are ânon-Hodgkinâs lymphoma and certain aspects of dietary intake.â Imagine the effect on the results if the authors had selected exposures from an occupational health survey or from a mental health survey instead of from a heart health survey. Also, the proposed method assumes that exposures and diseases not included in the hierarchy are not priorities for future research. Is it not possible that some important exposures and diseases might have been inadvertently excluded? Third, the performance of the proposed method has not been evaluated. In fact, some of its elements are known to be ï¬awed. For example, the proposed criteria for epidemiologic 1047-2797/99/$âsee front matter PII S1047-2797(98)00050-7 Maldonado and Poole EDITORIAL AEP Vol. 9, No. 1 January 1999: 17â18 evidence include consistency of ï¬ndings across studies. This is a ï¬awed criterion (11). Inconsistency across study populations and over time is expected; it is not evidence against a causal relationship (7, 11). Fourth, the limitations of the approach are not adequately acknowledged, and no tools are proposed for quantifying the impact of limitations on the decision-making process. For example, several of the inputs required for Kreiger et al.âs approach are imperfect. Estimates of exposure prevalence from surveys are
Annals of Epidemiology – Elsevier
Published: Jan 1, 1999
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