Destriar el gra de la palla

Arran de l’apunt de l’altre dia, he tingut la sort de reprendre la correspondència e-epistolar amb un metge català que fa molts anys, dècades, que viu (i treballa) als Estats Units. Malauradament, no he tingut mai l’oportunitat de conèixer-lo en persona, però fa temps que, de tant en tant, intercanviem correus electrònics i sempre és un plaer conversar virtualment i en la distància amb ell. Pel que escriu, i per com ho escriu, és una persona d’una extensa formació, amb la paraula justa en cada moment i el matís, que permeten descriure les coses de manera precisa.

Espero que no li sàpiga greu si recullo aquí, sense el seu permís, algunes de les observacions que em feia en el seu correu, perquè crec que són interessants i complementen l’apunt anterior.

Et volia dir només que el que descrius és sens dubte epidemiologia però que, a diferencia del que sembla que passa a tot l’estat, hi ha gran diferència entre epidemiòlegs i especialistes en malalties infeccioses, que és una de les especialitats mèdiques, a les quals va un que pateix de TB [tuberculosi], o infeccions fúngiques o SIDA. Ho sé molt bé, perquè la meva estimada filla està a punt de defensar la tesi doctoral en Salut Pública a Johns Hopkins, que li donarà un PhD, no pas un MD i, de segur, [els PhD] no tracten malalts. És molt difícil definir bé, i breument, [que és] l’epidemiologia.

[…] En general, l’epidemiologia estudia les relacions entre la salut humana i les condicions ambientals. Algú diu que els treballadors de l’amiant es moren de mesoteliomes. L’única forma de saber si és veritat o no és posar a treballar un equip d’epidemiòlegs. En aquest cas, el que fan és fer una taula amb els mesoteliomes observats entre els treballadors de l’amiant i els comparen amb els mesoteliomes presents en un grup de defuncions de gent comparable en tot, excepte en l’ocupació, fent les estadístiques que cal per convèncer. O a vegades surt gent que diu que els nens d’un poble es moren de leucèmies, o que les dones en un altre lloc pateixen de més càncers de mama que la població general, cosa que pot ser veritat o no (gairebé mai n’és). Els epidemiòlegs tenen molta feina però sense ells seria impossible establir una relació de causa i efecte. Entre les seves peculiaritats, tenen entrevistadors que entren a les cases a preguntar coses, cosa difícil i sovint perillosa, tenen criteris per definir una cohort (un grup de persones lligades per alguna cosa), saben llegir i utilitzar les taules de mortalitat públiques. En el meu cas, em vaig posar en contacte amb els epidemiòlegs de Mount Sinai per escriure el meu darrer article que descriu la presència de nanotubs als pulmons dels treballadors del World Trade Center. ¿Que la polseguera generada al WTC va causar malalties o no? Cal preguntar als epidemiòlegs si hi ha relació o no.

[…] No te res a veure amb la qualitat del teu article, que he trobat interessantíssim, però em va sorprendre molt la primera vegada que vaig escoltar que algú anomenava epidemiòlegs als ID Doctors (infectious diseases doctors) que, en general, no saben gran cosa ni d’epidemiologia ni d’estadística.

World Trade Center fog

He volgut reproduir les seves paraules perquè defineixen molt bé i delimiten què és el que fan els epidemiòlegs. I perquè també, posen de manifest el valor i la importànica d’una ciència rigorosa, fonamentada en estudis sòlids amb tots els ets i uts (i.e. els controls necessaris), que permetin destriar el gra de la palla: distingir allò que té una relació de causa i efecte d’allò que és pura coincidència.

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