title: Epidemiology, public health, and the rhetoric of false positives.
abstract: BACKGROUND
  As an observational science, epidemiology is regarded by some researchers as inherently flawed and open to false results. In a recent paper, Boffetta et al. [Boffetta P, McLaughlin JK, LaVecchia C, Tarone RE, Lipworth L, Blot WJ. False-positive results in cancer epidemiology: a plea for epistemological modesty. J Natl Cancer Inst 100:988-995 (2008)] argued that "epidemiology is particularly prone to the generation of false-positive results." They also said "the tendency to emphasize and over-interpret what appear to be new findings is commonplace, perhaps in part because of a belief that the findings provide information that may ultimately improve public health" and that "this tendency to hype new findings increases the likelihood of downplaying inconsistencies within the data or any lack of concordance with other sources of evidence." The authors supported these serious charges against epidemiology and epidemiologists with few examples. Although we acknowledge that false positives do occur, we view the position of Boffetta and colleagues on false positives as unbalanced and potentially harmful to public health.
  
  
  OBJECTIVE
  We aim to provide a more balanced evaluation of epidemiology and its contribution to public health discourse.
  
  
  CONCLUSIONS
  Boffetta and colleagues ignore the fact that false negatives may arise from the very processes that they tout as generating false-positive results. We further disagree with their proposition that false-positive results from a single study will lead to faulty decision making in matters of public health importance. In practice, such public health evaluations are based on all the data available from all relevant disciplines and never to our knowledge on a single study.
  
  
  CONCLUSIONS
  The lack of balance by Boffetta and colleagues in their evaluation of the impact of false-positive findings on epidemiology, the charge that "methodological vigilance is often absent" in epidemiologists' interpretation of their own results, and the false characterization of how epidemiologic findings are used in societal decision making all undermine a major source of information regarding disease risks. We reaffirm the importance of epidemiologic evidence as a critical component of the foundation of public health protection.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA. blaira@mail.nih.gov
authors.forename: Aaron
authors.initials: A
authors.lastname: Blair
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Saracci
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Cocco
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
authors.forename: Philippe
authors.initials: P
authors.lastname: Grandjean
authors.forename: Manolis
authors.initials: M
authors.lastname: Kogevinas
authors.forename: David
authors.initials: D
authors.lastname: Kriebel
authors.forename: Anthony
authors.initials: A
authors.lastname: McMichael
authors.forename: Neil
authors.initials: N
authors.lastname: Pearce
authors.forename: Miquel
authors.initials: M
authors.lastname: Porta
authors.forename: Jonathan
authors.initials: J
authors.lastname: Samet
authors.forename: Dale P
authors.initials: DP
authors.lastname: Sandler
authors.forename: Adele Seniori
authors.initials: AS
authors.lastname: Costantini
authors.forename: Harri
authors.initials: H
authors.lastname: Vainio
mesh_terms: D015982:Bias; D001943:Breast Neoplasms / Q000139:chemically induced; D003069:Coffee / Q000009:adverse effects; D003632:Dichlorodiphenyldichloroethane / Q000633:toxicity; D004812:Epidemiologic Methods; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D010190:Pancreatic Neoplasms / Q000209:etiology; D011634:Public Health
chemical_list: D003069:Coffee; D003632:Dichlorodiphenyldichloroethane