White swans, black ravens, and lame ducks: necessary and sufficient causes in epidemiology

Several authors have used Popper's "white swan" example to support arguments for a falsificationist approach to epidemiology. The statement "all swans are white" cannot be verified by finding even a large number of white swans, but can be falsified by finding a single black swan. An analogous epidemiologic example that has been proposed is the hypothesis that a particular virus is a necessary cause of acquired immunodeficiency syndrome (AIDS). Such examples, however, have little relevance to science since scientific theories are not generalizations of facts; rather, they involve an understanding of the underlying processes that cause certain facts to occur. Furthermore, the "white swan" example is particularly inapplicable to epidemiology, since most factors of scientific or public health importance are neither necessary nor sufficient causes of disease. Nevertheless, epidemiologic research has achieved success in the understanding and prevention of disease. These points are exemplified by applying Rothman's model of causal constellations, which provides a conceptual basis for the development of epidemiologic theories.