‘Epidemiologie wordt grootschalig misbruikt’

“Wetenschap is een belangrijk stuk gereedschap. Het is onze enige manier om uit te maken wat waar is en wat alleen maar wordt beweerd. Als we dat gereedschap nu misbruiken dan is het waardeloos wanneer we het nodig hebben. Epidemiologie is ooit een van de meest waardevolle wetenschappelijke gereedschappen geweest. Tóch wordt het zo vaak misbrukt dat het niet meer als zodanig herkenbaar is. Als zelfs de British Medical Association deze wetenschap misbruikt, wie neemt het dan op voor de ware wetenschap?”


Op deze manier eindigt een erg kritisch artikel over de rol van de epidemiologie in de medische sector. Het is juist deze mishandelde epidemiologie die ons de tirannieke tabakswet heeft gebracht. Gebaseerd op… niets…


Epidemie als ‘blame game’, een spelletje om ergens de schuld te kunnen leggen…


In 1995, science writer Gary Taubes warned that the science of epidemiology (tracing the source and causes of disease) was reaching a crisis point. In “Epidemiology Faces Its Limits” (Science, Jul. 14, 1995), Taubes argued that modern epidemiology was in danger of becoming a “pathological science” because it had devolved into a data dredging exercise, mindlessly searching an ever-expanding pool of danger for marginally significant associations unpredicted by any a priori hypothesis. For instance, researchers might discover by sifting through volumes of data on ovarian cancer that women who eat yoghurt every day suffer the illness marginally more than non-yoghurt eaters and therefore decide that yoghurt is a risk factor for cancer. The future did indeed seem bleak.


Yet traditional epidemiology had its stout defenders. There were certain rules guaranteeing the sanctity of epidemiology. For instance, while Taubes argued that marginal relative risks were being touted as proof of causation when they could not possibly tell us anything certain, the medical journals did not accept that (a relative risk is a number that describes how much more likely someone with the risk factor is than the general population to suffer the relevant disease. Thus, if yoghurt eaters suffer ovarian cancer twice as much as other women, their relative risk is said to be 2). The New England Journal of Medicine (NEJM) told Taubes that, “As a general rule of thumb, we are looking at a relative risk of 3 or more [before accepting a paper for publication].” A former statistical consultant backed this up, but said, “If it’s a 1.5 relative risk, and it’s only one study and even a very good one, you scratch your chin and say maybe.”


 


Yet in the years since Taubes’ article, things have changed somewhat. For instance, a study published in NEJM’s equally venerable competitor the Journal of the American Medical Association in March 2002 argued that air pollution was strongly associated with early death from lung cancer and cardiovascular disease. The study was extensive. Yet the relative risk was a total of 1.12 — nowhere near even the “maybe” level of 1995. The assertion of strong association was breathless in its effrontery..


De rest van het artikel en een beschrijving van het rechtvaardigen van het misbruik ervan door de BMA is te vinden op Tech Central Station.

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