Tel Aviv Pg 7sins


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Tel Aviv Pg 7sins

  1. 1. The Seven Deadly Sins of Environmental Health Research … and the Precautionary Virtues Philippe Grandjean University of Southern Denmark Harvard School of Public Health
  2. 2. The seven main attitudes that underlie sins were first identified by St. John Cassian (360 - 435) and refined by Pope St. Gregory the Great (540 - 604) ”A very partial list” Aviad Kleinberg Professor of History, Tel Aviv University … probably more widely known from modern action movies than from environmental epidemiology
  3. 3. Dante’s Mount Purgatory …and a modern version
  4. 4. Superbia (pride) Self-delusion, grandiose illusions Paying overzealous attention and pious respect to high scientific standards … when judging the work of colleagues Condescending attitude toward studies from other countries or cultures AJPH 2001;91:1749-57
  5. 5. Pride ignores the bias in epidemiology conclusions* Methodological feature Main direction of error Low statistical power False negative Use of 5 % probability level False negative Use of 20% probability level to minimize risk of type II error False negative Post hoc hypothesis False positive Pressures against false alarm False negative Publication bias False positive etc… Developed with David Gee, EEA, and Collegium Ramazzini colleagues
  6. 6. Invidia (envy) Ingratitude and failure to recognize others’ achievements Abusing “criteria” for causality “All scientific work is incomplete… All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us the freedom to ignore the knowledge we already have, or to postpone the action that it appears to demand at the given time.” A Bradford Hill (1965) Envious researchers mistake the validity of their own conclusions for meticulousness in identifying presumed violations of causal “criteria”
  7. 7. UCSF Brown & Williamson Documents
  8. 8. Impartiality in science Researchers (and their sponsors) may try to strengthen their own views by pointing out presumed violations of causal “criteria”… …but failure to satisfy such formal criteria provides little support for the absence of a causation
  9. 9. Ira (Wrath) Injury is transformed into the pleasure of vengeance Often coupled with narrow-minded inflexibility … when rejecting the evidence [There is] still no positive proof of a causal relationship between the use of thalidomide during pregnancy and malformations in the newborn… [and it is] encouraging to note that studies in pregnant rats have not shown a single malformation in more than 1,100 offspring of thalidomide-treated animals. Frank N. Getman, President, William S.Merrell Co. (1962)
  10. 10. Gula (gluttony): Endless replication creates inertia and constipation • The majority of published papers in environmental health journals deals with a limited, rather stable list of pollutants • PubMed lists over 15,000 scientific publications on lead – endless repetition? • At the same time, PubMed lists very few papers on, e.g., perfluorooctane sulfonates • Such discrepancy may be justified only if lead constitutes a paradigm (which is applied)
  11. 11. Gluttony: Demand of full documentation, complete evidence and Lust: Desire for prestige and publications …pave the way for continued studies, more funding
  12. 12. Lust and greed may be explored by vested interests to short-cut research in health and environment Biasing the choices of study topics Hiding unwanted data Tainting the conclusions
  13. 13. ”Doubt” is our product (Brown and Williamson, 1969)* *Glantz SA et al. The cigarette papers. Berkeley: UC Press, 1996, p. 171. From AJPH
  14. 14. Acedia (sloth) Indifference to the welfare of others Apathy, callousness and lack of caring Hiding in the ivory tower 700 Safe level now Blood-lead concentration (µg/L) 600 recommended by 500 many public-health 400 officials 300 200 100 0 1960 1970 1985 1991 Year when CDC action limit was changed Truly safe level
  15. 15. Sloth: Committing Type III errors by studying the wrong (though convenient) parameters 70% of Americans own running shoes but don’t run
  16. 16. What would Dante have suggested?
  17. 17. In interpreting environmental research, we must recognize that a phenomenon may exist, even if we cannot see it: What could be known, given our research opportunities and methodologies?
  18. 18. The Precautionary Principle • In situations of potentially serious or irreversible threats to health or to the environment, the need to act to reduce potential hazards before there is strong proof of harm, should take into account likely costs and benefits of action and inaction • Introduced as the ‘Vorsorgeprinzip’ in social context in Germany during the early 1930s • Formally extended to environmental policy during about 1970 as a planning instrument • The modern PP was born and included in the first convention on protection of the North Sea in 1984 and is now part of the EU treaty
  19. 19. Precautionary Usefulness of approach principle Complements risk assessment when incertitude increases Risk assessment Becomes less useful when incertitude increases Scientific understanding Complexity of problem
  20. 20. Precautionary virtues needed to counterbalance the deadly sins The virtues must address… The limitations to epidemiologic evidence Conclusions being provisional and temporary The impact of uncertainties Worst-case scenario, not just null hypothesis Facilitating application of the “Precautionary Principle” in decision-making
  21. 21. Extent of community response The Science-Policy Gap: Proposal for a Bridge Risk assessment Precautionary monitoring of Evidence- suspected based exposures action Stakeholder Precautionary involvement action to Initial protect groups research Focused at high risk research Time / Degree of scientific certainty
  22. 22. Prudent interpretation of epidemiology may be inspired by, but does not depend on, the Precautionary Principle The subject is capable of being decided by exact numerical investigation, but I have thought it better to publish my inquiry in its present imperfect state than to wait till I should be able to make such a complete research as I could wish, more especially as, by directing the attention of the profession to the question, it may be earlier decided. John Snow (1855)
  23. 23. What an individual is capable of may be measured by how far his understanding is from his willing. What a person can understand he must also be able to make himself will. Between understanding and willing lie the excuses and evasions. Kierkegaard
  24. 24. Virtues inspired by the Precautionary Principle • Provide the best possible input to decision-making and application of the precautionary principle • Accept and explore uncertainties and their implications • Take into consideration what could be known given the current research insights and opportunities • Absence of evidence should not be taken as evidence of absence of a hazard • Science planning and reporting is part of a dynamic interface with decision-making and intervention • Include open discussion with stakeholders
  25. 25. Precautionary remedies for ailing epidemiology Vice Precautionary virtue Pride Preoccupation Humility Exploration of with methodology uncertainty Envy Failure to Fairness What could be recognize known, given achievements the evidence? by others Wrath Self-righteous Empathy Weighing in all intimidation of relevant competitors evidence
  26. 26. Vice Precautionary virtue Lust Desire for Restraint Balanced academic honors choice of research methods/topics Gluttony Excessive craving Innova- Limiting for publications tion attempts of replication Greed Benefit from Trans- Involvement vested interests parency of all stakeholders Sloth Callousness Com- Public health to injustice passion responsibility
  27. 27. Expunging sins Poll: Of the seven deadly sins, this ONE is my biggest failing: Lust 35% Anger 18% Pride 12% Sloth 10% Envy 10% Gluttony 9% Greed 6% Precautionary thinking …in planning, conducting, analyzing, and reporting
  28. 28. The ”new” sins • Genetic modification • Human experimentation • Polluting the environment • Social injustice • Causing poverty • Financial gluttony • Taking drugs
  29. 29. Environmental Researchers’ Paradise Sloth Gluttony Ascent To expunge facilitated by their sins Lus t precautionary researchers Greed virtues must climb Wr ath Mount Envy Purgatory Pride (substantially) revised from Dante Alighieri (1265-1321), with apologies