease.

Well, sounds futuristic, but the "low hanging fruit" has hardly all been picked as we know what public health interventions can moderately decrease the incidence of diabetes, it is a matter of political will and funding such initiatives.

But you know what? A lot of the interventions for those at risk of diabetes are recommendations that doctors would make for most patients and we already are looking at patients with "pre-diabetes" as those who should receive extra counseling and more intensive preventive care. Would a polygenic test change this? I think the most benefit of the genetic epidemiological research of type II diabetes will be in drug development downstream from this basic science research.

Same thing with lung cancer. There is low lying fruit aplenty! Smoking cessation programs could save millions, and hundreds of millions if you look at developing countries.

In some circles, I know HIV is considered to be a chronic disease due to its management. Its a livable condition with the proper care and time (and money). Magic Johnson was one person who has really shown what can be done if the proper time and money is dedicated towards living with the infection.

A lot of physicians don't like simply dismissing HIV/AIDS as simply a chronic disease, and I agree. A good proportion of HIV/AIDS patients can't tolerate their medications, or skip doses and develop resistance and die of AIDS, or from HIV associated diseases. The public health work regarding HIV/AIDS needs folks who understand infectious diseases as HIV is still an infectious disease, which is how it is studied at the population level.

I actually do GxE research, and it is interesting (to me). But unfortunately, wide scale studies are still very expensive to do, so it's a bit difficult to do right now.

It is patently obvious that you dabble in genetic epidemiology! You believe your field to be the future, and despite limited exposure to other areas such as ID, you incorrectly concluded that ID is in decline. After receiving a PhD in a biological field, I had a lot of knowledge about a very specific field, but not much outside of this field, medical school greatly enriched my understanding, and improved my ability to understand different fields of biomedical research. I think MPH programs should give students a broad understanding of the various concentrations and why no one field can deliver the complete solution for a certain disease.

Almost every post-doc, grad student and basic science faculty member I have known is really into their field and believes it to be the next new thing, and sometimes they disparage other fields with faulty assumptions and lack of knowledge of the importance of the other field.

 

[ChaiMeow]

Nice argument guys, BUT having earned my MPH with an emphasis in infectious disease epi I can speak to the fact that despite growing need there just isn't much love or funding for us...ESPECIALLY at the MPH level. I'm off to medical school, but still have plans to apply to the EIS at a later date. Realistically if you want an ID epi job you're going to have to get it overseas usually via the CDC which often required a peace corps tour to get your foot into the door.

 

[EpiWin]

Realistically if you want an ID epi job you're going to have to get it overseas usually via the CDC which often required a peace corps tour to get your foot into the door.

This is probably the most uninformed answer on this thread.