Silva Luis Carlos, Ordúñez Pedro
National Medical Sciences Information Center, Havana, Cuba.
MEDICC Rev. 2014 Apr;16(2):66-71. doi: 10.37757/MR2014.V16.N2.11.
This paper contextualizes the chronic kidney disease epidemic and related burden of disease affecting Central American farming communities. It summarizes the two main causal hypotheses (heat stress and agrochemicals), draws attention to the consequences of dichotomous reasoning concerning causality, and warns of potential conflicts of interest and their role in "manufacturing doubt." It describes some methodological errors that compromise past study findings and cautions against delaying public health actions until a conclusive understanding is reached about the epidemic's causes and underlying mechanisms. It makes the case for a comprehensive approach to the historical, social and epidemiological facts of the epidemic, for critically assessing existing studies and for enhanced rigor in new research.
本文将慢性肾病的流行情况以及影响中美洲农业社区的相关疾病负担置于具体情境中进行阐述。它总结了两个主要的因果假设（热应激和农用化学品），提请注意关于因果关系的二分法推理的后果，并警告潜在的利益冲突及其在“制造怀疑”中的作用。它描述了一些损害过往研究结果的方法学错误，并告诫不要等到对该流行病的病因和潜在机制有了确凿的认识才采取公共卫生行动。它主张采用综合方法来研究该流行病的历史、社会和流行病学事实，批判性地评估现有研究，并提高新研究的严谨性。
