title: Alarums false, alarums real: challenges and threats to the future of epidemiology.
abstract: OBJECTIVE
  A review of recent threats and challenges to epidemiology suggests that some represent an opportunity to advance the discipline while others are a major threat to conducting epidemiologic work.
  
  
  METHODS
  Two issues are identified which should advance the publication and conduct of epidemiologic research. Three are discussed that exemplify current threats.
  
  
  RESULTS
  Epidemiologists have a role in helping journalists improve the communication of risk information in the media. Methodological advances for studies of rare exposure being related to rare disease should reduce the frequency of conflicting results in the epidemiologic literature. Three significant external forces that threaten epidemiologic research are identified. These are: unbridled discovery during litigation as exemplified by Bendectin, breast implants and cellular telephones; over zealous privacy laws; and the negative impact of managed care on epidemiologic research.
  
  
  CONCLUSIONS
  The American College of Epidemiology has a major role to play in protecting the profession from some of the real threats that face it, and in helping meet the challenges.
authors.affiliation: Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Bracken
mesh_terms: D000932:Antiemetics / Q000009:adverse effects; D018427:Breast Implants; D003219:Confidentiality / Q000331:legislation & jurisprudence; D004025:Dicyclomine; D004319:Doxylamine / Q000009:adverse effects; D004338:Drug Combinations; D004813:Epidemiology / Q000639:trends*; D006801:Humans; D018156:Journalism, Medical; D008329:Managed Care Programs / Q000639:trends; D011736:Pyridoxine / Q000009:adverse effects; D013689:Telephone; D014481:United States
chemical_list: D000932:Antiemetics; D004338:Drug Combinations; C004454:dicyclomine, doxylamine, pyridoxine drug combination; D004025:Dicyclomine; D004319:Doxylamine; D011736:Pyridoxine