1. The Seven Deadly Sins of
Environmental Health Research
… and the
Precautionary
Virtues
Philippe Grandjean
University of Southern Denmark
Harvard School of Public Health

2. The seven main attitudes
that underlie sins
were first identified
by St. John Cassian (360 - 435)
and refined by Pope
St. Gregory the Great (540 - 604)
”A very partial list”
Aviad Kleinberg
Professor of History, Tel Aviv University
… probably more widely known
from modern action movies
than from environmental epidemiology

3. Dante’s Mount Purgatory
…and a modern version

4. Superbia (pride)
Self-delusion, grandiose illusions
Paying overzealous attention and pious
respect to high scientific standards
… when judging the work of colleagues
Condescending attitude toward studies from
other countries or cultures
AJPH 2001;91:1749-57

5. Pride ignores the bias
in epidemiology conclusions*
Methodological feature Main direction of error
Low statistical power False negative
Use of 5 % probability level False negative
Use of 20% probability level to
minimize risk of type II error False negative
Post hoc hypothesis False positive
Pressures against false alarm False negative
Publication bias False positive
etc…
Developed with David Gee, EEA, and Collegium Ramazzini colleagues

6. Invidia (envy)
Ingratitude and failure to recognize others’ achievements
Abusing “criteria” for causality
“All scientific work is incomplete…
All scientific work is liable to be upset or modified by advancing
knowledge. That does not confer upon us the freedom to
ignore the knowledge we already have, or to postpone the
action that it appears to demand at the given time.”
A Bradford Hill (1965)
Envious researchers mistake the validity of their
own conclusions for meticulousness in identifying
presumed violations of causal “criteria”

7. UCSF Brown & Williamson Documents

8. Impartiality in
science
Researchers (and their
sponsors) may try to
strengthen their own
views by pointing out
presumed violations of
causal “criteria”…
…but failure to satisfy
such formal criteria
provides little support
for the absence of a
causation

9. Ira (Wrath)
Injury is transformed into the pleasure of
vengeance
Often coupled with narrow-minded inflexibility
… when rejecting the evidence
[There is] still no positive proof of a causal relationship between
the use of thalidomide during pregnancy and malformations in
the newborn… [and it is] encouraging to note that studies in
pregnant rats have not shown a single malformation in more
than 1,100 offspring of thalidomide-treated animals.
Frank N. Getman, President, William S.Merrell Co. (1962)

10. Gula (gluttony): Endless replication
creates inertia and constipation
• The majority of published papers in
environmental health journals deals with a
limited, rather stable list of pollutants
• PubMed lists over 15,000 scientific
publications on lead – endless repetition?
• At the same time, PubMed lists very few
papers on, e.g., perfluorooctane sulfonates
• Such discrepancy may be justified only if lead
constitutes a paradigm (which is applied)

11. Gluttony:
Demand of full
documentation,
complete evidence
and Lust:
Desire for prestige
and publications
…pave the way for
continued
studies, more
funding

12. Lust and greed may be explored
by vested interests
to short-cut research
in health and environment
Biasing the choices of study topics
Hiding unwanted data
Tainting the conclusions

13. ”Doubt” is our product
(Brown and Williamson, 1969)*
*Glantz SA et al.
The cigarette
papers.
Berkeley:
UC Press, 1996,
p. 171. From AJPH

14. Acedia (sloth)
Indifference to the welfare of others
Apathy, callousness and lack of caring
Hiding in the ivory tower
700 Safe level now
Blood-lead concentration (µg/L)
600 recommended by
500
many public-health
400
officials
300
200
100
0
1960 1970 1985 1991
Year when CDC action limit was changed
Truly safe level

15. Sloth: Committing Type III errors by studying the
wrong (though convenient) parameters
70% of Americans own running shoes but don’t run

16. What would Dante have
suggested?

17. In interpreting
environmental
research,
we must recognize
that a phenomenon
may exist, even if we
cannot see it:
What could be known,
given our research
opportunities and
methodologies?

18. The Precautionary Principle
• In situations of potentially serious or irreversible
threats to health or to the environment, the need
to act to reduce potential hazards before there is
strong proof of harm, should take into account
likely costs and benefits of action and inaction
• Introduced as the ‘Vorsorgeprinzip’ in social
context in Germany during the early 1930s
• Formally extended to environmental policy
during about 1970 as a planning instrument
• The modern PP was born and included in the
first convention on protection of the North Sea in
1984 and is now part of the EU treaty

19. Precautionary
Usefulness of approach principle
Complements risk assessment
when incertitude increases
Risk assessment
Becomes less useful
when incertitude increases
Scientific understanding
Complexity of problem

20. Precautionary virtues needed to
counterbalance the deadly sins
The virtues must address…
The limitations to epidemiologic evidence
Conclusions being provisional and temporary
The impact of uncertainties
Worst-case scenario, not just null hypothesis
Facilitating application of the “Precautionary
Principle” in decision-making

21. Extent of community response The Science-Policy Gap: Proposal for a Bridge
Risk assessment
Precautionary
monitoring of Evidence-
suspected based
exposures action
Stakeholder Precautionary
involvement action to
Initial protect groups
research Focused at high risk
research
Time / Degree of scientific certainty

22. Prudent interpretation of epidemiology may be
inspired by, but does not depend on, the
Precautionary Principle
The subject is capable of being decided by
exact numerical investigation, but I have thought
it better to publish my inquiry in its present
imperfect state than to wait till I should be able
to make such a complete research as I could
wish, more especially as, by directing the
attention of the profession to the question, it
may be earlier decided.
John Snow (1855)

23. What an individual is
capable of may be
measured by how far
his understanding
is from his willing.
What a person can
understand he must
also be able to make
himself will.
Between understanding
and willing lie the
excuses and evasions.
Kierkegaard

24. Virtues inspired by the
Precautionary Principle
• Provide the best possible input to decision-making and
application of the precautionary principle
• Accept and explore uncertainties and their implications
• Take into consideration what could be known given the
current research insights and opportunities
• Absence of evidence should not be taken as evidence
of absence of a hazard
• Science planning and reporting is part of a dynamic
interface with decision-making and intervention
• Include open discussion with stakeholders

25. Precautionary remedies
for ailing epidemiology
Vice Precautionary virtue
Pride Preoccupation Humility Exploration of
with methodology uncertainty
Envy Failure to Fairness What could be
recognize known, given
achievements the evidence?
by others
Wrath Self-righteous Empathy Weighing in all
intimidation of relevant
competitors evidence

26. Vice Precautionary virtue
Lust Desire for Restraint Balanced
academic honors choice of
research
methods/topics
Gluttony Excessive craving Innova- Limiting
for publications tion attempts of
replication
Greed Benefit from Trans- Involvement
vested interests parency of all
stakeholders
Sloth Callousness Com- Public health
to injustice passion responsibility

27. Expunging sins
Poll: Of the seven deadly sins,
this ONE is my biggest failing:
Lust 35%
Anger 18%
Pride 12%
Sloth 10%
Envy 10%
Gluttony 9%
Greed 6%
Precautionary thinking
…in planning, conducting,
analyzing, and reporting

28. The ”new” sins
• Genetic modification
• Human experimentation
• Polluting the environment
• Social injustice
• Causing poverty
• Financial gluttony
• Taking drugs

29. Environmental
Researchers’
Paradise
Sloth
Gluttony Ascent
To expunge
facilitated by
their sins Lus t
precautionary
researchers Greed
virtues
must climb Wr ath
Mount Envy
Purgatory Pride
(substantially) revised from Dante Alighieri (1265-1321), with apologies