To the Editor:
Promoting the need for further research in the face of demonstrated harms from exposure in communities elsewhere is premised on policymakers’ claims that policy action cannot be justified until effects seen elsewhere are demonstrated locally. This argument must be recognized for what it usually is: namely, a delay tactic to maintain the status quo. I suggest that, with proper community engagement, the need for research instead of action would be exposed early on and thus be obviated.
This said, Savitz1 is to be commended for his commentary in EPIDEMIOLOGY. He advises us, before embarking on a study, to ask “To what end?” Equivalently we might ask: “In whose best interests?” The researcher’s passion to conduct research must be balanced against local community interests. The International Society for Environmental Epidemiology’s (ISEE’s) 2012 Ethics Guidelines2 address, in some depth, the need for community engagement as integral to respecting community interests.
From the core values expressed in ISEE’s 2012 Ethics Guidelines, “… Our duty as scientists is to do the best science possible with a view to reducing uncertainties. However, the presence of uncertainty is no justification for inaction in the face of environmental harms.”2,3 The Precautionary Principle is applied where there is scientific evidence of potential harm, but the matter may be considered by some to be unsettled as to causation.
There is no justification for delaying action to protect exposed populations, especially if the agent has already been shown to cause adverse health effects in other exposed populations. Furthermore, there are pollution episodes which involve population exposures to known toxicants/carcinogens, but the specific health outcomes are rare or have not been adequately studied. In these situations, it is necessary to extrapolate from knowledge that we have about the agents to protect the public, again invoking the Precautionary Principle. A worthy component of the action plan may include prospective medical monitoring and surveillance of the exposed population; this, instead of undertaking a potentially inconclusive etiologic study that would only delay needed action.
The author thanks Dr. Shira Kramer for her constructive review.
Colin L. Soskolne
University of Alberta
Edmonton, AB, Canada
Health Research Institute
University of Canberra
Canberra, ACT, Australia
1. Savitz DA. Commentary: response to environmental pollution: more research may not be needed. Epidemiology. 2016;27:919–920.
3. Hill AB. The environment and disease: association or causation? Proceed R Soc Med 1965;58:295–300.