On the evolution of concepts of causal and preventive interdependence in epidemiology in the late 20th century.

Abstract

The 1970s and 1980s saw the appearance of many papers on the topics of synergy, antagonism, and similar concepts of causal interactions and interdependence of effects, with a special emphasis on distinguishing these concepts from that of statistical interaction - the need for a product term in a model. As an example, Miettinen defined "synergism" as "the existence of instances in which both risk factors are needed for the effect", whereas "antagonism" is where "at least one [factor] can block the solo effect of the other". In response, Greenland and Poole constructed a systematic analysis of 16 possible individual response patterns in a deterministic causal model for two binary exposure variables, and showed how these patterns can be mapped onto nine types of sufficient causes, which in turn can be simplified into four intuitive categories. Although these and other papers recognized that epidemiology cannot directly study biological mechanisms underlying interaction, they showed how it can usefully study causal and preventive interdependence - which, despite its mechanistic agnosticism, has important implications for clinical decision making as well as for public health.