To the Editor:
I have concerns about the commentary of VanderWeele and colleagues1 on “positive epidemiology,” which, despite the question mark in its title, is a largely uncritical appraisal of the potential of positive risk factors for health. Is there really a distinction between positive and negative risk factors, and positive and negative health? Most traditional risk factors could be presented positively (i.e., not smoking, being socioeconomically advantaged, exercising, and eating healthily). Also, most health states have positive and negative representations (e.g., life expectancy vs. death rate).
VanderWeele and colleagues1 mention employment as a “positive” risk factor, but this obscures the wealth of research on unemployment and health that often concludes that employment is beneficial.2 Thus, claiming a novel research agenda by reframing established areas of research as positive is concerning.
As a social scientist, I would not dismiss a possible role for religion in health, but as argued by some leading epidemiologists, the effect sizes reported in recent research by VanderWeele and colleagues1 seem unlikely to be causal given their high level3 and there is no mention of these critiques in the commentary. It is of concern that a commentary in a leading epidemiology journal would not even mention these views when claiming that “positive” risk factors effect sizes are in the realm of established ones.
One funder of the research is the John Templeton Foundation that, according to its web site,
“... aims to advance human well-being by supporting research on the Big Questions, and by promoting character development, individual freedom, and free markets. The Foundation takes its vision from its founding benefactor, the late Sir John Templeton, who sought to stimulate what he described as ‘spiritual progress.”4
Although most funders aim to improve health, the reader may not be aware that a funder of this research promotes the worldview outlined. In my reading, this worldview is reflected in the commentary. It is concerning that such an uncritical promotion is published in a leading epidemiology journal.
MRC/CSO Social and Public Health Sciences Unit
University of Glasgow
Glasgow, United Kingdom
1. VanderWeele TJ, Chen Y, Long K, Kim ES, Trudel-Fitzgerald C, Kubzansky LD. Positive epidemiology? Epidemiology. 2020;31:189–193.
2. Roelfs DJ, Shor E, Davidson KW, Schwartz JE. Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality. Soc Sci Med. 2011;72:840–854.
3. Davey Smith G. Post–modern epidemiology: when methods meet matter. Am J Epidemiol 2019;188:1410–1419.
4. John Templeton Foundation. Available at: www.templeton.org
. Accessed 1 March 2020.