Grandjean Philippe
Institute of Public Health, University of Southern Denmark, Winslowparken 17, DK-5000 Odense C, Denmark.
Toxicol Appl Pharmacol. 2005 Sep 1;207(2 Suppl):652-7. doi: 10.1016/j.taap.2004.11.029.
Empirical studies in toxicology aim at deciphering complex causal relationships, especially in regard to human disease etiologies. Several scientific traditions limit the usefulness of documentation from current toxicological research, in regard to decision-making based on the precautionary principle. Among non-precautionary aspects of toxicology are the focus on simplified model systems and the effects of single hazards, one by one. Thus, less attention is paid to sources of variability and uncertainty, including individual susceptibility, impacts of mixed and variable exposures, susceptible life-stages, and vulnerable communities. In emphasizing the need for confirmatory evidence, toxicology tends to penalize false positives more than false negatives. An important source of uncertainty is measurement error that results in misclassification, especially in regard to exposure assessment. Standard statistical analysis assumes that the exposure is measured without error, and imprecisions will usually result in an underestimation of the dose-effect relationship. In testing whether an effect could be considered a possible result of natural variability, a 5% limit for "statistical significance" is usually applied, even though it may rule out many findings of causal associations, simply because the study was too small (and thus lacked statistical power) or because some imprecision or limited sensitivity of the parameters precluded a more definitive observation. These limitations may be aggravated when toxicology is influenced by vested interests. Because current toxicology overlooks the important goal of achieving a better characterization of uncertainties and their implications, research approaches should be revised and strengthened to counteract the innate ideological biases, thereby supporting our confidence in using toxicology as a main source of documentation and in using the precautionary principle as a decision procedure in the public policy arena.
毒理学的实证研究旨在解读复杂的因果关系,尤其是在人类疾病病因方面。就基于预防原则的决策而言,几种科学传统限制了当前毒理学研究文献的实用性。毒理学的非预防方面包括对简化模型系统的关注以及对单一危害影响的逐一研究。因此,对变异性和不确定性的来源关注较少,包括个体易感性、混合和可变暴露的影响、易感生命阶段以及脆弱社区。在强调确证证据的必要性时,毒理学往往对假阳性的惩罚比对假阴性的惩罚更严厉。不确定性的一个重要来源是测量误差,这会导致错误分类,尤其是在暴露评估方面。标准统计分析假定暴露的测量没有误差,而不精确性通常会导致对剂量 - 效应关系的低估。在测试一种效应是否可被视为自然变异性的可能结果时,通常会应用5%的“统计显著性”限值,尽管这可能会排除许多因果关联的发现,仅仅是因为研究规模太小(因此缺乏统计效力),或者因为某些参数的不精确性或有限敏感性妨碍了更明确的观察。当毒理学受到既得利益影响时,这些限制可能会加剧。由于当前毒理学忽视了更好地描述不确定性及其影响这一重要目标,研究方法应予以修订和加强,以抵消固有的意识形态偏见,从而增强我们将毒理学作为主要文献来源以及将预防原则作为公共政策领域决策程序的信心。