IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v15y2018i8p1726-d163301.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/15/8/1726/pdf
    Download Restriction: no

    File URL: https://www.mdpi.com/1660-4601/15/8/1726/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. 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.
    2. 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.
    3. 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.
    4. Anne-Louise Ponsonby & Terence Dwyer, 2014. "Biomedicine must look beyond P values," Nature, Nature, vol. 507(7491), pages 169-169, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Lauralyn A McIntyre & David Moher & Dean A Fergusson & Katrina J Sullivan & Shirley H J Mei & Manoj Lalu & John Marshall & Malcolm Mcleod & Gilly Griffin & Jeremy Grimshaw & Alexis Turgeon & Marc T Av, 2016. "Efficacy of Mesenchymal Stromal Cell Therapy for Acute Lung Injury in Preclinical Animal Models: A Systematic Review," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-16, January.
    2. Rusdi Abd Rashid & Sharmilla Kanagasundram & Mahmoud Danaee & Hazreen Abdul Majid & Ahmad Hatim Sulaiman & Muhammad Muhsin Ahmad Zahari & Chong Guan Ng & Benedict Francis & Wan Azlinda Irnee Wan Husin, 2019. "The Prevalence of Smoking, Determinants and Chance of Psychological Problems among Smokers in an Urban Community Housing Project in Malaysia," IJERPH, MDPI, vol. 16(10), pages 1-9, May.
    3. Kimberley E Wever & Carlijn R Hooijmans & Niels P Riksen & Thomas B Sterenborg & Emily S Sena & Merel Ritskes-Hoitinga & Michiel C Warlé, 2015. "Determinants of the Efficacy of Cardiac Ischemic Preconditioning: A Systematic Review and Meta-Analysis of Animal Studies," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-17, November.
    4. Dominic Palazzolo & John M. Nelson & Zuri Hudson, 2019. "The Use of HPLC-PDA in Determining Nicotine and Nicotine-Related Alkaloids from E-Liquids: A Comparison of Five E-Liquid Brands Purchased Locally," IJERPH, MDPI, vol. 16(17), pages 1-13, August.
    5. Hanna Mojska & Iwona Gielecińska & Edyta Jasińska-Melon & Joanna Winiarek & Włodzimierz Sawicki, 2020. "Are AAMA and GAMA Levels in Urine after Childbirth a Suitable Marker to Assess Exposure to Acrylamide from Passive Smoking during Pregnancy?—A Pilot Study," IJERPH, MDPI, vol. 17(20), pages 1-15, October.
    6. Nathalie Percie du Sert & Viki Hurst & Amrita Ahluwalia & Sabina Alam & Marc T Avey & Monya Baker & William J Browne & Alejandra Clark & Innes C Cuthill & Ulrich Dirnagl & Michael Emerson & Paul Garne, 2020. "The ARRIVE guidelines 2.0: Updated guidelines for reporting animal research," PLOS Biology, Public Library of Science, vol. 18(7), pages 1-12, July.
    7. Bossert, Leonie & Hagendorff, Thilo, 2021. "Animals and AI. The role of animals in AI research and application – An overview and ethical evaluation," Technology in Society, Elsevier, vol. 67(C).
    8. Sònia Torres & Carla Merino & Beatrix Paton & Xavier Correig & Noelia Ramírez, 2018. "Biomarkers of Exposure to Secondhand and Thirdhand Tobacco Smoke: Recent Advances and Future Perspectives," IJERPH, MDPI, vol. 15(12), pages 1-25, November.
    9. Rosalie V. Caruso & Richard J. O'Connor & W. Edryd Stephens & K. Michael Cummings & Geoffrey T. Fong, 2013. "Toxic Metal Concentrations in Cigarettes Obtained from U.S. Smokers in 2009: Results from the International Tobacco Control (ITC) United States Survey Cohort," IJERPH, MDPI, vol. 11(1), pages 1-16, December.
    10. Constance Holman & Sophie K Piper & Ulrike Grittner & Andreas Antonios Diamantaras & Jonathan Kimmelman & Bob Siegerink & Ulrich Dirnagl, 2016. "Where Have All the Rodents Gone? The Effects of Attrition in Experimental Research on Cancer and Stroke," PLOS Biology, Public Library of Science, vol. 14(1), pages 1-12, January.
    11. Arianna Antonucci & Matteo Vitali & Stefano Martellucci & Vincenzo Mattei & Carmela Protano, 2020. "A Cross-Sectional Study on Benzene Exposure in Pediatric Age and Parental Smoking Habits at Home," IJERPH, MDPI, vol. 17(15), pages 1-17, July.
    12. Benjamin T. Kopp & Juan Antonio Ortega-García & S. Christy Sadreameli & Jack Wellmerling & Estelle Cormet-Boyaka & Rohan Thompson & Sharon McGrath-Morrow & Judith A. Groner, 2016. "The Impact of Secondhand Smoke Exposure on Children with Cystic Fibrosis: A Review," IJERPH, MDPI, vol. 13(10), pages 1-10, October.
    13. Robin van Eenige & Peternella S Verhave & Peter J Koemans & Ivo A C W Tiebosch & Patrick C N Rensen & Sander Kooijman, 2020. "RandoMice, a novel, user-friendly randomization tool in animal research," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-8, August.
    14. Adam R Ferguson & Karen-Amanda Irvine & John C Gensel & Jessica L Nielson & Amity Lin & Johnathan Ly & Mark R Segal & Rajiv R Ratan & Jacqueline C Bresnahan & Michael S Beattie, 2013. "Derivation of Multivariate Syndromic Outcome Metrics for Consistent Testing across Multiple Models of Cervical Spinal Cord Injury in Rats," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-13, March.
    15. Anna Maria Stabile & Alessandra Pistilli & Desirée Bartolini & Eleonora Angelucci & Marco Dell’Omo & Gabriele Di Sante & Mario Rende, 2022. "Short-Term Effects of Side-Stream Smoke on Nerve Growth Factor and Its Receptors TrKA and p75 NTR in a Group of Non-Smokers," IJERPH, MDPI, vol. 19(16), pages 1-11, August.
    16. Sri Sumartiningsih & Setya Rahayu & Eko Handoyo & Jung-Charng Lin & Chin Leong Lim & Michal Starczewski & Philip X. Fuchs & Chia-Hua Kuo, 2022. "Systemic Lactate Elevation Induced by Tobacco Smoking during Rest and Exercise Is Not Associated with Nicotine," IJERPH, MDPI, vol. 19(5), pages 1-8, March.
    17. Susanne Wieschowski & Diego S Silva & Daniel Strech, 2016. "Animal Study Registries: Results from a Stakeholder Analysis on Potential Strengths, Weaknesses, Facilitators, and Barriers," PLOS Biology, Public Library of Science, vol. 14(11), pages 1-12, November.
    18. Jigen Na & Huiting Chen & Hang An & Nan Li & Lailai Yan & Rongwei Ye & Zhiwen Li, 2022. "Association of Rare Earth Elements with Passive Smoking among Housewives in Shanxi Province, China," IJERPH, MDPI, vol. 19(1), pages 1-12, January.
    19. Branislav Kolena & Ida Petrovičová & Miroslava Šidlovská & Henrieta Hlisníková & Lenka Bystričanová & Soňa Wimmerová & Tomáš Trnovec, 2020. "Occupational Hazards and Risks Associated with Phthalates among Slovakian Firefighters," IJERPH, MDPI, vol. 17(7), pages 1-15, April.
    20. Konstantinos K Tsilidis & Orestis A Panagiotou & Emily S Sena & Eleni Aretouli & Evangelos Evangelou & David W Howells & Rustam Al-Shahi Salman & Malcolm R Macleod & John P A Ioannidis, 2013. "Evaluation of Excess Significance Bias in Animal Studies of Neurological Diseases," PLOS Biology, Public Library of Science, vol. 11(7), pages 1-10, July.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:15:y:2018:i:8:p:1726-:d:163301. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.