Epidemiology without primary prevention: the emblematic story of Gela, Sicily, Italy

Abstract Background The town of Gela is located next to a large petrochemical area, one of the National Priority Contaminated Sites. Several excesses of mortality and morbidity have been documented. In the 90s local paediatricians and citizens signalled excesses of congenital anomalies. In early 2000s the public prosecutor opened investigations on workers and population health. Methods The prevalence of birth defects resident in Gela obtained by multiple info-sources was compared with data of registries of Sicily, Italy, Europe since 1991. Results In 1991-2002, excesses for different groups of anomalies were found; the rate of hypospadias (56.7/10,000 births) was 2.5 times higher than references. In 2003-2010, excesses of genital, urinary and total anomalies were observed; the rate of hypospadias (46.7/10,000) was from 1.7 to 2.3 times higher than references. High rate of hypospadias born in 2006-2010 (77.1/10,000) was confirmed by a recent national study. Using 2010-14 data collected by the Sicily Registry of birth defects, alone or merged with hospital discharge records, excesses of 5.5 and 3.8 emerged when compared with regional figures. A case-control study conducted in 2004 for the local prosecutor, despite low statistical power, signalled significant risks for consumers of local fruit, vegetables, fish, seefood (OR 6.0 to 51.3). Conclusion The studies performed in Gela confirmed rates of hypospadias at the highest-level ever reported in scientific literature. Despite the recommendations contained in published papers, no etiological study was promoted in the last decade, and no primary prevention action has been implemented, not avoiding a large number of congenital anomalies, other diseases and premature deaths. The debate has been constantly sterilized by a claim to obtain conclusive proof of causality. The story is emblematic of the consequences of decoupling of epidemiology and primary prevention and of hiding or minimizing ethical issues in public health.