Spitzer 2 and Frances 3 replied that epidemiological data can never replace clinical judgment and the lack of clinical experience. Both Spitzer and Frances pay homage to the Herculean efforts of the epidemiologists and insist the efforts are not futile. Neither, however, suggests why these studies are of value beyond providing an estimate of burden, such as a prevalence estimate. The translation of these estimates from the community to policy, however, is exactly what most critics challenge. No area of epidemiology replicates a clinical entity exactly.
Measurement error plagues community and clinical diagnosis alike.
For example, Murphy and colleagues 4 challenge the belief that the frequency of depression is rising in Western society. Although the Stirling County sample is limited to a geographic region from which it is difficult to generalize, the capacity to study a population for 40 years is rare, especially when instrumentation has been deployed so that surveys throughout the 40 years can be directly compared. Stirling County data do not definitively refute a trend upward in the frequency of depression in Western society, yet they do provide reason to question the generalization. In our opinion, these studies represent psychiatric epidemiology at its best. Murphy and colleagues have known for years that gems yet undiscovered lie buried in the original Stirling County surveys and the ongoing longitudinal explorations.