Forensic Epidemiology in Italy: principles and practice

Our plain-English summary of Forensic Epidemiology in Italy: principles and practice, by V. Chiesa, A. Odone, C. Signorelli (Acta Bio-medica, 2017).

The study

• Authors: V. Chiesa, A. Odone, C. Signorelli
• Journal: Acta Bio-medica
• Published: 2017;88(3):360-364
• Read it: PubMed · Publisher · Free full text

Abstract

Forensic epidemiology (FE) implies the use of epidemiological data in the processes and the involvement of epidemiologists in judicial proceedings. FE is essential for the assessment of causal association between the exposure to specific agents and the occurrence of diseases. In this paper we describe FE principles and applications in the Italian context as in recent years FE emerged increasingly as well as the need of experienced and trained epidemiological experts able to navigate legal proceedings. In the literature, the principles of FE have been widely described by different authors, among them: Kennet Rothman who introduced the definition of cause, Sir Austin Bradford Hill who proposed an analytic framework to assess the causal association, and recently by Sana Loue who described the actual legislation and application of FE in the United States. Despite the legislation varies among different countries epidemiological methods and theories represent the foundation for the application of FE we illustrate in this paper. The association between environmental pollution and disease, mobile phones and cancer, vaccines and autism, asbestos and pleural mesothelioma are all situations that underscore the need for FE investigations in criminal acts. Causal association is a complex process: in real life only in limited cases causal associations are assessed by gathering robust scientific evidence, while cases with doubts and situations where different approaches to questions may lead to discordant arguments to questions may lead to discordant arguments are more frequent. Therefore, during the assessment of causation in civil and criminal matters the choice the epidemiological expert - with his knowledge and expertise - and the evidence from well-designed studies are crucial to fill the gaps between clinical and epidemiological data and the low.

In plain English

This article was a descriptive overview, not a new study. The authors described the principles of forensic epidemiology (the use of epidemiological data and experts in court cases) and how it has been applied in Italy. They summarized earlier writers' ideas on causation, including Rothman's definition of a cause and Bradford Hill's nine viewpoints for judging whether an association is causal. They noted that Italy handles harm from toxic exposures in criminal trials, which require proof "beyond any reasonable doubt". The United States uses civil cases decided on what is "most likely". Among Italian cases, they described the Eternit case in Turin, where, they wrote, the company exposed around 3000 people to asbestos. They stated that earlier cohort and case-control studies used in that case showed a statistically significant correlation between asbestos exposure and asbestosis, lung cancer and mesothelioma. They also discussed industrial pollution, mobile phone and vaccine cases. The authors concluded that evidence from well-designed studies is particularly relevant, and that causal associations are established by robust scientific evidence only in limited cases.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive overview (narrative review/commentary) of forensic epidemiology principles and Italian court cases; no new data were collected
• Who was studied: No study population. The article discusses Italian legal cases, including the Eternit asbestos case in Turin (around 3000 people exposed to asbestos, per the article), the Ilva steel plant in Taranto, Tirreno Power in Savona, and court cases about mobile phones and vaccines
• Exposure: Examples discussed include asbestos (in relation to pleural mesothelioma), environmental pollution, mobile phones and vaccines; no fiber types or doses are given
• Main results:
  • The authors described different standards of proof: "beyond any reasonable doubt" for criminal liability (Italy) and "most likely" for civil liability (United States)
  • The authors described the Cozzini Cassation judgment in the Eternit process as an example of an epidemiological assessment for its completeness
  • The authors stated that earlier cohort and case-control studies used in the Eternit case (not this article's own research) showed a statistically significant correlation between asbestos exposure and asbestosis, lung cancer and mesothelioma
  • Regarding vaccine court cases, the authors stated that a causal link between vaccines and autism has never been demonstrated
  • The authors noted that a 2017 Ivrea court judgment linking a worker's tumor to mobile phone use met criticism from the scientific community
• The authors' conclusion: The authors concluded that evidence from well-designed studies is particularly relevant, and that in real life causal associations are established by robust scientific evidence only in limited cases

Topics

Medical terms in this study, explained in our Lexicon: Epidemiology, Pleural Mesothelioma, Causation.

Related studies

• Using environmental forensic microscopy in exposure science — J.R. Millette, R.S. Brown, et al. (2008)
• Toxicology and epidemiology: improving the science with a framework for combining toxicological and epidemiological evidence to establish causal inference — H.O. Adami, S.C. Berry, et al. (2011)
• Epidemiology and the law: courts and confidence intervals — T. Christoffel, S.P. Teret (1991)
• Epidemiology of pleural mesothelioma in North-western Italy (Piedmont) — G.F. Rubino, G. Scansetti, et al. (1972)
• Epidemiology of pleural mesothelioma in Italy — R. Filiberti, F. Montanaro (2004)
• Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition) — A.J. Alberg, J.G. Ford, et al. (2007)

Browse return to medical research.