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On the Nature of Evidence and ‘Proving’ Causality: Smoking and Lung Cancer vs. Sun Exposure, Vitamin D and Multiple Sclerosis

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  • Robyn M. Lucas

    (National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra 2600, Australia
    Centre for Ophthalmology and Visual Science, University of Western Australia, Perth 6009, Australia)

  • Rachael M. Rodney Harris

    (National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra 2600, Australia)

Abstract

If environmental exposures are shown to cause an adverse health outcome, reducing exposure should reduce the disease risk. Links between exposures and outcomes are typically based on ‘associations’ derived from observational studies, and causality may not be clear. Randomized controlled trials to ‘prove’ causality are often not feasible or ethical. Here the history of evidence that tobacco smoking causes lung cancer—from observational studies—is compared to that of low sun exposure and/or low vitamin D status as causal risk factors for the autoimmune disease, multiple sclerosis (MS). Evidence derives from in vitro and animal studies, as well as ecological, case-control and cohort studies, in order of increasing strength. For smoking and lung cancer, the associations are strong, consistent, and biologically plausible—the evidence is coherent or ‘in harmony’. For low sun exposure/vitamin D as risk factors for MS, the evidence is weaker, with smaller effect sizes, but coherent across a range of sources of evidence, and biologically plausible. The association is less direct—smoking is directly toxic and carcinogenic to the lung, but sun exposure/vitamin D modulate the immune system, which in turn may reduce the risk of immune attack on self-proteins in the central nervous system. Opinion about whether there is sufficient evidence to conclude that low sun exposure/vitamin D increase the risk of multiple sclerosis, is divided. General public health advice to receive sufficient sun exposure to avoid vitamin D deficiency (<50 nmol/L) should also ensure any benefits for multiple sclerosis, but must be tempered against the risk of skin cancers.

Suggested Citation

  • Robyn M. Lucas & Rachael M. Rodney Harris, 2018. "On the Nature of Evidence and ‘Proving’ Causality: Smoking and Lung Cancer vs. Sun Exposure, Vitamin D and Multiple Sclerosis," IJERPH, MDPI, vol. 15(8), pages 1-13, August.
  • Handle: RePEc:gam:jijerp:v:15:y:2018:i:8:p:1726-:d:163301
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    References listed on IDEAS

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    1. H Bart van der Worp & David W Howells & Emily S Sena & Michelle J Porritt & Sarah Rewell & Victoria O'Collins & Malcolm R Macleod, 2010. "Can Animal Models of Disease Reliably Inform Human Studies?," PLOS Medicine, Public Library of Science, vol. 7(3), pages 1-8, March.
    2. Reinskje Talhout & Thomas Schulz & Ewa Florek & Jan Van Benthem & Piet Wester & Antoon Opperhuizen, 2011. "Hazardous Compounds in Tobacco Smoke," IJERPH, MDPI, vol. 8(2), pages 1-16, February.
    3. Anne-Louise Ponsonby & Terence Dwyer, 2014. "Biomedicine must look beyond P values," Nature, Nature, vol. 507(7491), pages 169-169, March.
    4. Xia Jiang & Paul F. O’Reilly & Hugues Aschard & Yi-Hsiang Hsu & J. Brent Richards & Josée Dupuis & Erik Ingelsson & David Karasik & Stefan Pilz & Diane Berry & Bryan Kestenbaum & Jusheng Zheng & Jiana, 2018. "Genome-wide association study in 79,366 European-ancestry individuals informs the genetic architecture of 25-hydroxyvitamin D levels," Nature Communications, Nature, vol. 9(1), pages 1-12, December.
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