Forensic epidemiology

The discipline of forensic epidemiology (FE) is a hybrid of principles and practices common to both forensic medicine and epidemiology. FE is directed at filling the gap between clinical judgment and epidemiologic data for determinations of causality in civil lawsuits and criminal prosecution and defense.

Forensic epidemiologists formulate evidence-based probabilistic conclusions about the type and quantity of causal association between an antecedent harmful exposure and an injury or disease outcome in both populations and individuals. The conclusions resulting from an FE analysis can support legal decision-making regarding guilt or innocence in criminal actions, and provide an evidentiary support for findings of causal association in civil actions.

Applications of forensic epidemiologic principles are found in a wide variety of types of civil litigation, including cases of medical negligence, toxic or mass tort, pharmaceutical adverse events, medical device and consumer product failures, traffic crash-related injury and death, person identification and life expectancy.

The term Forensic Epidemiology was first associated with the investigation of bioterrorism in 1999, and coined by Dr. Ken Alibek, the former chief deputy of the Soviet bioweapons program. The scope of FE at that time was confined to the investigation of epidemics that were potentially man-made. After the US Anthrax attacks of 2001 the CDC defined forensic epidemiology as a means of investigating possible acts of bioterrorism.

At the present time FE is more widely known and described as the systematic application of epidemiology to disputed issues of causation that are decided in (primarily) civil, but also criminal courts. The use of epidemiologic data and analysis as a basis for assessing general causation in US courts, particularly in toxic tort cases, has been described for more than 30 years, beginning with the investigation of the alleged relationship between exposure to the Swine Flu vaccine in 1976 and subsequent cases of Guillain–Barré syndrome.[1]

More recently FE has also been described as an evidence-based method of quantifying the probability of specific causation in individuals. The approach is particularly helpful when a clinical differential diagnosis approach to causation is disputed. Examples covering a wide variety of applications of FE are listed below under Examples of Investigative Questions Addressed by Forensic Epidemiologists.

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