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Additional resources for Basic Epidemiology
Similarly, in the evaluation of a therapeutic drug to see if it “causes” recovery from illness, there must be a comparison to recovery without the drug or with using another one. Not surprising, then, relative risk is the most important measure of risk used by epidemiologists and health professionals in their studies of causality. 3 The pellagra research papers discussed earlier are free of any calculations of relative risk; the raw numbers were expected to tell the story. Indeed all through the 1940s and 1950s there was almost no mention of relative risk in scientific research.
Clinicians often publish these observations as “letters to the editor,” and the medical journal the Lancet is one of the most popular places to find them. The letters are not considered by the health professions to be evidence that the cause of a disease has been identified; there have been too many false alarms for that and the fallibility of case reports is well understood. However, they create hypotheses for further study, and some, a small but important minority of case reports, do turn out to be supported by more rigorous research.
These contaminants were likely the product of a large nineteenth-century tanning industry in Woburn that made leather belts and shoes for Civil War soldiers. The Woburn leukemia cluster led to a best-selling book and movie,6 adding to a heated and inflammatory environment, the kind that can hinder the investigation of disease clusters. A detailed study of the Woburn water supply by Harvard biostatisticians showed that homes with affected children were twice as likely to have had 24 Chance and Randomness some water supplied by wells G and H than were homes of children outside the cluster.