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The precautionary principle brings a special challenge to the practice of evidence-based public health decision making, suggesting changes in the interpretative methods of public health used to identify causes of disease. In this paper, precautionary changes to these methods are examined: including discounting contrary evidence, reducing the number of causal criteria, weakening the rules of evidence assigned to the criteria, and altering thresholds for statistical significance. All such changes reflect the precautionary goal of earlier primary preventive intervention, i.e. acting on insufficient evidence, the least amount, or minimum level, of evidence for causation. Evaluating the impact of these changes will be difficult without a careful study of how well the current methods of causal inference work, their theoretical foundations, and the ethical implications of their applications. That research program will be most productive if it is jointly developed by public health professionals trained in the ethics and philosophy and by bioethicists and philosophers trained in the theories, methods, and practice of public health. Keywords: causation, decision-making, epidemiology, ethics, precautionary principle, prevention, public health, scientific methods

Objectives. This study was undertaken to examine popular press reports of the association between alcohol and breast cancer. Methods. Articles from scientific journals and stories from newspapers and magazines published from January 1, 1985, to July 1, 1992, were retrieved from six on-line databases. Lay press stories were analyzed to determine which medical articles were publicized and what information was reported. Results. Fifty-eight scientific articles on the relationship of alcohol and breast cancer were found, and 64 newspaper and 23 magazine stories were retrieved. The press cited 11 studies, 19% of those published during the study period. Three studies were featured in 77% of popular press stories. No scientific review articles were reported. Behavioral recommendations were given to the public in 63% of stories. Conclusions. The vast majority of scientific studies on alcohol and breast cancer were ignored in press reports. We encourage researchers and the popular press to give the public a broader understanding of public health issues. (Am J Public Health. 1995; 85:1082-1086), Newspapers and magazines may present skewed versions of medical research. All popular press articles from January 1985 to July 1992 on the connection between alcohol consumption and breast cancer were retrieved and abstracted. All scientific reports during the same period were treated similarly. Fifty-eight scientific reports and 87 popular articles on this topic were published during this time. Three scientific reports were featured in 77% of the popular articles. Forty-seven (81%) scientific reports were never cited by the press. All of the articles published in the popular literature were taken from only 7 of the 29 scientific journals reviewed. Popular articles variously recommended drinking less, drinking less if at high risk, drinking moderately, no change, or weighing risks and benefits. Selective reporting of single studies and contradictory advice only serves to confuse and alienate the public.

Epidemiologists may benefit from the disciplines of history, philosophy of science, ethics, literature, and art. Within these disciplines lie answers to the questions of who we are, what is right, how to think, and when to act. Studying and participating in the humanities may also help epidemiologists focus their professional concerns on the humanity their methods serve. A parallel phenomenon in the clinical sciences--medical humanities--provides support for the approach (and some lessons). (Am J Public Health. 1995; 85:914-918), Study of the humanities may help epidemiologists regain a more humanistic approach. The introduction of other disciplines can help epidemiologists become more flexible, creative, and critical thinkers; more aware of their connection to public health; and less hampered by dogma. Medical history provides a context for what epidemiologists do and enlightens about past triumphs and tragedies. Literature often uses medical themes to explore the consequences of illness, death, and the ethics and politics of medical practice. Philosophy teaches ways of thinking about ethics and reasoning through moral dilemmas. Even the arts, through such artworks as the AIDS quilt, teaches about the human suffering and caring that come with disease.