Woodward A, McMichael A J
Department of Community Medicine, University of Adelaide, South Australia.
Eur J Cancer. 1991;27(11):1472-9. doi: 10.1016/0277-5379(91)90034-b.
The apparent effect of passive smoking on cancer risk has become an important social and political issue. For this reason alone the strength of the epidemiological evidence warrants close examination. The research published to date indicates a positive association of passive smoking with lung cancer, but there is no consistent evidence of associations with cancer at other sites. We have summarised the epidemiological evidence, and examined the major criticisms raised against these studies. These criticisms include alleged bias arising from misclassification of exposure to environmental tobacco smoke (ETS) or of personal smoking history, and from differential publication of positive findings. In their strongest form, these critiques challenge the ability of epidemiology to establish causation on any issue. We argue that epidemiology is not inherently different from other branches of science--in each of which scientific "proof" of cause and effect involves judgement based on measurement and logical interference. We also describe the application of epidemiological data to establishing proof, in courts of law, of the lung cancer risk of passive smoking.
被动吸烟对癌症风险的明显影响已成为一个重要的社会和政治问题。仅出于这一原因，流行病学证据的力度就值得仔细审视。迄今为止发表的研究表明，被动吸烟与肺癌呈正相关，但没有一致的证据表明与其他部位的癌症有关联。我们总结了流行病学证据，并审视了针对这些研究提出的主要批评意见。这些批评包括所谓的因对环境烟草烟雾（ETS）暴露或个人吸烟史的错误分类，以及因阳性结果的差异发表而产生的偏差。这些批评最强烈的形式是质疑流行病学在任何问题上确立因果关系的能力。我们认为，流行病学与其他科学分支本质上没有不同——在每一个分支中，因果关系的科学“证明”都涉及基于测量和逻辑推理的判断。我们还描述了流行病学数据在法庭上用于确立被动吸烟导致肺癌风险的证据方面的应用。
