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

Journal article


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. CCCU Expert Comment.
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
JournalCCCU Expert Comment
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/
Publication dates
Print20 May 2017
Publication process dates
Deposited24 May 2017
Output statusPublished
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https://repository.canterbury.ac.uk/item/882vv/why-absence-of-evidence-of-risk-is-not-the-same-as-evidence-for-absence-of-risk

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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