In a dispassionate and painstaking way, Kabat sheds light on four health scares: radon, electromagnetic fields from power lines, DDT as a cause of breast cancer, and second-hand tobacco smoke.
If epidemiologists are to contribute useful insights, they need to be mindful of strengths versus weaknesses in evidence. Kabat quotes a distinguished pioneer of risks associated with cigarettes, Sir Richard Peto: "epidemiology is so beautiful and provides such an important perspective on human life and death, but an incredible amount of rubbish is published." After hyping by journalists, rubbish can be given undue credibility by governments eager to respond to public concerns. John Ioannadis: "In the past, we had few research findings, while currently we have too many research findings. Therefore, getting rid of tentative but wrong research findings should become at least as important as finding new ones." Kabat supports weighing evidence in a critically-minded, inter-disciplinary way. The only way to overcome misinformation is via still stronger science.
Chapter 2 overviews the field of epidemiology. Kabat mentions examples of valuable achievements: cholera as a water-borne disease; smoking and cancers; alcohol and cancers; risk factors for heart disease; estrogen, progesterone and breast cancer; sleep position and sudden infant death syndrome; solar radiation and skin cancer; hepatitis b and liver cancer. Cholera was a clear cause, a problem amenable to investigation by mapping victims and water supplies.
Kabat readably integrates narrow articles into an understandable big picture. Physicist William R. Bennett (pioneer of gas lasers) calculated a barefoot railroad worker standing on wet tracks bearing electric current would receive a dose orders of magnitude lower than fields normally inside our bodies. New England Journal of Medicine: "all these epidemiological studies have been conducted in pursuit of a cause of cancer for which there is no plausible biologic basis." Kabat: "it is hard to escape the impression that the reluctance of the National Institute for Environmental Health Sciences working group to close the door on the possibility of electromagnetic force as a cause of leukemia had more to do with its members' stake in this area of research than with scientific rigor." Self-interest may have blinded them to "fundamental insights about the phenomenon whose effects they were investigating." Epidemiology should work in conjuction with other disciplines, not disregard them.
It is when health scares are at their most contentious that society is in most need of scientists willing to look honestly at a topic, without succumbing to prevailing fashion. Without an unswerving commitment to seek the truth, science ill-serves the public good. Kabat offers worthy lessons to epidemiologists who aspire to serve via honest practice. Well done.
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