Several decades ago I was immersed in a writing-and-speaking schedule that ultimately empowered businesses to eliminate smoking from their premises. I know — it’s hard to remember when everyone smoked at work! During that fifteen years of publishing and speaking on the issue of smoking control in the workplace, I frequently confronted tobacco industry prostitutes (whoops – I think I mean “spokespeople”) who asserted, among other blather, that there was no scientific evidence linking smoking to health issues (I’m not making this up!). The basis for this ludicrous claim was that all of the smoking-verses-health evidence came from epidemiology, not from the gold-standard of randomized controlled trials (RCT’s) that gets drugs approved by the FDA.
The inference in their silly argument was that epidemiology wasn’t really science! That somehow the exhaustive study of populations and observable differences, and the power of inferential statistics, weren’t enough to condemn smoking – we needed randomized trials! How would you like to be in a randomized trial group that is assigned to smoke two packs of cigarettes a day for twenty years?
Let me be clear in this foggy confusion. Epidemiology is THE science that gives us compelling data connecting particular behaviors to health outcomes. And make no mistake about it; there are reams of incontrovertible evidence to support virtually everything that is asserted in this blog series. Randomized trials work in certain research venues – but rarely in the geneses and courses of disease, especially those “diseases” that are, in reality, damage to parts of the human body.
For example, we know that dietary fat contributes to body cholesterol, to plaque accumulation, to the narrowing of arterial walls, and to so-called coronary heart disease (damage to the cardiovascular system). We know this from epidemiology, not from engaging volunteers in unsavory and unethical human trials! Not from subscribing to the Josef Mengele School of professional medical ethics! The most important findings in nutrition, indeed, the essence of science-based nutrition, emerges from epidemiology, not from human experimentation. Not from random trials.
Epidemiology is a science!