Considerations on guidelines of epidemiologic practice

Epidemiologists in the United States have been intrigued for almost two decades by the prospect of guidelines of epidemiologic practice: an issue partially raised by a perceived need for criteria that may distinguish advocacy positions from more conservative interpretations in epidemiology. Preliminary efforts have considered questions of subject protection, of study structure and documentation, and of professional etiquette. Deeper ethical interests have been coalescing around the need for candor and truth in the interpretation of uncertain epidemiologic findings--a need construed to be central to trustworthiness, and whose consideration would bring about a reappraisal of other aspects of epidemiologic practice. Openness about uncertainties would likely develop naturally into a search for ways to measure the relative strength of epidemiologic warnings, as an aid to ranking public health priorities. Principles aimed at resolving ethical, operational, and priority questions become interdependent elements of professional guidelines for epidemiology.