Why absence of evidence of risk is not the same as evidence for absence of risk

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Mills, H., De Vivo, M. and Beedie, C. 2017. Why absence of evidence of risk is not the same as evidence for absence of risk. Canterbury Christ Church University.
AuthorsMills, H., De Vivo, M. and Beedie, C.
Abstract

Yesterday’s news indicating the potential overplaying of the risk of alcohol in pregnancy highlights the professional and ethical tensions that scientists and evidence-based practitioners face on a daily basis. On the one side is the often incredible power of medical and scientific knowledge, on the other the daily encroachment of medicine and science into every aspect of our lives, what is termed ‘medicalisation’.

Many academics and even practitioners have presented coherent and powerful arguments against medicalisation, often identifying the worrying role of commercial, political and similar interested agencies in its apparently insidious spread.

But there are occasions in which these arguments, no matter how well made, no matter how reasonable, and no matter how well intentioned, can be counter-productive. Yesterday’s media around alcohol and pregnancy may be just such an example.

As scientists with a keen interest in exercise and pregnancy, we have to daily consider the tensions between common sense and an un-medicalised approach, and one based on scientific evidence, even if that evidence is not complete. The bottom line, however, is that we also have to veer on the side of caution.

Exercise was once considered a risk to pregnant mothers, we now know the benefits. The risks were overplayed in early research, and subsequent evidence indicated the positive effects of exercise on health during pregnancy. Likewise, evidence for the harmful effects of alcohol may have been overplayed, but where is the evidence for benefit? It is a maxim of knowledge that lack of evidence for something is not the same as evidence for the lack of something. Unlike many areas of science, it is problematic to research the real effects of alcohol during pregnancy, it is an emotive issue riddled with ethical and pragmatic challenges.

But there is a further risk. Any practitioner in public health will be happy to tell you that many people will hear what they want to hear, they will ignore the 99% of messages that indicate, for example, that smoking is harmful, and hear the 1% that indicates a lack of harm.

Scientists and academics should challenge scientific data, it is how science and knowledge progress. But in doing so we must exercise caution because the difference between the message sent – the evidence is not as strong as we like to think – and the messages that people hear – that it’s not as dangerous as we thought to drink alcohol during pregnancy – is stark.

Year2017
PublisherCanterbury Christ Church University
Official URLhttps://blogs.canterbury.ac.uk/expertcomment/alcohol-in-pregnancy-why-absence-of-evidence-for-a-risk-is-not-the-same-as-evidence-for-absence-of-risk/
Output statusPublished
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Print20 May 2017
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Deposited24 May 2017
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Is Olympic inspiration associated with fitness and physical activity in English schoolchildren? A repeated cross- sectional comparison before and 18 months after London 2012
Beedie, C., Sandercock, G. and Mann, S. 2016. Is Olympic inspiration associated with fitness and physical activity in English schoolchildren? A repeated cross- sectional comparison before and 18 months after London 2012. British Medical Journal Open. 6. https://doi.org/10.1136/bmjopen-2016-011670
Placebo and nocebo effects during repeat sprint performance
Hurst, P., Beedie, C., Coleman, D. and Foad, A. 2016. Placebo and nocebo effects during repeat sprint performance.
Knowledge and experience of placebo effects modifies athletes’ intentions to use sport supplements
Hurst, P., Beedie, C., Coleman, D. and Foad, A. 2016. Knowledge and experience of placebo effects modifies athletes’ intentions to use sport supplements.
“Already tired – do I need to be more tired?!” Eliciting the modal salient exercise beliefs of pregnant women in East Kent (United Kingdom).
De Vivo, M. and Mills, H. 2015. “Already tired – do I need to be more tired?!” Eliciting the modal salient exercise beliefs of pregnant women in East Kent (United Kingdom).
Illegal drug use damages the ethos of sport and risks the health of athletes
Beedie, C. 2016. Illegal drug use damages the ethos of sport and risks the health of athletes. Canterbury Christ Church University.
Examining the effectiveness of the theory of planned behaviour in explaining exercise intention and behaviour during pregnancy: a meta-analysis
De Vivo, M., Hulbert, S., Mills, H. and Uphill, M. 2016. Examining the effectiveness of the theory of planned behaviour in explaining exercise intention and behaviour during pregnancy: a meta-analysis. Journal of Reproductive and Infant Psychology. https://doi.org/10.1080/02646838.2015.1118022
Public attitudes toward people with intellectual disabilities after viewing Olympic or Paralympic performance
Ferrara, K., Burns, J. and Mills, H. 2015. Public attitudes toward people with intellectual disabilities after viewing Olympic or Paralympic performance. Adapted Physical Activity Quarterly. 32 (1), pp. 19-33. https://doi.org/10.1123/apaq.2014-0136
Validity and reliability of critical power field testing
Karsten, B., Jobson, S., Hopker, J., Stevens, L. and Beedie, C. 2015. Validity and reliability of critical power field testing. European Journal of Applied Physiology. 115 (1), pp. 197-204. https://doi.org/10.1007/s00421-014-3001-z
“I could have gone off much harder”. Post-race counterfactual thinking in indoor rowers.
Dray, K., Uphill, M., Mills, H. and Southam, M. 2015. “I could have gone off much harder”. Post-race counterfactual thinking in indoor rowers.
Examining the effectiveness of the Theory of Planned Behaviour in predicting exercise intention and behaviour during pregnancy: Preliminary findings from a random effects meta-analysis
De Vivo, M., Hulbert, S., Mills, H. and Uphill, M. 2014. Examining the effectiveness of the Theory of Planned Behaviour in predicting exercise intention and behaviour during pregnancy: Preliminary findings from a random effects meta-analysis.
The BASES expert statement on emotion regulation in sport
Lane, A., Beedie, C., Jones, M., Uphill, M. and Devonport, T. 2012. The BASES expert statement on emotion regulation in sport. Journal of Sports Sciences. 30 (11), pp. 1189-1195. https://doi.org/10.1080/02640414.2012.693621
Exploring perceptions of success within an exercise referral scheme: a mixed method investigation
Mills, H., Crone, D., James, D. and Johnston, L. 2012. Exploring perceptions of success within an exercise referral scheme: a mixed method investigation. Evaluation Review. 36 (6), pp. 407-429. https://doi.org/10.1177/0193841X12474452
The potential power of the Paralympics - changing attitudes towards people with intellectual disabilities
Parrot, K., Burns, J., Mills, H. and Baker, P. 2012. The potential power of the Paralympics - changing attitudes towards people with intellectual disabilities.
'Even if you can’t skip, you have a skip in your step when you walk out of the gym': a study into patients' perceptions of an exercise referral scheme
Mills, H., Crone, D., Johnston, L. and James, D. 2007. 'Even if you can’t skip, you have a skip in your step when you walk out of the gym': a study into patients' perceptions of an exercise referral scheme.
The BASES expert statement on emotion regulation in sport: produced on behalf of the British Association of Sport and Exercise Sciences
Lane, A., Beedie, C., Jones, M., Uphill, M. and Devenport, T. 2011. The BASES expert statement on emotion regulation in sport: produced on behalf of the British Association of Sport and Exercise Sciences. The Sport and Exercise Scientist. 29, pp. 14-15.
Emotional intelligence: associations with emotions, emotion regulation and rowing performance
Uphill, M. and Mills, H. 2011. Emotional intelligence: associations with emotions, emotion regulation and rowing performance. British Journal of Sports Medicine. 45 (15). https://doi.org/10.1136/bjsports-2011-090606.36
Response to article: Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis
Crone, D., James, D., Mills, H. and Johnston, L. 2011. Response to article: Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis. British Medical Journal (BMJ). 2011 (343). https://doi.org/10.1136/bmj.d6462
Building Bridges - An innovative tool to capture small health behaviour changes; the development process
Mills, H., Uphill, M. and Weed, M. 2011. Building Bridges - An innovative tool to capture small health behaviour changes; the development process.
Factors associated with exercise referral scheme success
Mills, H. 2009. Factors associated with exercise referral scheme success.
'Even if you can't skip, you have a skip in your step when you walk out of the gym': a study into patients' perceptions of an exercise referral scheme
Mills, H., James, D., Chrone, D. and Johnston, L. 2007. 'Even if you can't skip, you have a skip in your step when you walk out of the gym': a study into patients' perceptions of an exercise referral scheme. Journal of Sports Sciences. 25 (S2), pp. 108-109.
Placebo effect of an inert gel on experimentally induced leg muscle pain
Hopker, J., Foad, A., Beedie, C., Coleman, D. and Leach, G. 2010. Placebo effect of an inert gel on experimentally induced leg muscle pain. Open Access Journal of Sports Medicine. 1, pp. 215-221.
A mixed method investigation into the perception and measurement of success in an exercise referral scheme
Mills, H., Crone, D., James, D. and Johnston, L. 2010. A mixed method investigation into the perception and measurement of success in an exercise referral scheme.
‘Like I say to my dad, it’s not you’re fat, it’s probably muscle’ – exploring young boys’ perceptions of the physical activity and health relationship
Mills, H. and Mendez, K. 2010. ‘Like I say to my dad, it’s not you’re fat, it’s probably muscle’ – exploring young boys’ perceptions of the physical activity and health relationship.
Mood and performance: test of a conceptual model with a focus on depressed mood
Lane, A., Terry, P., Beedie, C., Curry, D. and Clark, N. 2001. Mood and performance: test of a conceptual model with a focus on depressed mood. Psychology of Sport and Exercise. 2 (3), pp. 157-172. https://doi.org/10.1016/S1469-0292(01)00007-3
Caffeine works: whether you believe it or not: evidence for pharmacological effects of caffeine ingestion on 40km cycling performance
Foad, A., Beedie, C. and Coleman, D. 2006. Caffeine works: whether you believe it or not: evidence for pharmacological effects of caffeine ingestion on 40km cycling performance.
Placebo effects of ergogenic aids in sports performance: experimental, psychometric and interview data
Beedie, C., Foad, A., Coleman, D. and Uphill, M. 2006. Placebo effects of ergogenic aids in sports performance: experimental, psychometric and interview data.
Is caffeine all in the head? Evidence for the placebo effects attributable to caffeine in cycling performance
Beedie, C., Stuart, E., Coleman, D. and Foad, A. 2006. Is caffeine all in the head? Evidence for the placebo effects attributable to caffeine in cycling performance.
Preparing students for the real world
Beedie, C. 2005. Preparing students for the real world. Sport and Exercise Scientist. 6.
Possible implications of nervous system-immune system links in sports rehabilitation
Beedie, C. and Hopker, J. 2005. Possible implications of nervous system-immune system links in sports rehabilitation. SportEX Medicine.
Potential for the use of the placebo effect in sport rehabilitation
Beedie, C. and Hopker, J. 2005. Potential for the use of the placebo effect in sport rehabilitation. SportEX Medicine.
Mood matters: a response to Mellalieu
Lane, A., Beedie, C. and Stevens, M. 2005. Mood matters: a response to Mellalieu. Journal of Applied Sport Psychology. 17 (4), pp. 319-325. https://doi.org/10.1080/10413200500313610
Beliefs versus reality, or beliefs as reality? The placebo effect in sport and exercise
Beedie, C. and Foad, A. 2008. Beliefs versus reality, or beliefs as reality? The placebo effect in sport and exercise. in: Lane, A. (ed.) Sport and Exercise Psychology London Hodder Education. pp. 211-225
Public health and physical activity
Mills, H., Crone, D. and El Ansari, W. 2009. Public health and physical activity. in: Wilson, F. and Mabhala, M. (ed.) Key Concepts in Public Health Los Angeles SAGE Publications Ltd. pp. 202-206
Factors associated with physical activity referral completion and health outcomes
James, D., Mills, H., Crone, D., Johnston, L., Morris, C. and Gidlow, C. 2009. Factors associated with physical activity referral completion and health outcomes. Journal of Sports Sciences. 27 (10), pp. 1007-1017. https://doi.org/10.1080/02640410903214248
Identification of placebo responsive participants in 40km laboratory cycling performance
Beedie, C., Foad, A. and Coleman, D. 2008. Identification of placebo responsive participants in 40km laboratory cycling performance. Journal of Sports Science and Medicine. 7 (1), pp. 166-175.
Pharmacological and psychological effects of caffeine ingestion in 40-km cycling performance
Foad, A., Beedie, C. and Coleman, D. 2008. Pharmacological and psychological effects of caffeine ingestion in 40-km cycling performance. Medicine and Science in Sports and Exercise. 40 (1), pp. 158-165. https://doi.org/10.1249/mss.0b013e3181593e02
Towards empirical distinctions between emotion and mood: a subjective contextual model
Beedie, C. 2007. Towards empirical distinctions between emotion and mood: a subjective contextual model. in: Lane, A. (ed.) Mood and Human Performance: Conceptual, Measurement and Applied Issues New York Nova Science Publishers. pp. 63-87
Positive and negative placebo effects resulting from the deceptive administration of an ergogenic aid
Beedie, C., Coleman, D. and Foad, A. 2007. Positive and negative placebo effects resulting from the deceptive administration of an ergogenic aid. International Journal of Sports Nutrition and Exercise Metabolism. 17 (3), pp. 259-269.
Placebo effects of caffeine on cycling performance
Beedie, C., Stuart, E., Coleman, D. and Foad, A. 2006. Placebo effects of caffeine on cycling performance. Medicine & Science in Sports & Exercise. 38 (12), pp. 2159-2164. https://doi.org/10.1249/01.mss.0000233805.56315.a9
Distinctions between emotion and mood
Beedie, C., Terry, P. and Lane, A. 2005. Distinctions between emotion and mood. Cognition & Emotion. 19 (6), pp. 847-878. https://doi.org/10.1080/02699930541000057
Placebo effects in competitive sport: qualitative data
Beedie, C. 2007. Placebo effects in competitive sport: qualitative data. Journal of Sports Science and Medicine. 6 (1), pp. 21-28.
The placebo effect in sports performance: a brief review
Beedie, C. and Foad, A. 2009. The placebo effect in sports performance: a brief review. Sports Medicine. 39 (4), pp. 313-329. https://doi.org/10.2165/00007256-200939040-00004