[Epidemiology, «liaisons dangereuses», and public health]

Two recent articles in the French daily Le Monde raised the issue of conflicts of interest with specific reference to the case of an Italian epidemiologist nominated for a key position in a French public institution. The issue can be seen - and is here discussed - from the angle of the social role of scientists, in particular epidemiologists. The viewpoint developed is that epidemiologists having key responsibilities in public institutions, whose mission is not only to carry research but to channel its results into the process of public health decisions, are akin practicing clinicians who are also involved in research. Their social role, and what the public expect of them, is to orient their research and interpret the unavoidable uncertainties of the results in a way that maximizes benefits and minimizes risks to people's health. Being directly or indirectly involved in practical decisions at clinical or public health levels, they cannot be "neutral" in respect to health, as a researcher could be. This viewpoint is particularly relevant in respect to the doctrine maintaining that false positive results are today the dominant methodological issue in epidemiology and consequently avoidance of decisions based on possibly false positive results is the top priority in all circumstances. In fact, depending on the specific circumstances, this may turn out contrary to the principle of maximizing benefits and minimizing risks to people's health, hence the "doctrine of false positives" is erroneous for epidemiologists working in public institutions with responsibilities for translating research into actions.