The Poverty of Epidemiology

Abstract

A perusal of the abstracts of papers presented at the twenty-third annual meeting of the Society for Epidemiological Research at Snowbird, Utah (June 12-15, 1990) [1], made me wonder whether epidemiology, the absence of epidemics, is not a misnomer for scaremongering made respectable by the use of sophisticated statistical methods, and whether one of the reasons for this state of affairs is not a high prevalence of epidemiologists when the incidence of problems soluble by epidemiological methods is low. It would seem that any combination of and disease, regardless of biological implausibility, or even without any underlying hypothesis, is fair game for calculating relative risks, odds ratios, or proportional hazards. The association game has three possible outcomes: positive association, negative association, or no association. As any of these three outcomes is generally thought to be interesting, controversial, or just in need of further research, they all get published. Combining these three possible outcomes with any two combinations of a potential risk factor (traditionally, sexual behaviour, alcohol drinking, and smoking, but now including any pleasurable activity, be it idleness, eating, or coffee drinking), the game has more possible combinations than Cluedo. The scope of epidemiological research has been enormously widened by including passive exposures to invisible electromagnetic waves, whether from home appliances, overhead wires, X-ray machines, or space, passive exposures to other people's smoke or other air pollutants, passive exposures to innumerable food additives, and other menaces of everyday life. Three groups of researchers looked at male breast cancer, a relatively uncommon disorder. According to one abstract, more than three medical X-rays increased the risk. Another study lent support to the theory that exposure to electromagnetic fields may be related to [male] breast