Public health and epistemology

Our plain-English summary of Public health and epistemology, by D.S. Egilman (American Journal of Industrial Medicine, 1992).

The study

• Author: D.S. Egilman
• Journal: American Journal of Industrial Medicine
• Published: 1992;22(3):457-9
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a short commentary, not a research study, written in reply to a 1991 article by Enterline. That article had stated that the asbestos-cancer relationship was not established until 1965 because epidemiological studies were delayed. The author disagreed. The author argued that epidemiological studies were available before 1965, citing Merewether (1949) and Doll (1955), and that between 1930 and 1950 pathological studies carried more weight than epidemiological ones. The author wrote that by 1942 there were enough pathological data to support a causal link between asbestosis and lung cancer. The author also quoted a 1977 letter from Higgins to Enterline that stressed non-statistical biological reasons for concluding that asbestos caused lung cancer. The author argued that public health action should not wait for a complete scientific consensus. In the author's view, the force of a response should depend on the strength of the association, the severity of the health effects and the importance of the product. The author asserted that asbestos product manufacturers chose not to warn workers despite what the author called overwhelming evidence of hazard. The commentary presented no new data.

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: commentary (opinion piece responding to another author's article); no original data
• Who was studied: No people were studied. The commentary discusses how evidence on asbestos and cancer was viewed, mainly between 1930 and 1950.
• Exposure: Asbestos in general, discussed in relation to lung cancer and asbestosis. No fiber types, products, jobs or doses are specified.
• Main results:
  • The author disagreed with Enterline's statement that the asbestos-cancer relationship was not established until 1965. The author argued that epidemiological studies were available long before 1965.
  • The author argued that by 1942 there were enough pathological data to support a causal link between asbestosis and lung cancer.
  • The author quoted a 1977 letter from Higgins to Enterline. The letter said that non-statistical biological features shaped many people's conclusions more than the statistical evidence did.
  • The author stated that the epidemiological question was settled by Doll in 1955.
  • The author argued that reasonable suspicion of an asbestos-cancer relationship existed by the early 1940s.
  • The author argued that public health decisions cannot wait for a complete scientific consensus, because there is never complete consensus.
  • The author asserted that asbestos product manufacturing companies chose not to warn workers or test their products despite what the author called overwhelming evidence of hazard.
• The authors' conclusion: The author concluded that the lack of one type of information (such as epidemiological data) should not blind people to overwhelming evidence of another type, and that action should be based on current knowledge.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer.

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