Weed Douglas L
Office of Preventive Oncology, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA.
J Med Philos. 2004 Jun;29(3):313-32. doi: 10.1080/03605310490500527.
The precautionary principle brings a special challenge to the practice of evidence-based public health decision-making, suggesting changes in the interpretative methods of public health used to identify causes of disease. In this paper, precautionary changes to these methods are examined: including discounting contrary evidence, reducing the number of causal criteria, weakening the rules of evidence assigned to the criteria, and altering thresholds for statistical significance. All such changes reflect the precautionary goal of earlier primary preventive intervention, i.e. acting on insufficient evidence, the least amount, or minimum level, of evidence for causation. Evaluating the impact of these changes will be difficult without a careful study of how well the current methods of causal inference work, their theoretical foundations, and the ethical implications of their applications. That research program will be most productive if it is jointly developed by public health professionals trained in the ethics and philosophy and by bioethicists and philosophers trained in the theories, methods, and practice of public health.
预防原则给循证公共卫生决策的实践带来了特殊挑战，这意味着用于确定疾病病因的公共卫生解释方法需要改变。本文探讨了这些方法的预防性变化：包括对相反证据不予考虑、减少因果标准的数量、弱化赋予这些标准的证据规则，以及改变统计显著性的阈值。所有这些变化都反映了早期初级预防干预的预防目标，即在因果关系证据不足、数量最少或水平最低的情况下采取行动。如果不仔细研究当前因果推断方法的有效性、其理论基础以及应用的伦理含义，就很难评估这些变化的影响。如果该研究项目由接受过伦理学和哲学培训的公共卫生专业人员以及接受过公共卫生理论、方法和实践培训的生物伦理学家和哲学家共同开展，将会取得最大成效。
