COMING TO TERMS WITH THE TERMS OF RISK

Terms such as risk, risk factors, and especially the term cause are in consistently and imprecisely used, fostering scientific miscommunicati on and misleading research and policy. Clarifying such terms is the es sential first step. We define risk and a risk factor (protective facto r) and their potency, set out the conceptual basis of the methods by w hich risk factors are identified and potency demonstrated, and propose criteria for establishing the status of a risk factor as a fixed or v ariable marker or a causal risk factor. All definitions are based on t he stale of scientific knowledge (empirical documentation), rather tha n on hypotheses, speculations, or beliefs. We discuss common approache s and pitfalls and give a psychiatric research example. Imprecise repo rts can impede the search for understanding the cause and course of an y disease and also may be a basis of inadequate clinical or policy dec ision-making. The issues in risk research are much too important to to lerate less than precise terminology or the less than rigorous researc h reporting that results from imprecise and inconsistent terminology.