Risk assessment and epidemiologic evidence in environmental health science.There appears to be a serious conceptual error about the role of the various environmental health sciences in Kundi's otherwise interesting and informative commentary on "Causality causality, in philosophy, the relationship between cause and effect. A distinction is often made between a cause that produces something new (e.g., a moth from a caterpillar) and one that produces a change in an existing substance (e.g. and the Interpretation of Epidemiologic Evidence" (Kundi 2006). This error is exemplified in his next-to-last paragraph: Most risk assessment procedures demand that for chronic diseases such as cancer there must be epidemiologic evidence before an extrinsic agent can be ascribed a hazardous potential for human health. In fact, it is solely toxicologic evidence that is used for the overwhelming majority of agents to which a "hazardous potential for human health" is ascribed. I am unaware of any risk assessment process that requires epidemiology to recognize hazardous potential for human health. Perhaps Kundi (2006) meant that there must be epidemiologic evidence for a chemical to achieve the level of a known or proven cause of a hazard to human health. However, the misunderstanding in the above quote permeates his commentary. As Kundi (2006) correctly recognized, it is better to prevent the introduction or use of agents that would cause adverse effects eventually identifiable in an epidemiologic study epidemiologic study A study that compares 2 groups of people who are alike except for one factor, such as exposure to a chemical or the presence of a health effect; the investigators try to determine if any factor is associated with the health effect . Such prevention is primarily the role of predictive toxicology toxicology, study of poisons, or toxins, from the standpoint of detection, isolation, identification, and determination of their effects on the human body. Toxicology may be considered the branch of pharmacology devoted to the study of the poisonous effects of drugs. . Yet, as Kundi stated in his abstract, his recommended dialogue approach to "the potential for disease causation causation Relation that holds between two temporally simultaneous or successive events when the first event (the cause) brings about the other (the effect). According to David Hume, when we say of two types of object or event that “X causes Y” (e.g. " starts with epidemiology. Kundi (2006) concluded that the principle that every disease has a cause is metaphysical met·a·phys·i·cal adj. 1. Of or relating to metaphysics. 2. Based on speculative or abstract reasoning. 3. Highly abstract or theoretical; abstruse. 4. a. Immaterial; incorporeal. , but still has heuristic A method of problem solving using exploration and trial and error methods. Heuristic program design provides a framework for solving the problem in contrast with a fixed set of rules (algorithmic) that cannot vary. 1. value. He appears to mean that the principle of causation helps us explore the potential that environmental factors cause human disease--and that we do so by developing models, such as risk assessment, that approximate reality without achieving certainty. However, a risk assessment, or any other model, that must depend on epidemiologic evidence to recognize the potential for disease causation represents a failure of environmental health science. The author declares he has no competing financial interests. Bernard D. Goldstein Graduate School of Public Health University of Pittsburgh Pittsburgh, Pennsylvania “Pittsburgh” redirects here. For the region, see Pittsburgh Metropolitan Area. Pittsburgh (pronounced IPA: /ˈpɪtsbɚg/) is the second largest city in the Commonwealth of Pennsylvania. E-mail: bdgold@pitt.edu REFERENCE Kundi M. Causality and the interpretation of epidemiologic evidence. 2006. Environ Health Perspect 114:969-974. |
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