40 Jurimetrics 321 (1999-2000)
Epidemiology, Justice, and the Probability of Causation

handle is hein.journals/juraba40 and id is 333 raw text is: EPIDEMIOLOGY, JUSTICE, AND THE
PROBABILITY OF CAUSATION
Sander Greenland
James M. Robins*
ABSTRACT: The concept of probability of causation forms the basis of important
legal standards, legislation, and compensation schemes, which in turn use epidemiologic
data to estimate the probability of causation. This usage is a misapplication of epidemiol-
ogy, because it has been shown that without imposing restrictive biologic assumptions,
epidemiologic data cannot supply estimates of the probability of causation. Although the
misapplication of the probability of causation concept responds to the need to resolve
cases in a rational and consistent manner, this need does not justify continued misuse of
epidemiologic data in compensation decisions. Compensation schemes and legal standards
must recognize that an upper bound on the probability of causation cannot be determined
from epidemiologic data alone; biologic models also are needed. Although equitable
compensation schemes can be formulated without reference to the probability of causation,
all schemes must deal with fundamental methodologic uncertainties in estimation.
CITATION: Sander Greenland and James M. Robins, Epidemiology, Justice, and the
Probability of Causation, 40 Jurimetrics J. 321-340 (2000).
This article concerns the distinction between the excess incidence caused by
an exposure (the attributable fraction) and the probability that the exposure
caused an individual's disease (the probability ofcausation). Our points are not
*Sander Greenland is Professor, Department of Epidemiology, UCLA School of Public Health,
Los Angeles, CA 90095-1772. James M. Robins is Professor, Departments of Epidemiology and
Biostatistics, Harvard School of Public Health, Boston, MA 02115-9957.The authors are grateful to
Ben Armstrong, Jan Beyea, Geoffrey Howe, Hal Morgenstem, Mark Parascandola, Diana Petitti,
Jonathan Samet, Noel Weiss, and an anonymous reviewer for their valuable comments on this
manuscript.

SPRING 2000

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