Toolkit for detecting misused epidemiological methods

BACKGROUND

Critical knowledge of what we know about health and disease, risk factors, causation, prevention, and treatment, derives from epidemiology. Unfortunately, its methods and language can be misused and improperly applied. A repertoire of methods, techniques, arguments, and tactics are used by some people to manipulate science, usually in the service of powerful interests, and particularly those with a financial stake related to toxic agents. Such interests work to foment uncertainty, cast doubt, and mislead decision makers by seeding confusion about cause-and-effect relating to population health. We have compiled a toolkit of the methods used by those whose interests are not aligned with the public health sciences. Professional epidemiologists, as well as those who rely on their work, will thereby be more readily equipped to detect bias and flaws resulting from financial conflict-of-interest, improper study design, data collection, analysis, or interpretation, bringing greater clarity-not only to the advancement of knowledge, but, more immediately, to policy debates.

METHODS

The summary of techniques used to manipulate epidemiological findings, compiled as part of the 2020 Position Statement of the International Network for Epidemiology in Policy (INEP) entitled Conflict-of-Interest and Disclosure in Epidemiology, has been expanded and further elucidated in this commentary.

RESULTS

Some level of uncertainty is inherent in science. However, corrupted and incomplete literature contributes to confuse, foment further uncertainty, and cast doubt about the evidence under consideration. Confusion delays scientific advancement and leads to the inability of policymakers to make changes that, if enacted, would-supported by the body of valid evidence-protect, maintain, and improve public health. An accessible toolkit is provided that brings attention to the misuse of the methods of epidemiology. Its usefulness is as a compendium of what those trained in epidemiology, as well as those reviewing epidemiological studies, should identify methodologically when assessing the transparency and validity of any epidemiological inquiry, evaluation, or argument. The problems resulting from financial conflicting interests and the misuse of scientific methods, in conjunction with the strategies that can be used to safeguard public health against them, apply not only to epidemiologists, but also to other public health professionals.

CONCLUSIONS

This novel toolkit is for use in protecting the public. It is provided to assist public health professionals as gatekeepers of their respective specialty and subspecialty disciplines whose mission includes protecting, maintaining, and improving the public's health. It is intended to serve our roles as educators, reviewers, and researchers.

Does paraquat cause Parkinson's disease? A review of reviews

To examine the extent to which a consensus exists in the scientific community regarding the relationship between exposure to paraquat and Parkinson's disease, a critical review of reviews was undertaken focusing on reviews published between 2006 and the present that offered opinions on the issue of causation. Systematic searches were undertaken of scientific databases along with searches of published bibliographies to identify English language reviews on the topic of paraquat and Parkinson's disease including those on the broader topic of environmental and occupational risk factors for Parkinson's disease. Of the 269 publications identified in the searches, there were twelve reviews, some with meta-analyses, that met the inclusion criteria. Information on methods used by the reviewers, if any, and source of funding was collected; the quality of the reviews was considered. No author of any published review stated that it has been established that exposure to paraquat causes Parkinson's disease, regardless of methods used and independent of funding source. A consensus exists in the scientific community that the available evidence does not warrant a claim that paraquat causes Parkinson's disease. Future research on this topic should focus on improving the quality of epidemiological studies including better exposure measures and identifying specific mechanisms of action. Future reviews of emerging evidence should be structured as systematic narrative reviews with meta-analysis if appropriate.

Asbestos in Colombia: Industry versus science and health

The usefulness of an industrial product must be measured both in economic profitability and product safety terms, and the social benefit it represents. In the case of asbestos, due to its harmful effects on human health, its use, handling and production has been banned in high-income countries thanks to the efforts carried out by their oversight bodies. Worldwide, the industrial use of this mineral has been associated with high morbidity and mortality rates, hence the importance of denouncing the health effects of asbestos.Asbestos is a term used to refer to six naturally occurring silicate minerals that are used in the manufacture of building materials, such as asbestos–cement, and automotive components, including brake linings and brake pads; however, it has been proved that inhaling asbestos microscopic fibers can lead to the development of lung diseases (pneumoconioses) and cancer. In many cases, these diseases are caused by a short occupational or environmental exposure to it, but their clinical manifestation occurs several years after the first time of exposure.The main objective of this paper is to reflect on the hazards related to the use of asbestos and to influence public health policies addressing this problem in Colombia, so that by means of the newly adopted law banning the use of this mineral in our country, significant progress is made in aspects such as the identification and the monitoring of people who were exposed to it, and the handling, removal and final disposal of materials containing asbestos.

The Monsanto Papers: Poisoning the scientific well

OBJECTIVE

Examination of de-classified Monsanto documents from litigation in order to expose the impact of the company's efforts to influence the reporting of scientific studies related to the safety of the herbicide, glyphosate.

METHODS

A set of 141 recently de-classified documents, made public during the course of pending toxic tort litigation, In Re Roundup Products Liability Litigation were examined.

RESULTS

The documents reveal Monsanto-sponsored ghostwriting of articles published in toxicology journals and the lay media, interference in the peer review process, behind-the-scenes influence on retraction and the creation of a so-called academic website as a front for the defense of Monsanto products.

CONCLUSION

The use of third-party academics in the corporate defense of glyhphosate reveals that this practice extends beyond the corruption of medicine and persists in spite of efforts to enforce transparency in industry manipulation.

Can Neoliberal Capitalism Affect Human Evolution?

The connection between genes and health outcomes is significantly moderated by social factors. Health inequalities result from the differential accumulation of exposures and resource access rooted in class-based circumstances. In the neoliberal era in the United States, changed physical and socioeconomic conditions facing the poorer members of society have been characterized as traumatogenic (capable of producing a wound or injury). This paper will argue that research that points to the transgenerational influence of environmental impacts on health suggests 2 important reconsiderations of the link between the economy and health. First, an understanding of the health of any society requires an understanding not only of current but also past environmental conditions and the economy that produces those conditions. Second, it suggests that the way in which economic policy is analyzed needs to be reconsidered to incorporate the transgenerational impacts of environmental conditions produced by those policies.

Evidence Regarding the Impact of Conflicts of Interest on Environmental and Occupational Health Research

PURPOSE OF REVIEW

This review describes published literature providing evidence for financial conflicts of interest in environmental and occupational health research. Secondary goals were to describe evidence that (a) utilized quantitative methods to evaluate the association of conflicts with study outcomes, and (b) assessed undisclosed as well as disclosed conflicts of interest.

RECENT FINDINGS

Forty-three studies were identified which contained descriptions of the impact of financial conflicts of interest on research results; 11 of these conducted quantitative analyses to demonstrate these relationships. All 11 articles which quantified associations identified significant associations of the presence of financial conflicts of interest with study findings. In studies which measured undisclosed conflicts, these comprised a substantial proportion of all conflicts. Suggestions for improving understanding and interpretation of research results are presented.

Ethics, morality, and conflicting interests: how questionable professional integrity in some scientists supports global corporate influence in public health

Clinical and public health research, education, and medical practice are vulnerable to influence by corporate interests driven by the for-profit motive. Developments over the last 10 years have shown that transparency and self-reporting of corporate ties do not always mitigate bias. In this article, we provide examples of how sound scientific reasoning and evidence-gathering are undermined through compromised scientific enquiry resulting in misleading science, decision-making, and policy intervention. Various medical disciplines provide reference literature essential for informing public, environmental, and occupational health policy. Published literature impacts clinical and laboratory methods, the validity of respective clinical guidelines, and the development and implementation of public health regulations. Said literature is also used in expert testimony related to resolving tort actions on work-related illnesses and environmental risks. We call for increased sensitivity, full transparency, and the implementation of effective ethical and professional praxis rules at all relevant regulatory levels to rout out inappropriate corporate influence in science. This is needed because influencing the integrity of scientists who engage in such activities cannot be depended upon.

The "trust" heuristic: arguments from authority in public health

The work of public health depends on a relationship of trust between health workers and members of the public. This relationship is one in which the public must trust the advice of health experts, even if that advice is not always readily understood or judged to be agreeable. However, it will be argued in this article that the pact of trust between public health workers and members of the public has been steadily eroded over many years. The reasons for this erosion are examined as are attempts to characterize the concept of trust in empirical studies. The discussion then considers how a so-called informal fallacy, known as the "argument from authority," might contribute to attempts to understand the trust relationship between the public and health experts. Specifically, this argument enables the lay person to bridge gaps in knowledge and arrive at judgements about public health problems by attending to certain logical and epistemic features of expertise. The extent to which lay people are able to discern these features is considered by examining the results of a study of public health reasoning in 879 members of the public.

[Conflicts of interest in the research, production and dissemination of medicines]

This paper analyzes the debate about the ethical conflicts of the methods used by the pharmaceutical industry in the research, production and dissemination of medicines. Three aspects are examined: the involvement of medical professionals with representatives of the pharmaceutical industry; the conflicts of interest regarding their role as sponsors of scientific research; and the evaluation of drugs on human beings. It is seen that the message for health promotion comes from medicalization; the major pharmaceutical industries do not exclusively produce merchandise, but especially subjectivities. In this way, the type of order established by them is revealed.

Riscos, saúde e justiça ambiental: o protagonismo das populações atingidas na produção de conhecimento

É discutida a participação das comunidades em situações de injustiça ambiental na produção de conhecimentos, as quais são decorrentes de desigualdades e de discriminações na distribuição de riscos e benefícios do desenvolvimento econômico. São destacados os limites epistemológicos e políticos para a produção de conhecimentos e de alternativas que possibilitem o avanço na construção de sociedades mais justas e sustentáveis. A partir de uma visão ampliada de saúde são discutidos os limites das abordagens científicas em reconhecer a importância do saber local, seja para analisar riscos ambientais ou seus efeitos à saúde, incluindo os estudos epidemiológicos. Tais limites relacionam-se basicamente ao ocultamento de conflitos e incertezas, à falta de contextualização da exposição aos riscos e efeitos sobre a saúde, assim como às dificuldades de diálogo com as comunidades. O artigo apresenta ainda contribuições e avanços decorrentes de movimentos por justiça ambiental. Concluiu-se que uma perspectiva construtivista, processual e democrática de confrontação de saberes e práticas poderá orientar a produção científica em prol da justiça ambiental.

Data sharing: not as simple as it seems

In recent years there has been a major change on the part of funders, particularly in North America, so that data sharing is now considered to be the norm rather than the exception. We believe that data sharing is a good idea. However, we also believe that it is inappropriate to prescribe exactly when or how researchers should preserve and share data, since these issues are highly specific to each study, the nature of the data collected, who is requesting it, and what they intend to do with it. The level of ethical concern will vary according to the nature of the information, and the way in which it is collected - analyses of anonymised hospital admission records may carry a quite different ethical burden than analyses of potentially identifiable health information collected directly from the study participants. It is striking that most discussions about data sharing focus almost exclusively on issues of ownership (by the researchers or the funders) and efficiency (on the part of the funders). There is usually little discussion of the ethical issues involved in data sharing, and its implications for the study participants. Obtaining prior informed consent from the participants does not solve this problem, unless the informed consent process makes it completely clear what is being proposed, in which case most study participants would not agree. Thus, the undoubted benefits of data sharing does not remove the obligations and responsibilities that the original investigators hold for the people they invited to participate in the study.

Vinyl chloride industry in the courtroom and corporate influences on the scientific literature

Pressure from the vinyl chloride (VC) industry on researchers involved in industry-sponsored studies and on regulatory agencies has been documented since 1970s. This commentary describes the influence of a lawsuit pursued by workers of an Italian VC plant on the recent scientific debate on VC exposure and risk of hepatocellular carcinoma (HCC). Original studies carried out by consultants of the public prosecutors and by independent researchers supported the above association. VC-industry consultants published two reviews during the lawsuit, claiming that liver angiosarcoma was the only VC-related cancer. The judges concluded that the evidence of the association between HCC and VC was still not convincing. After the trial, the risk of HCC was confirmed by a re-assessment of VC carcinogenicity from the International Agency for Research on Cancer, but other subsequent industry-funded reviews criticized the new evidence. Industry-funded authors cited each other, and rarely disclosed conflicts of interest. Based on a network of collaborating researchers, industrial interests can shape the literature enhancing the background noise surrounding the scientific evidence.