Gennaro Valerio, Ricci Paolo, Levis Angelo Gino, Crosignani Paolo
Dipartimento Epidemiologia e prevenzione, Istituto nazionale ricerca sul cancro, Genova, Italia.
Epidemiol Prev. 2009 Jul-Oct;33(4-5 Suppl 2):49-56.
Epidemiology is a public health oriented discipline and is aimed to detect the spatial, temporal, social and causal distribution of diseases in the human population, in order to promote timely and effective preventive solutions. This paper highlights some gold standard of the epidemiological method and suggests some considerations for a critical comprehension of epidemiological studies, in particular those that deny or minimize the existence of public health risks. This paper will focus on some crucial elements such as definition, attribution, misclassification and underestimation of the harmful exposures caused by a multitude of factors, undervaluation of the possible interactions among harmful agents (even when law limits are respected), selection of exposed populations, insufficient number of studied diseases, importance of the right comparisons between similar groups when the reference population is used, disproportion between shortness of follow-up in respect with long latency period of the studied diseases, including cancer. This paper also observes that many epidemiologists carry out confirmative studies rather than exploratory ones, and they end to both underestimate and underevaluate the multiplicity of the causal associations in favour of a reductive and a critical approach to the statistics which, in final analysis, wants to replace epidemiology. It points out, moreover, that neglecting primary prevention as well as precautionary principles in the interpretation of public health studies, arises the suspicion of professional limitation or strong conflict of interests (business bias). Epidemiology is naturally oriented to both primary prevention and public health defense, and today, more than ever before, for many reasons, among which the overwhelming market power that is first and foremost the cause of the general increase of populations affected by avoidable pathologies, a systematic, correct and timely application of this precious discipline seems to be urgent to us. In conclusion, we would suggest that some technical-scientific and institutional initiatives should overcome the intrinsic limits of the current aetiological researches. The rigorous adhesion of epidemiology to its scientific method appears to be absolutely necessary in order to enforce the Italian constitutional principle which states that health defence is a fundamental right of each individual and a concern for the whole community.
流行病学是一门以公共卫生为导向的学科，旨在检测人群中疾病的空间、时间、社会和因果分布，以促进及时有效的预防措施。本文强调了流行病学方法的一些黄金标准，并提出了一些批判性理解流行病学研究的注意事项，特别是那些否认或最小化公共卫生风险存在的研究。本文将重点关注一些关键要素，如定义、归因、多种因素造成的有害暴露的错误分类和低估、有害因素之间可能相互作用的低估（即使在遵守法律限制的情况下）、暴露人群的选择、所研究疾病数量不足、使用参考人群时相似组之间正确比较的重要性、研究疾病（包括癌症）的长潜伏期与随访时间过短之间的不均衡。本文还指出，许多流行病学家进行的是验证性研究而非探索性研究，他们最终往往低估和轻视因果关联的多样性，而倾向于采用简化和批判性的统计方法，而这种统计方法最终想要取代流行病学。此外，本文指出，在解释公共卫生研究时忽视一级预防和预防原则，会引发对专业局限性或强烈利益冲突（商业偏见）的怀疑。流行病学自然地倾向于一级预防和公共卫生防御，如今，出于多种原因，其中首要原因是压倒性的市场力量导致受可避免疾病影响的人群普遍增加，对我们来说，系统、正确和及时地应用这一宝贵学科似乎尤为迫切。总之，我们建议一些技术科学和机构举措应克服当前病因学研究的内在局限性。为了强化意大利宪法原则，即健康防御是每个人的基本权利以及整个社会的关切事项，严格遵循流行病学的科学方法似乎绝对必要。
